-Tropical Medicine, the nominal divorce was no How he faced that difficulty at an advanced age, and catastrophe to the hospital, which obtained the space overcame it by working abroad, is a testimony both it then needed for expansion and improvement, while to his personal courage and to the esteem in which it retained the cooperation in daily work along with he was held outside Austria. In this country his a free exchange of facilities with the other. Before name will be put in the niche of fame alongside the formal opening Sir Walter Fletcher delivered an those of Bowman, Donders, von Graefe, and Nettleship. address on the work of the hospital and on its value as a centre for clinical teaching and research in tropical GRÜNFELDER’S TOE REFLEX.
medicine. He commented on the threefold work of the hospital. Its patients are drawn from the contacts
seafaring trade, from the coasts of India, and Burma, from the Gold Coast, and from Ceylon, the Malay States. All classes are helped without regard to colour, to creed, or to social rank. They include officers and men of the mercantile marine, planters, engineers, missionaries, traders, the explorers who develop the Empire, and the servants of the State who administer it in all its various and distant parts. Its second great function was the development of Manson’s idea to found a school for affording instruction in tropical medicine to medical officers in the colonial service, and the lecture theatre was to perpetuate Manson’s name. The hospital had further inestimable value in the training of nurses to meet ’the special problems of disease in tropical climates. Finally, it was a centre of research inseparable from the daily work of the healer or teacher, and the only .source of progress in the cure and prevention of disease. Manson had himself taught the lesson that the clinician dealing with disease must acquire his own skill in the technical methods of the laboratory. But in spite of the work of Manson and of Ross malaria had not yet been conquered. There were to-day more, not fewer, sufferers from malaria in India, and even in the tercentenary year of the introduction of Jesuits’ bark, physicians were, Sir Walter said, still ignorant which constituent of the He bark was the most effective against malaria. wished the hospital well, not only for the sake of sufferers from disease, but for the sake of the better development and greater happiness of every part of the Empire. The new wards, pathological laboratories, and demonstration theatre have been added at a cost of 13,000, raised by the efforts of Sir Leslie of
Hildegard Rothe1 has published the results investigations made at the Berlin Children’s Hospital into the reflex recently described by Griinfelder. This reflex, which is of interest to otologists and to podiatrists, consists in dorsal flexion of the great toe combined with a fan-wise spreading of the other toes. As described by Grünfelder,2 it is elicited by continued pressure on an area of the skull at the intersection of the lambdoid, occipitomastoid, and parietomastoid sutures, which corresponds in the infant with a corner of the posterior Dr.
lateral fontanelle ; and it is found in the presence of disease of the middle ear in children up to the age of five years. It is especially in infants and young children that inflammation of the middle ear is difficult to determine and apt to escape recognition, and here Griinfelder’s reflex may be useful if it proves reliable. Dr. Rothe has looked for it in about 150 children with disease of the ear, and in the same number of children with healthy ears. She finds that it is usu ally spontaneous, but that it is increased, and sometimes elicited when otherwise absent, by pressure on the region mentioned by Grünfelder; it does not always take the form originally described, but sometimes consists in dorsal flexion of the great toe with plantar flexion of the other toes, and sometimes in a fanwise spreading of the little toes without marked dorsal flexion of the great toe ; it is therefore not always equally easy to recognise. The reflex is crossed-that is, it is seen in the left foot in disease of the right ear, and vice versa. Dr. Rothe confirms Dr. Grimfelder’s statement that it is found early in otitis media before visible changes in the drum membrane, and she associates it with increase of pressure in the tympanum. She found it present 98 times in 100 cases of acute otitis media before perforation, 12 times in 47 cases of suppurative otitis after perforation, and 3 times in 15 cases of mastoiditis with discharge ; but not at all in 4 cases of Eustachian catarrh, and only 3 times in 150 cases of other illWhen the reflex nesses without disease of the ear. occurred after perforation of the drum there was usually insufficient drainage, with pulsation of discharge, redness, or swelling of the drum. In one case antrotomy was followed by fall of temperature and disappearance of the reflex. Of the three children with other diseases who showed the reflex, one was suffering from encephalitis, one had external otitis, had rhinopharyngitis without showing any and one aural disease on repeated examination. of sign These findings suggest that the reflex is indeed a reliable indication of disease of the tympanum in young children.
ERNST FUCHS. THE death last Sunday in Vienna of Hofrat Prof. Ernst Fuchs in his eightieth year removes one who had come to be known as " the grand old man " of ophthalmology. Few can have had a wider circle of friends and acquaintances, and many, in countries as far apart as Austria and China, India and America, will feel sad that they will see him no more. His dinner parties at his delightful home in Vienna in pre-war days were usually of the nature of an international gathering. Fuchs was an excellent linguist and an ideal host. A great traveller, there can be few countries of any note he had not visited. He was a very hard worker and a prolific writer. His Textbook of Ophthalmology, one of the best medical text-books ever written, has run through some dozen German editions, half a dozen English ones, and has Dr. C. S. Myers, who has been director of the been translated into many other languages. Fuchs, like many great men, was a very humble one. He National Institute of Industrial Psychology since its would ask anyone working in his clinic who possessed inception, has been appointed principal of the instispecial knowledge to impart it to him. He would tute in order that he may devote the whole of his discuss sympathetically any difficulty or problem time to research and educational activities. Air. with those far inferior to himself in knowledge and G. H. Miles, D.Sc., who has been assistant director for several years, has been appointed director and give of his best to them. Few, if any students, left will take charge of the whole of its practical activities: a real his clinic without a feeling of regret and affection for the man himself. Fuchs was formerly a 1 Deut. Med. Woch., Oct. 24th, p. 1822. 2 Zeit. der Kinderheilk., 1929, xlvii., 641. "wealthy man but the war left him impoverished. ____