TABES DORSALIS AND SYPHILIS.

439 feels quite wellIeight days after admission. A careful and thorough examinaHe is, nevertlie-tion, both at the time and after the specimen had been preless, always in great danger immediately after the attack ; ;served, revealed a condition of softening in the right lenticular but with complete rest and prudent avoidance of all un-nucleus and internal capsule and a somewhat atrophied con( A similar but smaller area of the right frontal lobe. necessary exertion of the heart he may escape this danger,dition which will be passed when the softened cardiac muscle hasof softening existed in the left lenticular nucleus, while the cicatrised. Dr. Kernig treated several extremely grave cases medulla, pons and cord appeared normal, except for some according to this rule without a single relapse, though one ofdescending change in the right pyramidal tract. The kidneys the patients had remained for four years under observation. were granular and the heart dilated. The case is an interestPatients must be particularly careful at such times, when from ing one and forms a valuable addition to a now well-recoprevious experience a paroxysm may be expected. Walking in gnised variety of paralysis in which the symptoms closely heavy clothes must be absolutely avoided. With the first resembling those of ordinary bulbar paralysis are due to a .symptom of an approaching attack the sufferer must rest lesion on each side of the cerebrum. immediately, and if possible assume the recumbent position. When the attack occurs in the street the patient must immeTABES DORSALIS AND SYPHILIS. diately be removed to his home and should certainly not IN a recent number of the Berliner A7inise7io TVoclumsc7t7’ift .attempt to continue walking. At the same time Dr. Kernig Professor Erb gave additional support to his well-known views does not fail to appreciate the value of regular and rational in regard to the close connexion between tabes dorsalis and exercise when no fresh attack is imminent and sufficient rest syphilis. These again have lately been called in question by has been taken after the last paroxysm. Professor Leyden, and now an abstract of Professor Erb’s reply appears in the Nellrologisclle CentraZbZatt. Professor COMPULSORY SANITARY WORKS. Leyden had called in question the reliability of Professor Erb’s THE Local Government Board are taking proceedings statistical proofs, but to this the latter retorts that if in a cmder Section 299 of the Public Health Act, 1875, to compel number of patients suffering from certain conditions 80 to 90 Worcester so to deal with its sewage as no longer to con- per cent. of those are found to have suffered from syphilis, taminate the river Severn. The city had been given a defi- while in a similar number suffering from other diseases only nite time in which to carry out the necessary works ; nothing 20 per cent. have had syphilis, there seems to be good ground had been done in the matter, and now application has been for postulating a causal connexion between the two conmade to the Court of Queen’s Bench for a rule nisi for a ditions. Professor Leyden’s second objection is the inefficacy ,manrla11WS to compel the Corporation to carry out the order of anti-syphilitic remedies in tabes dorsalis, but to this Professor of the Local Government Board. A similar rule was asked for Erb’s answer is that the success of such drugs is not necessary against the Corporation of Rochester, but oddly enough it was in order to establish a diagnosis of syphilis, and that there are limited to the village of Borstal. Why this comparatively many cases of tertiary syphilis affecting the brain and Hisignincant and outlying part of the city has been selected spinal cord in which mercury and iodide of potassium are ior the exercise of compulsory powers it is a little difficult to quite inefficacious. Professor Leyden’s third point is the disunderstand. We have shown what is the state of Rochester similarity of the morbid anatomy in cases of tabes dorsalis and ,city with its liquid filth soaking away into multitudinous cess- tertiary syphilis, but, as Professor Erb points out, it is a matter pools, and the place has become notorious for its maintained of extreme difficulty, even impossibility, to say in such cases default in regard to sewerage. The city as such is left what is syphilitic and what is not in the various morbid conout and Borstal alone is attacked. It may be that the lives ditions found ; and he finally concludes by expressing the of the prisoners and of those who are under Government opinion that in the great majority of cases of tabes dorsalis ’control at Borstal are regarded as of especial importance in there is a distinct causal connexion between that condition Government circles ; but the general public are hardly and syphilis. ikely to look upon any such differentiation in the same light. must be maintained

even

when the

after the paroxysm and has

a

patient good pulse.

,

I

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REJECTION OF NOTIFICATION AT NEWTON-ABBOTT.

PSEUDO-BULBAR PARALYSIS.

AT the recent meeting of the Newton-Abbott rural sanitary IN the inaugural dissertation of Dr. Max Anderlya is authority, which, on the advice of the medical officer of celated at length a case of this character. A brief account of health, declined to adopt the Infectious Diseases (Notificait is given in the last number of the Neurolog’ische Oentralblatt tion) Act, 1889, some very remarkable arguments were used The patient was a joiner who had enjoyed good health until and statements made. One of these statements had reference he was forty. At that age he had an attack in which the to the number of cases of scarlet fever passing without medical power of one side (he could not remember which) was im- attendance. The medical officer of health said that in that, paired and he had some difficulty in moving his tongue and district three-fourths of the cases have no medical attendance. en articulating. He soon regained the lost power and was He said that, in an experience of nineteen years, in which he practically as well as before. Nine years later he had a had seen scarlet fever in farm-houses and dairies in the large sudden attack, losing power in his right side and experiencing and populous district of 180 square miles, no instance had a good deal of difficulty in swallowing. He improved very occurred of the conveyance of the disease. Does it not .’nnch, but the right arm and leg remained permanently strike him that as cases are not reported and not even weak. Two years later he lost power in his left side and he attended by medical men such an experience cannot go !had considerable difficulty in talking and also in swallowing. for much or be set against the positive contrary experience A year after this last attack he was admitted into the hospital of others. The argument of some of the speakers was that the and he was then found to be very weak on the right side and Notification Act was preferred to the Act of 1890 because almost completely powerless on the left. He also had much notification involved a small fee to the medical men. ’1ifficultyin swallowing; articulation was difficult and was nasal This is a gross and rude misrepresentation. We must in character. The reflexes were present. There was loss of confess our surprise at the attitude of the medical ,ensibility on the left side and the patient was unable to move officer in dwelling on the fact that his authority would his eyes to the left of the middle line. The fundi were normal. have to pay fifteen shillings for notifying six cases of the ilis condition remained the same as regards power; he wandered disease in one family, and generally that the disease was so a little during the day, rather more during the night; the mild in the county as to be beyond recognition and almost respiration became of the Cheyne-Stokes variety and he died ’ beneath notice. Does it not occur to him that under