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practical way. The value of the vital statistics gathered by the
State Board is explained, and the duty of those who are required
by the law to fill out the certificates is fully defined. Blank certi-
ficates, having the questions properly answered, are given as
models to be followed. Bound with the manual is a copy of the
Public Health Law, to which it is designed to serve as a- com-
mentary. The volume will be found to be of the greatest value
to all who are interested in the public health, and it will enable
boards of health and health officers to be certain of their positions
in their dealings either with their municipal governments or with
the people. Price, $1.50 ; delivered upon receipt of price. Banks
4 Brothers, Albany, N. Y.



A New Illustrated Dictionary op Medicine, Biology, and
Collateral Sciences. — Dr. George M. Gould, already well known
as the editor of two small medical dictionaries, has now about
ready an unabridged, exhaustive work of the same class, upon
which he and a corps of able assistants have been uninterruptedly
engaged for several years.

The feature that will attract immediate attention is the large
number of fine illustrations that have been included, many of which
~ as, for instance, the series of over fifty of the bacteria^have been
drawn and engraved especially for the work. Every scientific-



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190 LITERARY NOTES.

minded physician will also be glad to have defined several thous-
and commonly used terms in biology, chemistry, etc.

The chief point, however, upon which the editor relies for the
success of his book, is the unique epitomization of old and new
knowledge. It contains a far larger number of words than any
other one-volume medical lexicon. It is a new book, not a revision
of the older volume. The pronunciation, etymology, definition,
illustration, and logical groupings of each word are given. There
has never been such a gathering of new words from the living
literature of the day. It is especially rich in tabular matter, a
method of presentation that focuses, as it were, a whole subject so
as to be understood at a glance.

The latest method of spelling certain terms, as adopted by cer-
tain scientific bodies and authorities, have all been included, as
well as those words classed as obsolete by some editors, but still
used largely in the literature of today, and the omission of which
in any work aiming to be complete would make it unreliable as an
exhaustive work of reference.

The publishers, Messrs. P. Blakiston Son & Co., announce that,
notwithstanding the large outlay necessary to its production on
such an elaborate plan, the price will be no higher than that of the
usual medical text-book.



A New Medical Dictionary. — A completely new medical dic-
tionary is announced for early publication by Lea Brothers & Co.
The author. Dr. Alexander Duane, of New York, is already widely
known as the medical expert for Webster's International Diction-
ary. His new work has been drafted to supply medical students
with all desired information concerning the words they will meet
in their course of reading, and as the vocabulary has been selected
most liberally, the work will be of value to practitioners also.
The pronunciation of each word is given by a simple and obvious^
phonetic spelling ; then follows the derivation, an unexcelled aid
to memory, and finally a full definition. Descriptive matter has
been appended to such words as cannot be adequately explained
by simple definition. Thus, diseases are described, and their
symptoms and treatment are given ; drugs are followed by their
properties, effects, doses, etc. Extensive tables of bacteria, doses,
etc., are placed in the alphabet most conveniently for reference.
A work of real value is promised, and we shall take an early oppor-
tunity of reviewing it in these columns.



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LITERARY NOTES. 191

Gray's Anatomy, New (Thirteenth) Edition. — Another edition,
the thirteenth, of this standard work is announced for early publi-
catioH by Messrs. Lea Brothers & Co. It is hardly too much to
say that this work has been the most popular of all medical text-
books whatever since its first appearance, in 1851. Its text has
been revised successively by the foremost anatomists of a genera-
tion, and the present edition embodies whatever changes were
necessary to make it represent its advancing science. The illus-
trations have always been noted for their clearness. Their large
size has rendered it possible to print the names of the parts directly
upon them, thereby indicating not only their names, but also their
extent — a most important matter. A liberal use of colors has
been made to secure additional prominence for certain parts. Not-
withstanding these improvements, the constantly increasing
demand has justified a reduction in the price of the colored edition.
An early review will appear in these columns.



A Text-Book of Normal Histology, by Dr. George A. Piersol,
Professor of Anatomy in the University of Pennsylvania, is
announced by J. B. Lippincotjb Company, among other new medi-
cal publications, for early issue. The author is eminently qualified
by learning, research, and experience as a teacher, to prepare such
an important work as this, and in the arrangement of the text
shows a wise sympathy with the wants of the students. While
his descriptions of the various tissues and organs are sufficiently
full, he has carefully avoided such detail as would bewilder the
learner. The numerous illustrations are excellent, and with few
exceptions cover the entire field of normal histology.



Ditnglison's New Pronouncing Medical Dictionary. — A new
edition of Dunglison's Medical Dictionary is announced as in press
for early publication. It has been thoroughly revised and greatly
enlarged, and will contain about forty-four thousand new medical
words and phrases. Pronunciation has been introduced into the
new edition by means of a simple phonetic spelling. This work has
always been noted for the fulness of its definitions, ample explan>
ations being its distinguishing characteristic. In the new edition
much encyclopedic information, difficult of access elsewhere, will
be found conveniently at hand. Especial attention has been
devoted to matters of practical value. A review will appear in an
early issue.



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192 LITEBAKY NOTES.

Db. Thomas Mobs Madden, well known as one of the foremost
gynecologists of Europe, has prepared a hand-book of Diseases
Peculiar to Women, which will be published at once by J. B. Lip-
pincott Company. The work is more than usually important, from
the fact that it contains the result of the author's wide experience
and is embellished with numerous excellent sketches of gynecolo-
gical diseases and appliances, together with engravings and draw-
ings or photographs of cases under clinical observation made by
some of the most eminent physicians in England and America.
The work is entitled Clinical Gynecology.



Elinoe Fenton, by David S. Foster, is a charming romance, the
scene of which is laid in the heart of the Adirondacks. The plot
is full of incident, and the characters, manners, and sceneiy are
happily depicted. Love receives a due share of attention, its
blisses, its woes, its apparent defects, and ultimate victory being
described with much humor in a very life-like way. Mr. Foster
has produced a pleasing story that is sure to increase a reputation
already recognized. It is published by J. B. Lippincott Company.



About October 15th, a Medical Directory of the State of Connecti-
cut will be issued by the Danbury Medical Printing Company, of
Danbury, Conn. It will contain a list of all the medical practi-
tioners of the State, the various medical societies, all the dentists
and dental societies, druggist and pharmaceutical societies, nurses
and training schools for nurses, hospitals, etc. Price, $1.00, deliv-
ered free by post.

Fbank R. Stockton has written the . history of " How I Wrote
* The Lady, or the Tiger,' " for the next issue of ITie Jjodies*
Home Journal^ and tells what came of the writing of the famous
story, and the condition of his own mind, at the present time, of
the correct solution of the problem, whether the lady or the tiger
came out of the opened door.

Notice to Contbibutobs. — We are glad to receive contributions
from every one who knows anything of interest to the profession. Arti-
cles designed for publication in the Joubnal should be handed in before
the first day of the month. The Editors are not responsible for the
views or opinions of contributors. All communications should be
addressed to the Managing Editor, 284 Fbanklin St.. Buffalo. N. Y.



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Buffalo Medical .^Surgical Journal

Vol. XXXIII. NOVEMBER, 1893. No. 4.

PARANOIA, WITH DELUSIONS OF CHANGE IN SEX.*

PSYCHOLOGICAL OBSERVATIONS AND SUBGICAL NOTES.

bt c. b. burr, M. D.,
Medical Superintendent of the Eastern Michigan Asylum.

I BBLrsYB that alienists generally will bear me out in the state-
ment, that delusions of sexual change are of relatively rare occur-
rence. In an experience with the insane in a large State asylum,
extending over a period of many years, I can call to mind but two
or three cases presenting these symptoms. In view of this, the
study of the genesis of such delusions comes to my mind as a
matter of considerable interest.

A. P., a woman, single, aged 36 at the time of her admission, came
under observation in the Eastern Michigan Asylum in 1885. She had
always shown a lack of application and adaptability, was naturally
suspicious and apt to misconstrue motives, was erratic, and had met
with numerous failures and disappointments. Mental disease was said
to have existed for ten years, and for the three years immediately pre-
ceding her admission rational intervals had been wanting. A period of
great depression, succeeded by excitement and the development of
extravagant delusions, occasioned her admission to the asylum. She
was suspicious and thought her life threatened. She denied relation-
ship with the members of her family, and called herself ' ' Queen
Anne.^^ At one time she expressed the delusion that she had been
ravished. She alleged conspiracy on the part of her relatives, claimed
that she was an adopted daughter of R. P., and that he, dying, had
made her sole legatee. Upon this she based her claim to all the prop-
erty in possession of the family. ' • Some one " had told her, ten years
ago, that there was a vault in the house filled with gold that belonged
to her, and this she made unsuccessful attempts to find. She did not
explain the reasons for believing hei-self of royal lineage, but alleged
that if opportunity were offered she could prove it. She displayed a
reluctance to comply with the rules of the Institution because of supers
iority to those about her and to all regulations, signed herself ' ' Prin-
cess," was selfish, and would work for herself only. In July, 1886,
about one year after her admission, physical failure was noticed. Her

L Read before the American Medico-Psychological Association, Chicago, June, 1898.



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194 BURR : PARANOIA.

countenance became sallow and she lost flesh, but opposed any invests
Ration of her case. From this condition recovery soon took place. In
August of the same year she expressed the delusion that she was the
mother of ten children, became more elated, signed herself "Lady

A ," disposed of hall property, on the ground that it was hers, by

throwing it out of the windows, and was pleased to discard her nights
dress after one night^s wearing. She expressed delusions of poison.
In the year 1887 she was more industrious, but was inclined to seclude
herself, and closed the opening to the ventilating flue with a cloth to
prevent the * ' hot gas ^^ from descending. She called herself ' ' Richard
the Lion-Hearted^s Daughter." Her physical health was fair, but on
one occasion she had an attack of vomiting, the cause of which could
not be discovered. In 1888, she developed the delusion that there waa
a child concealed in her mattress, and frequently tore it open under
that impression. In the same year the note is made that she * ' is appar-
ently losing mental force, and her conversation has less point and
coherency." She still disclaimed relationship with her family, and was
alternately patronizing and rude toward her relatives when they visited
her. In September, 1888, physical failure is again noted. She com-t
plained of bloating and pain in the abdomen. Her pulse was weak and
intermittent, and she suffered from monorrhagia and metrorrhagia, an
interval of but two weeks occurring between periods of flowing. There
was also present at this time a sub-acute rheumatism, referred to the
knees. In the following January, 1889, she declared that her head
was *' filled with babies." On one occasion she contracted a cold, from
exposure consequent upon removing her mattress from the bed, under
the impression that there were "young ones in it that might crawl
into" her. She asserted that she was the "fourteenth daughter of
Bang James," that her name was " Iceldoor, " because her father waa
born in the arctic regions as the result of union of the temperate and
frigid zones. In March she had a sensation in the abdomen, which
caused her to request the physician to listen to " hear the young ones."
In April, 1891, there occurred a complete change in these impressions.
She then, for the first time, claimed that she was a man, desired to be
called "Mr. Leslie," and alluded to her clothing as if she thought it
were that of a man. Later she wished to be known as "Lord HaU
ton," showed a marked preference for the society of men, and was
extremely indignant toward the attendants for bestowing upon her
ordinary attentions. She sat in her room much of the time, assum-
ing man-like attitudes, wore her dresses looped up above her shoe-
tops, and parted her hair on one side ; declined to walk with the
party, because out of place with women, and demanded that a
barber come upon the hall to shave her at regular intervals. On
the day of the fire at the Asylum she separated herself from the
party as it was passing from one hall, through the center building, to



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bitbr: pabanoia. 195

another. Her absence was discovered, and when asked what her pur-
pose was, she replied that she was about to get a lunch for the fire-
men. At night she plead law. In March, 1892, she expressed the
delusion that there were children in her body, which could not be born
because children were only born of women. Her physical health
became much improved, although the flow from the uterine cavity was
profuse, frequent, and irregular. In April, while convalescing from a
fever, she complained of pain in her right side. Examination showed
an enlarged abdomen, over which there was an extended area of dull-
ness, and two small tumors, apparently in the abdominal wall. Exam-
ined later by Dr. Manton, consulting gynecologist, the presence of a
solid tumor, probably in connection with the uterus, was diagnosticated.
During the months of May and June she suffered from suppuration of
the middle ear. This was succeeded by a collection of pus posterior to
the ear, and sub-periosteal, which required surgical interference.
After recovering from the operation she improved much physically.
During subsequent investigations of the abdomen she explained that
at some previous time she had been operated upon and her genitals
made to conform to those of a female. She spoke of her vagina as
a wound. The abdominal enlargement increased very rapidly.

In March, 1893, laparatomj was performed by Dr. Manton.
An incision four inches in length was necessary, because of the
large size and irregular shape of the tumor. This proved to be a
uterine fibro-cyst, weighing seven pounds. There was no pedicle
in connection with the tumor, and, in extracting it, removal of
much of the uterine tissue was necessary. A Koebele's serre-noeud
was applied at the level of the internal os. After the removal of
the tumor, the abdomen was thoroughly washed out with hot
water, the stamp fixed with pins fastened in the lower angle of
the wound, and the abdominal incision closed. She has recovered
rapidly, and without incident of any surgical importance, is now
able to be about the hall, and is in every respect more comfortable
than previous to the operation. For some time following it she
objected to attentions from the nurses, and was extremely improper
in her remarks to those who came near her, because of the impro-
priety of their presence in the sick-room of a man. She insisted
upon being called "Jim Michilimackinac," and was extremely
irritable if spoken of as '* she " or " her," or called by her own
name. Since getting up from bed, however, her mental improve-
ment has been of the most marked and conspicuous character. She
is less irritable toward those about her, is pleasant when addressed,
and takes an interest in hospital matters. Previous to the opera-



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196 BUBR : PABANOIA.

tion she was irritable, inclined to seclude herself, unwilling to
converse, and did not show interest in anything outside of her
delusions. She now seeks thecompauy of others, enters pleasantly
into their conversation, and avoids no one. While still contending
that she is a man, and asserting that many years ago an operation was
made with the effect of unsexing her, her assertions are less irri-
table made, and arguments to show the falsity of her belief are not
met, as heretofore, with anger, rage, and vituperation. Her
avoidance, in the past, of the society of women, arose, doubtless,
in a measure from her delusion that she was of the opposite sex.
While this delusion still persists, it does not lead her to the same
conduct. For the first time in the many years she has been under
observation, she is on friendly terms with her attendants, seems
to take delight in doing little things which they request, and
shows an affectionate disposition. Previous to the operation she
was restless at night and inclined to sit up in bed and talk. Now
she sleeps soundly the night through. She no longer speaks of
babies in her abdomen or in her mattress.

In view of the size and character of the tumor, and the liability
to attacks of peritonitis which constantly menaced the patient, the
removal of the tumor was undertaken none too soon, and the
results of the operation, surgically speaking, have been highly
gratifying. Whether the absence of the tumor will correct the
delusions in respect to sex, it is yet too early to predict. Such
manifest improvement in her general mental condition having
already occurred, however, much is hoped for.

If, as Ribot contends, " the personality results from two funda-
mental factors — the bodily constitution, with its tendencies and
feelings, and the memory," we must, I think, seek for the genesis
of this delusion in the changed sensations arising from the sexual
organs in consequence of its presence. Lallemant, quoted by
Kibot, records the case of a patient who believed himself to be a
woman, and who wrote letters to an imaginary lover. At the
autopsy there was found hypertrophy with induration of the pros-
tate, and alteration of the ejaculatory glands. Ribot makes the
assertion that it is probable that in many cases of this kind there
has been a perversion or abolition of the sexual feelings.

That the delusion as to the change in sex developed about the
same time that the uterine fibroid began to make serious encroach-
ments, seems reasonable to conclude from the history of the case,
the delusion having been present for about two years. While



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GRAM : STATISTICS OF INFECTIOUS DISEASES.



197



metrorrhagia bad occurred previous to that time, it is probable
that the tumor had not before acquired a growth sufficient to
determine any marked alteration in the organic sensations pro-
ceeding from the pelvic viscera.



STATISTICS OF INFECTIOUS DISEASES.^

By FRANKLIN C. GRAM, M. D.
Registrar of Vitol Statistics, Department of Health, Buffalo, N. Y.

Under ordinary circumstances, statistics prove a dry subject, but
when we examine those of infectious diseases our interest increases
as we proceed.

I have compiled, in as brief a manner as possible, during the
short period at my disposal, a summary of the statistics of all the
principal infectious diseases recorded in the office of the Registrar
of Vital Statistics, for this city, beginning with the year 188&
— the first in which a complete detailed statement was published.
Experience and acquired knowledge gradually improved the
system of securing and compiling the necessary statistics in this
department, so that today it stands as near the realization of
perfection as any of the best standards adopted in this country.

I shall first present the table in its entirety :



















1..


2

.3%


1.




1886


1887


1888


1880


1890


1891


1892


OS

5"


o»2S

it




















:5


I


ConsumBtion .•


438
344


466
436


460
303


440
314


498
347


549
381


546
376


3,375
2,591


.335
.257


.09457


Cholera lafantum


.07488


Diohtheria


123
147
61
40
70


183
147

77
100

62


174
136
68
88
47


130
76
TA

fiO

68


HI
124
08
21

89


165
177
129
67
73


177
149
98
81
49


1,063
956
4W
450

448


.106
.095
.049
.045
.045


.03066


Croop


.02760


TvDhoid Fever


.01484


Scarlet Fever


.01290


Cerebro-Spinal Meningitis. .


.01298


Whoonlnt? Coufph


20


24


17


61


18


14


76


2:i0i .023


r¥¥UU


Measles


B
13

7


60
13
12


35

18
12


B

10
7


56
14
13


47
17
11


18
26
15


226' .022 ' .00652


Errsinelas


ml .0ll!.00325


Syphilis


77 .008 1 .00222


Small-Pox


....


....


44


3


....






47


.005 1.00135


XotaL


1,266


1,670


1,402


1,227


1,389


1,630


1,614


10,067












Total from all Causes. . .


3.860


4,688


4.920


4,328


6,117


6,001


5,697


34,629













1. Read belore the Buffalo Academy of Medicine, Tuesday evening. September 12, 1893.



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198 gram: statistics of infectious diseases.

Let us now analyze the foregoing table, and make a few
additions as we proceed.

Influenza is not mentioned therein, as I only found it in the
summary for the year 1891, which stated that the remarkable
number of fifty-five deaths were ascribed to this cause. Consider-
ing the prevailing fad at that time, physicians were either very
successful in treating this disease, or they certified to the true
cause of death, whenever the alleged << grip " robbed them of a
patient. So common was it to call everything by that name,
that you will pardon me for mentioning two cases, both of which
were treated by old and successful practitioners, and with similar
remedies. The first was that of a middle-aged lady, who had
erysipelas of the face in an unmistakable degree. It was
pronounced a case of '^grip," and phenacetine was prescribed.
The second case was that of a man who was suffering from an
acute attack of prostatitis and orchitis. This was promptly
designated as *'grip," and he was given the same kind of treatment
as the woman got for her face.

Of the total number of fifty-five, who were certified to as
having succumbed to influenza, five were under one year, two
between three and four years, five between twenty and thirty, one
between thirty and forty, three between forty and fifty, ten between
fifty and sixty, thirteen between sixty and seventy, and sixteen
were seventy and over. There were twenty-four males, thirty-one
females, and only one colored.

Small-pox, you will note, were only mentioned during the
years 1888-89, when forty-seven deaths from that disease occurred
in this city. During the same period, about 250 deaths occurred
in this State from the same cause. The records at the Quarantine
Hospital show that during the epidemic, lasting from January 24,
1882, to July 7, 1883, forty-nine cases of small-pox were treated
at that institution, with only seven deaths, or about fourteen per
cent.; while, during the last epidemic, 114 cases were treated at
the Quarantine Hospital, from July 16, 1888, to October 12, 1889,
with thirty-three deaths, or about twenty-nine per cent. There
were 147 cases in all, with forty-seven deaths.

Considering the large number of cases of measles which occur,



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 20 of 78)