AMYOTROPHIC LATERAL SCLEROSIS.

320 Professor Collins, affected by the disease-viz., the motor and the association cells-commissural and columnar c ells. From a study of the literature on the subject Profe Eessor Collins was able to collect 11 cases of amyotrophic la lateral sclerosis with necropsy in which the pathological p] process involved in their entirety both the systems of nerve cc cells above mentioned. He points out also that the disease ir might exist in its most typical forms without involving the p, pyramidal tracts. The affection was thus different from prog gressive muscular atrophy because of the different clinical c and anatomical changes. The etiology of amyocourse was After a careful examilateral sclerosis obscure. trophic n nation of the entire literature he had selected 94 typical c cases and had added to these nine of his own, four of Of these 103 the latter being confirmed by necropsy. collected cases 54 were males and 49 were females. The "STREET CAR COLDS." IN THE LANCET of Jan. 17th, p. 208, appeared an account fourth and fifth decades of life were found to be equally from the pen of our New York correspondent of the dis- liable to develop amyotrophic lateral sclerosis. The average duration of the disease was two years, the minimum being a graceful overcrowding of street and elevated railway cars in few months and the maximum nine years. The upper limb the city of New York. The bulletin of the city of Chicago was affected first in 39 cases, the lower limb in 14, and both for the week ended Jan. 10th refers to a somewhat similar upper and lower limbs in 11 cases, while the disease comstate of matters existing in that city. menced with bulbar symptoms in 21 cases. Traumatism did Street ear colds," says the bulletin, are, in the experience of every in with physician frightful rapidity. not, in Professor Collins’s view, seem to be an adequate cause general practice, increasing Pneumonia and bronchitis, as direct results, are endemic in every part nor did overwork, including hard manual labour and exof the city. Since the first of the year there has been a 22 per cent. increase in the deaths from these two diseases and, as compared with haustion of special sets of muscles, as in gold-beaters, seem to the first ten days of 1902, the increase is a little more than 41 per enter into the etiology. The disease occurred mostly among cent. Again the department urges that every able-bodied person shun the street cars, both surface and elevated, as far as possible. the working classes. Six patients gave a history of syphilis, Especially should men, young and middle-aged, walk rather than ride but this was probably not more than the actual percentage in them any reasonable distance. This would make it possible fOJ women, young and old, to have some chance of at least getting inside of syphilis generally prevalent in the class of patients at and so prevent others of them from collapsing from cold and fatigm In the discussion following the reading of the Clinic on the overcrowded platforms. A brisk walk of two miles or less to his office in the present weather would be vastly better for every busines: Professor Collins’s paper at the meeting of the New York man than a ride of the same distance in the mephitic, disease saturated atmosphere of the average street-car. Neurological Society Dr. Bernard Sachs said that the disease The pathology of "a cold" is very uncertain, but there car was recognised clinically by the combination of spastic parabe no doubt that a cold, whether it be real influenza or not plegia with atrophic paralysis. He had seen many cases of does lower the resisting powers of the organism. Foul air o " spinal cord syphilis with muscular atrophy " but he would air which has been breathed over and over again is a poten not classify them as true amyotrophic lateral sclerosis. He held that there was a closer relation between progressive cause of headache, to say nothing of predisposing person muscular atrophy and amyotrophic lateral sclerosis than Prowho breathe it to other complaints. fessor Collins admitted. Progress of the disease was, however, much slower in the ordinary type of the former than in AMYOTROPHIC LATERAL SCLEROSIS. the latter. Dr. J. R. Hunt cited a case of amyotrophic Professor Joseph Collins of New York has published lateral sclerosis of very acute onset in which the necropsy an important paper on the subject of this rare disease revealed a degeneration of certain association tracts of the of the spinal cord in the New York Medical News of cerebral cortex and suggested that this was the anatomical He states that he has met with only basis for Dec. 27th, 1902. of the mental symptoms observed in this case. many seven cases of the disease among 7000 patients seen by In closing the discussion Professor Collins restated his him at the Neurological Clinic of the City Hospital belief that progressive muscular atrophy and the disease during a period of ten years. The symptoms and pro- under discussion were different pathologically, clinically, and gress of the disease are illustrated by the following etiologically. He saw nothing in "abiotrophy"or the typical case which is cited by him. The patient was theory of a special vital defect in the nerve tissues, which a woman, aged 37 years, who complained much of had a bearing upon the pathogenesis of amyotrophic lateral pain in the head and in the nuchal muscles. This was sclerosis, as in the latter disease the process was probably an followed by a gradually developing atrophy of the acute infection. muscles of the shoulder-girdle, neck, and hands and by Babinski’s greata slight spasticity of the upper limbs. PAUPER ALIENS AND LONDON HOSPITALS. toe phenomenon was observed to be present. There were Two questions which have been recently agitating the early and marked symptoms of bulbar paralysis. The total duration of the symptoms was about three years, minds of correspondents of more than one daily newspaper at the end of which period she died. The necropsy revealed are closely connected to an extent which the general the following conditions. There was a marked atrophy with reader is not at all likely to suspect and in a way disappearance of the nerve cells in the anterior cornuawhich seems to have escaped the observation of the throughout the entire spinal cord, the change being most; sagacious pressman. The questions to which we refer The cervical and dorsall are those of alien immigration and of London hospitals. marked in the thoracic region. segments showed a zone of degenerated nerve fibre.i To anybody unfamiliar with the clientèle of a large encircling the anterior cornua and due to the degeneratior general hospital in London the extent to which foreigners of the nervous processes of commissural and columnar cells. prevail there would provide no little surprise if he were to The neuroglia was in a state of proliferation in tht investigate the question. If such an inquirer were to spend degenerated areas mentioned. The anterior spinal nerVEa Saturday among the out-patients of an East-end hospitalroots were atrophied but the pyramidal tracts were intact, the London Hospital, let us say, or the Children’s Hospital Thus, two systems of cells in the spinal cord were, say; in the Hackney-road-his surprise would amount to nothing

tuberculosis mental symptoms of a special kind could be detected which had a diagnostic value tending to the suspicion of impending tubercle. Phenomena of the same order-nervous and sexual hyper-excitability-had also been observed in certain animals. Thus in cows incipient tuberculosis was attended with morbid sexual excitement and depraved appetite, the animal acting like one in heat and also eating dirt and bits of wood. On killing the animal incipient tubercles could be found in the lungs. He had also noticed in dogs developing tuberculosis that from being gentle and affectionate they became snappish and irritable and showed abnormal sexual excitement. He as the in animals one of toxaemia affecting regarded process the brain and nervous system.

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