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THE ETIOLOGY AND EARLY DIAGNOSIS OF GENERAL PARALYSIS.
536
A GLIMPSE INTO THE NATCRE OF THINGS.
his advice on all matters connected with A negatively charged chemical atom is one having a its hygienic requirements should be of the greatest value to surplus of electrons, the number depending upon the valency, the architect. He will advise on questions of air-space, whilst a positively charged atom is one having a deficiency ventilation, drainage, and the means for the disposal of solid of atoms. Truly we have here a glimpse into the nature refuse from the wards. The last-named is a matter of things. Veil after veil i3 being lifted and, as Sir William moment in a because the Crookes said before the British Association at Bristol in of infective hospital peculiar character which such refuse often possesses, and which 1898, the face of Nature grows more beautiful, august, and renders its retention in the vicinity of the patients a serious wonderful with every barrier that is withdrawn. danger. Another of his duties will be that of frequent SMALL-POX IN LONDON. inspection of all drains and other sanitary appliances about the hospital. The ease with which these may become THE small-pox returns for the past week show but little inefficient in a building occupied by a large number of improvement. On Saturday, Feb. 15th, 33 fresh cases were He may also be called upon to persons is notorious. notified and removed ; on Sunday, the 16th, there were 39 advise, in consultation with the medical staff, upon the fresh cases ; on Monday, the 17th, there were 71 fresh cases ; nursing of infectious cases with the view of minimising risks on Tuesday, the 18th, there were 63 fresh cases ; and on of infection. Questions of practical disinfection of all kinds Wednesday, the 19th, there were 54 fresh cases. will further fall with propriety within his province. Measures of isolation and quarantine, when infectious disease chances THE ETIOLOGY AND EARLY DIAGNOSIS OF to break out amongst the patients, will also require his GENERAL PARALYSIS. attention and advice. All these things and many more will be DR. WiJjLlAM PICKETT opened an important discusdemanded of a sanitary officer, and it is plain that functions of such vital importance can only be efficiently performed by sion on the Etiology and Early Diagnosis of General Paraone who enjoys special qualifications in public health, and lysis of the Insane at a recent meeting of the Philadelwho has acquired by actual experience in the routine working phia Neurological Society, an account of which appeared of a hospital an intimate acquaintance with the subject. It in the Journal of -Yervous and Mental Diseases of New York The observations of recent observerscannot well be denied that the practical efficiency of a for January, 1902. and the welfare of its so notably Iirafft-Ebing - had shown that an antecedent largely hospital patients depend - upon its hygienic conditions that the status of the officer syphilitic infection could be ascertained in three-fourths responsible for them may justly be placed higher than it has of the patients examined, and that elderly general paraDr. Pickett. been in the past. It is for this reason that we welcome the lytics were immune to syphilitic infection. his on of about to be taken the for 149 cases Children, step by investigation Belgrave Hospital general paralysis for we believe that it is one fraught with the best possible admitted as patients to the Philadelphia Hospital, could ’consequences for the future of hospital sanitation. only find signs of antecedent syphilis in 60 per cent., but he thought that the actual proportion of syphilitics was slightly higher and that most of the early cases A GLIMPSE INTO THE NATURE OF THINGS. In the discussion which followed Prowere demented. THE momentous question, what is matter ?has for long fessor Charles K. Mills stated that an experience of been put aside by many ardent investigators as probably 25 years in private practice combined with the study for ever insoluble. But when we are told that we have of the literature of the subject led him to conclude actually touched the borderland where matter and force that from 85 to 90 per cent. of general paralytics had seem to merge into one another we may reasonably assume antecedent syphilis. Dr. F. X. Dercum said that the proportion that we are on the eve of gaining a nearer insight into its of demented cases in early general paralysis was, in his nature. This was the subject which Sir William Crookes experience, large-nearly as large as that given by Dr. took the opportunity of discussing before His Royal Pickett and Professor Mendel. He did not believe that there Highness the Prince of Wales on the occasion of was any relationship between general paralysis and epilepsy his formal admission to the Fellowship of the Royal and he denied any causal relation between alcohol and Society on Feb. 6th. Sir William. Crookes’s declaration general paralysis. "Almost, ifnot all, male paretics,"said marks a very important epoch in the progress of science, Dr. Dercum,’’ drink to excess in the earlier period of their -and it was fitting that this epoch should have been associated He also pointed out that such patients were disease."" with an interesting and historical Royal incident. The very prone to develop delusions of marital infidelity. existence of a fourth state of matter has for a long time Dr. Alfred Gordon referred to the almost invariable been indicated in radiant phenomena. Sir William Crookes presence of congenital syphilis in juvenile paretics and cited called it the "ultra-gaseous"state, and later "radiant the recently recorded observations of Regis, who in every one matter," while more recently the latter phrase has given of five consecutive cases of juvenile paresis found congenital way in favour of the term "electrons." An electron is, so In a discussion at the New York Medical Society1 syphilis. to speak, an atom of electricity which exists always on the causation and early diagnosis of general paralysis in the presence of the atom of matter. The electron is Dr. Arthur Hurd of Buffalo stated that he found signs of the satellite of the particle which when liberated from it antecedent syphilis in 68 per cent. of patients, but pointed under the influence of electric discharge behaves not as a to the fact that though syphilis was widely prevalent in gas but more, as Sir William Crookes says, like a fog or mist, Egypt and Japan paresis was rare in both countries. He clinging to positively electrified bodies and thereby losing argued that the overwork and keen stresses of western mobility and settling on the walls of the container if left civilisation excited general paralysis in a brain weakened by - quiet. In the radiant matter-tube, under the influence of syphilis and thought that in time to come the disease would the current the material atoms arrange themselves in groups, increase in the two countries referred to. In America the while the rushing swarms of electrons driven from the disease was most common amongst military men, actors, negative pole meet them. The effect of the bombardment is stock-brokers, and men accustomed to mental overstrain, light and heat. The questions, what are x rays and what is and rare amongst Quakers and the clergy. Dr. Dercum adio-activity may soon in the light of these revelations said that early diagnosis was important, the mistake receive a satisfactory answer. The basis of the electron is made most often being to regard early general paralysis probably the same in all cases, the protyle of Crookes, .from which the chemical atoms are assumed to be formed. 1 New York Medical News, Feb. 1st, 1902.
present moment,
of
basing
"
.
THE WORKING OF PLAGUE MEASURES IN INDIA.
’’ The paralytic," said Dr. Dercum, neurasthenia. seldom came of himself to consult a physician, he was brought by his friends, and unlike the neurastheniae [or hypochondriac] he had no long story to tell." The paretic in the early stages of his disease was liable to lapses of memory, of decency, and of ability for work. The neurastheniac after brief and light sleep had a wakeful morning, felt depressed on rising, and did not care to face The the day, while he felt at his best in the evening. tossed bed with or on the other in little no hand, paretic, a little the the and in sleep during only slept morning. night He felt at his best in the forenoon and was quite exhausted Dr. Charles Wagner said that general in the evening. had increased steadily in America since 1850, paralysis being first noticed in the period 1850 to 1860. At present 10 per cent. of all patients in American asylums were paretics. It was especially prevalent among native-born Americans, whereas the alien population was more liable to develop psychoses. Dr. Edward Cowles declared that antisyphilitic treatment did not benefit paretics and argne<1 that the disease was a toxsemia like myxcedema. as ..
THE WORKING
OF PLAGUE
MEASURES
to the air and sunshine. Owing to the action of the health officer and the local authorities in Bombay there seems to be every prospect of the suitable machinery being present and ready for carrying out these objects. We need scarcely add that, as far as practicable, recourse should also be had to the use of Haffkine’s method of preventive inoculation against plague.
exposed
-
CHELSEA CLINICAL SOCIETY. THE annual clinical debate of this society is fixed for March llth and 18th next at the Jenner Institute of Preventive Medicine, Chelsea Gardens, Grosvenor-road, S.W., at 8.30 P.m. The subject selected for discussion is " Cancer -its Nature, Origin, and General Principles of Treatment." The debate will be opened by Dr. J. F. Payne and full particulars will be shortly announced. The debate will her open to all members of the medical profession.
THE CASE
our
OF THE LATE ANDERSON.
MR.
R.
B.
MR. WALTER MONNINGTON, the honorary secretary of the fund in aid of the widow and children of the late Mr. R. B. 1, Anderson, F.R.C.S. Eng., writes to us as follows :The committee formed to appeal for aid for the widow and sons of the late Mr. R. B. Anderson, F.R.C.S. Eng., beg to announce that the subscriptions now received amount in all to 202 5s. 6d. and to request intending subscribers to kindly forward their donations at once, marked " For the Anderson Fund," to the manager of the Union Bank of London, Chancery-lane, London, as it is definitely proposed to close the account on the 28th inst. A strong hope was entertained of collecting at least £ 500-the sum, it might well be remembered, fixed by the jury by their verdict in Mr. Anderson’s favour in Anderson v. (xorrie
IN
INDIA.
THOSE of
537
readers who have been in the habit of
referring to the "Notes from India"furnished by our special correspondent will have been enabled to keep themselves fairly abreast with the progress of plague in that country. From the increase of the plague mortality which has been taking place of late and the high general death- and Others." It is still desired that the 2202 now in hand may he rate of Bombay it may safely be inferred that the city of largely augmented before the fund closes on the last day of this month. Bombay will not escape the usual epidemic rise of the We need not again expatiate upon Mr. Anderson’s wrongs disease which, according to past experience, occurs at this or upon the needs of his widow and children. It is not a This very naturally has given rise to increased season. large sum which is wanted now-only .6300. Surely those vigilance and efforts on the part of Dr. J. A. Turner, the medical practitioners who have not yet subscribed-there are health officer, and the medical and municipal authorities many such-will not hesitate in making up the comThe organisation and methods of procedure paratively small sum required. concerned. set forth in some articles which appeared are fully "
in the Times of India of Feb. lst. It goes without sayTYPHOID MASTITIS. that all systems of sanitary organisation and public 1--N- the American Journal of the ltTedcal Sciences for health measures must be circumscribed within the limits of what is practically attainable, and their methods of December, 1901, Dr. F. Davis, jun., Dr. H. S. Patterson, and working should be such as are not calculated to arouse Dr. A. W. Hewlett have published a case of this very rare a general spirit of antagonism on the part of those to whom complication of typhoid fever. A woman, aged 34 years, they have to be applied. If this be the case even among was admitted to hospital on May 25th in the third week of educated people who are willing to make some sacrifices and an attack of typhoid fever. The temperature was 105° F. to submit to personal inconvenience in the public interest, rose spots were present, and Widal’s reaction was obtained, it is still more so in the case of Oriental races who are but blood cultures made on May 27th and 31st did not yield tied and bound by religious and social traditions and who are the typhoid bacillus. On June 9th, the thirty-sixth day of intensely conservative where these are concerned. The aim in the disease, the temperature became normal. Three days view is not so much, perhaps, what is sound and logical in later the patient complained of pain in the left breast. On theory or what might be applicable to a small and relatively June 14th the breast was swollen, a hard and tender isolated population where all the conditions are known-like lump was felt on its outer side, and the axillary that of a rural village, for example. Large glands were enlarged and tender. On June 15th the right cities and towns have to be dealt with where the health breast was also tender. Lead and opium compresses were conditions are unfavourable and complicated, and preventive applied and the breasts seemed to improve, but the temmeasures cannot be pushed to a logical conclusion without perature, which began to rise on the 15th, showed causing much discomfort and even hardship. What seems wide daily oscillations of the septic type between 99° to be the most suitable course under such circumstances and 102°, and not the staircase" character of a typhoid h the organisation of some good, simple, and uniformL relapse. On the 20th the swelling and tenderness of left had become much more marked and involved on a establishthe breast the sanitary system practical working basis, ment of some method for the early notification of disease the two upper and the outer lower quadrants. The skin was and death, together with arrangements for promptly evacuat- freely moveable and the nipple was not bound down. On ing infected and overcrowded localities and buildings by the the 24th the temperature reached 104° and fluctuation was selection and provision of sites and encampments suitable) detected. Under chloroform an incision was made and 150 for immediate occupation. Such measures will not only allowr cubic centimetres of thick pus containing the typhoid of the removal of people in anticipation of an outbreak and1 bacillus in pure culture were obtained. The abscess cavity the thinning of overcrowded localities, but will permit also oif consisted of many loculi which were broken up with the a thorough disinfection of the evacuated houses being carriec1 finger. After the operation the temperature at once fell to out and of their being subsequently ventilated and freelJ9 normal and healing was uninterrupted. The swelling in the
ing
and’ populous
.
.
A GLIMPSE INTO THE NATCRE OF THINGS.
his advice on all matters connected with A negatively charged chemical atom is one having a its hygienic requirements should be of the greatest value to surplus of electrons, the number depending upon the valency, the architect. He will advise on questions of air-space, whilst a positively charged atom is one having a deficiency ventilation, drainage, and the means for the disposal of solid of atoms. Truly we have here a glimpse into the nature refuse from the wards. The last-named is a matter of things. Veil after veil i3 being lifted and, as Sir William moment in a because the Crookes said before the British Association at Bristol in of infective hospital peculiar character which such refuse often possesses, and which 1898, the face of Nature grows more beautiful, august, and renders its retention in the vicinity of the patients a serious wonderful with every barrier that is withdrawn. danger. Another of his duties will be that of frequent SMALL-POX IN LONDON. inspection of all drains and other sanitary appliances about the hospital. The ease with which these may become THE small-pox returns for the past week show but little inefficient in a building occupied by a large number of improvement. On Saturday, Feb. 15th, 33 fresh cases were He may also be called upon to persons is notorious. notified and removed ; on Sunday, the 16th, there were 39 advise, in consultation with the medical staff, upon the fresh cases ; on Monday, the 17th, there were 71 fresh cases ; nursing of infectious cases with the view of minimising risks on Tuesday, the 18th, there were 63 fresh cases ; and on of infection. Questions of practical disinfection of all kinds Wednesday, the 19th, there were 54 fresh cases. will further fall with propriety within his province. Measures of isolation and quarantine, when infectious disease chances THE ETIOLOGY AND EARLY DIAGNOSIS OF to break out amongst the patients, will also require his GENERAL PARALYSIS. attention and advice. All these things and many more will be DR. WiJjLlAM PICKETT opened an important discusdemanded of a sanitary officer, and it is plain that functions of such vital importance can only be efficiently performed by sion on the Etiology and Early Diagnosis of General Paraone who enjoys special qualifications in public health, and lysis of the Insane at a recent meeting of the Philadelwho has acquired by actual experience in the routine working phia Neurological Society, an account of which appeared of a hospital an intimate acquaintance with the subject. It in the Journal of -Yervous and Mental Diseases of New York The observations of recent observerscannot well be denied that the practical efficiency of a for January, 1902. and the welfare of its so notably Iirafft-Ebing - had shown that an antecedent largely hospital patients depend - upon its hygienic conditions that the status of the officer syphilitic infection could be ascertained in three-fourths responsible for them may justly be placed higher than it has of the patients examined, and that elderly general paraDr. Pickett. been in the past. It is for this reason that we welcome the lytics were immune to syphilitic infection. his on of about to be taken the for 149 cases Children, step by investigation Belgrave Hospital general paralysis for we believe that it is one fraught with the best possible admitted as patients to the Philadelphia Hospital, could ’consequences for the future of hospital sanitation. only find signs of antecedent syphilis in 60 per cent., but he thought that the actual proportion of syphilitics was slightly higher and that most of the early cases A GLIMPSE INTO THE NATURE OF THINGS. In the discussion which followed Prowere demented. THE momentous question, what is matter ?has for long fessor Charles K. Mills stated that an experience of been put aside by many ardent investigators as probably 25 years in private practice combined with the study for ever insoluble. But when we are told that we have of the literature of the subject led him to conclude actually touched the borderland where matter and force that from 85 to 90 per cent. of general paralytics had seem to merge into one another we may reasonably assume antecedent syphilis. Dr. F. X. Dercum said that the proportion that we are on the eve of gaining a nearer insight into its of demented cases in early general paralysis was, in his nature. This was the subject which Sir William Crookes experience, large-nearly as large as that given by Dr. took the opportunity of discussing before His Royal Pickett and Professor Mendel. He did not believe that there Highness the Prince of Wales on the occasion of was any relationship between general paralysis and epilepsy his formal admission to the Fellowship of the Royal and he denied any causal relation between alcohol and Society on Feb. 6th. Sir William. Crookes’s declaration general paralysis. "Almost, ifnot all, male paretics,"said marks a very important epoch in the progress of science, Dr. Dercum,’’ drink to excess in the earlier period of their -and it was fitting that this epoch should have been associated He also pointed out that such patients were disease."" with an interesting and historical Royal incident. The very prone to develop delusions of marital infidelity. existence of a fourth state of matter has for a long time Dr. Alfred Gordon referred to the almost invariable been indicated in radiant phenomena. Sir William Crookes presence of congenital syphilis in juvenile paretics and cited called it the "ultra-gaseous"state, and later "radiant the recently recorded observations of Regis, who in every one matter," while more recently the latter phrase has given of five consecutive cases of juvenile paresis found congenital way in favour of the term "electrons." An electron is, so In a discussion at the New York Medical Society1 syphilis. to speak, an atom of electricity which exists always on the causation and early diagnosis of general paralysis in the presence of the atom of matter. The electron is Dr. Arthur Hurd of Buffalo stated that he found signs of the satellite of the particle which when liberated from it antecedent syphilis in 68 per cent. of patients, but pointed under the influence of electric discharge behaves not as a to the fact that though syphilis was widely prevalent in gas but more, as Sir William Crookes says, like a fog or mist, Egypt and Japan paresis was rare in both countries. He clinging to positively electrified bodies and thereby losing argued that the overwork and keen stresses of western mobility and settling on the walls of the container if left civilisation excited general paralysis in a brain weakened by - quiet. In the radiant matter-tube, under the influence of syphilis and thought that in time to come the disease would the current the material atoms arrange themselves in groups, increase in the two countries referred to. In America the while the rushing swarms of electrons driven from the disease was most common amongst military men, actors, negative pole meet them. The effect of the bombardment is stock-brokers, and men accustomed to mental overstrain, light and heat. The questions, what are x rays and what is and rare amongst Quakers and the clergy. Dr. Dercum adio-activity may soon in the light of these revelations said that early diagnosis was important, the mistake receive a satisfactory answer. The basis of the electron is made most often being to regard early general paralysis probably the same in all cases, the protyle of Crookes, .from which the chemical atoms are assumed to be formed. 1 New York Medical News, Feb. 1st, 1902.
present moment,
of
basing
"
.
THE WORKING OF PLAGUE MEASURES IN INDIA.
’’ The paralytic," said Dr. Dercum, neurasthenia. seldom came of himself to consult a physician, he was brought by his friends, and unlike the neurastheniae [or hypochondriac] he had no long story to tell." The paretic in the early stages of his disease was liable to lapses of memory, of decency, and of ability for work. The neurastheniac after brief and light sleep had a wakeful morning, felt depressed on rising, and did not care to face The the day, while he felt at his best in the evening. tossed bed with or on the other in little no hand, paretic, a little the the and in sleep during only slept morning. night He felt at his best in the forenoon and was quite exhausted Dr. Charles Wagner said that general in the evening. had increased steadily in America since 1850, paralysis being first noticed in the period 1850 to 1860. At present 10 per cent. of all patients in American asylums were paretics. It was especially prevalent among native-born Americans, whereas the alien population was more liable to develop psychoses. Dr. Edward Cowles declared that antisyphilitic treatment did not benefit paretics and argne<1 that the disease was a toxsemia like myxcedema. as ..
THE WORKING
OF PLAGUE
MEASURES
to the air and sunshine. Owing to the action of the health officer and the local authorities in Bombay there seems to be every prospect of the suitable machinery being present and ready for carrying out these objects. We need scarcely add that, as far as practicable, recourse should also be had to the use of Haffkine’s method of preventive inoculation against plague.
exposed
-
CHELSEA CLINICAL SOCIETY. THE annual clinical debate of this society is fixed for March llth and 18th next at the Jenner Institute of Preventive Medicine, Chelsea Gardens, Grosvenor-road, S.W., at 8.30 P.m. The subject selected for discussion is " Cancer -its Nature, Origin, and General Principles of Treatment." The debate will be opened by Dr. J. F. Payne and full particulars will be shortly announced. The debate will her open to all members of the medical profession.
THE CASE
our
OF THE LATE ANDERSON.
MR.
R.
B.
MR. WALTER MONNINGTON, the honorary secretary of the fund in aid of the widow and children of the late Mr. R. B. 1, Anderson, F.R.C.S. Eng., writes to us as follows :The committee formed to appeal for aid for the widow and sons of the late Mr. R. B. Anderson, F.R.C.S. Eng., beg to announce that the subscriptions now received amount in all to 202 5s. 6d. and to request intending subscribers to kindly forward their donations at once, marked " For the Anderson Fund," to the manager of the Union Bank of London, Chancery-lane, London, as it is definitely proposed to close the account on the 28th inst. A strong hope was entertained of collecting at least £ 500-the sum, it might well be remembered, fixed by the jury by their verdict in Mr. Anderson’s favour in Anderson v. (xorrie
IN
INDIA.
THOSE of
537
readers who have been in the habit of
referring to the "Notes from India"furnished by our special correspondent will have been enabled to keep themselves fairly abreast with the progress of plague in that country. From the increase of the plague mortality which has been taking place of late and the high general death- and Others." It is still desired that the 2202 now in hand may he rate of Bombay it may safely be inferred that the city of largely augmented before the fund closes on the last day of this month. Bombay will not escape the usual epidemic rise of the We need not again expatiate upon Mr. Anderson’s wrongs disease which, according to past experience, occurs at this or upon the needs of his widow and children. It is not a This very naturally has given rise to increased season. large sum which is wanted now-only .6300. Surely those vigilance and efforts on the part of Dr. J. A. Turner, the medical practitioners who have not yet subscribed-there are health officer, and the medical and municipal authorities many such-will not hesitate in making up the comThe organisation and methods of procedure paratively small sum required. concerned. set forth in some articles which appeared are fully "
in the Times of India of Feb. lst. It goes without sayTYPHOID MASTITIS. that all systems of sanitary organisation and public 1--N- the American Journal of the ltTedcal Sciences for health measures must be circumscribed within the limits of what is practically attainable, and their methods of December, 1901, Dr. F. Davis, jun., Dr. H. S. Patterson, and working should be such as are not calculated to arouse Dr. A. W. Hewlett have published a case of this very rare a general spirit of antagonism on the part of those to whom complication of typhoid fever. A woman, aged 34 years, they have to be applied. If this be the case even among was admitted to hospital on May 25th in the third week of educated people who are willing to make some sacrifices and an attack of typhoid fever. The temperature was 105° F. to submit to personal inconvenience in the public interest, rose spots were present, and Widal’s reaction was obtained, it is still more so in the case of Oriental races who are but blood cultures made on May 27th and 31st did not yield tied and bound by religious and social traditions and who are the typhoid bacillus. On June 9th, the thirty-sixth day of intensely conservative where these are concerned. The aim in the disease, the temperature became normal. Three days view is not so much, perhaps, what is sound and logical in later the patient complained of pain in the left breast. On theory or what might be applicable to a small and relatively June 14th the breast was swollen, a hard and tender isolated population where all the conditions are known-like lump was felt on its outer side, and the axillary that of a rural village, for example. Large glands were enlarged and tender. On June 15th the right cities and towns have to be dealt with where the health breast was also tender. Lead and opium compresses were conditions are unfavourable and complicated, and preventive applied and the breasts seemed to improve, but the temmeasures cannot be pushed to a logical conclusion without perature, which began to rise on the 15th, showed causing much discomfort and even hardship. What seems wide daily oscillations of the septic type between 99° to be the most suitable course under such circumstances and 102°, and not the staircase" character of a typhoid h the organisation of some good, simple, and uniformL relapse. On the 20th the swelling and tenderness of left had become much more marked and involved on a establishthe breast the sanitary system practical working basis, ment of some method for the early notification of disease the two upper and the outer lower quadrants. The skin was and death, together with arrangements for promptly evacuat- freely moveable and the nipple was not bound down. On ing infected and overcrowded localities and buildings by the the 24th the temperature reached 104° and fluctuation was selection and provision of sites and encampments suitable) detected. Under chloroform an incision was made and 150 for immediate occupation. Such measures will not only allowr cubic centimetres of thick pus containing the typhoid of the removal of people in anticipation of an outbreak and1 bacillus in pure culture were obtained. The abscess cavity the thinning of overcrowded localities, but will permit also oif consisted of many loculi which were broken up with the a thorough disinfection of the evacuated houses being carriec1 finger. After the operation the temperature at once fell to out and of their being subsequently ventilated and freelJ9 normal and healing was uninterrupted. The swelling in the
ing
and’ populous
.
.