ANTITUBERCULOUS VACCINATION.

1340 average, and that other conditions compare favourably, but the Board must be prepared to do more than is perhaps necessary in the provinces to attract women to its service, especially having regard to the severe competition in London from other hospitals and other forms of employment. Doubtless bearing in mind the difficulty of persuading local authorities to undertake extra expenditure, Dr. Cuff proposes a scale of increased salaries so moderate as to be, in our opinion, of doubtful -efficacy. For probationers, to be accepted at 19 instead of 21 years, he has suggested a commencing salary of JE20 a year instead of R18 as at present, rising to R22 instead of f:20, with proportionate increases in upper grades and special increments - of R2 a year after five and ten years’ service. Better food and accommodation for nurses and two alternative schemes for granting extra leave are also proposed. The Hospitals Committee adopted the lesser of these schemes and approved the other proposals. On May 2nd the Board, practically without discussion-although in the interval since their first presentation the new arrangements have been subjected to considerable criticism outsideendorsed the action of the Hospitals Committee. RIGHT-BRAINEDNESS IN RIGHT-HANDED VIDUALS AND THE QUESTION OF

"CROSSED APHASIA,"

INDI-

in a rightthere was no trace of sensory aphasia in this case and no agraphia, the sensory speech centres must be localised in the left hemisphere, seeing that the right superior destroyed. In other words, temporal gyrus was " the case is one of crossed aphasia," one in which there is a proven dissociation of the motor and The importance of the sensory speech centres. case will be obvious to all who are interested in the problems of cerebral localisation. It is paralleled to some extent by another recent case recorded by Dr. E. Long,1 in which the motor speech centres were proved to be on the right side, and the sensory speech centres on the left, in a lefthanded patient. These and other cases suggest that differing degrees of right- and left-handedness exist, and that corresponding to the intermediate stages between absolute right-handedness and absolute left-handedness are possibly analogous variations in the complete or incomplete repre. sentation of the speech centres in one or other hemisphere. If this view is based on evidence which is not as yet very complete, at the least it has much to recommend it, and further investiga. tions calculated to throw light on this important question will be awaited with interest.

placed

handed

in

the

right

woman.

But

hemisphere

as

ANTITUBERCULOUS VACCINATION.

IN 1913 Professor Maragliano published the aphasia, whichever they be, latest results of his studies as to immunisation have never yet succeeded in explaining those of tubercle means the antituberculous by anomalous or "negative"cases of which a fair against him vaccine made at his institute at Genoa. by number of instances are now on record. Almost Dr. Since then Curti has 586 Eugenio performed .as many " negative " cases exist, which the theory and gives his experiences of vaccinations this kind, associated with the name of Professor Pierre Marie fails to explain satisfactorily, as anomalous cases of the method in a paper in the Gazzetta degli left unelucidated by the classical theory, cases to Ospedali of April 9th. Of the 586 persons vaccinated, the solution of which Marie’s theory was specially about 5 per cent. gave no reaction of any sort either directed. Attention has recently, therefore, turned local or general, and these were for the most part robust individuals with family history. The along rather a different line, and some prominence absence of reaction wasgood attributable to special has been given to the possibility of variations in and not to error in resistance, organic any the localisation of the speech centres in different In 80 per cent. there was sometimes, technique. individuals. It is not intended thereby to depreciate the main and well-established facts of localisation, and after a few hours, slight aching in the arm, and at the site of inbut merely to suggest that in certain otherwise accompanied by tingling, first a redness oculation appeared, followed by inexplicable cases variations in the site of the lasted some days, this being which pustule speech faculty may be present. This view was a followed in its turn by a yellowish scab, which tentatively advanced by more than one of the earlier writers on aphasia, but no instance of such after falling left a hard nodule, and afterwards These manifestations were variation that has been put on record can compare a dull red stain. some local itching and a rise of by accompanied with one which has recently been worked out by not Dr. Kurt Mendel, of Berlin, and published in the temperaturerarely exceeding 37.5° C., which was the who comnoticed always by patients, merely Neurologisches Centralblatt of Feb. 15th, 1912, This subfebrile state began and again, with further details, in the number for plained of lassitude. about 24 the inoculation when the hours after The patient was a woman, March lst, 1914. formed This and lasted a couple of days. pustule .aged 42, who was certainly right-handed, and in took In in individuals. normal place perfectly none of whose relatives had left-handedness ever about 15 cent. there were which per pustules As the result of an embolus been remarked. from cardiac disease she became paralysed on assumed the dimensions of a halfpenny, and were the whole of the left side, and had complete accompanied with swollen axillary glands and a These patients, however, motor aphasia. The lesion was eventually found febrile reaction of 390. to be an embolic softening of the right inferior did not complain of feeling ill, and were not prefrontal convolution, the right island of Reil, and vented from following their occupation. The local the right superior temporal convolution. Not manifestations lasted for ten days also in these cases. A further investigation into the condition examination content with a macroscopieal merely, Dr. Mendel has made a microscopical investigation and history of such patients showed that they were of both hemispheres, and is able to state that the persons w ith a bad family history, or who lived with lesion is as above mentioned ; the left hemi- tuberculous people, or had some form of strumous manifestation, or were in such a poor state of sphere is intact, and the pyramidal paths are health as to warrant the suspicion of a special mormally crossed in the lower part of the medulla. to tubercle. When persons with predisposition oblongata. The case therefore stands on record as one in which the motor speech centres are definitely L’Encéphale. June, 1913. RIVAL theories of

1

1341 were vaccinated in this way a reaction occurred. It seems, theremarked strongly fore, practically certain that antituberculous vaccination is absolutely innocuous and is useful, moreover, in that it affords, by the intensity of the local manifestations, a criterion by which the greater or less resistance of the patient to tubercle may be judged. What will be the advantages derived from Maragliano’s vaccination in the future remains to be seen. Certainly if it were the means of saving not more than 10 per cent. of those predestined to tuberculosis, it would be a victory to be proud of.

advanced tubercle

the interior of the uterus,

consisting

of

an

endo--

scopic tube, irrigating attachment, obturator, and,

He has used. it in about 20 was proposed to perform dilatation with curettement. By this means it is possible to see the lining membrane of the uterine body as of a velvety appearance and dark red colour. The slightest injury provokes- bleeding. The cervical mucosa is pink, or yellow according to its vascularity, and the arborising lines can be readily detected. He describes two cases in which facts of diagnostic value were brought to light by this method. In one a patient suspected of disease was found to be suffering from. malignant AND VACCINATION. BLINDNESS, SMALL-POX, villous endometritis. The other was a case of incomTHE admirable work done by the United States plete abortion; here uteroscopy discovered a piece of. in the Philippines in the practical stamping out of foetal envelope adhering to the fundus, whence it less spectacular than the elimina- was readily detached with small placental forceps.. small-pox, tion of yellow fever from Havana and the Panama Hitherto Dr. Heineberg has carried out this pro-Canal Zone, is nevertheless of the utmost value, cedure under general anaesthesia, but he thinks it not only for its immediate results, but in consequence will be possible to use local anaesthetics only in of its demonstration of the efficacy of vaccination certain selected cases. Careful asepsis is, of course, when thoroughly and radically enforced. It is well as essential as in any intra-uterine procedure. Acute known that before the occupation of the Philippines anteflexions, which might constitute a bar to by the United States small-pox was always endemic, inspection of the uterine cavity, may be overcome, and its exacerbations were frequent and severe. he thinks, by careful dilatation of the uterine canal So far back as 1899 Dr. Llewellys F. Barker stated with bougies. Profuse bleeding is an absolute that when the American army first went to Manila obstacle to the application of this method, a circumit had a large mortality from small-pox, which stance which, if it prove insurmountable, will was as common among the natives as scarlet greatly restrict the value of uterine endoscopy. fever or measles in America, a large propor- Moreover, as Dr.. Heineberg observes, incautious tion of the faces encountered being pitted. use of the instrument is capable of inflicting serious Wholesale vaccination by Dr. Bourns with the injury, especially in cases of acute infection of the aid of 18 Filipino physicians had, however, entirely genital tract, and in pregnant patients it would, of wiped the disease out. It has been for years course, be absolutely inadmissible. It remains to rarely in evidence in the reports of the principal be seen, therefore, whether a method which is zymotic diseases in foreign places, published weekly subject to so many restrictions will yield informa-in the United States Public Health Reports ; the tion of sufficient importance to justify its application Report for April 3rd shows for the third quarter on any considerable scale. Whether or not, it is of 1913 only 15 cases, while the Report for an interesting venture. The progress and manifold the fourth quarter shows no cases and no applications of the endoscopic plan of diagnosis deaths. This valuable official publication for during the past 50 years constitute a remarkable March 27th, 1914, contains an authoritative illustration of the psychological fact embodied in, account of a most interesting investigation regard- the popular saying, " Seeing is believing." ing the prevalence and causes of blindness in Cebu. Twenty-three towns were visited, of which In all 145 cases were 12 reported blindness. PATHOLOGICAL ANTAGONISM IN RELATION TO DIABETES. examined, and the chief cause was found to be small-pox, 48 cases. Most of these small-pox cases IT is a clinical fact, to which, perhaps, toohad been blind for many years, only 3 having little attention has been paid, that one disease may occurred in the past five years. The Report adds : In this relation to antagonise another. appear "Since the Americans have begun the systematic afford a striking example, an attack erysipelas may and compulsory vaccination of all people smalil-pox cutting short other conditions. The explanation of is no longer a cause of blindness." There are these facts is not at present known. other ways, too, besides that of one disease by its UTERINE ENDOSCOPY. incidence obliterating the effects of another which Thus one disease To the already formidable list of instruments for demonstrate this antagonism. the former is interanother when Dr. the the human into recesses of may replace body peering Alfred Heineberg, a Philadelphia gynæcologist, pro- mittent in incidence; or direct medical intervention, poses to add yet another. His preliminary announce- such as a surgical operation, may check an oldment, in the April number of Surgery Gynæcology, standing pre-existing disease, against which such and Obstetrics, begins with a recitation of the means intervention was not primarily directed. H. S. Stark hitherto employed for the diagnosis of intra-uterine’ in the Medical Record (1914, vol. lxxxv., p. 64-5) disease: bimanual palpation of the uterus as a records some interesting observations in relation. whole, the uterine probe, digital exploration of the to diabetes. He recognises three groups in which. uterine cavity, and microscopic examination of pathological antagonism can be noted. (a) Where curettings from the uterine mucosa. As he points an intercurrent symptom checks the gh-cosuria. out, the method of curettage, to which most import- In two cases of diabetes an attack of urticaria ance is attached in the diagnosis of uterine cancer, stopped the excretion of sugar. More interesting yields valuable results, but often disappoints or than these, perhaps, was a case of diabetes in So long misleads just in those cases where its help would which the patient contracted syphilis. He has therefore as the Wassermann reaction was positive the have been most desirable. designed an endoscope for visual examination of glycosuria persistedwhen the negative reaction

though

lighting cases,

attachment.

in all of which it