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THE NERVOUS SYSTEM IN SCLERODERMA.
43
year’s statement to call for comment ; it is still more conspicuous in the statement now under review. In this we see no matter for regret, although it must be admitted that Wright
in last
to those who are behind the scenes and know the details of all the various cases dealt with there are none more interesting, none in which it is possible to extend the helping hand with a livelier sense of satisfaction than those in which a timely loan helps a brother overtaken by sudden adversity to help himself. That of a truth is the kind of mercy that is
"twice blessed"and in the person both of him who gives and him who takes. Nor should it be forgotten that the repayments made by those who had benefited by the Fund form a most welcome addition to the resources of the Almoners and one by no means to be despised, seeing that a sum of upwards of Z200 has in this way been placed at their disposal during the period now under consideration. This work, as we have before remarked, is so intimately associated with THE LANCET that we feel ourselves at liberty when writing about it to express our sincere thanks to the honorary officers-Almoners and Auditorwho have during the past year undertaken the duty of administering the Fund. Sir Samuel Wilks, Sir William Mac Cormac, and Sir Henry Pitman have in this way renewed the evidence which they havegiven in previous years of their interest in the welfare of the most unfortunate of our professional brethren. Sir William Turner who has been elected to the Presidency of the General Medical vacated by the lamented death of the late Sir Richard Quain, has kindly consented also to assume the charitable P61e of an Almoner of THE LANCET Fund and has personally interested himself in the discharge In presenting to each and all of of its duties. them our thanks we assume to speak not only for ourselves as donors of the Fund, to whom its due administration is naturally a matter of solicitude, but in the name also of those who benefit by it and whose gratitude, not always articulate, is in not a few cases evidenced by expressions which it is a privilege to convey but a satisfaction largely alloyed with sympathetic sorrow to receive. The application form of THE LANCET Relief Fund will be found in our present issue and can be readily detached for use in case of need. We again take an opportunity of asking those of our readers who may have occasion to assist in furthering any application made for relief from this source to note carefully the conditions on which applicants become entitled to participate in the benefits of the Fund, as it is still found that many requests are put forward which are so far outside the objects of the benefaction that they cannot be entertained and from such applications nothing but disappointment can result. All applications should be made (in writing) to the Secretary, Mr. Edward Davies, THE LANCET Offices, 423, Strand, London.
Council,
TRUE HEROISM. UN lJec. G25tn, lö8ö, occurred an opportunity tor one ot those acts of unassuming heroi, m which we are proud to be able to say are not s ) very uncommon amongst us. In Clerkenwell Close therd lives an elzetr3-plater by name Grimme, but he was away and the foreman, Franklin, was in charge. The workshop is very small and the materials and chemicals necessary for the trade have mostly to be placed on the ftucr. At the time of the acident there stood on the nojr an earbh(:n
ran upstairs, opened a window and called for help, after which he lost consciousness for a few minutes. On coming down he saw a soldier on the stairs. He groped his way into the room, hauled out one child by the legs, gave it to the soldier and again became unconscious. The soldier, who is a gunner in the Royal Artillery named William Hall, was going along the street when he noticed a crowd. He made his way into the house three separate times and brought out the children first and afterwards the father. The sufferers were taken to St. Bartholomew’s Hospital and attended to. We have told this tale very plainly, but it seems to us that the action of both Wright and Hall is beyond all praise. Very possibly neither quite knew the danger which he was running, but anybody who has ever experienced that sensation of being gripped by the throat which the inhalation of hydrocyanic acid and carbonic acid produces will appreciate the pluck shown by these two heroes, and especially the bravery of Hall who went into the house three separate times. The crowd outside, by way of contrast, stood still, stared, and did nothing. The pluck of Hall and Wright will never be forgotten, and we hope that they will receive the Albert medal or some similar recognition of their admirable conduct.
THE NERVOUS SYSTEM IN SCLERODERMA. IN the December number of the Glasgon: Med’ical .Toicrrucl Dr. Lindsay Steven publishes a lecture on a very interesting and important case of scleroderma in which there was pronounced hemiatrophy of the face, body, and extremities and in which he had an opportunity of examining the condition post mortem. A full clinical account of the case was published in the International Clinics in 1897. As regards the patient’s condition on readmission to hospital in the spring of 1898 it need only be said that her skin on the affected side showed breaking down and ulceration, and it was on account of this and of the symptoms of an ovarian tumour-symptoms dating from August, 1897-that she sought readmission. Abdominal section was performed for the removal of this tumour but unfortunately she succumbed on the third day after operation. As regards the internal organs it need only be said that there was complete absence of pericardium, and there were cicatrices in the spleen and a condition of the kidneys of mixed parenchymatous and interstitial nephritis. The cortical matter of the hemisphere opposite to the atrophic side was perhaps a little thinner, but no microscopic examination is recorded. In the spinal cord, however, the grey matter of the right (the affected side) anterior horn was diminished, the ganglion cells were smaller and less numerous, and their nuclei and plasma granules were not so well defined as in the corresponding cells of the opposite side. The neuroglia also in the right horn seemed denser than in the left. Corresponding changes could not be made out in the medulla or pons. Throughout the cord, medulla, and pons the arteries, especially of the grey matter, were surrounded by spaces, either empty or containing a structureless homogeneous material, and most of these spaces had well-defined margins. The nerve fibres from the cervical and lumbar plexuses showed a well-marked parenchymatous degeneration. The skin showed the absence of fat, thickening of the horny layer, and atrophy of the papillas. Between the papillse and the muscles there was a thick layer of dense connective tissue. Dr. Lindsay Steven regards the atrophy of the anterior horn, the changes in the cells there, and the cavities abound the vesse’s as of much importance and significance in reference to the morbid anatomy of scleroderma. He koks upon the condition as the result:of.these changes-i.e., as a trophoneurosis of central
44
’l’.t1.lli uvY.&isa
The neuritis he regards as secondary and recent. The is of much interest and its importance is enhanced by the long time-twelve years-during which the patient had been under observation. We should doubt, however, whether Dr. Lindsay Steven’s explanation of the relation of the changes in the skin to those’ in the central nervous system will be quite satisfactory to everyone, and we should have thought it would hardly be necessary to invoke some recent parenchymatous neuritis to account for changes in the peripheral nerves. With such changes in the anterior horn cells and in the skin, changes in the nerves, both parenchymatous and interstitial, would be quite what we should expect. It would also be interesting to know the microscopical character of the changes in the cerebral
origin. case
eortex.
THE NEW PHYSICAL LABORATORY OF THE OWENS COLLEGE, MANCHESTER. THE
laboratory of which the foundation. stone has been the twenty-fifth anniversary of the occupation of the present Owens College buildings will be the largest and most completely equipped in this country. It stands on a separate plot of ground adjoining the Owens College site and consists of a main building and a large annexe, the latter being more especially intended for electro-technical work. The principal building is 100 ft. long and laid
over
on
60ft. wide
and consists of
a
basement and three
storeys. The cost of the building with fittings and It is intended to new apparatus is estimated at 30,000. have at least one room set aside for constant temperature work and to establish a small plant for the production of low temperatures. An electro-technical laboratory will be added in which large currents will be available for electric furnaces. One of the features of the laboratory will be a carefully-planned system of ventilation combined with an attempt to exclude dust as far as possible from all rooms and especially from instrument cases. The plenum it had be because takes to rejected system up too much valuable basement space, because it is ineffective as regards exclusion of dust, and because the inevitable noise and mechanical shaking due to the fans would have seriously interfered with the work of the laboratory. The architect is Mr. J. W. Beaumont who, before finally drawing the plans, was sent by the Council of the Owens College to visit the principal modern laboratories of Germany.
VACCINATION LITERATURE AND LEAFLETS. asked from time to time where literature on the subject of vaccination can be obtained such as would be suitable for the purposes of educating the public in this matte: by the aid of lectures and by the gratuitous distribution of trustworthy pamphlets and leaflets. We would refer inquirers as to this to Dr. Francis Bond, honorary secretary of the Jenner Society, Gloucester. Under Dr. Bond’s supervision a series of very valuable pamphlets and leaflets has been compiled. Some are suitable for lecturers, others for issue to the public by vaccination officers, others, again, for distribution by district visitors. On this subject it is desirable to remind boards of guardians who desire that children within their jurisdictions shall be protected against small-pox andits miserable consequences that section 28 of the Vaccination Act, 1867, is still in force, and that under this section they are empowered to pay out of their funds all reasonable expenses in circulating information on the subject of small-pox or vaccination md in taking measures of this sort in order to promote vaccination. This section has been held to cover of literathe distribution always fully ture of this description and it would be well if public vaccinators were to urge boards of guardians to supply
WE
are
COLLEGE, MANCHESTER.
LOAN. -1,
1899.
leaflets such as are issued by the Jenner Society to vaccination ofiicers with a view to their distribution together with any notices which they may have to issue in accordance with the regulations governing the duties under the Act of 1898. ___
THE CENTENARY OF THE RUSSIAN MEDICAL MILITARY ACADEMY. ON Thursday, Dec. 29th, at St. Petersburg the celebration of the Centenary of the Russian Medical Military Academy was opened by a religious service. The prize distribution to the successful students of the year then took place in the presence of the Grand Duke Constantine (the Honorary President of the ’Academy) and of the Minister of War and other distinguished men, including the Bishop of Finland and other ecclesiastics. Early on Friday morning a grand requiem service was held in memory of past Russian Emperors, patrons of the Academy. The great function of the celebration took place afterwards in the largest hall in St. Petersburg before a most distinguished company presided over by the Minister of War, the numerous decorations worn upon the brilliant uniforms of the officers and the bright colouring of the academic costumes of various nationalities giving much grandeur to the scene. Representatives from universities and scientific bodies were presented on the raised platform and offered congratulations from their respective societies. Among the British institutions which sent messages were the Royal Society, the Universities of Oxford, Cambridge, Edinburgh, Glasgow, and Aberdeen, and the Royal College of Surgeons of England. The delegates from these bodies comprised the Dean of Trinity Hall, Rev. H. S. Cronin, Professor Shipley, Mr. Owen, Mr. Cross, Professor Ogston, and Dr. Ferguson.
FRACTURE OF THE
INTERNAL TABLE SKULL.
OF THE
FROM a priori considerations we should hardly have considered it possible that the inner table of the skull could be broken without any fracture of the outer table, yet this lesion has been observed many times and Captain Standage, I.M.S. recorded an instance of its occurrence in THE LANCET of Nov. 26th, 1898, p. 1388. The earliest reference to this form of injury is to be found in a work called " De Fractura Cranii," published by Jacobus Berengarius in 1535 ; Ambrose Par6 alludes to it also.l Garegeot relates a case observed by Mery.2 Pott mentions twocases in his work "Observations on the Nature and Consequences of Wounds and Cotttusions of the Head."3 Samuel Cooper described the condition in his "Surgical Dictionary."4.4 W. F. Teevan5 was the first to point out the true explanation of the greater extent. of the fracture of the inner table in ordinary fractures of the skull and therefore the reason why the inner table may be broken while the outer suffers no injury. He showed that in all fractures it is the side of extension and not the side of compression which is the first to break, and when the skull is struck the outer table is compressed and the inner table is stretched. Guthrie, in his " Commentaries on the Surgery of War,"describes the occurrence of this form of injury, but probably the best account is to be found in the "Medical and Surgical History of the War of the Rebellion7 ; during that war there were 20 cases in which the inner table was broken without any fracture or depression of the outer table; in 4 of the cases trephining was unavailingly performed and only 1 patient recovered of the whole number of cases. La Mottestated that a"cracked pot sound " could be obtained w
1
2
Traité des
x., p. 225, 1652. Chirurgie, second edition, 1738,
Œuvres, vol.
Opérations
de
p. 122. 3 5
4
London, 1760, p. 16.
vol. iii.,
Eighth edition, p. 899.
British and Foreign Medico-Chirurgical Review, vol. xxxvi., p. 189. 7 Part I., vol. i., 6 Sixth p. 141. edition, p. 341. 8
Observations de
Chirurgie,
vol. ii.,
p. 303.
year’s statement to call for comment ; it is still more conspicuous in the statement now under review. In this we see no matter for regret, although it must be admitted that Wright
in last
to those who are behind the scenes and know the details of all the various cases dealt with there are none more interesting, none in which it is possible to extend the helping hand with a livelier sense of satisfaction than those in which a timely loan helps a brother overtaken by sudden adversity to help himself. That of a truth is the kind of mercy that is
"twice blessed"and in the person both of him who gives and him who takes. Nor should it be forgotten that the repayments made by those who had benefited by the Fund form a most welcome addition to the resources of the Almoners and one by no means to be despised, seeing that a sum of upwards of Z200 has in this way been placed at their disposal during the period now under consideration. This work, as we have before remarked, is so intimately associated with THE LANCET that we feel ourselves at liberty when writing about it to express our sincere thanks to the honorary officers-Almoners and Auditorwho have during the past year undertaken the duty of administering the Fund. Sir Samuel Wilks, Sir William Mac Cormac, and Sir Henry Pitman have in this way renewed the evidence which they havegiven in previous years of their interest in the welfare of the most unfortunate of our professional brethren. Sir William Turner who has been elected to the Presidency of the General Medical vacated by the lamented death of the late Sir Richard Quain, has kindly consented also to assume the charitable P61e of an Almoner of THE LANCET Fund and has personally interested himself in the discharge In presenting to each and all of of its duties. them our thanks we assume to speak not only for ourselves as donors of the Fund, to whom its due administration is naturally a matter of solicitude, but in the name also of those who benefit by it and whose gratitude, not always articulate, is in not a few cases evidenced by expressions which it is a privilege to convey but a satisfaction largely alloyed with sympathetic sorrow to receive. The application form of THE LANCET Relief Fund will be found in our present issue and can be readily detached for use in case of need. We again take an opportunity of asking those of our readers who may have occasion to assist in furthering any application made for relief from this source to note carefully the conditions on which applicants become entitled to participate in the benefits of the Fund, as it is still found that many requests are put forward which are so far outside the objects of the benefaction that they cannot be entertained and from such applications nothing but disappointment can result. All applications should be made (in writing) to the Secretary, Mr. Edward Davies, THE LANCET Offices, 423, Strand, London.
Council,
TRUE HEROISM. UN lJec. G25tn, lö8ö, occurred an opportunity tor one ot those acts of unassuming heroi, m which we are proud to be able to say are not s ) very uncommon amongst us. In Clerkenwell Close therd lives an elzetr3-plater by name Grimme, but he was away and the foreman, Franklin, was in charge. The workshop is very small and the materials and chemicals necessary for the trade have mostly to be placed on the ftucr. At the time of the acident there stood on the nojr an earbh(:n
ran upstairs, opened a window and called for help, after which he lost consciousness for a few minutes. On coming down he saw a soldier on the stairs. He groped his way into the room, hauled out one child by the legs, gave it to the soldier and again became unconscious. The soldier, who is a gunner in the Royal Artillery named William Hall, was going along the street when he noticed a crowd. He made his way into the house three separate times and brought out the children first and afterwards the father. The sufferers were taken to St. Bartholomew’s Hospital and attended to. We have told this tale very plainly, but it seems to us that the action of both Wright and Hall is beyond all praise. Very possibly neither quite knew the danger which he was running, but anybody who has ever experienced that sensation of being gripped by the throat which the inhalation of hydrocyanic acid and carbonic acid produces will appreciate the pluck shown by these two heroes, and especially the bravery of Hall who went into the house three separate times. The crowd outside, by way of contrast, stood still, stared, and did nothing. The pluck of Hall and Wright will never be forgotten, and we hope that they will receive the Albert medal or some similar recognition of their admirable conduct.
THE NERVOUS SYSTEM IN SCLERODERMA. IN the December number of the Glasgon: Med’ical .Toicrrucl Dr. Lindsay Steven publishes a lecture on a very interesting and important case of scleroderma in which there was pronounced hemiatrophy of the face, body, and extremities and in which he had an opportunity of examining the condition post mortem. A full clinical account of the case was published in the International Clinics in 1897. As regards the patient’s condition on readmission to hospital in the spring of 1898 it need only be said that her skin on the affected side showed breaking down and ulceration, and it was on account of this and of the symptoms of an ovarian tumour-symptoms dating from August, 1897-that she sought readmission. Abdominal section was performed for the removal of this tumour but unfortunately she succumbed on the third day after operation. As regards the internal organs it need only be said that there was complete absence of pericardium, and there were cicatrices in the spleen and a condition of the kidneys of mixed parenchymatous and interstitial nephritis. The cortical matter of the hemisphere opposite to the atrophic side was perhaps a little thinner, but no microscopic examination is recorded. In the spinal cord, however, the grey matter of the right (the affected side) anterior horn was diminished, the ganglion cells were smaller and less numerous, and their nuclei and plasma granules were not so well defined as in the corresponding cells of the opposite side. The neuroglia also in the right horn seemed denser than in the left. Corresponding changes could not be made out in the medulla or pons. Throughout the cord, medulla, and pons the arteries, especially of the grey matter, were surrounded by spaces, either empty or containing a structureless homogeneous material, and most of these spaces had well-defined margins. The nerve fibres from the cervical and lumbar plexuses showed a well-marked parenchymatous degeneration. The skin showed the absence of fat, thickening of the horny layer, and atrophy of the papillas. Between the papillse and the muscles there was a thick layer of dense connective tissue. Dr. Lindsay Steven regards the atrophy of the anterior horn, the changes in the cells there, and the cavities abound the vesse’s as of much importance and significance in reference to the morbid anatomy of scleroderma. He koks upon the condition as the result:of.these changes-i.e., as a trophoneurosis of central
44
’l’.t1.lli uvY.&isa
The neuritis he regards as secondary and recent. The is of much interest and its importance is enhanced by the long time-twelve years-during which the patient had been under observation. We should doubt, however, whether Dr. Lindsay Steven’s explanation of the relation of the changes in the skin to those’ in the central nervous system will be quite satisfactory to everyone, and we should have thought it would hardly be necessary to invoke some recent parenchymatous neuritis to account for changes in the peripheral nerves. With such changes in the anterior horn cells and in the skin, changes in the nerves, both parenchymatous and interstitial, would be quite what we should expect. It would also be interesting to know the microscopical character of the changes in the cerebral
origin. case
eortex.
THE NEW PHYSICAL LABORATORY OF THE OWENS COLLEGE, MANCHESTER. THE
laboratory of which the foundation. stone has been the twenty-fifth anniversary of the occupation of the present Owens College buildings will be the largest and most completely equipped in this country. It stands on a separate plot of ground adjoining the Owens College site and consists of a main building and a large annexe, the latter being more especially intended for electro-technical work. The principal building is 100 ft. long and laid
over
on
60ft. wide
and consists of
a
basement and three
storeys. The cost of the building with fittings and It is intended to new apparatus is estimated at 30,000. have at least one room set aside for constant temperature work and to establish a small plant for the production of low temperatures. An electro-technical laboratory will be added in which large currents will be available for electric furnaces. One of the features of the laboratory will be a carefully-planned system of ventilation combined with an attempt to exclude dust as far as possible from all rooms and especially from instrument cases. The plenum it had be because takes to rejected system up too much valuable basement space, because it is ineffective as regards exclusion of dust, and because the inevitable noise and mechanical shaking due to the fans would have seriously interfered with the work of the laboratory. The architect is Mr. J. W. Beaumont who, before finally drawing the plans, was sent by the Council of the Owens College to visit the principal modern laboratories of Germany.
VACCINATION LITERATURE AND LEAFLETS. asked from time to time where literature on the subject of vaccination can be obtained such as would be suitable for the purposes of educating the public in this matte: by the aid of lectures and by the gratuitous distribution of trustworthy pamphlets and leaflets. We would refer inquirers as to this to Dr. Francis Bond, honorary secretary of the Jenner Society, Gloucester. Under Dr. Bond’s supervision a series of very valuable pamphlets and leaflets has been compiled. Some are suitable for lecturers, others for issue to the public by vaccination officers, others, again, for distribution by district visitors. On this subject it is desirable to remind boards of guardians who desire that children within their jurisdictions shall be protected against small-pox andits miserable consequences that section 28 of the Vaccination Act, 1867, is still in force, and that under this section they are empowered to pay out of their funds all reasonable expenses in circulating information on the subject of small-pox or vaccination md in taking measures of this sort in order to promote vaccination. This section has been held to cover of literathe distribution always fully ture of this description and it would be well if public vaccinators were to urge boards of guardians to supply
WE
are
COLLEGE, MANCHESTER.
LOAN. -1,
1899.
leaflets such as are issued by the Jenner Society to vaccination ofiicers with a view to their distribution together with any notices which they may have to issue in accordance with the regulations governing the duties under the Act of 1898. ___
THE CENTENARY OF THE RUSSIAN MEDICAL MILITARY ACADEMY. ON Thursday, Dec. 29th, at St. Petersburg the celebration of the Centenary of the Russian Medical Military Academy was opened by a religious service. The prize distribution to the successful students of the year then took place in the presence of the Grand Duke Constantine (the Honorary President of the ’Academy) and of the Minister of War and other distinguished men, including the Bishop of Finland and other ecclesiastics. Early on Friday morning a grand requiem service was held in memory of past Russian Emperors, patrons of the Academy. The great function of the celebration took place afterwards in the largest hall in St. Petersburg before a most distinguished company presided over by the Minister of War, the numerous decorations worn upon the brilliant uniforms of the officers and the bright colouring of the academic costumes of various nationalities giving much grandeur to the scene. Representatives from universities and scientific bodies were presented on the raised platform and offered congratulations from their respective societies. Among the British institutions which sent messages were the Royal Society, the Universities of Oxford, Cambridge, Edinburgh, Glasgow, and Aberdeen, and the Royal College of Surgeons of England. The delegates from these bodies comprised the Dean of Trinity Hall, Rev. H. S. Cronin, Professor Shipley, Mr. Owen, Mr. Cross, Professor Ogston, and Dr. Ferguson.
FRACTURE OF THE
INTERNAL TABLE SKULL.
OF THE
FROM a priori considerations we should hardly have considered it possible that the inner table of the skull could be broken without any fracture of the outer table, yet this lesion has been observed many times and Captain Standage, I.M.S. recorded an instance of its occurrence in THE LANCET of Nov. 26th, 1898, p. 1388. The earliest reference to this form of injury is to be found in a work called " De Fractura Cranii," published by Jacobus Berengarius in 1535 ; Ambrose Par6 alludes to it also.l Garegeot relates a case observed by Mery.2 Pott mentions twocases in his work "Observations on the Nature and Consequences of Wounds and Cotttusions of the Head."3 Samuel Cooper described the condition in his "Surgical Dictionary."4.4 W. F. Teevan5 was the first to point out the true explanation of the greater extent. of the fracture of the inner table in ordinary fractures of the skull and therefore the reason why the inner table may be broken while the outer suffers no injury. He showed that in all fractures it is the side of extension and not the side of compression which is the first to break, and when the skull is struck the outer table is compressed and the inner table is stretched. Guthrie, in his " Commentaries on the Surgery of War,"describes the occurrence of this form of injury, but probably the best account is to be found in the "Medical and Surgical History of the War of the Rebellion7 ; during that war there were 20 cases in which the inner table was broken without any fracture or depression of the outer table; in 4 of the cases trephining was unavailingly performed and only 1 patient recovered of the whole number of cases. La Mottestated that a"cracked pot sound " could be obtained w
1
2
Traité des
x., p. 225, 1652. Chirurgie, second edition, 1738,
Œuvres, vol.
Opérations
de
p. 122. 3 5
4
London, 1760, p. 16.
vol. iii.,
Eighth edition, p. 899.
British and Foreign Medico-Chirurgical Review, vol. xxxvi., p. 189. 7 Part I., vol. i., 6 Sixth p. 141. edition, p. 341. 8
Observations de
Chirurgie,
vol. ii.,
p. 303.