THE OPENING OF THE ROYAL EDWARD INSTITUTE AT MONTREAL.

1297 At has shown to be due to overdose of adrenalin. the end of six weeks nervous troubles appeared, and there was continuous tremor, increased by movement and most marked in the upper limbs, particularly in the hands. In November, 1899, 120 injections had been given and there The imwas considerable diminution of all the symptoms. end at the of 10 and now, years, the provement continued, and the melanodermia is scarcely perceptible spots in the mouth have almost disappeared. The patient weighs 100 kilogrammes and can walk all day without fatigue. Béclère has recorded a very similar case. The patient was a man, aged 24 years, who had suffered for 15 months from typical He Addison’s disease, which was progressing rapidly. of the four daily weighing suprarenal capsules sheep ingested from 10 to 15 grammes. A month later 1 cubic centimetre of the glycerine extract of the suprarenal capsules of the calf was injected daily. After four and a half months’ treatment he had gained 10 kilogrammes in weight and had almost completely recovered. Now, 11 years later, he is in good health. M. Boinet suggests that in such cases the adrenalin causes hypertrophy of portions of the suprarenal capsules which have remained sound. It sounds to us more probable that by supplying the deficient internal secretion it improves the health of the patient and allows the vis mediratrix nat1trae to produce the hypertrophy. In one of the cases of improvement reported by M. Boinet the patient was a woman, aged 66 years, with the characteristic pigmentation of the skin and mouth. She was very weak and was fatigued by the slightest effort, and suffered from lumbar pain and gastro-intestinal troubles. She took by the mouth daily extract of the suprarenal capsules of the calf. After some months she had almost completely recovered from the weakness, but the pigmentation was unchanged, and she also had ’tremor of the fingers. She still remains in this state nine years after the commencement of the treatment. In the other cases of improvement the result was similar. In the cases of failure:

small areas of meningitis, with unmistakeable vascular alterations in the shape of dilatation of vessels, interstitial hasmorrhagic foci, and peri- or paravascular inflammatory nodules. Microscopical investigation of the cortex showed that in some places it was sclerosed and demyelinised, while the cellular elements were often rarefied, sometimes disarranged, staining badly, and exhibiting granulation of the protoplasm. Many nerve cells were seen embedded in the white matter. The systems of tangential fibres had almost entirely disappeared. The cortical neuroglia was intensified and unusually rich in spider cells. Throughout the brain the blood-vessels were congested, with dilatation of the peri vascular sheaths ; deposits of pigment were seen frequently in their neighbourhood. In the lower nervous centres only minimal changes were observed. The pyramidal tracts were agenetic. From a correlation of the work of others Dr. Babonneix considers the view incontestable that the agenesis of the nervous centres is secondary to a process of chronic meningitis. The nature of this meningitis remains sub jt6di(Je. were

THE OPENING OF THE ROYAL EDWARD INSTITUTE AT MONTREAL. ON Oct. 21st the Royal Edward Institute, which has been erected at Montreal for the study and treatment of tuberculous disease, was opened by the King, who was at the time four and a half thousand miles away. The ceremony consisted in the hoisting of the Royal Standard, the opening of the main doors of the institute, and the switching on of its lights, the necessary machinery being set in motion by a weak electric current transmitted across the Atlantic from Chichester, where His Majesty completed the circuit at West Dean Park. He pressed the necessary button at 9 o’clock P.M. Greenwich time, and within a second the ceremony had been performed at Montreal, the time there being 4 P.M. Sir Charles Fitzpatrick, Deputy Governor of Canada, attended the ceremony in the unavoidable absence of Lord Grey, and addressed a large and brilliant assembly who also heard speeches from Sir George Drummond, chairman of the institute, and Dr. R. W. Philip of Edinburgh, its designer. The King telegraphed the following message to the chairman immediately after the opening had taken place :—

was obtained, but symptoms’ suprarenal insufficiency eventually supervened andl rapidly proved fatal. M. Boinet has described under the a group of symptoms consisting ofname of "Addison ism and pigmentation debility falling short of those of Addison’s’ disease due to suprarenal inadequacy. They are not uncommon in pulmonary tuberculosis, thus differing from true Addison’s disease, which is a primary tuberculosis of the Ihave much pleasure in declaring the Royal Edward suprarenal capsules. In this condition the suprarenal cap- Institute, Montreal, now open. The means by which I make sules are sclerosed, but not completely destroyed. Suprarenal1 this declaration testifies to the power of modern science, and treatment is very successful. M. Boinet therefore suggestss I am confident that the future history of the institute will that the cases of recovery from the symptoms of Addison’ss afford an equally strong testimony to the beneficent results of that power when applied to the conquest of disease under adrenalin may be cases ofAddisonism andI I shall disease and the relief of human suffering. not of true Addison’s disease. always take a lively interest in the institute, and I pray that the blessing of the Almighty may rest upon all those who

some

temporary improvement

of acute

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THE PATHOLOGICAL

ANATOMY OF

MONGOLIAN

IDIOCY.

pathology of this common form of imbecility is still1 not clearly determined. While some consider it due to ann agenesis of the nervous centres, others think the maldevelopIr ment is secondary to the ordinary processes of meningitis or chronic meningo-encephalitis. In the A’l’ohives de Médeoinc x des Enfants for July will be found a carefully described d examination of the central nervous system of a case of thee disease by Dr. Babonneix, working in the laboratory of )f Professor Raymond in Paris. The child, who presented the e usual anatomical stigmata, and in addition had symmetrical d syndactyly of the middle toes and double cryptorchidia, died attt the age of five years from tuberculosis. The convolutions of )f the brain were simple and the fissures shallow, but no obvious is anomaly was otherwise visible. The pia was thickened andLd somewhat adherent, but it, could be stripped without decortica,tion. Scattered irregularly over the surface of the brain Ln

work in and for it, and also upon those for whom it works. EDWARD R. AND I."

THE

THE DIAGNOSIS OF TUBERCULOUS MEDIASTINAL GLANDS.

WE published in our columns last week a note by Dr. John Allan on the importance of the early recognition of tuberculous mediastinal glands. The possibility of latent pulmonary tuberculosis in children is now generally recognised. The etiology has been further explained by researches which prove that the pathogenic bacilli may pass through the walls of the healthy intestine and become lodged in the mediastinal glands, so that infection through milk from a tuberculous cow may thus take place. Dr. Allan points out that in the study of latent pulmonary tuberculosis we are confronted with a difficult problem, and many points have to be carefully considered in the endeavours to deal correctly with it. He deals mainly with