1
1702 T the injection is slowly made. The needle is allowed to remain in situ for a couple of minutes in order to prevent bleeding from the puncture. Sometimes there is:,none ; if there is, pressure for a few minutes will control it. "The following solution is used : cocaine hydro- chlorate, one grain ; chloroform, ten minims ; alcohol, three drachms; and distilled water to half an ounce. Of this two cubic centimetres are injected. For succeeding injections the proportion of alcohol is increased and may reach as :much as 90 per cent. As this strong solution is more painful the amount of cocaine in it is doubled. Once the injection is made the pain is very slight. Usually there is only an uncomfortable sense of pressure or tension ; some- times there is diffuse headache. For the inferior maxillary branch the needle is inserted at the lower border of the zygoma, 2.5 centimetres in front of its descending root, which can always be felt and almost coincides with the anterior border of the external auditory meatus. The needle is directed slightly upwards, so as to hug the base of., the skull, and a little backward. At a depth of four centimetres it should reach the nerve. For the superior maxillary branch the line of the posterior border of the orbital process of the malar bone is taken as a guide prolonged to the posterior border of the zygoma and the needle is inserted half a centimetre posterior to this point. It is directed perpendicularly to the antero-posterior line but inclined slightly upwards in a direction which would attain at the depth of the foramen rotundum the level of the inferior extremity of the nasal bones. At the depth of five centimetres the nerve is reached. For the supra-orbital branch the needle is inserted at the external margin of the orbit opposite the fronto-malar articulations and passed along the external wall of the orbit to a depth of 3.5 to 4 centimetres. The intra-orbital injection is hazardous on account of the proximity of the optic nerve and motor nerves of the eye. The affected nerve is more often missed than reached by the needle, but though it is desirable to reach it this is not necessary. Alcohol injected near the nerve diffuses so as to reach it. When the needle reaches the nerve pain is felt in its area of distribution and after the injection there is a swollen feeling. If the injec- tion is placed within the nerve sheath the neuralgia will cease at once; if not the injection may have to be repeated. Professor Patrick allows an interval of from five to seven days between injections of the same branch of the fifth nerve. How long the relief will last cannot yet be stated but it has lasted as long as two years. When the pain recurs the injections can be repeated. Dr. Hecht’s paper is ’, confirmatory of Professor Patrick’s. He finds that the prognosis of complete palliation after one or several injec- tions is excellent. Recurrence may be expected in from six to 12 mcnths but each relapse is rendered milder by the injections and ultimately the paroxysms may disappear. THE HAMPSTEAD GENERAL HOSPITAL. LAST week we announced that a general poll of the sub- scribers of the Hampstead General Hospital was to be taken as a result of a meeting of that body held at the hospital on Dec. 2nd, at which the report of a committee of sub- scribers was considered. It will be remembered that the report recommended the adoption, with a few changes in detail, of the proposal of King Edward’s Hospital Fund that the Hampstead and North-West London Hospitals should amalgamate and that the present staff of the Hampstead General Hospital should be replaced by consultants. This was opposed by the staff and the general body of the medical profession in the neighbour- hood and the motion to accept the report was lost by 40 votes to 29. The minority demanded a postal poll of all the subscribers, which has now reversed the decision of the meeting by 195 votes to 187, giving a majority of eight in favour of the report. Not many more than half of the subscribers voted. We are not yet informed whether the decision of this small majority will settle the dispute and we shall defer printing our report of the late meeting until we are in a position to deal fully with a matter involving important principles for the medical profession in London and the welfare of the Hampstead General Hospital. CROMWELL RELICS. " WHAT became of Cromwell’!" is the title of an article by Professor Churton Collins which appeared in 1881 in the Gentleman’s Magazine. The question is a vexed one. According to an ancient tradition Cromwell’s body was con- veyed away immediately after his death, in obedience to his last orders, and was buried on Naseby Field where he had obtained the greatest victory and glory." According to another account, Mary, Lady Fauconberg, Cromwell’s daughter, was able to convey the body away from its grave in the Abbey and to have it buried in her husband’s house of Newburgh in Yorkshire, where the tomb, an impenetrable marble one, is still shown. Another corpse was substituted for Cromwell’s in the Abbey and it was this nameless corpse which underwent the indignities put upon it in January, 1661, when the putative body was hanged on the gallows at Tyburn together with Ireton’s and Bradshaw’s, while the head was set up on a pole above Westminster Hall. This head, still transfixed by a spike which was let through the cranium by means of a specially drilled hole, is now in the possession of Mr. Horace Wilkinson of Sevenoaks. It is the head, curiously enough, of someone whose body has prob. ably been embalmed, for the top of the skull has been sawn off in order, presumably, to admit of the removal of the brains. The body to which this head belonged was buried under the gallows of Tyburn, unless, which is probable, the Fauconbprgs obtained the body there and carried it off. Death-masks of Cromwell might throw some light on the question of the identity of the head. One of these was in the Museum of the Royal College of Surgeons of England a century ago. It is described by William Clift as "an undoubted cast of the face of Oliver Cromwell." It was presumably a death-mask. Another such is, according to Waylen, in the possession of the Rev. Thomas Cromwell, rector of Michel Dean, Gloucestershire. It may be men- tioned that the measurements of the Sevenoaks head are said to correspond with those of extant likenesses and busts of the Protector. ___ INTERNATIONAL CONGRESS ON TUBERCULOSIS. AN International Congress on Tuberculosis will be held at Washington from Sept. 12th to Oct. 21st, 1908. The Congress is to be divided into seven sections : (1) Pathology and Bacteriology (President, Dr. William H. Welsh, Johns Hopkins Hospital) ; (2) Clinical Study of Tuberculosis (President, Dr. Vincent Boisditch, Boston) ; (3) Surgery and Orthopaedics (President, Dr. Charles H. Mayo, Rochester); (4) Tuberculosis in Children (President, Dr. Abraham Jacobi, New York) ; (5) Hygienic, Social, Industrial, and Economic Aspects of Tuberculosis (President, Dr. E. T. Devine, New York) ; (6) State and Municipal Control of Tuber- culosis (President, Surgeon-General Walter Wyman) ; and (7) Tuberculosis in Animals and its Relation to Men (Presi- dent, Dr. Leonard Pearson, Philadelphia). Three prizes of 9200 each (1000 dollars) will be given : the first for the best evidence of effective work in the prevention or relief of tuberculosis done by any voluntary association since the last International Congress in 1905 ; the second for the best exhibit of a tuberculosis sanatorium for the working classes ; and the third for the best exhibit of a furnished home for wage-earners. Several other prizes of smaller value are

THE HAMPSTEAD GENERAL HOSPITAL

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1702 T

the injection is slowly made. The needle is allowedto remain in situ for a couple of minutes in order to

prevent bleeding from the puncture. Sometimes there

is:,none ; if there is, pressure for a few minutes will

control it. "The following solution is used : cocaine hydro-chlorate, one grain ; chloroform, ten minims ; alcohol,three drachms; and distilled water to half an ounce. Ofthis two cubic centimetres are injected. For succeedinginjections the proportion of alcohol is increased and mayreach as :much as 90 per cent. As this strong solution ismore painful the amount of cocaine in it is doubled. Oncethe injection is made the pain is very slight. Usually thereis only an uncomfortable sense of pressure or tension ; some-times there is diffuse headache. For the inferior maxillarybranch the needle is inserted at the lower border of the

zygoma, 2.5 centimetres in front of its descending root,which can always be felt and almost coincides with theanterior border of the external auditory meatus. Theneedle is directed slightly upwards, so as to hug the baseof., the skull, and a little backward. At a depth offour centimetres it should reach the nerve. For the

superior maxillary branch the line of the posterior border ofthe orbital process of the malar bone is taken as a guideprolonged to the posterior border of the zygoma and theneedle is inserted half a centimetre posterior to this point.It is directed perpendicularly to the antero-posterior line butinclined slightly upwards in a direction which would attainat the depth of the foramen rotundum the level of theinferior extremity of the nasal bones. At the depth of

five centimetres the nerve is reached. For the supra-orbitalbranch the needle is inserted at the external margin of theorbit opposite the fronto-malar articulations and passedalong the external wall of the orbit to a depth of 3.5to 4 centimetres. The intra-orbital injection is hazardouson account of the proximity of the optic nerve and motornerves of the eye. The affected nerve is more often missedthan reached by the needle, but though it is desirable toreach it this is not necessary. Alcohol injected near thenerve diffuses so as to reach it. When the needle reachesthe nerve pain is felt in its area of distribution andafter the injection there is a swollen feeling. If the injec-tion is placed within the nerve sheath the neuralgia will

cease at once; if not the injection may have to be

repeated. Professor Patrick allows an interval of from five toseven days between injections of the same branch of the fifthnerve. How long the relief will last cannot yet be statedbut it has lasted as long as two years. When the painrecurs the injections can be repeated. Dr. Hecht’s paper is ’,confirmatory of Professor Patrick’s. He finds that theprognosis of complete palliation after one or several injec-tions is excellent. Recurrence may be expected in from sixto 12 mcnths but each relapse is rendered milder by theinjections and ultimately the paroxysms may disappear.

THE HAMPSTEAD GENERAL HOSPITAL.

LAST week we announced that a general poll of the sub-scribers of the Hampstead General Hospital was to be takenas a result of a meeting of that body held at the hospital onDec. 2nd, at which the report of a committee of sub-

scribers was considered. It will be remembered that the

report recommended the adoption, with a few changes indetail, of the proposal of King Edward’s Hospital Fundthat the Hampstead and North-West London Hospitalsshould amalgamate and that the present staff of the

Hampstead General Hospital should be replaced byconsultants. This was opposed by the staff and the

general body of the medical profession in the neighbour-hood and the motion to accept the report was lost by40 votes to 29. The minority demanded a postal poll ofall the subscribers, which has now reversed the decision of

the meeting by 195 votes to 187, giving a majority of eightin favour of the report. Not many more than half of thesubscribers voted. We are not yet informed whether thedecision of this small majority will settle the dispute andwe shall defer printing our report of the late meeting untilwe are in a position to deal fully with a matter involvingimportant principles for the medical profession in Londonand the welfare of the Hampstead General Hospital.

CROMWELL RELICS.

" WHAT became of Cromwell’!" is the title of an article

by Professor Churton Collins which appeared in 1881 in theGentleman’s Magazine. The question is a vexed one.

According to an ancient tradition Cromwell’s body was con-veyed away immediately after his death, in obedience tohis last orders, and was buried on Naseby Field where hehad obtained the greatest victory and glory." Accordingto another account, Mary, Lady Fauconberg, Cromwell’s

daughter, was able to convey the body away from its gravein the Abbey and to have it buried in her husband’s houseof Newburgh in Yorkshire, where the tomb, an impenetrablemarble one, is still shown. Another corpse was substitutedfor Cromwell’s in the Abbey and it was this nameless corpsewhich underwent the indignities put upon it in January,1661, when the putative body was hanged on the gallowsat Tyburn together with Ireton’s and Bradshaw’s, whilethe head was set up on a pole above Westminster Hall.This head, still transfixed by a spike which was let throughthe cranium by means of a specially drilled hole, is now inthe possession of Mr. Horace Wilkinson of Sevenoaks. It isthe head, curiously enough, of someone whose body has prob.ably been embalmed, for the top of the skull has been sawnoff in order, presumably, to admit of the removal of thebrains. The body to which this head belonged was buriedunder the gallows of Tyburn, unless, which is probable, theFauconbprgs obtained the body there and carried it off.Death-masks of Cromwell might throw some light on thequestion of the identity of the head. One of these was in

the Museum of the Royal College of Surgeons of England acentury ago. It is described by William Clift as "an

undoubted cast of the face of Oliver Cromwell." It was

presumably a death-mask. Another such is, according to

Waylen, in the possession of the Rev. Thomas Cromwell,rector of Michel Dean, Gloucestershire. It may be men-

tioned that the measurements of the Sevenoaks head are saidto correspond with those of extant likenesses and busts ofthe Protector.

___

INTERNATIONAL CONGRESS ON TUBERCULOSIS.

AN International Congress on Tuberculosis will be heldat Washington from Sept. 12th to Oct. 21st, 1908. The

Congress is to be divided into seven sections : (1) Pathologyand Bacteriology (President, Dr. William H. Welsh, JohnsHopkins Hospital) ; (2) Clinical Study of Tuberculosis

(President, Dr. Vincent Boisditch, Boston) ; (3) Surgery andOrthopaedics (President, Dr. Charles H. Mayo, Rochester);(4) Tuberculosis in Children (President, Dr. Abraham Jacobi,New York) ; (5) Hygienic, Social, Industrial, and EconomicAspects of Tuberculosis (President, Dr. E. T. Devine,New York) ; (6) State and Municipal Control of Tuber-culosis (President, Surgeon-General Walter Wyman) ; and(7) Tuberculosis in Animals and its Relation to Men (Presi-dent, Dr. Leonard Pearson, Philadelphia). Three prizesof 9200 each (1000 dollars) will be given : the first for thebest evidence of effective work in the prevention or relief oftuberculosis done by any voluntary association since the lastInternational Congress in 1905 ; the second for the bestexhibit of a tuberculosis sanatorium for the working classes ;and the third for the best exhibit of a furnished home for

wage-earners. Several other prizes of smaller value are