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THE SCHOOLS FOR BLIND, DEAF, AND DEFECTIVE CHILDREN.
PSEUDO-TABES OF TRAUMATIC ORIGIN.
414
The libraries of the Royal Colleges of Physicians and Surgeons and of the Royal Society of Medicine may be said, when taken together, to cover the whole-or nearly the wholefield of medical literature. In some directions they even cover a wider field than does the lavishly Statesupported library of the Surgeon-General’s DepartHere again, however, ment at Washington. comparative estimates are unnecessary. Our American Allies have certainly got a magnificent library, the index or catalogue of which is a monument of bibliography as useful to English scholars and librarians as to their American congeners. Among the millions of Englishspeaking people there is plenty of room for two great medical library systems-those, namely, of Washington and London. They form no mean portion of those national cultural resources which deserve reconsideration on the eve, let us hope, of a period of reconstruction. medical.
I
PSEUDO-TABES OF TRAUMATIC ORIGIN.
THAT a traumatic lesion of the cauda equina may -simulate in its clinical aspects a sclerosis of the .posterior columns is exemplified in a case recently
published by Dr. A. Mendicini, professor pathology in the University of Rome.
of
neuro-
The patient, a soldier, presented a syndrome characterised by amyosthenia of the legs, more marked on the right side, associated with hypotonia of the muscles, abolition of the Achillar reflexes and the left knee-jerk, Romberg’s sign, ataxic gait, lightning pains, and intermittent paræsthesia, with disturbance of sensation in the regions of the fifth lumbar and all the sacral nerves on both sides, but partly also of the third and fourth right and fourth left lumbar, together with derangement of the functions of micturition and defæcation. These phenomena followed a wound by shell splinters of the lower lumbar vertebrae, which at its onset
caused a complete paralysis. The resemblance to tabes was so marked that the doubt arose whether the patient might not have been the subject of a latent form of locomotor ataxy, but against this supposition it was ascertained that previous to the injury he had no symptoms referable to the nervous system ; moreover, the Argyll-Robertson sign wa3 absent. The seat of the injury and radiographic examination pointed, on the other hand, to a lesion of the cauda equina, the fibres of which were either contused by the ,fragments of shell, which were numerous, although it is more probable that these produced an endothecal haemorrhage. To this and the shock of the wound itself the initial paraplegia was certainly due, which passed off in about three weeks owing to gradual absorption of the blood extravasated into the meningeal sac. In fact, the irritative symptoms (retention of urine, pains, and painful priapism) became gradually lessened without giving place to noticeable paralytic phenomena. The progressive improvement of the patient justified the exclusion of a secondary inflammatory process of the meninges. The pathology of the case therefore resolves itself into one of peripheral radicular pseudo-tabes, which differs from the classic neuro-tabes in the topography of the sensory changes and in the presence of disturbances in the sphincters.
ataxy
in the recumbent
or
sitting posture. In
the contrary, an ataxic gait associated with Romberg’s sign is never met with in con. junction with absolute static and dynamic integrity of the legs in the supine or sitting position, not even in cases of tabes inferior in which the lesion is limited at the onset to the sacral or last lumbar
tabes,
on
roots.
____
THE SCHOOLS FOR BLIND, DEAF, AND DEFECTIVE CHILDREN.
THE Board of Education have recognised that assistance should be given forthwith to local education authorities and to the managers of voluntary institutions to assist them in meeting the additional charges now being incurred in respect of teachers’ salaries and the increased cost of food. They have accordingly decided, as an interim arrangement, to increase the grants payable under the regulations for these special schools. The Regulations which came into operation on April 1st, 1917, are modified : the grant payable each year fora certified school for blind or deaf children will be (1) at the rate of £8 10s. for each unit of average attendance in a certified day school ; (2) at the rate of £16 10s. for each unit of average attendance ina certified boarding school. The grant payable each year for a certified school for defective or epileptic children will be (1) at the rate of JE710s. for each’ unit of average attendance in a certified day school; (2) at the rate of £15 10s. for each unit of average attendance in a certified boarding school. It has also been decided to increase by JE1the grants payable to open-air schools under Part II. of the In an introductory Medical Grant Regulations. note to the circular officially announcing the modifications the Board says :some
The improvement and, indeed, the maintenance, of the efficiency of special schools, as of other types of school, must in a great measure depend upon the provision of a suitably qualified staff of teachers. Such a staff cn only be obtained and retained if adequate salaries are paid, and the Board rely on the school authorities to take the opportunity afforded by the increased grants to provide adequate salaries in special schools, regard being had to the special character of the duties required and the rates of salary payable to teachers of a similar standing in ordinary elementary schools.
We trust that the school authorities will see their way to discharging the responsibility towards their teachers thus placed upon them. THE WATER-SOLUBLE ACCESSORY IN YEAST.
AN interesting investigation on accessory food substances has for some time past been in progress in the bio-chemical laboratory of the Cancer Research Institute, in which the author, Dr. Mendicini’s patient had Romberg’s phenomenon Hospital Mr. J. C. Drummond, set out to isolate and identity and ataxic gait; when in bed, however, or seated the dietary factor B. The results appear in a paper he could move the legs correctly into any position in the December number of the Bio. published and retained the sense of position except in most Chemical Journal. Dietary factor B is the water’ of the toes. This fact is of some importance as soluble substance as distinct from A, accessory showing that only the paths proceeding from the the fat-soluble substance. It is probable that terminal segments of the lower limbs were the so-called " antineuritic vitamine is identical impervious to the transmission of deep sensation; with the water-soluble factor B. Little progress it explains the Romberg sign and disturbance of seems to have been made in elucidating the exact gait, and .demonstrates that if Romberg’s pheno- chemical nature of this substance, although some met with chiefly in relation to menon is of its properties are well known. The chief degeneration of the posterior roots it may also be attempts to isolate the substance have been made caused by simple plantar anaesthesia. On the other with yeast extracts, but the difficulty has been to hand, the retention in this patient of deep sensi- recover the vitamine as such after the raw of the lower limbs gives , bility in the proximal part material has been through fractionation pro the reason of the absence of static and dynamic carried out on well-known lines. Mr. cesses 1 Il Drummond says it is probable that the loss which Policlinico, Medical Section, Feb. 1st, 1918. ,
"
414
The libraries of the Royal Colleges of Physicians and Surgeons and of the Royal Society of Medicine may be said, when taken together, to cover the whole-or nearly the wholefield of medical literature. In some directions they even cover a wider field than does the lavishly Statesupported library of the Surgeon-General’s DepartHere again, however, ment at Washington. comparative estimates are unnecessary. Our American Allies have certainly got a magnificent library, the index or catalogue of which is a monument of bibliography as useful to English scholars and librarians as to their American congeners. Among the millions of Englishspeaking people there is plenty of room for two great medical library systems-those, namely, of Washington and London. They form no mean portion of those national cultural resources which deserve reconsideration on the eve, let us hope, of a period of reconstruction. medical.
I
PSEUDO-TABES OF TRAUMATIC ORIGIN.
THAT a traumatic lesion of the cauda equina may -simulate in its clinical aspects a sclerosis of the .posterior columns is exemplified in a case recently
published by Dr. A. Mendicini, professor pathology in the University of Rome.
of
neuro-
The patient, a soldier, presented a syndrome characterised by amyosthenia of the legs, more marked on the right side, associated with hypotonia of the muscles, abolition of the Achillar reflexes and the left knee-jerk, Romberg’s sign, ataxic gait, lightning pains, and intermittent paræsthesia, with disturbance of sensation in the regions of the fifth lumbar and all the sacral nerves on both sides, but partly also of the third and fourth right and fourth left lumbar, together with derangement of the functions of micturition and defæcation. These phenomena followed a wound by shell splinters of the lower lumbar vertebrae, which at its onset
caused a complete paralysis. The resemblance to tabes was so marked that the doubt arose whether the patient might not have been the subject of a latent form of locomotor ataxy, but against this supposition it was ascertained that previous to the injury he had no symptoms referable to the nervous system ; moreover, the Argyll-Robertson sign wa3 absent. The seat of the injury and radiographic examination pointed, on the other hand, to a lesion of the cauda equina, the fibres of which were either contused by the ,fragments of shell, which were numerous, although it is more probable that these produced an endothecal haemorrhage. To this and the shock of the wound itself the initial paraplegia was certainly due, which passed off in about three weeks owing to gradual absorption of the blood extravasated into the meningeal sac. In fact, the irritative symptoms (retention of urine, pains, and painful priapism) became gradually lessened without giving place to noticeable paralytic phenomena. The progressive improvement of the patient justified the exclusion of a secondary inflammatory process of the meninges. The pathology of the case therefore resolves itself into one of peripheral radicular pseudo-tabes, which differs from the classic neuro-tabes in the topography of the sensory changes and in the presence of disturbances in the sphincters.
ataxy
in the recumbent
or
sitting posture. In
the contrary, an ataxic gait associated with Romberg’s sign is never met with in con. junction with absolute static and dynamic integrity of the legs in the supine or sitting position, not even in cases of tabes inferior in which the lesion is limited at the onset to the sacral or last lumbar
tabes,
on
roots.
____
THE SCHOOLS FOR BLIND, DEAF, AND DEFECTIVE CHILDREN.
THE Board of Education have recognised that assistance should be given forthwith to local education authorities and to the managers of voluntary institutions to assist them in meeting the additional charges now being incurred in respect of teachers’ salaries and the increased cost of food. They have accordingly decided, as an interim arrangement, to increase the grants payable under the regulations for these special schools. The Regulations which came into operation on April 1st, 1917, are modified : the grant payable each year fora certified school for blind or deaf children will be (1) at the rate of £8 10s. for each unit of average attendance in a certified day school ; (2) at the rate of £16 10s. for each unit of average attendance ina certified boarding school. The grant payable each year for a certified school for defective or epileptic children will be (1) at the rate of JE710s. for each’ unit of average attendance in a certified day school; (2) at the rate of £15 10s. for each unit of average attendance in a certified boarding school. It has also been decided to increase by JE1the grants payable to open-air schools under Part II. of the In an introductory Medical Grant Regulations. note to the circular officially announcing the modifications the Board says :some
The improvement and, indeed, the maintenance, of the efficiency of special schools, as of other types of school, must in a great measure depend upon the provision of a suitably qualified staff of teachers. Such a staff cn only be obtained and retained if adequate salaries are paid, and the Board rely on the school authorities to take the opportunity afforded by the increased grants to provide adequate salaries in special schools, regard being had to the special character of the duties required and the rates of salary payable to teachers of a similar standing in ordinary elementary schools.
We trust that the school authorities will see their way to discharging the responsibility towards their teachers thus placed upon them. THE WATER-SOLUBLE ACCESSORY IN YEAST.
AN interesting investigation on accessory food substances has for some time past been in progress in the bio-chemical laboratory of the Cancer Research Institute, in which the author, Dr. Mendicini’s patient had Romberg’s phenomenon Hospital Mr. J. C. Drummond, set out to isolate and identity and ataxic gait; when in bed, however, or seated the dietary factor B. The results appear in a paper he could move the legs correctly into any position in the December number of the Bio. published and retained the sense of position except in most Chemical Journal. Dietary factor B is the water’ of the toes. This fact is of some importance as soluble substance as distinct from A, accessory showing that only the paths proceeding from the the fat-soluble substance. It is probable that terminal segments of the lower limbs were the so-called " antineuritic vitamine is identical impervious to the transmission of deep sensation; with the water-soluble factor B. Little progress it explains the Romberg sign and disturbance of seems to have been made in elucidating the exact gait, and .demonstrates that if Romberg’s pheno- chemical nature of this substance, although some met with chiefly in relation to menon is of its properties are well known. The chief degeneration of the posterior roots it may also be attempts to isolate the substance have been made caused by simple plantar anaesthesia. On the other with yeast extracts, but the difficulty has been to hand, the retention in this patient of deep sensi- recover the vitamine as such after the raw of the lower limbs gives , bility in the proximal part material has been through fractionation pro the reason of the absence of static and dynamic carried out on well-known lines. Mr. cesses 1 Il Drummond says it is probable that the loss which Policlinico, Medical Section, Feb. 1st, 1918. ,
"