THE HYGIENIC ASPECT OF PLAYGROUNDS.

537 grow the spiroohseta pallida in pure culture when taken direct from suitable lesions in man ; in these experiments the original spirochaetas were, as has been said, derived experimentally infected rabbits.

presence or absence is of considerable help in the interpretation of doubtful movements obtained by stimulation of the sole of the foot. In his experience no case presenting an extensor response from the sole has failed to present also the external malleolar sign, but reference is made to a case where this occurred in the experience of a colleague. Dr. Chaddock THE HYGIENIC ASPECT OF PLAYGROUNDS. adds in a footnote : 11 Subsequent observations show that THE President of the Board of Education has appointed even plantar flexion of the toes excited from the external a departmental committee to inquire and report (a) malleolus is as significant as extension or fanning of them ; whether it would be consistent with due regard to educathat in cases of unilateral capsular lesions the external tional and hygienic considerations that the minimum malleolar sign often occurs on both sides-on the paralysed standard of playground accommodation for new public side with Babinski, on the unparalysed side without elementary schools prescribed in the building regulations Babinski It has been (homologous motor fibres). of the Board of Education-viz., 30 feet per head of accomfound pure and unilaterally in two cases of cerebro-spinal modation-should be modified or adjusted according to meningitis (epidemic) and in a case of tuberculous cerebrothe size, design, or situation of schools, the proximity of spinal meningitis. It has been found in one case (no nervous recreation-grounds or open spaces, the density of popu- lesion apparent) from the ankle where the foot had been dislation, the cost of land, or otherwise ; (b) how far it is located forward creating an arthritis, which suggests some possible or desirable to define more precisely the standard of possible relation between this sign and arthritic ankle playground accommodation which the Board of Education will clonus." All who have had occasion to examine the skin require under the code of regulations for public elementary reflexes of the lower extremity must have observed how schools in the case of existing schools or to regulate the an extensor response is obtainable in pathological practice of the Board of Education in dealing with cases in frequently Dr. cases from other parts of the foot than the sole. which the playground accommodation is considered to be Chaddock considers, however, that he has found a definite insufficient. The committee will consist of Mr. L. A. in the external malleolar area, and the observation Selby-Bigge, C.B., principal assistant secretary of the specificity is peculiarly interesting and worthy of investigation. If it Elementary Education Branch of the Board of Education be as the author thinks, that flexion of the toes from (chairman); Sir George Newman, chief medical officer of thisshown, area is "as significant as extension or fanning, " then the Board of Education; Mr. J. C. Iles, H.M.I., divisional the"reflexis not comparable to the toe phenomenon of inspector for the North-Western Division; Mr.vF. H. B. Babinski. The significance of its unilateral occurrence in Dale, H.M.I., divisional inspector for the Metropolitan and bilateral occurrence in hemiDivision ; Mr. A. B. McLachlan, of the Local Government cerebro-spinal meningitis is not, plegia perhaps, apparent ; in the latter instance the Board ; with Mr. L. J. Morison as secretary. homolateral pyramidal fibres are always a variable quantity. Whether the" reflex" bears any relation to stimulation of A NEW DIAGNOSTIC SIGN OF ORGANIC NERVOUS the extensor brevis digitorum muscle, direct or otherwise, is DISEASE. not referred to by Dr. Chaddock. Medical Jozcrnal for July there is an IN the interstate PROTEIN HYPERSENSITIVENESS. article by Dr. Charles Gilbert Chaddock, of St. Louis, AMONG the manifold phases of the problem of infection entitled"A Preliminary Communication concerning a New Diagnostic Nervous Sign." Dr. Chaddock has been struck and morbidity in tuberculosis the phenomenon of protein by the ready occurrence of the Babinski phenomenon when hypersensitiveness is an interesting one. We have received a the same form of irritation that has elicited it from the copy of a pamphlet of Dr. K. Krause containing the results of sole of the foot is applied to the skin just beneath the investigations which he has made in the Saranac Laboratory external malleolus, while no response can be obtained for the Study of Tuberculosis. He divides the inquiry into from other skin areas of the lower extremity. In cases, three parts. The first deals with " active sensitization." Dr. however, where irritation of almost any area of skin Krause concludes that practically any parenteral route by over the lower extremity calls forth the extensor toe which a quantity of tuberculo-protein can be introduced response, the external inframalleolar area does not dis- into the guinea-pig will specifically sensitise the animal. tinguish itself in any way. Impressed by these observations, Sensitisation may be obtained with equal facility by Dr. Chaddock has been in the habit of commencing examina- !, way of the peritoneal cavity, the skin, the subcutaneous tion of the skin reflexes in patients by investigating the tissue, the cerebral subdural space, and (although he nature of the response from the above-mentioned region. did not try the method) possibly by intravenous injecHis method is to scratch the skin with a moderately tion. He found that sensitisation can be produced with pointed nail-file. In some cases the merest touch is an amount of tubereulo-protein that is represented by sufficient to excite the sign ; in others, rather severe 0-00005 gramme dry weight. He gives details of his experiscratching may be required. He has found that the most ments which will prove interesting to those versed in sensitive point is usually over a slight depression just in laboratory methods. The second part of the investigation front of the lower margin of the external malleolus. From deals with the relation of tuberculo-protein hypersensitivean examination of a series of 245 cases, including normal ness to the tuberculin. reaction and to tuberculin immunity. individuals as well as a great number of all sorts of nervous His experiments led him to two conclusions-(1) once cases, Dr. Chaddock is satisfied that irritation of the external sensitiveness to tuberculo-protein is acquired by a nonmalleolar area causes no reaction normally ; in pathological tuberculous animal the repeated absorption of more protein cases extension of the great toe, or o all the toes, or fan-like tends only to increase this condition ; and (2) tolerance to separation of them, obtained from this area, is indicative of tuberculo-protein cannot be attained in the non-tuberculous organic disease of the spino-cortical reflex paths. He con- animal by gradually raising the dosage or diminishing the of time between doses. Dr. Krause’s remarks on cludes that the external malleolar sign is usually present when the ordinary Babinski toe response is present ; that it these two points are involved, but, if they are followed, is often present when the latter is absent; that it may will prove of value to other observers. The third subdealt with in this pamphlet is hypersensitiveness coexist with, or outlast, the latter, and that its

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