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PURIFORM CEREBRO-SPINAL FLUID IN URÆMIC COMA.
PURIFORM CEREBRO-SPINAL FLUID IN URÆMIC COMA. may act
as
centres of education in infant
hygiene, for,
as
Lady Helmsley says, although every woman is supposed to know how to manage a baby by instinct, we know, alas, how untrue is this supposition. The only natural instinct is to " suckle the child, all else has to be learnt." The fact that illegitimate children are not refused in these creches is to be commended. The President of the society is H. R. H. Princess Christian, and the address of the secretary, Mr. W. A. Lawton, is 1, Upper Montague-street, Russellsquare, London, W.C. The other charity of which we speak is the Jewish Sick Room Help Society for supplying district Its work is noteworthy in that a .nurses to the Jewish poor. has been introduced, and during the ,provident department no less than out of the £1705 expended on £517 present year the 1543 cases attended by the society’s nurses has been collected in pennies from 2450 members in a limited area in the East-End of London, which, the committee truly observes, "is a remarkable evidence of the possibilities of thrift work amongst our people." The secretary of the society is Mrs. Alice Model, of 105, Fellows-road, London, N.W., who was its joint foundress with Miss Lowy. PURIFORM CEREBRO-SPINAL FLUID IN URÆMIC COMA. LUMBAR puncture, an operation which has come into use
1313
meningitis in uræmia, for there were no symptoms whatever of meningitis. Moreover, the effusion of polynuclear cells was a transitory phenomenon. The symptoms of meningitis are due to a superficial alteration of the cerebral cortex. In this case there was no alteration ; the phenomena were essentially vascular. The polynuclears were intact and no microbes were present. This condition-an aseptic puriform effusion containing intact polynuclears-was first described by M. Widal.a He found it in the cerebro-spinal fluid in syphilis of the central nervous system and in aseptic purulent pleural effusion after pneumonia. He attributed the integrity of the polynuclears to the fact that they were not damaged in the phagocytosis of microbes. M. Chauffard ascribed the puriform cerebro-spinal fluid in his case to the retention of nitrogenous substances which acted as toxins and also to the increased blood pressure paroxysmally increased by the convulsions which produced venous stasis. In the diapedesis of leucocytes the polynuclears were predominant because they the most mobile elements. M. Caussade and M. Willette suggest that the complex poisons which are retained in the system in uraemia produced congestion of the pia mater and diapedesis from chemotaxis. It is known that certain poisons This condition has been cause congestion of the pia mater. found in poisoning by salicylate of sodium. are
in recent years, has revealed many facts concerning RABIES IN PRUSSIA. the condition of the cerebro-spinal fluid in disease. At a A DURING the last few years there seems to have been a meeting of the Société Medicate des Hôpitaux of Paris on considerable increase in the number of persons bitten by M. 24th Caussade and M. Willette e July reported a case rabid in Prussia, according to the Allgemeine animals of ursemic coma in which they were surprised to find the e ivedicinische Central-Zeitung of Oct. 17th. In the year 1902 .cerebro-spinal fluid puriform. A man, aged 26 years, wass the admitted into hospital on the evening of May 31st last.,. officially reported cases were 250. In each of the four d following years between 300 and 380 were reported, and in On that day he was suddenly seized with convulsions and 1907 no less than 405. In 274 of these cases the animals On examination n soon after admission he became comatose. were proved to have been really suffering from rabies. r on the following day he was inerte" " and did not answer Most of the persons bitten were taken to the Pasteur stations The was 100 and the was s pulse temperature questions. i which have been established at Berlin and Breslau. Of the normal. There was no rigidity of the neck and Kernig’s and Babinski’s signs were absent. The knee-jerks were normal. 266 who were inoculated two died, and of the six who were There was complete incontinence of urine and fasces. The facee not inoculated two also died. Three of the four fatal bites were on the face. The mortality of the inoculated cases was was a little swollen and there was slight cedema of the eyelids and lower limbs. There was more pronounced oedema of f thus 0 ’ 75 per cent., which is a more favourable result than the lumbar region. d that obtained in 1906, when four cases out of 236 inoculated Auscultation of the heart revealed " 2 proved fatal, a mortality of 1 .69 per cent. Of course, most marked "bruit de galop." A little urine was obtained with the catheter and found loaded with albumin. Ursemic coma a of the wounds were inflicted by dogs but there were 12 cases of cat-bite and one of a hog-bite. was diagnosed and bleeding to 400 grammes was performed,, after which the patient recovered from the coma. On the following day he could speak ; he remembered no previous illness but had suffered from headache for some time. i NEW REGULATIONS FOR THE PREVENTION OF GRINDERS’ PHTHISIS. Improvement continued and at his request he was discharged THE Home Secretary has issued a draft of the new on July 15th. At this period two litres of urine containing .a gramme of albumin per litre were passed in the 24 hours, regulations which he proposes to enforce for the grinding of headache occurred at times, there was slight cedema of metals and racing of grindstones. These have been recomthe ankles, and the left ventricle was hypertrophied, but mended to Mr. Gladstone by the Cutlers’ Company, the the "bruit de galop" had disappeared. At the time the Sheffield Chamber of Commerce, and the Sheffield Cutlery was bled lumbar puncture was performed and yielded Council which represents the workmen. The draft has been patient turbid cerebro-spinal fluid under high pressure. Chemical printed and circulated in accordance with Section 80 of the analysis showed that it contained 0’ 4 gramme of urea and Factory and Workshop Act, 1901, in order that any persons 8 grammes of chlorides per litre, and traces of sugar and interested may suggest their amendment, and that competent albumin. The fluid contained an abundance of cells which were inquiry may be held into any reasonable objections which ’made up as follows: polynuclears, 90 per cent. ; lymphocytes, may be thus lodged against the new regulations. These .8 per cent. ; and large mononuclears, 2 per cent. The fluid are directed against the heavy mortality from grinders’ was sterile and the polynuclears were intact. Five days later phthisis, which is a matter of the gravest concern to both lumbar puncture was again performed and the cerebro-spinal men and masters, and which came under full discussion at fluid was found free from cells. Only one similar case the Sheffield meeting of the British Medical Association. .appears to have been reported: M. Chauffard has describedi The processes which it is desired to amend are the manu" Ur6mie Aigue et Polynucléose Rachidienne."" It is to be facture of cutlery, of tools, and of cutting and piercing noted that in spite of the oondition of the cerebro-spinal instruments and appliances of iron or steel ; the profluid the case narrated above cannot be termed an example of cesses of dry rough glazing in which emery or similar
only
.
-
1 Semaine Médicale, 1907, p. 361.
2
THE
LANCET, May 25th, 1907, p. 1446.
as
centres of education in infant
hygiene, for,
as
Lady Helmsley says, although every woman is supposed to know how to manage a baby by instinct, we know, alas, how untrue is this supposition. The only natural instinct is to " suckle the child, all else has to be learnt." The fact that illegitimate children are not refused in these creches is to be commended. The President of the society is H. R. H. Princess Christian, and the address of the secretary, Mr. W. A. Lawton, is 1, Upper Montague-street, Russellsquare, London, W.C. The other charity of which we speak is the Jewish Sick Room Help Society for supplying district Its work is noteworthy in that a .nurses to the Jewish poor. has been introduced, and during the ,provident department no less than out of the £1705 expended on £517 present year the 1543 cases attended by the society’s nurses has been collected in pennies from 2450 members in a limited area in the East-End of London, which, the committee truly observes, "is a remarkable evidence of the possibilities of thrift work amongst our people." The secretary of the society is Mrs. Alice Model, of 105, Fellows-road, London, N.W., who was its joint foundress with Miss Lowy. PURIFORM CEREBRO-SPINAL FLUID IN URÆMIC COMA. LUMBAR puncture, an operation which has come into use
1313
meningitis in uræmia, for there were no symptoms whatever of meningitis. Moreover, the effusion of polynuclear cells was a transitory phenomenon. The symptoms of meningitis are due to a superficial alteration of the cerebral cortex. In this case there was no alteration ; the phenomena were essentially vascular. The polynuclears were intact and no microbes were present. This condition-an aseptic puriform effusion containing intact polynuclears-was first described by M. Widal.a He found it in the cerebro-spinal fluid in syphilis of the central nervous system and in aseptic purulent pleural effusion after pneumonia. He attributed the integrity of the polynuclears to the fact that they were not damaged in the phagocytosis of microbes. M. Chauffard ascribed the puriform cerebro-spinal fluid in his case to the retention of nitrogenous substances which acted as toxins and also to the increased blood pressure paroxysmally increased by the convulsions which produced venous stasis. In the diapedesis of leucocytes the polynuclears were predominant because they the most mobile elements. M. Caussade and M. Willette suggest that the complex poisons which are retained in the system in uraemia produced congestion of the pia mater and diapedesis from chemotaxis. It is known that certain poisons This condition has been cause congestion of the pia mater. found in poisoning by salicylate of sodium. are
in recent years, has revealed many facts concerning RABIES IN PRUSSIA. the condition of the cerebro-spinal fluid in disease. At a A DURING the last few years there seems to have been a meeting of the Société Medicate des Hôpitaux of Paris on considerable increase in the number of persons bitten by M. 24th Caussade and M. Willette e July reported a case rabid in Prussia, according to the Allgemeine animals of ursemic coma in which they were surprised to find the e ivedicinische Central-Zeitung of Oct. 17th. In the year 1902 .cerebro-spinal fluid puriform. A man, aged 26 years, wass the admitted into hospital on the evening of May 31st last.,. officially reported cases were 250. In each of the four d following years between 300 and 380 were reported, and in On that day he was suddenly seized with convulsions and 1907 no less than 405. In 274 of these cases the animals On examination n soon after admission he became comatose. were proved to have been really suffering from rabies. r on the following day he was inerte" " and did not answer Most of the persons bitten were taken to the Pasteur stations The was 100 and the was s pulse temperature questions. i which have been established at Berlin and Breslau. Of the normal. There was no rigidity of the neck and Kernig’s and Babinski’s signs were absent. The knee-jerks were normal. 266 who were inoculated two died, and of the six who were There was complete incontinence of urine and fasces. The facee not inoculated two also died. Three of the four fatal bites were on the face. The mortality of the inoculated cases was was a little swollen and there was slight cedema of the eyelids and lower limbs. There was more pronounced oedema of f thus 0 ’ 75 per cent., which is a more favourable result than the lumbar region. d that obtained in 1906, when four cases out of 236 inoculated Auscultation of the heart revealed " 2 proved fatal, a mortality of 1 .69 per cent. Of course, most marked "bruit de galop." A little urine was obtained with the catheter and found loaded with albumin. Ursemic coma a of the wounds were inflicted by dogs but there were 12 cases of cat-bite and one of a hog-bite. was diagnosed and bleeding to 400 grammes was performed,, after which the patient recovered from the coma. On the following day he could speak ; he remembered no previous illness but had suffered from headache for some time. i NEW REGULATIONS FOR THE PREVENTION OF GRINDERS’ PHTHISIS. Improvement continued and at his request he was discharged THE Home Secretary has issued a draft of the new on July 15th. At this period two litres of urine containing .a gramme of albumin per litre were passed in the 24 hours, regulations which he proposes to enforce for the grinding of headache occurred at times, there was slight cedema of metals and racing of grindstones. These have been recomthe ankles, and the left ventricle was hypertrophied, but mended to Mr. Gladstone by the Cutlers’ Company, the the "bruit de galop" had disappeared. At the time the Sheffield Chamber of Commerce, and the Sheffield Cutlery was bled lumbar puncture was performed and yielded Council which represents the workmen. The draft has been patient turbid cerebro-spinal fluid under high pressure. Chemical printed and circulated in accordance with Section 80 of the analysis showed that it contained 0’ 4 gramme of urea and Factory and Workshop Act, 1901, in order that any persons 8 grammes of chlorides per litre, and traces of sugar and interested may suggest their amendment, and that competent albumin. The fluid contained an abundance of cells which were inquiry may be held into any reasonable objections which ’made up as follows: polynuclears, 90 per cent. ; lymphocytes, may be thus lodged against the new regulations. These .8 per cent. ; and large mononuclears, 2 per cent. The fluid are directed against the heavy mortality from grinders’ was sterile and the polynuclears were intact. Five days later phthisis, which is a matter of the gravest concern to both lumbar puncture was again performed and the cerebro-spinal men and masters, and which came under full discussion at fluid was found free from cells. Only one similar case the Sheffield meeting of the British Medical Association. .appears to have been reported: M. Chauffard has describedi The processes which it is desired to amend are the manu" Ur6mie Aigue et Polynucléose Rachidienne."" It is to be facture of cutlery, of tools, and of cutting and piercing noted that in spite of the oondition of the cerebro-spinal instruments and appliances of iron or steel ; the profluid the case narrated above cannot be termed an example of cesses of dry rough glazing in which emery or similar
only
.
-
1 Semaine Médicale, 1907, p. 361.
2
THE
LANCET, May 25th, 1907, p. 1446.