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ON THE "INTENSIVE" MERCURIAL TREATMENT OF GENERAL PARALYSIS AND TABES DORSALIS.
690 of her sex would feel themselves placed in an embarrassing tuberculosis is spread and the means which may be adopted position by the admission of a man suffering from an extreme to diminish its dissemination. degree of retention of urine or bleeding profusely from a recent laceration of the external genitals. It is neither ON THE "INTENSIVE" MERCURIAL TREATnor elaborate this desirable to MENT OF GENERAL PARALYSIS AND necessary argument, but it is manifest that if the lady does not deal with such cases as TABES DORSALIS. part of her ordinary work it is hardly in the interest of a PROFESSOR LEMOINE of Lille has contributed to the patient suffering in the way we have suggested that she Revue Neurologique of July 30th last an important practical should have to treat him in an emergency. paper on the treatment of general paralysis and tabes dorsalis by the hypodermic injection of an organic salt SURRA IN THE PHILIPPINE ISLANDS. of mercury in large doses and for prolonged periods. THE existence of surra in the Philippine Islands is He refers to the view generally entertained by many definitely announced and is causing considerable mortality physicians that general paralysis and tabes dorsalis are among the transport animals and cavalry horses of the but little capable of improvement under the so-called United States army of occupation, some 2000 animals "intensive"form of mercurial treatment, and publishes having died from it during the last six months of 1901. a number of cases where the results of treatment, The disease has proved almost invariably fatal and has especially as regards general paralysis, are so strikingly caused some alarm owing to the possibility of its introduction beneficial as to suggest that the question requires re12 cases are recorded by him at some into the United States. Captain Curry, M.D, reports that consideration. the carrier of surra in the Philippines is a biting fly, the length, six being cases of general paralysis and six of tabes S’tomoxys calcitrans1 He has examined a large number of dorsalis submitted to treatment. Two out of the six cases flies and mosquitoes but has found the trypanosome only in of general paralysis are recorded below as typical and illus. this species, in which it may remain alive for 24 hours after trative. Case 1. The patient was a man, aged 29 years, biting an infected animal. This fly is very abundant in and with a history of syphilitic infection. He had been well about Manila, especially in the stables and corrals, and it treated with mercury after he had contracted the disease lays its eggs in the dung, in which the larvse and pupae and had married subsequently and begotten two apparently He developed general paralysis later. As a prophylactic measure, all remedial agents healthy children. thrive. On then under observation he was submitted to the the destruction or disinfection lime or failed, coming having by rebroleum of animal excrement in all stables and corrals is form of mercurial treatment alluded to at the heading of this annotation. He was given daily hypodermic injections recommended. of benzoate of mercury to the extent of two centigrammes DURHAM COUNTY CONSUMPTION SANATORIUM. (three-tenths of a grain) per dose, from Oct. 10th to Dec. 1897. The treatment was carried out uninterruptedly 25th, WE have received a copy of the third annual report of the with the following results. Speech and memory, which had for the Prevention and of in the Cure Consumption Society county of Durham. We cordially agree with the general hitherto been impaired and defective, were much improved tone of the report. We have frequently urged that it but the general mental weakness remained the same. From is the duty of medical men to educate their patients time to time since then, up to February, 1902, treatment was continued. The mental and physical conditions improved as to the danger of infection which may arise from the further and only a slight pupillary inequality remained. He of The tuberculous committee improper disposal sputum. of the Durham Society has been adopting this principle. had since 1897 begotten four children, all of whom appeared Addresses have been given to meetings of workmen, to be healthy. Case 2. The patient was a man, aged 27 members of the Sunderland board of guardians, and the years, of alcoholic habits, neuropathic predisposition, and Cooperative Society, and letters have been sent to the various impulsive temper. He had had syphilis when a youth, and local authorities asking them to adopt preventive measures. some years afterwards he developed symptoms of general Several authorities now offer the free disinfection of rooms paralysis with grandiose delusions and megalomania. He vacated by consumptives and distribute leaflets showing the was then admitted into an asylum and treated with great danger of indiscriminate spitting, of breathing close daily injections of benzoate of mercury to the extent and vitiated air, and the need for the better ventilation of two centigrammes (three-tenths of a grain) per dose, The injections were given for 15 days and lighting of cow-byres, as well as the more stringent as in Case 1. and then discontinued for a similar period. continuously to of It is the supervision interesting milk-supply. note that voluntary notification of cases of consump- The dose was then raised to three centigrammes (about tion has been in force in Sunderland for a year half a grain), the intervals of treatment and disconand the medical officer of health states that 96 cases tinuance being as before, the whole period of treatment During have been reported. Sunderland has a population of extending from May to the end of September. over 146,000, so that the number notified cannot be October considerable amelioration was seen both mentally The treatment was now reduced to two stated to be large. Further, the borough of Gateshead and physically. has also adopted voluntary notification, so that this measure centigrammes (three-tenths of a grain) per dose, and this was is now in force amongst over a quarter of a million of the continued for seven months. A slight apoplectiform seizure population in the county. We shall await with interest I occurred once during this period. At the end of the time it further intelligence of the result of this experiment. The was noticed that the disease (dementia) was arrested, though! report of the medical officer (Dr. J. Gray) as to the the patient’s original character and disposition-viz., those Professor results of the sanatorium treatment ia certainly satis- of a neuropath-were clinically unmistakeable. Lemoine detailed accounts of four other cases of gives factory and we trust that the necessary funds will be forthtreated as mentioned. In all the six cases general paralysis more beds. Attached to the is to an coming provide report article on Consumption : Its Prevention and Cure." It is he observed marked improvement of symptoms both mental intended for the use of sanitary authorities, boards of and physical, but, as he points out, longer periods of observaguardians, consumptives, and the general public." Informa- tion are necessary before it can be conclusively established tion is given in a popular manner of the methods by which that the disease has been definitely arrested in such cases. "
1 American Medicine
July 19th, 1902, p. 95.
The excellent results obtained, however, in these cases oi he regards as justifying publication. Oi
general paralysis
69t head-master. He was ably aided by 12 teachers and four assistants, who were paid out of a small fund-, Theraised by Mrs. Ward and her personal friends. cost amounts to about E60 a week, which is much thesame as the expenditure in the New York and Chicago’ vacation schools which have been for some years in progress. We cordially sympathise with this experiment, because it; seems to us that it helps in a small way to militate against embryo hooliganism. The children and their parents areready for an extension of the scheme next year. The school buildings already exist, the necessary funds for teachers and materials can surely be furnished by the London School THE FIRST VACATION SCHOOL IN ENGLAND. Board provided that it is clearly laid down that the’ children’s brains are not to be worked during their oneALL ratepayers know that the children of board schools month’s holiday, but there is one great difficulty which wehave the month of August in every year as holidays. cannot help foreseeing, and that is the supply of teachers, A few of the more fortunate ones get away into the if the movement is to become It is obvious that. country, which is obviously the most ideal way of spending board school teachers should notgeneral. be encouraged to give up the summer vacation. But by far the greater number of their necessary holiday, but it may be quite justifiable to the London children have no country air to look forward as in the late experiment, teachers engaged in. to and spend August indoors, where they’ are perpetually employ, or middle-class education, aided by studente. secondary in their mothers’ way, or outdoors on the pavements from training colleges, who usually get at least two months’ getting into all kinds of mischief, quarrelling, and in the summer. Are there enough of these to make fighting. Mrs. Humphry Ward has this year tried an holidays vacation schools practicable in London and otherexperiment at the Passmore Edwards Settlement in general ’? cities large Tavistock-place, of opening a voluntary school during August for the children of the neighbourhood who habitually SMOKE PREVENTION AND PETROLEUM LAMP attend some 10 board schools and three voluntary schools. ACCIDENTS. Children able to pay a country visit or those wanted by NOT the least interesting sections of the annual report of their mothers for household work were excluded, but more than 600 others volunteered with acclamation to attend, the chief officer of the Public Control Department of the and spent happy hours, tinged only with the one disappoint- London County Council are those relating to the steps ment that they could not stay longer for more classes. No taken to prevent smoke nuisance and to the returns showpunishments were necessary, excellent discipline was main- ing the number of petroleum lamp accidents investigated by tained, and the threat of being sent to the head-master, the Council’s inspectors. It is satisfactory to note that thewho had power to dismiss from the school, was always found action taken under the Public Health Act by the Council. sufficient by the teachers. The children were divided into and by the borough councils during the year ended two classes which alternately worked for two and a half hours March 31st, 1902, has resulted in 819 cases of nuisances in the morning or the afternoon for five days in the week being reported, of which 541 were regarded as serious. only. In the Duke of Bedford’s large garden adjoining the Legal proceedings, however, were taken by the borough, settlement we found on the day of our visit five classes councils in only 119 cases and convictions were obtained. happily grouped under trees clay-modelling, listening to in 106 of these, the total amount of penalties imposed being stories, engaged in kindergarten games, needlework for nearly £551. We rejoice to find that the Public Health the girls, and nature study which was taking the form of Committee are considering how they can increase their a demonstration on tadpoles. In another corner a joyous, powers in this matter and it is suggested that the special. class was shouting building arange of mountains in the sand- section of the Act should be so worded as to cover any heap, the children working with feverish activity in the short serious emission of smoke from a chimney. Further, it is half hour at their disposal. In the house we saw many in- proposed to impose a direct penalty of not exceeding £10 teresting lessons going on, such as housewifery (which in- for the first offence, to be increased for subsequent offences, cludes the washing and dressing of a baby), drawing from instead of applying to smoke nuisance, as at present, the. memory from previous lessons and copying flowers, singing complicated procedure that may be properly applicable to a. to the piano, gymnastics in a fine gymnasium, drilling, sanitary nuisance. We certainly agree that if the law could, dancing, and carpentering. Among the favourite classes be so amended its active administration would at once for both boys and girls was cooking in the kitchen, where lead to a considerable diminution of the smoke nuisance. With winter approaching the boys proudly showed us the baked savoury mince and which still afflicts London. the plum-pudding which they had just learned to make. we trust that a strong endeavour will be made to A dramatic class was rehearsing a scene from the Mid- bring such excellent proposals into effect. Under the samer Act proceedings were taken in regard to 74 cases of summer Night’s -Drea7n, which was eventually acted for the benefit of the parents, and another favourite half hour was smoke nuisance arising from railway locomotives. The that spent in the library, well stocked with story-books. worst offenders in this respect were the South-Eastern and The various so-called lessons were all carefully chosen to Chatham Company who contributed just one-half of the. employ the children’s muscles rather than their brains and all cases and paid accordingly one-half of the total amount of lesson books were rigidly eschewed. The children varied penalties ( £230) imposed. The Brighton line comes next, in age from six to 13 years, infants not having been then the Great Eastern, then the Southend line (four cases), accepted. A trained nurse was on duty all through the and the London and North-Western (three cases). The day, ready for the reception of any sick children ; she Midland, Great Northern, Great Western, Great Central, and. was also responsible for the cleanliness of the lavatories London and South-Western railway companies do not appear and general hygiene. Parents of the children stated that in the category. The number of lamp accidents investigated they had never had such a peaceful August before, and by the Council’s inspectors during the past year was the same £ the general success of the experiment seemed to be greatly as in the previous year-namely, 204-whilst the number of. shown by Mr. Holland, fatal cases diminished to 18, in which 21 lives were lost. In due to the perfect organisatio
six cases of tabes dorsalis submitted to the same form of mercurial treatment five improved moderately and one very markedly as regards the ataxia of gait, but lightning pains still occurred at times in all and the knee-jerks were absent. Professor Lemoine uses the benzoate of mercury because it can be injected locally without harm to the patient. He advises deep injection into the subcutaneous tissue and muscular fasciae, and says that the pain produced is slight. Summarising his results generally he thinks that the improvement attained in cases of general paralysis is greater and more striking than in cases of tabes dorsalis.
the
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1 American Medicine
July 19th, 1902, p. 95.
The excellent results obtained, however, in these cases oi he regards as justifying publication. Oi
general paralysis
69t head-master. He was ably aided by 12 teachers and four assistants, who were paid out of a small fund-, Theraised by Mrs. Ward and her personal friends. cost amounts to about E60 a week, which is much thesame as the expenditure in the New York and Chicago’ vacation schools which have been for some years in progress. We cordially sympathise with this experiment, because it; seems to us that it helps in a small way to militate against embryo hooliganism. The children and their parents areready for an extension of the scheme next year. The school buildings already exist, the necessary funds for teachers and materials can surely be furnished by the London School THE FIRST VACATION SCHOOL IN ENGLAND. Board provided that it is clearly laid down that the’ children’s brains are not to be worked during their oneALL ratepayers know that the children of board schools month’s holiday, but there is one great difficulty which wehave the month of August in every year as holidays. cannot help foreseeing, and that is the supply of teachers, A few of the more fortunate ones get away into the if the movement is to become It is obvious that. country, which is obviously the most ideal way of spending board school teachers should notgeneral. be encouraged to give up the summer vacation. But by far the greater number of their necessary holiday, but it may be quite justifiable to the London children have no country air to look forward as in the late experiment, teachers engaged in. to and spend August indoors, where they’ are perpetually employ, or middle-class education, aided by studente. secondary in their mothers’ way, or outdoors on the pavements from training colleges, who usually get at least two months’ getting into all kinds of mischief, quarrelling, and in the summer. Are there enough of these to make fighting. Mrs. Humphry Ward has this year tried an holidays vacation schools practicable in London and otherexperiment at the Passmore Edwards Settlement in general ’? cities large Tavistock-place, of opening a voluntary school during August for the children of the neighbourhood who habitually SMOKE PREVENTION AND PETROLEUM LAMP attend some 10 board schools and three voluntary schools. ACCIDENTS. Children able to pay a country visit or those wanted by NOT the least interesting sections of the annual report of their mothers for household work were excluded, but more than 600 others volunteered with acclamation to attend, the chief officer of the Public Control Department of the and spent happy hours, tinged only with the one disappoint- London County Council are those relating to the steps ment that they could not stay longer for more classes. No taken to prevent smoke nuisance and to the returns showpunishments were necessary, excellent discipline was main- ing the number of petroleum lamp accidents investigated by tained, and the threat of being sent to the head-master, the Council’s inspectors. It is satisfactory to note that thewho had power to dismiss from the school, was always found action taken under the Public Health Act by the Council. sufficient by the teachers. The children were divided into and by the borough councils during the year ended two classes which alternately worked for two and a half hours March 31st, 1902, has resulted in 819 cases of nuisances in the morning or the afternoon for five days in the week being reported, of which 541 were regarded as serious. only. In the Duke of Bedford’s large garden adjoining the Legal proceedings, however, were taken by the borough, settlement we found on the day of our visit five classes councils in only 119 cases and convictions were obtained. happily grouped under trees clay-modelling, listening to in 106 of these, the total amount of penalties imposed being stories, engaged in kindergarten games, needlework for nearly £551. We rejoice to find that the Public Health the girls, and nature study which was taking the form of Committee are considering how they can increase their a demonstration on tadpoles. In another corner a joyous, powers in this matter and it is suggested that the special. class was shouting building arange of mountains in the sand- section of the Act should be so worded as to cover any heap, the children working with feverish activity in the short serious emission of smoke from a chimney. Further, it is half hour at their disposal. In the house we saw many in- proposed to impose a direct penalty of not exceeding £10 teresting lessons going on, such as housewifery (which in- for the first offence, to be increased for subsequent offences, cludes the washing and dressing of a baby), drawing from instead of applying to smoke nuisance, as at present, the. memory from previous lessons and copying flowers, singing complicated procedure that may be properly applicable to a. to the piano, gymnastics in a fine gymnasium, drilling, sanitary nuisance. We certainly agree that if the law could, dancing, and carpentering. Among the favourite classes be so amended its active administration would at once for both boys and girls was cooking in the kitchen, where lead to a considerable diminution of the smoke nuisance. With winter approaching the boys proudly showed us the baked savoury mince and which still afflicts London. the plum-pudding which they had just learned to make. we trust that a strong endeavour will be made to A dramatic class was rehearsing a scene from the Mid- bring such excellent proposals into effect. Under the samer Act proceedings were taken in regard to 74 cases of summer Night’s -Drea7n, which was eventually acted for the benefit of the parents, and another favourite half hour was smoke nuisance arising from railway locomotives. The that spent in the library, well stocked with story-books. worst offenders in this respect were the South-Eastern and The various so-called lessons were all carefully chosen to Chatham Company who contributed just one-half of the. employ the children’s muscles rather than their brains and all cases and paid accordingly one-half of the total amount of lesson books were rigidly eschewed. The children varied penalties ( £230) imposed. The Brighton line comes next, in age from six to 13 years, infants not having been then the Great Eastern, then the Southend line (four cases), accepted. A trained nurse was on duty all through the and the London and North-Western (three cases). The day, ready for the reception of any sick children ; she Midland, Great Northern, Great Western, Great Central, and. was also responsible for the cleanliness of the lavatories London and South-Western railway companies do not appear and general hygiene. Parents of the children stated that in the category. The number of lamp accidents investigated they had never had such a peaceful August before, and by the Council’s inspectors during the past year was the same £ the general success of the experiment seemed to be greatly as in the previous year-namely, 204-whilst the number of. shown by Mr. Holland, fatal cases diminished to 18, in which 21 lives were lost. In due to the perfect organisatio
six cases of tabes dorsalis submitted to the same form of mercurial treatment five improved moderately and one very markedly as regards the ataxia of gait, but lightning pains still occurred at times in all and the knee-jerks were absent. Professor Lemoine uses the benzoate of mercury because it can be injected locally without harm to the patient. He advises deep injection into the subcutaneous tissue and muscular fasciae, and says that the pain produced is slight. Summarising his results generally he thinks that the improvement attained in cases of general paralysis is greater and more striking than in cases of tabes dorsalis.
the
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