(Concluded from p. 715) Sixty-five instances of attempts at relief of severe pain by various surgical procedures have been reported. The following tentative conclusions seem justifiable: The least satisfactory results attend interruption of peripheral nerves. Posterior rhizotomy is strongly contra-indicated if it denervates a significant part of a limb. Interruption of spino-thalamic pain conducting pathways is a most useful procedure, provided it is carried out at a level sufficiently high above the pain-initiating lesion, and in the absence of certain definite contraindications. The ill-effects of chordotomy have been exaggerated, but the patient must be instructed to empty the bladder at regular intervals. Temporary chemical interruption of sympathetic pathways may significantly break a cycle of pain. Operative sympathetomy must be complete for the affected part. Pain may recur after adequate prefrontal leucotomy. In selecting methods of pain-relief surgery, the expectation of life in a given case is most important. A potent cause of failure is inadequate denervation. The ï¿½psychologicalï¿½ make-up of the patient is perhaps an important cause of failure.
Gargoylism is a condition in children characterized by a large head, resting on a very short neck, with coarse features and corneal haziness. The abdomen is distended by a large liver and spleen, and an umbilical hernia is often present. A dorsa-lumbar kyphosis and limbs which appear too short for the body, with some limitation of full extension at the joints, in a mentally deficient child who may also be deaf, complete the picture in this most remarkable disease. A review of the literature is made to bring out the historical clinical and pathological features of gargoylism, and a report of a case of this condition is presented.