CHORDOMA.

248 the brain in comatose conditions, distinguishing them CHORDOMA. from ureemic and diabetic coma, and also as a prognostic sign of grave significance in bilateral absence THE occurrence in relation to the vertebral column of the phenomenon. It may further serve as a useful of tumours derived from notochordal tissue was clearly sign as evidence of a peripheral paralysis in subjects established by Ribbert in 18J4. They are rare, but. in whom the ordinary method of investigation is not as rare as they seem, for a certain number not easy, as in the insane or alcoholic, and in are doubtless unrecognised and unrecorded. A comchildren. Dr. Modonesi’s publication of his observation prehensive account of the condition in the January of the bulbo-mimetic reflex preceded for some time issue of the Journal of Pathology and Bacteriology, that of other similar reflexes by Pierre Marie and by Prof. M. J. Stewart, of Leeds, and Dr. J. E. Morin, C. Foix. In the latter’s " Signe de la Face " the reflex summarises what is known in a useful way and should action of the muscles of expression is obtained by lead to the identification of further examples ; once pressure, not on the globe of the eye, but on the it is known, the tumour may often be recognised at ascending branch of the occipital nerve. In each first sight. It occurs chiefly in situations corresponding instance it would appear that a contraction of the to the ends of the notochord, i.e., in the neighbourhood facial muscles is produced by pressure of a painful of the spheno-occipital synchondrosis and in the sacrocharacter, and the two reflexes are not integrally coccygeal region, about equally in each ; only 3 cases different. out of 57 have been described in other places. More frequent in males than females, cases have occurred PURU. at ages from 16 to 72, the age of the sacral cases being THE specific infective disease caused by the distinctly the higher. It is usually of low malignancy, infiltrative and destructive, especially of bone, Treponema pertenue is most commonly known by the slowly and generally without metastases. The head cases name applied to it in Africa, yaws or framboesia, but it also occurs in other parts of the world under various give the symptoms of a slowly growing tumour of the giddiness, failure of sight, designations. Thus in Ceylon it is called " parangi," base of the skull-headache, The sacrococcygeal cases in Fiji " coko," in the Pacific Islands " buba," and in cranial nerve palsies, &c. the Federated Malay States " puru." The committee suffer at first mostly from pain, and later pressure on for public health education of Malaya has recently nerves may give various motor, sensory and trophic issued a pamphlet1 on the disease, written by Dr. disturbances in the legs ; if the tumour extends mostly A. Viswalingam, with the object of encouraging close inwards pressure on the bladder and rectum may be troublesome, if mostly outwards a characteristic cooperation between public health workers and the very external tumour appears and slowly extends. Anatothat in of the so that this world, general public part the tumour is well encapsuled and divided intensely crippling disease may be eradicated. It is mically estimated that 60 per cent. of the natives suffer or have into lobules by fibrous tissue trabeculae ; the substance suffered from the disease which afflicts all ages, but is is composed of translucent whitish or bluish gelatinous. more prevalent in childhood, and particularly abounds material, rather like a colloid cancer, which in the in insanitary country districts where the filth and later stages may become almost liquid. The more general unhealthy conditions favour the occurrence of malignant examples are more solid, firm, and opaque. the disease. Spread by sexual intercourse is apparently Histologically the younger, more cellular areas have a solid epithelial aspect, alveolar in arrangement; very uncommon, the more usual course of events being in older parts the abundant cytoplasmic vacuolation the entrance of the spirochsete through trivial wounds and abrasions on exposed parts. The incubation produces the remarkable bladder-like physahphorous period varies from a few weeks to months, and the cells and a sort of vacuolated syncytium, while the initial lesion is found at the site of infection and mucinous fluid which is formed at first cuts up the cells consists of a granuloma which arises in the deep into columns and later forms a lake in which only a tissues of the skin. A more characteristic initial lesion few scattered cells are visible. The microscopical is the occurrence of one or more small papules which structure is in this way rather various in different increase in size and secrete a viscid yellowish discharge. cases and in different parts of the same tumour, but The second stage consists of eruptions which appear it seems always to be recognisable. Prof. Stewart in successive crops and may last for years. Small also deals shortly with the heterotopic" notochordal ecchordosis granulomata appear some weeks or months after the tissue found about the dorsum sellee—the spheno-occipitalis "-which is not so parent sore and are accompanied by an irregular physaliphora fever. Discrete forms are common in older and very rare if it is looked for, and which, with similar confluent forms in younger people. Pitted sores upon misplaced notochord in the sacral region, may possibly the feet are very common, and great thickening of the ’, be the origin of chordoma. The paper gives a detailed skin and bones of the arms and legs also occurs. The ’, account of the third example which has been met with third stage consists of an exfoliative dermatitis of the ’, in Leeds in recent years, and is followed by a descripof an Edinburgh case by Drs. W. A. Alexander palms and soles which may go on to a more severe ’I tion J. W. Struthers. Others will doubtless turn up and the skin loses its and while fissuring, pig- I thickening ment in patches. Treatment by salvarsan and its as the condition becomes more familiar. derivatives gives excellent results, as is shown by the photographs accompanying Dr. Viswalingam’s monograph. Similar results were obtained by Dr. INDEX TO " THE LANCET," VOL. II., 1925. Winckel in Java, as our Berlin correspondent reported THE Index and Title-page to Vol. II., 1925, which last week. The Federated Malay States Government has placed salvarsan within the reach of all sufferers. was completed with the issue of Dec. 26th, is now The question of prevention is largely bound up with ready. A copy will be sent gratis to subscribers matters of personal and domestic cleanliness, and on receipt of a post-card addressed to the Manager of THE LANCET, 1, Bedford-street, Strand, W.C. 2. measures are being undertaken to eradicate the disease by hygienic means. Dr. Viswalingam points out that Subscribers who have not already indicated their some of the failure to curtail the disease in the past desire to receive Indexes regularly as published has been due to its being confounded with such other should do so now. diseases as lupus, leprosy, and syphilis. He emphasises, however, that its symptomatology renders it a distinct disease but it is unfortunate that in his otherNORTH WALES MENTAL HOSPITAL.-The number wise excellent account of " puru " he makes no of patients in the hospital is 1061. Of these, 935 are ratemention of the Wassermann reaction which other aided cases, and the average weekly cost of maintenance observers have found consistently positive in African during the past quarter was 19s. per head. The medical superintendent, Dr. Frank Jones, reports that the recoveryyaws." rate was maintained at a high level-51 per cent. for the 1 The Puru of Malaya : its Treatment and Eradication. last quarter, as against an average for similar institutions.

probably

____

"

London : John Bale, Sons and Danielsson.

1925.

of 30 per cent.