1
554 quite familiar to the few who knew London well, but it has now definitely been put on record. The police standard represents more or less the views of the inhabitants of a given locality and is actually regulated by the orders which they receive from their officers. At the present time it is notorious that many parts of London are in- adequately supplied with police and consequently in the present circumstances it is impossible that these districts should be kept in proper order. It is necessary for the well-being and for the safety of London that all parts of the town should be under complete and efficient police protection and the quarters occupied by poor aliens should by no means be neglected in this respect. This is a matter of much more importance than the statement made by the Immigration Reform Association to the effect that "alien immigrants have ...... been the cause of financial ruin to numerous English retail traders." "There is," we are told, "serious danger of anti-alien riots," and the paragraph in which this information is given is so worded that it seems to imply that such riots would not be altogether unjustifiable, "so severe is the hardship as it affects our own work- ing class." We have no doubt that these words are founded on fact, but they prove an additional reason for strengthening the hands of the police and also for expecting at an early date from the Association some idea of how it is proposed to discriminate between the good and the bad stranger before he establishes himself within our gates. FRACTURE OF THE MANDIBLE DURING TOOTH EXTRACTION. A CASE of fracture of the mandible during tooth extraction is recorded by Mr. J. H. Badcock in the recent issue of the Transactions of the Odontological Society. A right third molar which was misplaced had been the seat of recurrent attacks of inflammation. The tooth was almost buried and was lying horizontally with the morsal surface pointing forwards. An attempt was made to remove the tooth but during the efforts to dislodge it the mandible fractured, the line of fracture running horizontally back- wards in a straight line from the lower border of the third molar. The fracture was treated and about three months subsequently the tooth was successfully removed. The removal of misplaced unerupted third molars is fre- quently extremely difficult. Where doubt exists as to the exact situation of the tooth a skiagram should be obtained. The muco-periosteum covering the bone should be reflected and the bone cut away so as to allow the tooth to be easily removed with forceps or elevator. The wound left must be properly treated by plugging. A considerable amount of suffering would be saved if the wounds made by tooth extraction were regarded in the same light as wounds in other parts of the body. - THE TREATMENT OF CHOREA. IN another column we publish a paper by Dr. R. T. Williamson on the treatment of chorea with aspirin. The drug was given in 35 consecutive cases of the disease and in all favourable results were obtained. The patients were kept away from school but were not confined to bed. The good results obtained, therefore, cannot be attributed to the in- fluence of enforced complete rest. Dr. Williamson states that he writes on the subject with some hesitation, since the disease is one which has usually a tendency to terminate in recovery in the course of time apart from any medical treatment. In severe cases, on the other hand, the disease cannot be immediately arrested by aspirin or by any drug or form of treatment. When steady and progressive improvement follows the adminis- tration of drugs usually one or two weeks, often a longer time, must elapse before recovery is complete. Bearing these facts in mind Dr. Williamson is quite correct in maintaining that there is necessity for great caution in drawing-conclusions as to the action of any drug. He has, however, performed good service in publishing the results he has already obtained. It is only by prolonged trial and extended experience on the part of many observers that the true value of any therapeutic measure can be ascertained and we, therefore, are glad to publish reports of treatment which hold out hopes of success in order that more ex- tended trial may be made. For this reason in our issue of last week we published a paper on the treatment of sporadic- dysentery by Mr. William Fingland. Cases of this nature are occasionally met with in this country which prove very rebellious to treatment. Mr. Fingland draws attention to a preparation obtained from the aplo- pappus baylahuen, a plant indigenous to South America. The few cases in which he tried the drug proved successful. It is, of course, not wise to express an opinion on the outcome of only three cases, but the symptoms produced by this affection are so distressing and so many procedures, medical and surgical, have been adopted in vain that we think that other practitioners may like to make use of the drug. ANÆSTHESIA PRODUCED BY HYPNOTISM. IT is no longer necessary in referring to hypnotism to waste words in discussing whether the condition is real or imaginary. Every careful, conscientious, and scientific observer who has investigated the subject has been convinced of its genuineness. But unfortunately credulity, superstition, chicanery, and fraud have been so closely associated with hypnotic exhibitions that only a comparatively small number of observers have had the patience to ascertain the true value of the hypnotic state. It is now thoroughly ac- cepted that a certain amount of anaesthesia can be produced in persons who have been hypnotised, but, inability to recognise painful impressions probably does not occur spontaneously in hypnosis but rather as the result of suggestion. Many operations have actually been performed upon subjects under anaesthesia pro- duced by hypnotism. Dr. Esdaile recorded 261 operations performed by himself in India while his patients were insensible from hypnotic suggestion. 1 A large number of the operations consisted in the removal of tumours vary- ing in weight from 10 to 103 pounds. In another column we publish an account of an amputation of the leg under hypnotism which shows the extent to which the anaesthesia can be carried. Such a degree of hypnosis, however, is difficult to secure and the time occupied in producing it may be long. Moreover-and this is highly important from the practical standpoint-the anaesthesia produced by hypnotism varies greatly in different subjects and is extremely uncertain in its nature and duration. The case we publish, therefore, can only be regarded to some extent as a curiosity, although the issue was highly favourable and seems to support the procedure employed very strongly. THE only case of plague discovered in. Cape Colony during the week ending July 25th occurred at East London. As regards Mauritius, a telegram from the Governor received at the Colonial Office on August 14th states that for the week ending August 13th there were 15 cases of bubonic plague and 12 deaths from the disease. Professor Rubert Boyce delivered an address in the Exami- nation Schools at Oxford, in connexion with the Oxford University extension meeting, upon Bacteriology in Relation to the Tropics. 1 Practical Therapeutics. Edited by F. P. Foster, M.D. Vol. i., p.

FRACTURE OF THE MANDIBLE DURING TOOTH EXTRACTION

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554

quite familiar to the few who knew London well,but it has now definitely been put on record. The policestandard represents more or less the views of the inhabitantsof a given locality and is actually regulated by the orderswhich they receive from their officers. At the presenttime it is notorious that many parts of London are in-

adequately supplied with police and consequently in thepresent circumstances it is impossible that these districtsshould be kept in proper order. It is necessary for the

well-being and for the safety of London that all

parts of the town should be under complete and efficient

police protection and the quarters occupied by poor aliensshould by no means be neglected in this respect. This is amatter of much more importance than the statement madeby the Immigration Reform Association to the effect that"alien immigrants have ...... been the cause of financial ruinto numerous English retail traders." "There is," we are told,"serious danger of anti-alien riots," and the paragraph inwhich this information is given is so worded that it seems toimply that such riots would not be altogether unjustifiable,"so severe is the hardship as it affects our own work-

ing class." We have no doubt that these words arefounded on fact, but they prove an additional reason forstrengthening the hands of the police and also for expectingat an early date from the Association some idea of how it isproposed to discriminate between the good and the badstranger before he establishes himself within our gates.

FRACTURE OF THE MANDIBLE DURING TOOTH

EXTRACTION.

A CASE of fracture of the mandible during tooth extractionis recorded by Mr. J. H. Badcock in the recent issue of theTransactions of the Odontological Society. A right thirdmolar which was misplaced had been the seat of recurrentattacks of inflammation. The tooth was almost buried andwas lying horizontally with the morsal surface pointingforwards. An attempt was made to remove the toothbut during the efforts to dislodge it the mandible

fractured, the line of fracture running horizontally back-wards in a straight line from the lower border of the

third molar. The fracture was treated and about threemonths subsequently the tooth was successfully removed.The removal of misplaced unerupted third molars is fre-

quently extremely difficult. Where doubt exists as to theexact situation of the tooth a skiagram should be obtained.The muco-periosteum covering the bone should be reflectedand the bone cut away so as to allow the tooth to be easilyremoved with forceps or elevator. The wound left must

be properly treated by plugging. A considerable amount

of suffering would be saved if the wounds made by toothextraction were regarded in the same light as wounds inother parts of the body.

-

THE TREATMENT OF CHOREA.

IN another column we publish a paper by Dr. R. T.

Williamson on the treatment of chorea with aspirin. The

drug was given in 35 consecutive cases of the disease and inall favourable results were obtained. The patients were keptaway from school but were not confined to bed. The goodresults obtained, therefore, cannot be attributed to the in-fluence of enforced complete rest. Dr. Williamson statesthat he writes on the subject with some hesitation, sincethe disease is one which has usually a tendency to

terminate in recovery in the course of time apart fromany medical treatment. In severe cases, on the other

hand, the disease cannot be immediately arrested byaspirin or by any drug or form of treatment. Whensteady and progressive improvement follows the adminis-tration of drugs usually one or two weeks, often a

longer time, must elapse before recovery is complete.Bearing these facts in mind Dr. Williamson is quite correctin maintaining that there is necessity for great caution indrawing-conclusions as to the action of any drug. He has,however, performed good service in publishing the resultshe has already obtained. It is only by prolonged trial andextended experience on the part of many observers that thetrue value of any therapeutic measure can be ascertainedand we, therefore, are glad to publish reports of treatmentwhich hold out hopes of success in order that more ex-tended trial may be made. For this reason in our issueof last week we published a paper on the treatment of

sporadic- dysentery by Mr. William Fingland. Casesof this nature are occasionally met with in this countrywhich prove very rebellious to treatment. Mr. Finglanddraws attention to a preparation obtained from the aplo-pappus baylahuen, a plant indigenous to South America.The few cases in which he tried the drug proved successful.It is, of course, not wise to express an opinion on the outcomeof only three cases, but the symptoms produced by thisaffection are so distressing and so many procedures, medicaland surgical, have been adopted in vain that we think thatother practitioners may like to make use of the drug.

ANÆSTHESIA PRODUCED BY HYPNOTISM.

IT is no longer necessary in referring to hypnotism to

waste words in discussing whether the condition is real

or imaginary. Every careful, conscientious, and scientificobserver who has investigated the subject has been convincedof its genuineness. But unfortunately credulity, superstition,chicanery, and fraud have been so closely associated withhypnotic exhibitions that only a comparatively small numberof observers have had the patience to ascertain the true

value of the hypnotic state. It is now thoroughly ac-cepted that a certain amount of anaesthesia can be

produced in persons who have been hypnotised, but,

inability to recognise painful impressions probably doesnot occur spontaneously in hypnosis but rather as the

result of suggestion. Many operations have actuallybeen performed upon subjects under anaesthesia pro-duced by hypnotism. Dr. Esdaile recorded 261 operationsperformed by himself in India while his patients were

insensible from hypnotic suggestion. 1 A large number

of the operations consisted in the removal of tumours vary-ing in weight from 10 to 103 pounds. In another columnwe publish an account of an amputation of the leg underhypnotism which shows the extent to which the anaesthesiacan be carried. Such a degree of hypnosis, however, isdifficult to secure and the time occupied in producing it maybe long. Moreover-and this is highly important from thepractical standpoint-the anaesthesia produced by hypnotismvaries greatly in different subjects and is extremely uncertainin its nature and duration. The case we publish, therefore,can only be regarded to some extent as a curiosity, althoughthe issue was highly favourable and seems to support theprocedure employed very strongly.

THE only case of plague discovered in. Cape Colony duringthe week ending July 25th occurred at East London. As

regards Mauritius, a telegram from the Governor receivedat the Colonial Office on August 14th states that for theweek ending August 13th there were 15 cases of bubonicplague and 12 deaths from the disease.

Professor Rubert Boyce delivered an address in the Exami-nation Schools at Oxford, in connexion with the Oxford

University extension meeting, upon Bacteriology in Relationto the Tropics.1 Practical Therapeutics. Edited by F. P. Foster, M.D. Vol. i., p.