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TABES AND SYPHILIS.
546 are’the prominent symptoms. Such cases last some months are dissolved. Dr. C. F. Zimmerman of Amsterdam, New and do not always recover. (o) Weak-mindedness, with York, has published in the American Medical Record an acute outbreaks after each fresh indulgence. These cases instance of the successful use of this antitoxin. The case are very numerous. While inmates of the asylum such occurred in May, 1895, and was believed by the author to be patients are quiet usually and well behaved, and only betray the first of the kind in America. In August, 1895, Dr. Wray the impaired state of their brains by being over-talka- Grayson, using the same serum, also obtained gratifying tive, easily please I., lazy, excitable on trivial provoca- results, which he communicated to the Washington Medical tion, unconcerned about the future, and quite willing to Society ; and Dr. C. F. Willington has reported another case remain in hospital for an indefinite period. They exhibit in the Boston Medical and Surgical Journal. no interest in till ir relations and only ask for food and oigarettes. When discharged these cases soon return in a THE ANTAGONISM OF CHLOROFORM AND worse condition, approaching that described under (b). They HYDROCYANIC ACID. rush about in an objectless fashion, pouring forth torrents of THE Journal of C’omparatize Pathology and Therapeutics abuse on everyone they come in contact with, and are unable for June contains an article by Professor Hobday, in which to obtain any sleep. At one moment they will strenuously he undertakes to show some very remarkable points of deny that they ever smoke haschish and the next will be between prussic acid and chloroform. In the loud in praise of its wonderful effects. Besides the cases antagonism lower animals chloroform kills by narcotising the recoming within these types there are many others of chronic spiratory centre, and as hydrocyanic acid is at once an mania, mania of persecution, and chronic dementia, which excitant of the centre, and a very rapid one, Professor The relation between the are said to be owing to haschish. decided to test how far it could be relied drug and insanity has yet to be determined notwithstanding Hobday in had failed through cases in which breathing the labours of the Indian Hemp Drug Commission,, whose upon He further sought to the action of chloroform. conclusions may be summed up as follows. The moderate discover whether chloroform would prove effectual as an use of Indian hemp has no physical, mental, or moral ill antidote to poisoning by hydrocyanic acid. In the first effects whatever. Its excessive use injures the physical conseries of cases thirty-one animals, dogs, cats, a sheep, a calf, stitution and may cause dysentery and bronchitis ; it tends and a horse, were from various causes in grave peril from to weaken the mind and may cause insanity sometimes; it induces mental depravity and poverty, but rarely crime. chloroform given to enable operations to be performed. The The injury caused by excessive use is confined almost inclu- respiration had ceased and the animals were in extremis. Various doses of Scheele’s acid were injected subcutaneously, ,sive]y to the consumer and scarcely affects society. It will artificial respiration was practised. For animals and be interesting, says Dr. Warnock in conclusion of this porwhich are mouth-breathers the acid is placed on the tion of his subject, to learn whether these views are borne back of the tongue from a teat and dipper. With out observations in
by
Egypt.
NEW YORK PASTEUR INSTITUTE. THE various antitoxic
serums
supplied by the
New York
Pasteur Institute are prepared under the superintendence of Br. Paul Gibier, who studied under Louis Pasteur and Dr.
to the
dose, it
has to be adjusted to the size and general state of the patient, for while a full medicinal dose is requisite an excessive one is of course highly perilous. Professor Hobday suggests one minim of Scheele’s acid for every seven or eight pounds weight of body substance. A second dose should not be given until it is certain that the first is fully eliminated. Dealing with the question, how far can the recovery of these animals be considered due to the acid and how far to the artificial respiration, the writer of the paper says : "Iam convinced that the use of the acid gives A number an enormously higher proportion of successes." of cases are also quoted in which the acid failed. In one instance the delay in adopting restorative measures was certainly the cause of death, while in most of the others it seems probable that the quantity of the acid administered A further series of cases is given showing was excessive. the antidotal power of chloroform in poisoning by prussic acid. Whatever the value of Professor Hobday’s researches may be-and we admit he has made a strong case-it cannot be denied that there is a danger unless great care is exercised, lest the patient saved from a Scylla should fall into a Charybdis.
regard
..Roux in Paris. The horses which yield diphtheria antitoxin are inoculated regularly twice a week for over eighteen , months, and the strength of the serum is expressed (accordiing to the method in use at the Pasteur Institute in Paris) as being such that 1 c.c. of it will immunise a body weighing up to 100 kilo (220 lb.) or 100,000 times the weight of the serum injected; it is put up in bottles containing either 5 c.c., 10 c.c., or 25 c.c., camphor being added to prevent deterioration. In ordinary cases 10 c.c. are injected when the disease is suspected and before the diagnosis is absolute, and the remaining 15 c.c. after a period of ’, twelve hours. Diphtheria antitoxin is also prepared as dry powder, which is said to preserve its antitoxic qualitiesi . and to resist deterioration for an indefinite length of time. When required for use, the one gramme of powder in the vial is dissolved in 10, 15, or even 25 c.c. of sterilised water. The ordinary diphtheria antitoxin sometimes fails to produce ’ the expected results, the reason of which in most instances TABES AND SYPHILIS. is that the infection is mixed, the diphtheria bacillus being .associated in the false membrane with the streptococcus. IN a recent number of the Berliner Klinisehe Wochenschrift ’.The New York Pasteur Institute has, however, following Erb contributes an article which has been evoked by the ’Marmorek’s method, succeeded in producing a new double publication of some recent statistics by Leyden apparently antitoxin, a serum which is efficacious against both diph- intended to show that the connexion between syphilis and theria and streptococcus infection ; this result has been tabes was by no means constant. Erb’s views, as is well attained by immunising horses against streptococcus virus known, are quite opposed to such a doctrine, and he holds after they had been already protected against diph- that the connexion between syphilis and tabes is a very theria. - A period of one year is necessary to immunise close, if not a constant, one. Leyden’s figures are an his Storbeck and a horses against streptococcus, immunising power analysed by pupil they comprise 108 Tetanus anti- cases. Of this number 69 4 per cent. are said to have of about 1 : 30,000 being reached. toxin is supplied’only as a dry powder-three grammes developed tabes without any preceding syphilis. Erb in a 25 c.c.’bottle, which, when an injection is to be made, criticises these figures, pointing out that the number is filled with sterilised water and shaken until the contentsconsidered is far too small for statistical purposes, and
a
-
547 further that 52 of the cases-33 women and 19 men-are vapours, or gases to be emitted from land at their Albert occurring among the lower classes. As is generally Colliery, Hollins-road, Oldham, to the nuisance or injury of recognised, negative evidence of the occurrence of syphilis the inhabitants of the neighbourhood. It is needless to say in the lower classes, or of its occurrence in women of any that there was evidence on both sides. Mr. Bailey, D.Sc., class, is not to be relied upon. Erb himself adduces evidence Ph.D., Lecturer on Chemistry in Owens College; Mr. gathered from a consideration of 200 cases of tabes occurring Tattersall, the medical oflicer of health of Oldham ; Dr. Of these 15 had no Niven, medical officer of health of Manchester, and a among men in the upper classes. evidence of infection, 123 had had undoubted secondary number of the inhabitants in the neighbourhood testified syphilis, while 62 had had chancres but no secondary to the injurious character of the emanations. But Mr. symptoms. Of the 62 who had only chancres 25 Orsman, F.C.S., public analyst of Wigan and South port ; had either an undoubted hard chancre or had been Dr. Harris, medical officer of health of the Chorley urban subjected to anti-syphilitic treatment on account of the and rural sanitary authorities, some other medical men suspicious character of their condition. Further, of the practising near the collieries and a number of residents 15 in whom there was no evidence of syphilitic infection said that no harm could result from the emanations. 11 could not be regarded as above suspicion on account of The Vice-Chancellor in his judgment stated that if there the occurrence of one or more attacks of gonorrhcea in some, were any nuisance it was the duty of the corporation to repeated miscarriages by the wives of others, and such like, protect the public at all costs by proving it to the satisso that out of the 200 cases there were really only 4- faction of the court. If that were so proved the injunction whom as far 2 cent.-in infection even must i.e., per could, syphilitic go though the effect was such as to stop the If any further defendants’ business. as that is usually possible, be excluded. On the other hand, the defendants on of were needed the close of tabes a said they were business company carrying on business in a dependence proof we statistics infection venture to think that these syphilitic manufacturing district and that no nuisance was committed. of Erb will furnish it. They further pointed to the calamitous consequences that would follow if the injunction were granted ; they would be THE PORTSMOUTH MEDICAL UNION. compelled to close their colliery and a large number of WE have received from the Portsmouth Medical Union the employes would be thrown out of work. The emanations report of the committee for the year 1895-96, dated Mid- were described as having a nasty, sulphurous smell and it summer, 1896, and this record of a first year’s work must be was stated that they produced most deleterious results on Not only have material anybody who breathed them; whilst, on the contrary, a considered very satisfactory. successes been obtained for some of its members, but the number of very respectable witnesses, who said they had Union has, in the opinion of the committee, " been the means lived in the neighbourhood for years, affirmed that they The facts of bringing together many medical men in friendship and had never been troubled by the smell. were that there were a and of a or before were at when burning heap colliery they goodwill, strangers to, enmity and shale which had on for or It the each other. is to confifty years, gone forty with, note," gratifying report it in the was not till that were received 1893 in the "that has complaints tinues, nearly every practitioner borough there and this time the at his to the and that the set in matter, thought corporation Union, example given support Portsmouth has been followed in several other towns. The was not sufficient evidence of nuisance to justify them increase in subscriptions in several friendly societies in taking action. At the same time Dr. Niven, then has been one of the chief results of the year’s work ; the medical officer of health of Oldham, had written a several members having already considerably benefited letter in 1892 to the colliery company saying that a by it, and there are several societies now considering dangerous and offensive nuisance existed or was being comthe demand for higher medical subscriptions. The com- mitted by them. Yet after that he and his committee mittee believe that the short black list already issued has decided that there was not evidence of a nuisance. Judgbeen found very useful, but must point out that unless ment was given for the defendants, but without costs. This members will send in their lists of debtors this record is a very important decision and one not encouraging to must necessarily be incomplete. It is obvious that much sanitary authorities. Surely, if a burning brick kiln can be remains to be done, but, if members will take the advice of considered a nuisance-and it has been decided so over and their representatives and act in combination, the committee over again,-then a burning shale heap giving off the same feel certain that they will be able to achieve still further products of combustion must also be a nuisance in a thickly cases
___
during the coming year. Many comparatively populated well-to-do patients are receiving medical relief for a merely ’, successes
district.
-
nominal sum. This is the greatest abuse from which the " ROENTGEN RAYS IN OPHTHALMIC SURGERY." profession suffers, and this will receive the first consideration ’, IN an article with the above title by Dr. Lewkowitsch from your representatives." The report, of which we quote published last week in our columns a method of applying nearly the whole, is commendably brief and yet touches on the Roentgen rays to the discovery of foreign bodies in the all the points urged by us in our series of articles entitled eye was given. It is not surprising that an effort should "The Battle of the Clubs." Local combination has in be made to utilise these rays for the discovery of foreign Portsmouth been already the means of arresting many of bodies in the eye, although the difficulties that present the abuses we noticed in our articles, and promises to effect themselves are considerable. It is, of course, exceedingly further good. difficult, if not impossible, to take photographs through the whole thickness of the head either in the sagittal IS A BURNING SHALE HEAP A NUISANCE ? or transverse direction, and the eye is so deeply ensconced JUDGMENT in a very important case has been given lately in the orbit, the bony walls of which obstruct the by his honour Vice-Chancellor Hill sitting in the Chancery passage of the rays, that the method can only be used -
Court of Lancashire at Manchester. The case was that of the Attorney-General v. the Chamber Colliery Company, Limited. The action was brought on the information of the Oldham corporation and the hearing of it lasted six days. The plaintiffs sought to obtain an injunction to restrain the defendant company from permitting any fumes,
with any prospect of success in cases where the opaque object is situated in the fore-part of the eye. Still Dr. Lewkowitsch has shown that with a little ingenuity and by taking advantage of the rolling movements of the eye a larger region than might be anticipated can be brought under observation. The number of cases in .
H
3
by
Egypt.
NEW YORK PASTEUR INSTITUTE. THE various antitoxic
serums
supplied by the
New York
Pasteur Institute are prepared under the superintendence of Br. Paul Gibier, who studied under Louis Pasteur and Dr.
to the
dose, it
has to be adjusted to the size and general state of the patient, for while a full medicinal dose is requisite an excessive one is of course highly perilous. Professor Hobday suggests one minim of Scheele’s acid for every seven or eight pounds weight of body substance. A second dose should not be given until it is certain that the first is fully eliminated. Dealing with the question, how far can the recovery of these animals be considered due to the acid and how far to the artificial respiration, the writer of the paper says : "Iam convinced that the use of the acid gives A number an enormously higher proportion of successes." of cases are also quoted in which the acid failed. In one instance the delay in adopting restorative measures was certainly the cause of death, while in most of the others it seems probable that the quantity of the acid administered A further series of cases is given showing was excessive. the antidotal power of chloroform in poisoning by prussic acid. Whatever the value of Professor Hobday’s researches may be-and we admit he has made a strong case-it cannot be denied that there is a danger unless great care is exercised, lest the patient saved from a Scylla should fall into a Charybdis.
regard
..Roux in Paris. The horses which yield diphtheria antitoxin are inoculated regularly twice a week for over eighteen , months, and the strength of the serum is expressed (accordiing to the method in use at the Pasteur Institute in Paris) as being such that 1 c.c. of it will immunise a body weighing up to 100 kilo (220 lb.) or 100,000 times the weight of the serum injected; it is put up in bottles containing either 5 c.c., 10 c.c., or 25 c.c., camphor being added to prevent deterioration. In ordinary cases 10 c.c. are injected when the disease is suspected and before the diagnosis is absolute, and the remaining 15 c.c. after a period of ’, twelve hours. Diphtheria antitoxin is also prepared as dry powder, which is said to preserve its antitoxic qualitiesi . and to resist deterioration for an indefinite length of time. When required for use, the one gramme of powder in the vial is dissolved in 10, 15, or even 25 c.c. of sterilised water. The ordinary diphtheria antitoxin sometimes fails to produce ’ the expected results, the reason of which in most instances TABES AND SYPHILIS. is that the infection is mixed, the diphtheria bacillus being .associated in the false membrane with the streptococcus. IN a recent number of the Berliner Klinisehe Wochenschrift ’.The New York Pasteur Institute has, however, following Erb contributes an article which has been evoked by the ’Marmorek’s method, succeeded in producing a new double publication of some recent statistics by Leyden apparently antitoxin, a serum which is efficacious against both diph- intended to show that the connexion between syphilis and theria and streptococcus infection ; this result has been tabes was by no means constant. Erb’s views, as is well attained by immunising horses against streptococcus virus known, are quite opposed to such a doctrine, and he holds after they had been already protected against diph- that the connexion between syphilis and tabes is a very theria. - A period of one year is necessary to immunise close, if not a constant, one. Leyden’s figures are an his Storbeck and a horses against streptococcus, immunising power analysed by pupil they comprise 108 Tetanus anti- cases. Of this number 69 4 per cent. are said to have of about 1 : 30,000 being reached. toxin is supplied’only as a dry powder-three grammes developed tabes without any preceding syphilis. Erb in a 25 c.c.’bottle, which, when an injection is to be made, criticises these figures, pointing out that the number is filled with sterilised water and shaken until the contentsconsidered is far too small for statistical purposes, and
a
-
547 further that 52 of the cases-33 women and 19 men-are vapours, or gases to be emitted from land at their Albert occurring among the lower classes. As is generally Colliery, Hollins-road, Oldham, to the nuisance or injury of recognised, negative evidence of the occurrence of syphilis the inhabitants of the neighbourhood. It is needless to say in the lower classes, or of its occurrence in women of any that there was evidence on both sides. Mr. Bailey, D.Sc., class, is not to be relied upon. Erb himself adduces evidence Ph.D., Lecturer on Chemistry in Owens College; Mr. gathered from a consideration of 200 cases of tabes occurring Tattersall, the medical oflicer of health of Oldham ; Dr. Of these 15 had no Niven, medical officer of health of Manchester, and a among men in the upper classes. evidence of infection, 123 had had undoubted secondary number of the inhabitants in the neighbourhood testified syphilis, while 62 had had chancres but no secondary to the injurious character of the emanations. But Mr. symptoms. Of the 62 who had only chancres 25 Orsman, F.C.S., public analyst of Wigan and South port ; had either an undoubted hard chancre or had been Dr. Harris, medical officer of health of the Chorley urban subjected to anti-syphilitic treatment on account of the and rural sanitary authorities, some other medical men suspicious character of their condition. Further, of the practising near the collieries and a number of residents 15 in whom there was no evidence of syphilitic infection said that no harm could result from the emanations. 11 could not be regarded as above suspicion on account of The Vice-Chancellor in his judgment stated that if there the occurrence of one or more attacks of gonorrhcea in some, were any nuisance it was the duty of the corporation to repeated miscarriages by the wives of others, and such like, protect the public at all costs by proving it to the satisso that out of the 200 cases there were really only 4- faction of the court. If that were so proved the injunction whom as far 2 cent.-in infection even must i.e., per could, syphilitic go though the effect was such as to stop the If any further defendants’ business. as that is usually possible, be excluded. On the other hand, the defendants on of were needed the close of tabes a said they were business company carrying on business in a dependence proof we statistics infection venture to think that these syphilitic manufacturing district and that no nuisance was committed. of Erb will furnish it. They further pointed to the calamitous consequences that would follow if the injunction were granted ; they would be THE PORTSMOUTH MEDICAL UNION. compelled to close their colliery and a large number of WE have received from the Portsmouth Medical Union the employes would be thrown out of work. The emanations report of the committee for the year 1895-96, dated Mid- were described as having a nasty, sulphurous smell and it summer, 1896, and this record of a first year’s work must be was stated that they produced most deleterious results on Not only have material anybody who breathed them; whilst, on the contrary, a considered very satisfactory. successes been obtained for some of its members, but the number of very respectable witnesses, who said they had Union has, in the opinion of the committee, " been the means lived in the neighbourhood for years, affirmed that they The facts of bringing together many medical men in friendship and had never been troubled by the smell. were that there were a and of a or before were at when burning heap colliery they goodwill, strangers to, enmity and shale which had on for or It the each other. is to confifty years, gone forty with, note," gratifying report it in the was not till that were received 1893 in the "that has complaints tinues, nearly every practitioner borough there and this time the at his to the and that the set in matter, thought corporation Union, example given support Portsmouth has been followed in several other towns. The was not sufficient evidence of nuisance to justify them increase in subscriptions in several friendly societies in taking action. At the same time Dr. Niven, then has been one of the chief results of the year’s work ; the medical officer of health of Oldham, had written a several members having already considerably benefited letter in 1892 to the colliery company saying that a by it, and there are several societies now considering dangerous and offensive nuisance existed or was being comthe demand for higher medical subscriptions. The com- mitted by them. Yet after that he and his committee mittee believe that the short black list already issued has decided that there was not evidence of a nuisance. Judgbeen found very useful, but must point out that unless ment was given for the defendants, but without costs. This members will send in their lists of debtors this record is a very important decision and one not encouraging to must necessarily be incomplete. It is obvious that much sanitary authorities. Surely, if a burning brick kiln can be remains to be done, but, if members will take the advice of considered a nuisance-and it has been decided so over and their representatives and act in combination, the committee over again,-then a burning shale heap giving off the same feel certain that they will be able to achieve still further products of combustion must also be a nuisance in a thickly cases
___
during the coming year. Many comparatively populated well-to-do patients are receiving medical relief for a merely ’, successes
district.
-
nominal sum. This is the greatest abuse from which the " ROENTGEN RAYS IN OPHTHALMIC SURGERY." profession suffers, and this will receive the first consideration ’, IN an article with the above title by Dr. Lewkowitsch from your representatives." The report, of which we quote published last week in our columns a method of applying nearly the whole, is commendably brief and yet touches on the Roentgen rays to the discovery of foreign bodies in the all the points urged by us in our series of articles entitled eye was given. It is not surprising that an effort should "The Battle of the Clubs." Local combination has in be made to utilise these rays for the discovery of foreign Portsmouth been already the means of arresting many of bodies in the eye, although the difficulties that present the abuses we noticed in our articles, and promises to effect themselves are considerable. It is, of course, exceedingly further good. difficult, if not impossible, to take photographs through the whole thickness of the head either in the sagittal IS A BURNING SHALE HEAP A NUISANCE ? or transverse direction, and the eye is so deeply ensconced JUDGMENT in a very important case has been given lately in the orbit, the bony walls of which obstruct the by his honour Vice-Chancellor Hill sitting in the Chancery passage of the rays, that the method can only be used -
Court of Lancashire at Manchester. The case was that of the Attorney-General v. the Chamber Colliery Company, Limited. The action was brought on the information of the Oldham corporation and the hearing of it lasted six days. The plaintiffs sought to obtain an injunction to restrain the defendant company from permitting any fumes,
with any prospect of success in cases where the opaque object is situated in the fore-part of the eye. Still Dr. Lewkowitsch has shown that with a little ingenuity and by taking advantage of the rolling movements of the eye a larger region than might be anticipated can be brought under observation. The number of cases in .
H
3