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A CASE OF PORENCEPHALY.
451 its results have been the cause of wide scandal to the profession. And it had become imperative to deal The men of Clydach are perhaps with it severely. their within rights in acting towards Mr. John Jones done. And we can quite understand their have as they Mr. Jenkins and their sympathy with him for friendship in the somewhat abrupt interference with his career involved in the recent Notice of the General Medical council. But they are scarcely likely to serve their friend by such harsh conduct to his late principal. They would have done better to re-appoint him and to have appealed for a short period of grace to the General Medical Council. Many members of the Council think that such a short period should be given for the sake of all persons concerned. Bat the most ardent friends of unqualified assistants must - see that the clange was necessary and that it was impossible any longer to insist on young medical men going through exhausthg and costly examinations to qualify for -the Medical Reghter and at the same time connive at the work of the profesion being done by men who have not given any such guuantees of competence. The workmen of Clydach should realise that the Council is not acting arbitrarily but on the pressure of coroners, home secretaries, and other powers of the law and in the real interests of -the working classes. -
PHYSICAL CURIOSITIES. NOT the least
feature of the colossal show at Olympia is the collection of ° ° freaks " which the industrious managers have been able to get together, That public interest in these ’creatures, whether human ci belonging to some lower order, is very deep is proved byhe tenour of letters which we now and again receive asking for explanations of the various physical phenomena manifested. We need hardly say that errors of development may produce extraordinary results and that the average " freak" is sinply an error of development, ’the curious or, it may be, monstrous appearances being as a rule easily comprehensible by students of embryology and fretal structure. But there are two persons giving performances at Olympia who are able to perform feats which must certainly produce a very astonishing impression on the anatomical mind. One of these entertainers, whose name is Delno Fritz, is a sword-swallower and asserts that he can swallow longer swords than bave ever been swallowed before. We for our part never want to see anyone swallow more rigid metal. To those who know the surface markings of the abdomen and the situation of the stomach it is little short of appalling to see this man pass a sword down his gullet until the hilt impinges upon his teeth and then withdraw the weapon and -demonstrate by outside measurement that in the erect posture the point falls some inches below the usual line of the lower curvature of the stomach. What really happens, f course, is that Delno Fritz has learnt, consciously or unconsciously, to stretch the somewhat loose and elastic tissues between the lips and the cardiac orifice of the stomach, so that these tissues will lie along his blunted sword in a condition of extension, while a protruded chin assists in the prolongation f the pharynx. It should be added that the solidity of the weapon with which the feat is performed is beyond question. A second person in whom medical men must be ’Interested is one Young Hermann, who can expand and contract his chest and abdomen at will to really remarkable dimensions. He is able to make a bond-fide difference of sixteen inches in his chest measurements and accordingly to snap chains and straps fastened across his thorax by the steadily extending pressure he is able to effect upon ’them. The alteration which he produces in his abdominal outlines are no.less striking. By swallowing air and then
interesting
.organised by Messrs. Banum and Bailey
upon it by contractions of the rectus abdominalis muscle, he can rapidly pass from the appearance of extreme corpulency to the appearance of horrible emaciation, the skin of the abdomen appearing in the latter case to lie against the spinal column. His extraordinary power of swallowing and inhaling air enables him to shift the apex beat of the heart many inches and otherwise to displace his viscera The power of swallowing air is not exceedingly rare,l but the extent to which Young Hermann possesses it is unexampled in our experience. It is probable that Joseph Clark, the celebrated posture-master of the seventeenth century, possessed the secret of this trick in addition to his unwholesome knack of dislocating many of his joints at will. It may be remembered that Clark’s favourite joke was to go to a tailor to be measured with his right shoulder, say, much higher than the left, to return to fit the suit on with the protuberance on the other side, and finally to call at the shop and reject the clothes indignantly, having this time assumed a central hump. Young Hermann might amuse himself in a similarly ill-natured way if the inclination took him.
effecting pressure
___
A CASE OF PORENCEPHALY. IN the February number of the Edinburgh Medical Journal Dr. George Gibson and Dr. Aldren Turner describe a case of this condition which is of sufficient rarity to make a careful record of each case examined very desirable. It is true that the condition is well recognised, but its etiology is still a point on which authorities differ. The patient was a woman, aged twenty-two years, who was admitted to hospital in a condition of status epilepticus. The history was that a few days after her birth -which had been a long and difficult process and effected with instrumental aid, she had had a series of convulsions and soon after had been noticed to be paralysed in the left hand. She was backward both in speaking and walking, but she went to school when about seven years of age and learnt without difficulty to read and spell. She could never learn to write, however. She had apparently remained free from fits until about the age of seven years, when convulsions returned and she continued to suffer from them periodically during the rest of her life. She was evidently feeble - minded and after the fits was occasionally violent-indeed, almost insane. The chief peculiarity of the convulsions from which she suffered after her admission to hospital was that they were all unilateral, but sometimes one side of the body was affected and sometimes the other. In spite of various efforts to control the convulsions they continued with great severity and ultimately the patient died from exhaustion. At the necropsy careful measurement failed to reveal anything more than a slightly larger size of the arm, foreNo difference in arm, leg, and thigh on the right side. The left side of the head the bones was made out. The middle and was distinctly larger than the right. posterior foshce of the skull were much larger on the left side than on the right. The right cerebral hemisphere was partly cystic and partly solid, the cystic part comprising the occipital lobe, the convolutions around the posterior end of the fissure of Sylvius and the ventral part of the temporo-sphenoidal lobe. The cavity communicated with the ventricle and was lined by a smooth membrane. The basal ganglia were atrophied. The left cerebellar hemisphere was considerably atrophied and there was partial atrophy of the mesial fillet on the right side. The part least implicated was the most internal, the so-called pes lemnisci, and this condition would support the view that the mesial fillet ends partly in the optic thalamus and partly in the cortex
1 Edinburgh Hospital Reports, 1895; THE LANCET, Aug. 1st, 1896, p. 305.
452 cerebri. There was partial atrophy of the right pyramidal the gathering ground of the water company resulted in tract. Dr. Gibson and Dr. Turner, in conclusion, point out securing the removal of many possible sources of pollution. that various views as to the etiology of this condition The difficulties in the way, however, were so great that the have been propounded, but that the one which has been Sanitary Committee recommended that a petition should most favourably received is that it originates in the block- be presented to the Local Government Board under the ing of an artery with secondary softening and cystic seal of the council, praying that legislation might be formation. Such an origin would seem likely in this case as initiated whereby every sanitary authority supplied by a the part of the hemisphere chiefly affected is that related to water company which is not also a sanitary authority the distribution of the posterior cerebral artery. If this should be empowered to authorise any duly appointed view is correct the occlusion probably took place either at or official to enter, inspect, inquire, and take samples at any part of any source or works of water-supply or water puri6just before birth. cation at any time by day or night, and whereby also such BOILER EXPLOSIONS water company should be required to afford all reasonable ACCORDING to the report on the working of the Boiler facilities and information for such inspection, inquiry, and Explosions Acts during the year ending June 30th, 1897, the sampling. Dr. Thresh gives instances of the great purifying total number of cases dealt with was 80 and by these power of the subsoil in addition to the surface soil, but explosions 27 persons were killed and 75 injured. This he points out that subsoil supplies derived from fissured represents a total of 102 persons killed and injured during strata should be very carefully watched. As is well known the year and exceeds the average (90’S) for the fifteen impurities may travel along such fissures for very consideryears during which the Act has been in operation by able distances. Dr. Thresh admits that the whole subject about 12’7 per cent. The loss of life taken alone is one which bristles with difficulties and that the full inspecto the closely approximates average (28’6) for the same tion of any source of public supply requires not only a. causes The of period. explosion show no important certain knowledge of geology, physiography, chemistry, and variation. Of the 80 cases dealt with 28 were attributed to of engineering, but a large amount of ingenuity and power of the defective condition of the boiler or of its fittings ; 33 to attention to details if no point is to be overlooked. "The defective design, workmanship, material, or construction, or strength of a chain is merely that of its weakest link and to, to undue working pressure ; 12 to ignorance or neglect miss the weak link is to court disaster." He concludes In by emphasising the importance of the inspection of of the attendants ; and 7 to miscellaneous causes. 42 cases the boilers proved to be under the inspection public water - supplies and of these inspections being of some public association or were used in vessels provided periodical, say once a year, and in the intervals with Board of Trade passenger certificates, but in many samples should be submitted to chemical and bacterioof these cases explosions were not due to defects which logical examination, the freqtency depending upon the existed when the last periodical inspection was made. We importance and character of the supply. In a note upon notice that three accidents were due to heating apparatus, the the circular bearing upon thif subject which was recently cause being undue pressure due to the pipes becoming’choked issued by the Local Government Board Dr. Thresh points with ice. In one case, that of an appliance used for warming out that this circular letter would have been more complete manufacturing premises, one person was killed. We have had it also directed attention to Section 7 of the Publia heard, fortunately, of no cases of kitchen boiler explosions Health (Water) Act, which renders it obligatory on the part this winter, for the simple reason that the winter has so far of every rural sanitary authority from time to time to take been a mild one and not visited by prolonged frost. At the such steps as may be necessary to ascertain the condition of same time, householders are now aware of the importance the water-supply within its district and authorises the pay. of having a safety valve connected with the boiler and some ment of all reasonable costs and expenses incurred by the useful instructions upon this head appeared in our columns authority for this purpose. of Feb. 8th, 1896. ---
-
-
THE INSPECTION OF WATER-SUPPLIES. DR. THRESH, the medical officer of health of the Essex County Council, has recently issued a reprint of his paper upon this subject and its issue is timely in view of the epidemic outbreaks which have recently occurred in several parts of the country. Notwithstanding the labours of various Royal Commissions and the unwearying efforts of the Local Government Board the outbreaks of preventable disease due to the pollution of public water-supplies, he remarks, furnish abundant proof of the fact that the care taken to insure the hygienic purity of water used for domestic purposes is in many cases utterly inadequate. He dwells upon the difficulty of preventing the pollution of surface water, which to be done completely can only be by acquiring and exercising control over the area from which such water is collected. The Public Health Acts, however, provide for the prevention of the source of pollution to streams. The control of the more imof the portant portions gathering ground is as important as the steps subsequently taken to purify the supply by filtration or storage. We are glad that Dr. Thresh calls attention to the fact that the sanitary authorities in a district may have on powers over either the collecting area or the company’s works. Representations to the various bodies concerned may result in improvements being effected, as in the case of Stockport, where the report of the borough medical officer of health upon the unsatisfactory conditions obtaining upon
MR. HALL HAINS’S DEFENCE FUND. A MEETING was held at the house of Mr. Joseph Smith, the chairman of the Defence Fund Committee, on Friday evening last, to present Mr. Hains with a cheque for the subscriptions received. The accounts were audited by Dr. J. Bait and were found to be correct. Subscriptions to the amount of £ 113 6s. 6d. had been received and after deducting .12.110. 6d. for the expenses of type-writing, postage, and stationery there remained a sum of £111 16s. In presenting a cheque for this amount to Mr. Hains the chairman referred at some length to the case. He had watched it carefully and was convinced from the first of the unfounded nature of the charge. He warmly congratulated Mr. Hains on having left the court without a stain on his character and on the fact that to many of his brother practitioners had come forward in the manner they had done. Undoubtedly a great many had not subscribed owing to the fact that they considered Mr. Hain.% should have belonged to some medical defence association. He had great pleasure in handing to Mr. Hains what he considered to be a very substantial sum. Mr. Hall Hains, in reply, said that words failed him to express the gratitude he felt to Mr. Joseph Smith and the subscribers for coming forward in so extremely kind a manner. No one who had not experienced it could understand the terrible mental distress he suffered whilst these charges were hanging over his head; and it was only the knowledge of his complete
PHYSICAL CURIOSITIES. NOT the least
feature of the colossal show at Olympia is the collection of ° ° freaks " which the industrious managers have been able to get together, That public interest in these ’creatures, whether human ci belonging to some lower order, is very deep is proved byhe tenour of letters which we now and again receive asking for explanations of the various physical phenomena manifested. We need hardly say that errors of development may produce extraordinary results and that the average " freak" is sinply an error of development, ’the curious or, it may be, monstrous appearances being as a rule easily comprehensible by students of embryology and fretal structure. But there are two persons giving performances at Olympia who are able to perform feats which must certainly produce a very astonishing impression on the anatomical mind. One of these entertainers, whose name is Delno Fritz, is a sword-swallower and asserts that he can swallow longer swords than bave ever been swallowed before. We for our part never want to see anyone swallow more rigid metal. To those who know the surface markings of the abdomen and the situation of the stomach it is little short of appalling to see this man pass a sword down his gullet until the hilt impinges upon his teeth and then withdraw the weapon and -demonstrate by outside measurement that in the erect posture the point falls some inches below the usual line of the lower curvature of the stomach. What really happens, f course, is that Delno Fritz has learnt, consciously or unconsciously, to stretch the somewhat loose and elastic tissues between the lips and the cardiac orifice of the stomach, so that these tissues will lie along his blunted sword in a condition of extension, while a protruded chin assists in the prolongation f the pharynx. It should be added that the solidity of the weapon with which the feat is performed is beyond question. A second person in whom medical men must be ’Interested is one Young Hermann, who can expand and contract his chest and abdomen at will to really remarkable dimensions. He is able to make a bond-fide difference of sixteen inches in his chest measurements and accordingly to snap chains and straps fastened across his thorax by the steadily extending pressure he is able to effect upon ’them. The alteration which he produces in his abdominal outlines are no.less striking. By swallowing air and then
interesting
.organised by Messrs. Banum and Bailey
upon it by contractions of the rectus abdominalis muscle, he can rapidly pass from the appearance of extreme corpulency to the appearance of horrible emaciation, the skin of the abdomen appearing in the latter case to lie against the spinal column. His extraordinary power of swallowing and inhaling air enables him to shift the apex beat of the heart many inches and otherwise to displace his viscera The power of swallowing air is not exceedingly rare,l but the extent to which Young Hermann possesses it is unexampled in our experience. It is probable that Joseph Clark, the celebrated posture-master of the seventeenth century, possessed the secret of this trick in addition to his unwholesome knack of dislocating many of his joints at will. It may be remembered that Clark’s favourite joke was to go to a tailor to be measured with his right shoulder, say, much higher than the left, to return to fit the suit on with the protuberance on the other side, and finally to call at the shop and reject the clothes indignantly, having this time assumed a central hump. Young Hermann might amuse himself in a similarly ill-natured way if the inclination took him.
effecting pressure
___
A CASE OF PORENCEPHALY. IN the February number of the Edinburgh Medical Journal Dr. George Gibson and Dr. Aldren Turner describe a case of this condition which is of sufficient rarity to make a careful record of each case examined very desirable. It is true that the condition is well recognised, but its etiology is still a point on which authorities differ. The patient was a woman, aged twenty-two years, who was admitted to hospital in a condition of status epilepticus. The history was that a few days after her birth -which had been a long and difficult process and effected with instrumental aid, she had had a series of convulsions and soon after had been noticed to be paralysed in the left hand. She was backward both in speaking and walking, but she went to school when about seven years of age and learnt without difficulty to read and spell. She could never learn to write, however. She had apparently remained free from fits until about the age of seven years, when convulsions returned and she continued to suffer from them periodically during the rest of her life. She was evidently feeble - minded and after the fits was occasionally violent-indeed, almost insane. The chief peculiarity of the convulsions from which she suffered after her admission to hospital was that they were all unilateral, but sometimes one side of the body was affected and sometimes the other. In spite of various efforts to control the convulsions they continued with great severity and ultimately the patient died from exhaustion. At the necropsy careful measurement failed to reveal anything more than a slightly larger size of the arm, foreNo difference in arm, leg, and thigh on the right side. The left side of the head the bones was made out. The middle and was distinctly larger than the right. posterior foshce of the skull were much larger on the left side than on the right. The right cerebral hemisphere was partly cystic and partly solid, the cystic part comprising the occipital lobe, the convolutions around the posterior end of the fissure of Sylvius and the ventral part of the temporo-sphenoidal lobe. The cavity communicated with the ventricle and was lined by a smooth membrane. The basal ganglia were atrophied. The left cerebellar hemisphere was considerably atrophied and there was partial atrophy of the mesial fillet on the right side. The part least implicated was the most internal, the so-called pes lemnisci, and this condition would support the view that the mesial fillet ends partly in the optic thalamus and partly in the cortex
1 Edinburgh Hospital Reports, 1895; THE LANCET, Aug. 1st, 1896, p. 305.
452 cerebri. There was partial atrophy of the right pyramidal the gathering ground of the water company resulted in tract. Dr. Gibson and Dr. Turner, in conclusion, point out securing the removal of many possible sources of pollution. that various views as to the etiology of this condition The difficulties in the way, however, were so great that the have been propounded, but that the one which has been Sanitary Committee recommended that a petition should most favourably received is that it originates in the block- be presented to the Local Government Board under the ing of an artery with secondary softening and cystic seal of the council, praying that legislation might be formation. Such an origin would seem likely in this case as initiated whereby every sanitary authority supplied by a the part of the hemisphere chiefly affected is that related to water company which is not also a sanitary authority the distribution of the posterior cerebral artery. If this should be empowered to authorise any duly appointed view is correct the occlusion probably took place either at or official to enter, inspect, inquire, and take samples at any part of any source or works of water-supply or water puri6just before birth. cation at any time by day or night, and whereby also such BOILER EXPLOSIONS water company should be required to afford all reasonable ACCORDING to the report on the working of the Boiler facilities and information for such inspection, inquiry, and Explosions Acts during the year ending June 30th, 1897, the sampling. Dr. Thresh gives instances of the great purifying total number of cases dealt with was 80 and by these power of the subsoil in addition to the surface soil, but explosions 27 persons were killed and 75 injured. This he points out that subsoil supplies derived from fissured represents a total of 102 persons killed and injured during strata should be very carefully watched. As is well known the year and exceeds the average (90’S) for the fifteen impurities may travel along such fissures for very consideryears during which the Act has been in operation by able distances. Dr. Thresh admits that the whole subject about 12’7 per cent. The loss of life taken alone is one which bristles with difficulties and that the full inspecto the closely approximates average (28’6) for the same tion of any source of public supply requires not only a. causes The of period. explosion show no important certain knowledge of geology, physiography, chemistry, and variation. Of the 80 cases dealt with 28 were attributed to of engineering, but a large amount of ingenuity and power of the defective condition of the boiler or of its fittings ; 33 to attention to details if no point is to be overlooked. "The defective design, workmanship, material, or construction, or strength of a chain is merely that of its weakest link and to, to undue working pressure ; 12 to ignorance or neglect miss the weak link is to court disaster." He concludes In by emphasising the importance of the inspection of of the attendants ; and 7 to miscellaneous causes. 42 cases the boilers proved to be under the inspection public water - supplies and of these inspections being of some public association or were used in vessels provided periodical, say once a year, and in the intervals with Board of Trade passenger certificates, but in many samples should be submitted to chemical and bacterioof these cases explosions were not due to defects which logical examination, the freqtency depending upon the existed when the last periodical inspection was made. We importance and character of the supply. In a note upon notice that three accidents were due to heating apparatus, the the circular bearing upon thif subject which was recently cause being undue pressure due to the pipes becoming’choked issued by the Local Government Board Dr. Thresh points with ice. In one case, that of an appliance used for warming out that this circular letter would have been more complete manufacturing premises, one person was killed. We have had it also directed attention to Section 7 of the Publia heard, fortunately, of no cases of kitchen boiler explosions Health (Water) Act, which renders it obligatory on the part this winter, for the simple reason that the winter has so far of every rural sanitary authority from time to time to take been a mild one and not visited by prolonged frost. At the such steps as may be necessary to ascertain the condition of same time, householders are now aware of the importance the water-supply within its district and authorises the pay. of having a safety valve connected with the boiler and some ment of all reasonable costs and expenses incurred by the useful instructions upon this head appeared in our columns authority for this purpose. of Feb. 8th, 1896. ---
-
-
THE INSPECTION OF WATER-SUPPLIES. DR. THRESH, the medical officer of health of the Essex County Council, has recently issued a reprint of his paper upon this subject and its issue is timely in view of the epidemic outbreaks which have recently occurred in several parts of the country. Notwithstanding the labours of various Royal Commissions and the unwearying efforts of the Local Government Board the outbreaks of preventable disease due to the pollution of public water-supplies, he remarks, furnish abundant proof of the fact that the care taken to insure the hygienic purity of water used for domestic purposes is in many cases utterly inadequate. He dwells upon the difficulty of preventing the pollution of surface water, which to be done completely can only be by acquiring and exercising control over the area from which such water is collected. The Public Health Acts, however, provide for the prevention of the source of pollution to streams. The control of the more imof the portant portions gathering ground is as important as the steps subsequently taken to purify the supply by filtration or storage. We are glad that Dr. Thresh calls attention to the fact that the sanitary authorities in a district may have on powers over either the collecting area or the company’s works. Representations to the various bodies concerned may result in improvements being effected, as in the case of Stockport, where the report of the borough medical officer of health upon the unsatisfactory conditions obtaining upon
MR. HALL HAINS’S DEFENCE FUND. A MEETING was held at the house of Mr. Joseph Smith, the chairman of the Defence Fund Committee, on Friday evening last, to present Mr. Hains with a cheque for the subscriptions received. The accounts were audited by Dr. J. Bait and were found to be correct. Subscriptions to the amount of £ 113 6s. 6d. had been received and after deducting .12.110. 6d. for the expenses of type-writing, postage, and stationery there remained a sum of £111 16s. In presenting a cheque for this amount to Mr. Hains the chairman referred at some length to the case. He had watched it carefully and was convinced from the first of the unfounded nature of the charge. He warmly congratulated Mr. Hains on having left the court without a stain on his character and on the fact that to many of his brother practitioners had come forward in the manner they had done. Undoubtedly a great many had not subscribed owing to the fact that they considered Mr. Hain.% should have belonged to some medical defence association. He had great pleasure in handing to Mr. Hains what he considered to be a very substantial sum. Mr. Hall Hains, in reply, said that words failed him to express the gratitude he felt to Mr. Joseph Smith and the subscribers for coming forward in so extremely kind a manner. No one who had not experienced it could understand the terrible mental distress he suffered whilst these charges were hanging over his head; and it was only the knowledge of his complete