SPIROCHÆTAL BRONCHITIS.

246 passages free from obstruction by secreTHE REAL BOTULISM. Older children are taught regularly to blow THE most recent monograph (No. 8, July 31st, noses without constricting the orifice in a of the Rockefeller Institute for Medical way which expands the chest at the same time. to a clinical and experimental Research is devoted to do this the same In children too young result is obtained by the application of an study of botulism by Dr. Ernest C. Dickson, from at San iris-root snuff to produce sneezing. Dr. Ormiston the Stanford University Medical School Dr. Dickson’s interest in the subject admits that she was sceptical of the method when Francisco. from an outbreak which occurred in it was brought to her notice by its inventor, but dates a banquet in a students’ after trying it herself for four years and in an December, 1913, after the club when article of food taken house, only experimental clinic for six months with Dr. by all the 12 students attacked was a salad of she has become convinced of its Octavia Lewin, value. In children with adenoids she finds the string beans (presumably the equivalent expression first improvement in the digestive system, followed or our runner beans) prepared at the home of The B. botulinus one of the members of the club. by relief of deafness and by a steady shrinkage in was not recovered from the of the one organs the adenoid growths. Both the cases which Dr. Ormiston cites were found to be better in the student who died, and all the salad had been eaten, none to examine ; but the clinical picture summer, the usual history with such children, and leaving was typical of botulism, and the peculiar type of it may be contended that the method is only likely thrombosis in the blood-vessels of meninges and to be successful in cases where ordinary brain, since shown experimentally to be characbreathing exercises would also have succeeded. teristics of botulism, was first demonstrated in the is But there is no doubt that the drill an fatal case by Professor W. Ophuls, pathologist of effective way of performing the very necessary Since this time Dr. Dickson nasal toilet, and results on a larger scale will be Stanford University. has investigated a number of outbreaks on the looked for with interest. Pacific coast of America, and has succeeded in isolating three strains of the infecting organism, SPIROCHÆTAL BRONCHITIS. twice from the crops or gizzards of chickens which MORE than ten years ago Castellani discovered had died after eating string beans or discarded in Ceylon a form of bronchitis due to a microbe and the third time from a can of string beans, Since maize, which he termed Spirochœta bronchialis. fellow to one which caused poisoning among a party that time cases have been described in various of 15 at an hotel dinner at Escondido, California, in parts of the world. At a recent meeting of the January, 1917. In this as in other outbreaks the of Paris Dr. H. Violle Académie de Médecine most striking symptom was progressive muscular reported what appear to be the first cases of this weakness, especially marked in the muscles of the curious affection observed in France. During three head and neck and called by the expressive name months he has seen 30 cases in the naval hospital " limber-neck" when it occurs in domestic fowls. of Saint-Mandrier, Toulon. The sputum is bloody, In one outbreak the condition is described thus :viscid, and of a uniform rose tint resembling gooseThere was extreme flaccidity of the muscles of the neck, berry juice. The colour is not observed in any other allowing the chin to rest upon the chest or the head to fall affection, and hence is diagnostic. Dr. Violle there- backward if not supported when the patient was elevated. fore proposes the title " bloody bronchitis." Some of It was a common occurrence to see a patient move her head them, the patients were admitted with the diagnosis of with her hands, and one girl who had long braids used with the head of the iron bed as a pulley, to swing her head phthisis, but repeated examinations of the sputum into position when she wished to move. The head could be failed to reveal the tubercle bacillus. On the con- rotated and held from falling to either side, but the anterior trary, smears stained with nitrate of silver showed and posterior supports were lacking." spirochætes, sometimes innumerable, of all forms The monograph will be read with keen interest and dimensions, some long and fine, others thick by all those who found a close resemblance to the and squat, with various undulations. Often these symptoms of botulism in the epidemic encephalitis organisms were almost in a state of purity, some- of a few months ago. Dr. Dickson’s monograph is times they were associated with other microbes. of special value because it shows that botulism, Blood examination revealed slight anaemia, pro- while endemic in the United States and comparabably due to the repeated haemoptysis. The affec- tively common on the Pacific coast, is not essention is relatively benign; the onset is insidious, tially a meat poison, but may also occur in canned the general condition is good, there is no fever, but vegetables and fruits. He advocates a campaign of headache occurs. The pulmonary signs are slight education to inform those who can fruits and and sometimes are absent. Often they are those vegetables of the danger of infection with of ordinary bronchitis, sometimes of apical bron- B. botulinus. chitis, or of congestion of the bases. Cough is frequent and may be painful. The sputum sometimes Colonel William R. M.D. Aberd., D.Se.., is abundant and may regularly be haemorrhagic or F.R.S.Edin., Sheriff of theSmith, City of London, professor of with in forensic medicine muco-hæmorrhagic alternating muco-purulent. King’s College, London, and Principal of the Royal Institute of Public Health, is a candidate for Relapses are frequent. It is important to recognise the Parliamentary representation of the Universities of the affection, as it is very contagious. It appears Scotland. to have been introduced into France by Asiatic THE identity of Mr. A. Stanford Morton may not troops or workers, or by troops which had been in have been recognisable under his official descripthe Levant. The disease has become acclimatised tion as Dr. generally Andrew Morton in the list of honours conferred in France-in the south, at any rate. A quarter of by the King of Italy (THE LANCET, August 17th, p. 215). the patients were Frenchmen. The affection may By an Order in Council, dated August 14th, the be complicated by graver affections, such as tuber- provisions of the Parliament and Local Elections Act, 1918. culosis, pneumonia, or broncho-pneumonia, the have been extended to the election of Members of the Medical Council by registered practitioners resident germs of which evidently enter the lung through General in the United Kingdom, the effect of which is to extend the the breaches made by the spirochætes. A look-out term of office of the existing Direct Representatives until should be kept for the carriers. Dec. 31st, 1919.

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