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LUMBAR PUNCTURE IN NEUROSYPHILIS
799
but was intimately connected with the prolongation of expiration. This led to a consideration of what effect such alteration in respiratory rhythm could have upon the circulation, and the conclusion is reached that prolongation of the expiratory phase will interfere with the venous return to, the right side of the heart and hence cause congestion in the tissues. This in turn will produce some alteration in the hydrogenion concentration of the blood around the cells of the respiratory centre, a conclusion already reached by Prof. F. R. Fraser2 from a study of the blood gases. Increased respiratory effort follows the stimulus of such a change in an individual already experiencing The greater some resistance to normal respiration. such resistance, the longer the expiration time and the greater the change in the centre. In this vicious circle lies the cause for the subjective feeling of .dyspnoea. Prof. Bruns and Dr. Herbst believe that by disciplining the breathing so as to equalise the inspiration and expiration time the vicious circle -can be broken and dyspncea relieved. On this basis various empirical systems of breathing exercises have already been devised.
It is on these two types of reaction that attention should be chiefly focused, as they provide definite evidence of involvement of the nervous system. And, as the great majority of the more ephemeral reactions have disappeared by the end of the third year, it follows that a lumbar puncture performed at this time is more likely to give trustworthy information than one which is performed at an earlier period. Ravaut has also produced evidence to show that neurosyphilis becomes progressively less latent, that is, less confined to changes in the cerebro-spinal fluid, the further from the time of infection the case is followed. Of the patients in whom cerebro-spinal fluid abnormalities were found at any period, only 5 per cent. of those examined during the secondary stage showed any clinical evidence of neurosyphilis, whereas from the end of the third year onwards the proportion gradually rose so that between the seventh and eighth years half showed clinical signs, and at the tenth year only one-fifth remained of a latent form. He considers therefore that an examination of the cerebro-spinal fluid becomes progressively less imperative after the end of the third year from the date of infection, although it may still be necessary when any neurological sign, however trivial, makes its appearance.
LUMBAR PUNCTURE IN NEUROSYPHILIS AT the Fournier centenary congress held in Paris last May the problem of neurosyphilis was discussed, ACCIDENTS FROM DISINFESTATION WITH and a resolution was unanimously passed expressing HYDROGEN CYANIDE the opinion of the congress that lumbar puncture ALTHOUGH the destruction of rats and insect pests was the best method of investigating the state of the by fumigation with hydrogen cyanide is now widely nervous system in the earlier stages of syphilis, and on sea-going vessels, this fumigant has been practised that every syphilitic should have his cerebro-spinal fluid examined at some definite time after his infection. little used in dwelling-houses, at least in this country. In a recent paper Ravauthas given his opinion that For certain purposes, as for instance the destruction the time at which one can learn most from this of mites in furniture, it is the only sure method, and examination if, as is usually the case, it is only it has many advantages in the eradication of parasitic but obviously the risk to human life is great and practicable to do one lumbar puncture, is the end of insects; the fumigation should be carried out with meticulous the third year. This opinion is based on 30 years’ Dr. F. M. llesserli,i has recently drawn experience of lumbar puncture in the early stages of precautions. attention to two deaths which occurred in Lausanne syphilis. The abnormalities in the cerebro-spinal fluid may following upon fumigation with hydrogen cyanide for the destruction of bugs. In one case the operators concern the cell count or the protein only, or these had apparently taken no precautions to ensure that may be combined with positive Wassermann and access to the fumigated flat was prevented during the colloidal reactions, forming what Ravaut calls a of airing, prior to thorough preliminary " complete reaction." The latter he considers as ventilation ; period in the the gas, which is highly other, of indicative meningo-parenchymatous lesions, the diffusible, found its cracks in floors and way through of which be from the nature may intensity judged to lower flat and a caused the death of one of -of the cerebro-spinal fluid changes. When the cell ceilings the Messerii draws to the risk attention occupants. count only is increased, it is probable that only the of in retention of the moisture, water, bedding, gas is meningo-vascular system attacked, whereas an excess cushions, hangings, and foodstuffs, and he lays of protein (which is usually associated with positive colloidal reactions) is evidence rather of a parenchyma- special emphasis upon the impossibility of limiting tous lesion. His experience has confirmed what is now the field of action of the fumigant in tenement although this can apparently be done on generally recognised-namely, that an increase in cell buildings, count and protein is commonly found during the ships. He cites ten instances of poisoning in Paris, advocates universal early months of syphilis, but that the majority of reported byof Kohn-Abrest, and In his opinion sulphur prohibition cyanide. hydrogen these reactions disappear either spontaneously or lethal to and is far dioxide is pests, sufficiently under treatment without being accompanied by any .clinical neurological sign. The minority are more preferable in view of the lesser risk to human life. In intense and persistent, and these may be divided into this connexion we may note that sanitarians in British ports have not ceased to rely upon sulphur for the two main groups :of ships, and that in other countries, where (1) Those in which no clinical symptoms make their fumigation had fallen into disrepute, a more dioxide sulphur In but which for months or such appearance, persist years. cases post-mortem examination may show evidence of favourable opinion of its efficacy is gaining ground. old-standing lesions of the nervous system. Occasionally The point still to be settled is the reliability of sulphur a slight clinical sign, quite disproportionate to the pathodioxide as a destroyer of the eggs of parasitic insects, logical lesion, makes its appearance in such cases. (2) Those in which the cerebro-spinal fluid reactions a subject which was touched upon at a meeting of increase progressively and persist, and in which, after a the Royal Sanitary Institutesome years ago, and latent period of varying duration, the clinical signs of a ’is being investigated afresh by Dr. W. C. Gunn at severe neurological disease make their appearance. To this The question deserves further consideration Glasgow. Ravaut the name type gives pre-clinical." ____
"
2 THE LANCET, 1927, i., 529, 589, 643. 3 Ravaut, P.: Le Monde Médical, 1932, xlii., 763.
1
Schweiz. med. Woch., 1932, lxii., 880. 2 Jour. Roy. San. Inst., 1925, xlvi., 286.
but was intimately connected with the prolongation of expiration. This led to a consideration of what effect such alteration in respiratory rhythm could have upon the circulation, and the conclusion is reached that prolongation of the expiratory phase will interfere with the venous return to, the right side of the heart and hence cause congestion in the tissues. This in turn will produce some alteration in the hydrogenion concentration of the blood around the cells of the respiratory centre, a conclusion already reached by Prof. F. R. Fraser2 from a study of the blood gases. Increased respiratory effort follows the stimulus of such a change in an individual already experiencing The greater some resistance to normal respiration. such resistance, the longer the expiration time and the greater the change in the centre. In this vicious circle lies the cause for the subjective feeling of .dyspnoea. Prof. Bruns and Dr. Herbst believe that by disciplining the breathing so as to equalise the inspiration and expiration time the vicious circle -can be broken and dyspncea relieved. On this basis various empirical systems of breathing exercises have already been devised.
It is on these two types of reaction that attention should be chiefly focused, as they provide definite evidence of involvement of the nervous system. And, as the great majority of the more ephemeral reactions have disappeared by the end of the third year, it follows that a lumbar puncture performed at this time is more likely to give trustworthy information than one which is performed at an earlier period. Ravaut has also produced evidence to show that neurosyphilis becomes progressively less latent, that is, less confined to changes in the cerebro-spinal fluid, the further from the time of infection the case is followed. Of the patients in whom cerebro-spinal fluid abnormalities were found at any period, only 5 per cent. of those examined during the secondary stage showed any clinical evidence of neurosyphilis, whereas from the end of the third year onwards the proportion gradually rose so that between the seventh and eighth years half showed clinical signs, and at the tenth year only one-fifth remained of a latent form. He considers therefore that an examination of the cerebro-spinal fluid becomes progressively less imperative after the end of the third year from the date of infection, although it may still be necessary when any neurological sign, however trivial, makes its appearance.
LUMBAR PUNCTURE IN NEUROSYPHILIS AT the Fournier centenary congress held in Paris last May the problem of neurosyphilis was discussed, ACCIDENTS FROM DISINFESTATION WITH and a resolution was unanimously passed expressing HYDROGEN CYANIDE the opinion of the congress that lumbar puncture ALTHOUGH the destruction of rats and insect pests was the best method of investigating the state of the by fumigation with hydrogen cyanide is now widely nervous system in the earlier stages of syphilis, and on sea-going vessels, this fumigant has been practised that every syphilitic should have his cerebro-spinal fluid examined at some definite time after his infection. little used in dwelling-houses, at least in this country. In a recent paper Ravauthas given his opinion that For certain purposes, as for instance the destruction the time at which one can learn most from this of mites in furniture, it is the only sure method, and examination if, as is usually the case, it is only it has many advantages in the eradication of parasitic but obviously the risk to human life is great and practicable to do one lumbar puncture, is the end of insects; the fumigation should be carried out with meticulous the third year. This opinion is based on 30 years’ Dr. F. M. llesserli,i has recently drawn experience of lumbar puncture in the early stages of precautions. attention to two deaths which occurred in Lausanne syphilis. The abnormalities in the cerebro-spinal fluid may following upon fumigation with hydrogen cyanide for the destruction of bugs. In one case the operators concern the cell count or the protein only, or these had apparently taken no precautions to ensure that may be combined with positive Wassermann and access to the fumigated flat was prevented during the colloidal reactions, forming what Ravaut calls a of airing, prior to thorough preliminary " complete reaction." The latter he considers as ventilation ; period in the the gas, which is highly other, of indicative meningo-parenchymatous lesions, the diffusible, found its cracks in floors and way through of which be from the nature may intensity judged to lower flat and a caused the death of one of -of the cerebro-spinal fluid changes. When the cell ceilings the Messerii draws to the risk attention occupants. count only is increased, it is probable that only the of in retention of the moisture, water, bedding, gas is meningo-vascular system attacked, whereas an excess cushions, hangings, and foodstuffs, and he lays of protein (which is usually associated with positive colloidal reactions) is evidence rather of a parenchyma- special emphasis upon the impossibility of limiting tous lesion. His experience has confirmed what is now the field of action of the fumigant in tenement although this can apparently be done on generally recognised-namely, that an increase in cell buildings, count and protein is commonly found during the ships. He cites ten instances of poisoning in Paris, advocates universal early months of syphilis, but that the majority of reported byof Kohn-Abrest, and In his opinion sulphur prohibition cyanide. hydrogen these reactions disappear either spontaneously or lethal to and is far dioxide is pests, sufficiently under treatment without being accompanied by any .clinical neurological sign. The minority are more preferable in view of the lesser risk to human life. In intense and persistent, and these may be divided into this connexion we may note that sanitarians in British ports have not ceased to rely upon sulphur for the two main groups :of ships, and that in other countries, where (1) Those in which no clinical symptoms make their fumigation had fallen into disrepute, a more dioxide sulphur In but which for months or such appearance, persist years. cases post-mortem examination may show evidence of favourable opinion of its efficacy is gaining ground. old-standing lesions of the nervous system. Occasionally The point still to be settled is the reliability of sulphur a slight clinical sign, quite disproportionate to the pathodioxide as a destroyer of the eggs of parasitic insects, logical lesion, makes its appearance in such cases. (2) Those in which the cerebro-spinal fluid reactions a subject which was touched upon at a meeting of increase progressively and persist, and in which, after a the Royal Sanitary Institutesome years ago, and latent period of varying duration, the clinical signs of a ’is being investigated afresh by Dr. W. C. Gunn at severe neurological disease make their appearance. To this The question deserves further consideration Glasgow. Ravaut the name type gives pre-clinical." ____
"
2 THE LANCET, 1927, i., 529, 589, 643. 3 Ravaut, P.: Le Monde Médical, 1932, xlii., 763.
1
Schweiz. med. Woch., 1932, lxii., 880. 2 Jour. Roy. San. Inst., 1925, xlvi., 286.