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TREATMENT OF DIPHTHERITIC PARALYSIS WITH ANTITOXIN.
243
THE IMPERIAL CANCER RESEARCH FUND.
regards tobacco, liquorice and glycerine appear to be the himself he may fancy he detects its odour in the breath of a chief foreign ingredients added, which agrees with our own person under examination. Finally, it would be useful to statements on the subject. Other substances found were know if it is common for a smell to appear as an epileptic and if it ever happens that we smell in our dreams. logwood and paraffin wax, neither of which, of course, is of 19 were found to consamples cigarettes poisonous. tain percussion caps and in one gunpowder was found.
aura
,
THE IMPERIAL CANCER
These were doubtless added to assist the combustion of the tobacco but it may be pointed out that nitrate of potassium is frequently a normal constituent of tobacco leaf. There seems to be an increasing importation of " skimmilk"cheese which comes chiefly from Holland. In one instance the cheese contained only 3’ 3 per cent. of fat. An interesting observation was made in regard to the examination of certain fishes taken from a river which was believed to have received the arsenical drainings from a mine in its vicinity. Arsenic was found to be present in the fish, and in another instance salmon peel taken from a stream at Lostwithiel, and supposed to have been poisoned with copper from mine drainage, were found to contain an appreciable quantity of copper. Altogether the annual reports from the Government Laboratory are invariably full of matters of interest to the nation and the one just issued is no
,
exception.
--
DIAGNOSIS BY SMELL. THE very
interesting letter from Dr. J. Burton ClelandI correspondence columns last weekgave several1 examples of diseases and conditions which might reveal them-
in
our
.
RESEARCH FUND.
THE annual meeting of the Imperial Cancer Research Fund was held on July 25th at the Examination Hall of the Royal Colleges on the Embankment. Reports from the executive committee, the general superintendent, and the honorary treasurer were read. It was announced that the difficulty which had arisen with the Post Office concerning the transmission through the post of specimens of cancer had been satisfactorily cleared up in the month of March. The report of Dr. E. F. Bashford, the general superintendent, contained matters of great interest concerning the growth of cancer and the possibility of protecting mice from the consequences of experimental cancer. Dr. Bashford points out that the results of these experiments only indicate the possibility of rendering normal mice unsuitable for the growth of experimental cancer. They have not enabled us to arrest the progress of experimental tumours, far less to effect the cure of the disease occurring naturally." It is well, we think, that the report should contain these words, for the members of the public at large are only too prone to catch at any straw which may appear to offer a chance of saving themselves from the abyss of cancer. We are beginning to We hope to see light on the problem but only a glimmer. treat the matter contained in the report at greater length in
of smell of the medical adviser. Hee instanced diabetes, enteric fever, acute rheumatism, plague, and retained placenta. The use of the nostrils in practical1 a future issue. life is continually being more or less ignored. The mouthTREATMENT OF DIPHTHERITIC PARALYSIS breather forgets that originally the breath of life was WITH ANTITOXIN. breathed into man’s nostrils ; too often he breathes the breath of death through his mouth, for by the use of that THE value of antitoxin in the treatment of diphtheria is channel he forfeits one of the protective mechanisms with now one of the best-established facts of therapeutics. But which he has been endowed. Nostril breathers are able to antitoxin does not appear to be used after the attack for the detect at once if any putrescent nidus is in the vicinity and treatment of the most important sequel-the paralysis. At thereupon they will remove it or else themselves. It is the meeting of the Societe Medicale des Hopitaux of Paris notorious that the sense of smell (thescent ") of animals is on June 15th M. J. Corn by read an important paper on this often highly developed. It is stated that the odour emitted use of antitoxin, to which we have previously referred.1 He from a small-pox patient will attract cheetahs from afar; first this in treatment 1904, and since that July, published flies soon settle on decomposing matter, on tuberculous time a number of successful cases have been recorded by sputum, and, as was a common experience during the late himself and other French writers. The following is an South African campaign, over the heads of enteric fever example. A man, aged 50 years, contractel a sore-throat patients. A peculiar smell with its associations is vividly for which only local treatment was used. Some days later recalled when perhaps years later it next reaches the he noticed a nasal intonation of the voice and regurgitation olfactory area. Among other diseases than those above of fluid through the nose. These symptoms were only mentioned which can be diagnosed, with more or less ephemeral, but some weeks later he had difficulty in certainty, by the sen?e of smell are abdominal fistula, walking and soon he became unable to leave his room. On bronchiectasis, cancers (undressed), some cases of erysipelas, examination atheromatous arteries, absent knee-jerks, and an favus (acetamide), some cases of fracture of the skull, aortic systolic murmur were found. Suspecting diphtheria, gangrene of the lung, ozaena foetida, baemorrhoids (bleeding), though entertaining the question of a vascular lesion of the pyaemia, septic mouth, stillicidium urioas, and undressedl nervous system, four injections, making a total of 80 cubic varicose ulcers. The odours of excreta are sometimes a usefulI centimetres of antitoxin, were given in four days. Almost aid to diagnosis ; thus tuberculous sputum smells like soakedI immediate improvement ensued and recovery took place in bread. It has been noticed frequently that after conducting eight days. ;n another case a girl, aged 14 years, was a post-mortem examination upon a highly-odoured corpse the into admitted hospital on March 24th last. On Jan. 14th faeces of the operator will for about two days emit a similarr she had a severe sore-throat, with formation of membrane, stench. Drugs may reveal themselves in the breath or other- which was not treated with antitoxin. A short time afterwise and thus give a clue to the malady for which they havee wards the voice became nasal, liquid regurgitated through the been prescribed-thus alcohol, antimony, assafoetida, garlic,’ and there were strabismus and diplopia. These symptoms nose, and iodoform. Similarly, a man who constantly when inn lasted for a short A fortnight before admission time. only public sucks a cachou or a mint-drop probably has very badd she had difficulty in walking which increased until the lower teeth and consequently foul breath. There is one cautionlimbs were completely paralysed. The upper limbs were which must be heeded-there may be an error in the.e affected in less degree. There was also paralysis of the observer’s own nostrils ; he may have lost his own sense oi)f trunk and neck ; the child could not sit up in bed or lift the smell, as after an attack of influenza or having taken alcohol)1 head. The knee-jerks were absent. In a great number
selves to the
sense
,
__
I
’
1
THE LANCET,
July 21st,
p. 188.
1
THE LANCET,
Juy 7th, 1906,
54. p.
THE COMPLICATIONS OF MUMPS.
244
of muscles both galvanic and faradic excitability was abolished. On March 25th and 26th two injections of 20 cubic centimetres of Roux’s antitoxin were given, and on
doubtless due to the further spread and activity of the specific oausative agent. The peculiarity of the special liability to infect the genital glands has long been known the 27th, 28h, and 29th three injections of ten cubic centi- and orchitis is generally recognised as one of the most metres (70 cubic centimetres in all). On the second day of serious complications of the disease. It may occur without the treatment the patient easily moved her legs. At the any parotid inflammation in rare cases and the possibility of end of the treatment she could sit up in bed. After a week this should be borne in mind during the course of an epirecovery was complete except that the knee-jerks were still demic of the disease. It more usually occurs in the third or absent. M. Comby has treated nine cases of diphtheritic fourth week of the disease and lasts for a week or less, being paralysis by this method and in all rapid recovery occurred. not infrequently followed by rapid atrophy of the testicle In most of the cases the paralysis was severe and took a affected by it. Comby found that this atrophy occurred in generalised or an ascending form. Previously fatal cases 103 instances among 163 cases of orchitis following mumps. of his cases of late diphtheritic paralysis were several. M. Ovaritis, salpingitis, vulvo-vaginitis with oedema of the vulva, Comby drew the following conclusions. 1. Every case of and mastitis occur in female cases, but more rarely. A singular diphtheritic paralysis, early or late, localised or generalised, difference between the incidence of the secondary inflamma. should be treated with antitoxin. 2. The injections should tions in the two sexes is that whereas orchitis occurs almost be given on several days in succession in doses of from ten to invariably after the age of puberty, the ovaritis, vulvo20 cubic centimetres, according to the age, so that a total vaginitis, and mastitis may occur in young female children. quantity of 60 to 80 cubic centimetres of Roux’s serum is It has been stated that pancreatitis may occur after given. 3. These injections are usually well tolerated and mumps, and a case has been described4 in which a only exceptionally produce any symptoms. 4. Neither the boy developed pain in the abdomen on the fourth day with age of the patient nor his previous state of health is a a tender swelling in the epigastrium. Lacrymal mumps contra-indication. The injections should be given even has also been described by Hirschberg. Among the com. when.antitoxin has been administered in the stage of sore- plications of the disease those affecting the nervous throat. system demand special notice. High fever associated with delirium may occur in uncomplicated cases, probably THE COMPLICATIONS OF MUMPS. from toxsemia, but occasionally signs of meningitis and AN interesting letter relating to the serious nature of even of involvement of the brain itself are observed the complications which may be associated with mumps in and such signs have occurred in nearly all the fatal adults was published in THE LANCET of July 21st by Major cases hitherto recorded. Peripheral neuritis has also been F. Smith, R.A.lB1.C. In an outbreak of that disease among occasionally observed to follow the disease. Major Smith some troops under his charge Major Smith found that five observed marked weakness of the lower limbs in several of cases out of a total of 11 had more or less serious comhis cases. Acute mania was observed in association with the plications, and he enters a noteworthy plea for the disease by Dr. R. Percy Smith.5 Of affections of the special more serious consideration of that disease which is too senses, one of the most common and serious is deafness, often regarded as of a trivial character. Although mumps which may be due to otitis from spread of inflammation to or epidemic parotitis is a highly contagious disease, yet the middle ear by the Eustachian tube, when it is usually the susceptibility to infection after exposure seems less recovered from, or to an actual incurable nerve deafness general than in the case of many other specific from affection of the labyrinth or of the nucleus of the contagious diseases ; as a consequence, not a few escape auditory nerve. This condition may occur in the second infection in childhpod, but epidemics from time to time week and may be preceded by tinnitus, vertigo, vomiting, occur in young adults, notably among soldiers or recruits. and fever. Optic neuritis followed by atrophy has also been Several epidemics of this kind with a considerable pro- described but it is a sequel of extreme rarity. Other conportion of serious complications or sequel have been ditions described as occurring in association with mumps are recorded by French army surgeons. Moreover, second endocarditis, pericarditis, arthritis, nephritis with ursemia, attacks of the disease, though rare, are by no means albuminuria, epistaxis, pneumonia, digestive disturbances unknown and the attacks in these circumstances are with jaundice, enlargement of the spleen, and certain skin often severe, according to Danchez.1 The severe cases of eruptions. The mildness of the typical disease as it occurs mumps and those characterised by serious complications in children and the rapidity with which convalescence occur for the most part in those above the age of 12 years follows in uncomplicated cases have served to distract and particularly in adults. The list of complications and attention from the severe character of some of the associated troublesome after-effects is a long and formidable one conditions, and since many of these are more likely to occur according to recent observations, and these are not neces- after neglect or exposure during the course of the disease sarily associated with marked local conditions. Indeed, it is obviously of great importance that even in mild severe local complications are extremely rare. Suppuration in cases, especially in adults, the utmost care should be taken or about the gland is very uncommon and is then doubtless to treat them seriously and from the first appearance of due to a secondary septic infection by way of the ducts of the the symptoms. Major Smith’s interesting letter serves a glands ; gangrene of the parotid gland is of even greater useful purpose in emphasising the importance of the rarity. The facial paralysis which appears in some cases is recognition of the serious character of the disease. probably due to compression of the facial nerve or to extension of the inflammatory process to its sheath, since THE EMPLOYMENT OF A SPECIAL PATHOit is a rule partial and temporary, recovering without LOGIST BY A CORONER. treatment in from six to ten It was are
___
days.
special
times in 60 cases among young soldiers and Petges.2 Suppression of the Courand by flow has also been observed to follow mumps.3 salivary the most serious Among complications are the socalled metastatic inflammations or metastases. These observed recorded
2
seven
1 La France Médicale, July 21st, 1900. Archiv de Médicine et de Pharmacie Militaire, 1899, p. 3 THE LANCET, June 23rd, 1883, p. 1087.
185.
THE report of Cockerton) on the
the district auditor
(Mr. T. Barclay County Council Monday. The report
accounts of the London
for the year 1904-05 was circulated on says : "In the course of the audit the British Medical Association, represented by their counsel, together with other 4
H. W. Jacob: Brit. Med. Jour., June 23rd, 1900, 5 THE LANCET, August 10th, 1889, p. 265.
p. 1532.
THE IMPERIAL CANCER RESEARCH FUND.
regards tobacco, liquorice and glycerine appear to be the himself he may fancy he detects its odour in the breath of a chief foreign ingredients added, which agrees with our own person under examination. Finally, it would be useful to statements on the subject. Other substances found were know if it is common for a smell to appear as an epileptic and if it ever happens that we smell in our dreams. logwood and paraffin wax, neither of which, of course, is of 19 were found to consamples cigarettes poisonous. tain percussion caps and in one gunpowder was found.
aura
,
THE IMPERIAL CANCER
These were doubtless added to assist the combustion of the tobacco but it may be pointed out that nitrate of potassium is frequently a normal constituent of tobacco leaf. There seems to be an increasing importation of " skimmilk"cheese which comes chiefly from Holland. In one instance the cheese contained only 3’ 3 per cent. of fat. An interesting observation was made in regard to the examination of certain fishes taken from a river which was believed to have received the arsenical drainings from a mine in its vicinity. Arsenic was found to be present in the fish, and in another instance salmon peel taken from a stream at Lostwithiel, and supposed to have been poisoned with copper from mine drainage, were found to contain an appreciable quantity of copper. Altogether the annual reports from the Government Laboratory are invariably full of matters of interest to the nation and the one just issued is no
,
exception.
--
DIAGNOSIS BY SMELL. THE very
interesting letter from Dr. J. Burton ClelandI correspondence columns last weekgave several1 examples of diseases and conditions which might reveal them-
in
our
.
RESEARCH FUND.
THE annual meeting of the Imperial Cancer Research Fund was held on July 25th at the Examination Hall of the Royal Colleges on the Embankment. Reports from the executive committee, the general superintendent, and the honorary treasurer were read. It was announced that the difficulty which had arisen with the Post Office concerning the transmission through the post of specimens of cancer had been satisfactorily cleared up in the month of March. The report of Dr. E. F. Bashford, the general superintendent, contained matters of great interest concerning the growth of cancer and the possibility of protecting mice from the consequences of experimental cancer. Dr. Bashford points out that the results of these experiments only indicate the possibility of rendering normal mice unsuitable for the growth of experimental cancer. They have not enabled us to arrest the progress of experimental tumours, far less to effect the cure of the disease occurring naturally." It is well, we think, that the report should contain these words, for the members of the public at large are only too prone to catch at any straw which may appear to offer a chance of saving themselves from the abyss of cancer. We are beginning to We hope to see light on the problem but only a glimmer. treat the matter contained in the report at greater length in
of smell of the medical adviser. Hee instanced diabetes, enteric fever, acute rheumatism, plague, and retained placenta. The use of the nostrils in practical1 a future issue. life is continually being more or less ignored. The mouthTREATMENT OF DIPHTHERITIC PARALYSIS breather forgets that originally the breath of life was WITH ANTITOXIN. breathed into man’s nostrils ; too often he breathes the breath of death through his mouth, for by the use of that THE value of antitoxin in the treatment of diphtheria is channel he forfeits one of the protective mechanisms with now one of the best-established facts of therapeutics. But which he has been endowed. Nostril breathers are able to antitoxin does not appear to be used after the attack for the detect at once if any putrescent nidus is in the vicinity and treatment of the most important sequel-the paralysis. At thereupon they will remove it or else themselves. It is the meeting of the Societe Medicale des Hopitaux of Paris notorious that the sense of smell (thescent ") of animals is on June 15th M. J. Corn by read an important paper on this often highly developed. It is stated that the odour emitted use of antitoxin, to which we have previously referred.1 He from a small-pox patient will attract cheetahs from afar; first this in treatment 1904, and since that July, published flies soon settle on decomposing matter, on tuberculous time a number of successful cases have been recorded by sputum, and, as was a common experience during the late himself and other French writers. The following is an South African campaign, over the heads of enteric fever example. A man, aged 50 years, contractel a sore-throat patients. A peculiar smell with its associations is vividly for which only local treatment was used. Some days later recalled when perhaps years later it next reaches the he noticed a nasal intonation of the voice and regurgitation olfactory area. Among other diseases than those above of fluid through the nose. These symptoms were only mentioned which can be diagnosed, with more or less ephemeral, but some weeks later he had difficulty in certainty, by the sen?e of smell are abdominal fistula, walking and soon he became unable to leave his room. On bronchiectasis, cancers (undressed), some cases of erysipelas, examination atheromatous arteries, absent knee-jerks, and an favus (acetamide), some cases of fracture of the skull, aortic systolic murmur were found. Suspecting diphtheria, gangrene of the lung, ozaena foetida, baemorrhoids (bleeding), though entertaining the question of a vascular lesion of the pyaemia, septic mouth, stillicidium urioas, and undressedl nervous system, four injections, making a total of 80 cubic varicose ulcers. The odours of excreta are sometimes a usefulI centimetres of antitoxin, were given in four days. Almost aid to diagnosis ; thus tuberculous sputum smells like soakedI immediate improvement ensued and recovery took place in bread. It has been noticed frequently that after conducting eight days. ;n another case a girl, aged 14 years, was a post-mortem examination upon a highly-odoured corpse the into admitted hospital on March 24th last. On Jan. 14th faeces of the operator will for about two days emit a similarr she had a severe sore-throat, with formation of membrane, stench. Drugs may reveal themselves in the breath or other- which was not treated with antitoxin. A short time afterwise and thus give a clue to the malady for which they havee wards the voice became nasal, liquid regurgitated through the been prescribed-thus alcohol, antimony, assafoetida, garlic,’ and there were strabismus and diplopia. These symptoms nose, and iodoform. Similarly, a man who constantly when inn lasted for a short A fortnight before admission time. only public sucks a cachou or a mint-drop probably has very badd she had difficulty in walking which increased until the lower teeth and consequently foul breath. There is one cautionlimbs were completely paralysed. The upper limbs were which must be heeded-there may be an error in the.e affected in less degree. There was also paralysis of the observer’s own nostrils ; he may have lost his own sense oi)f trunk and neck ; the child could not sit up in bed or lift the smell, as after an attack of influenza or having taken alcohol)1 head. The knee-jerks were absent. In a great number
selves to the
sense
,
__
I
’
1
THE LANCET,
July 21st,
p. 188.
1
THE LANCET,
Juy 7th, 1906,
54. p.
THE COMPLICATIONS OF MUMPS.
244
of muscles both galvanic and faradic excitability was abolished. On March 25th and 26th two injections of 20 cubic centimetres of Roux’s antitoxin were given, and on
doubtless due to the further spread and activity of the specific oausative agent. The peculiarity of the special liability to infect the genital glands has long been known the 27th, 28h, and 29th three injections of ten cubic centi- and orchitis is generally recognised as one of the most metres (70 cubic centimetres in all). On the second day of serious complications of the disease. It may occur without the treatment the patient easily moved her legs. At the any parotid inflammation in rare cases and the possibility of end of the treatment she could sit up in bed. After a week this should be borne in mind during the course of an epirecovery was complete except that the knee-jerks were still demic of the disease. It more usually occurs in the third or absent. M. Comby has treated nine cases of diphtheritic fourth week of the disease and lasts for a week or less, being paralysis by this method and in all rapid recovery occurred. not infrequently followed by rapid atrophy of the testicle In most of the cases the paralysis was severe and took a affected by it. Comby found that this atrophy occurred in generalised or an ascending form. Previously fatal cases 103 instances among 163 cases of orchitis following mumps. of his cases of late diphtheritic paralysis were several. M. Ovaritis, salpingitis, vulvo-vaginitis with oedema of the vulva, Comby drew the following conclusions. 1. Every case of and mastitis occur in female cases, but more rarely. A singular diphtheritic paralysis, early or late, localised or generalised, difference between the incidence of the secondary inflamma. should be treated with antitoxin. 2. The injections should tions in the two sexes is that whereas orchitis occurs almost be given on several days in succession in doses of from ten to invariably after the age of puberty, the ovaritis, vulvo20 cubic centimetres, according to the age, so that a total vaginitis, and mastitis may occur in young female children. quantity of 60 to 80 cubic centimetres of Roux’s serum is It has been stated that pancreatitis may occur after given. 3. These injections are usually well tolerated and mumps, and a case has been described4 in which a only exceptionally produce any symptoms. 4. Neither the boy developed pain in the abdomen on the fourth day with age of the patient nor his previous state of health is a a tender swelling in the epigastrium. Lacrymal mumps contra-indication. The injections should be given even has also been described by Hirschberg. Among the com. when.antitoxin has been administered in the stage of sore- plications of the disease those affecting the nervous throat. system demand special notice. High fever associated with delirium may occur in uncomplicated cases, probably THE COMPLICATIONS OF MUMPS. from toxsemia, but occasionally signs of meningitis and AN interesting letter relating to the serious nature of even of involvement of the brain itself are observed the complications which may be associated with mumps in and such signs have occurred in nearly all the fatal adults was published in THE LANCET of July 21st by Major cases hitherto recorded. Peripheral neuritis has also been F. Smith, R.A.lB1.C. In an outbreak of that disease among occasionally observed to follow the disease. Major Smith some troops under his charge Major Smith found that five observed marked weakness of the lower limbs in several of cases out of a total of 11 had more or less serious comhis cases. Acute mania was observed in association with the plications, and he enters a noteworthy plea for the disease by Dr. R. Percy Smith.5 Of affections of the special more serious consideration of that disease which is too senses, one of the most common and serious is deafness, often regarded as of a trivial character. Although mumps which may be due to otitis from spread of inflammation to or epidemic parotitis is a highly contagious disease, yet the middle ear by the Eustachian tube, when it is usually the susceptibility to infection after exposure seems less recovered from, or to an actual incurable nerve deafness general than in the case of many other specific from affection of the labyrinth or of the nucleus of the contagious diseases ; as a consequence, not a few escape auditory nerve. This condition may occur in the second infection in childhpod, but epidemics from time to time week and may be preceded by tinnitus, vertigo, vomiting, occur in young adults, notably among soldiers or recruits. and fever. Optic neuritis followed by atrophy has also been Several epidemics of this kind with a considerable pro- described but it is a sequel of extreme rarity. Other conportion of serious complications or sequel have been ditions described as occurring in association with mumps are recorded by French army surgeons. Moreover, second endocarditis, pericarditis, arthritis, nephritis with ursemia, attacks of the disease, though rare, are by no means albuminuria, epistaxis, pneumonia, digestive disturbances unknown and the attacks in these circumstances are with jaundice, enlargement of the spleen, and certain skin often severe, according to Danchez.1 The severe cases of eruptions. The mildness of the typical disease as it occurs mumps and those characterised by serious complications in children and the rapidity with which convalescence occur for the most part in those above the age of 12 years follows in uncomplicated cases have served to distract and particularly in adults. The list of complications and attention from the severe character of some of the associated troublesome after-effects is a long and formidable one conditions, and since many of these are more likely to occur according to recent observations, and these are not neces- after neglect or exposure during the course of the disease sarily associated with marked local conditions. Indeed, it is obviously of great importance that even in mild severe local complications are extremely rare. Suppuration in cases, especially in adults, the utmost care should be taken or about the gland is very uncommon and is then doubtless to treat them seriously and from the first appearance of due to a secondary septic infection by way of the ducts of the the symptoms. Major Smith’s interesting letter serves a glands ; gangrene of the parotid gland is of even greater useful purpose in emphasising the importance of the rarity. The facial paralysis which appears in some cases is recognition of the serious character of the disease. probably due to compression of the facial nerve or to extension of the inflammatory process to its sheath, since THE EMPLOYMENT OF A SPECIAL PATHOit is a rule partial and temporary, recovering without LOGIST BY A CORONER. treatment in from six to ten It was are
___
days.
special
times in 60 cases among young soldiers and Petges.2 Suppression of the Courand by flow has also been observed to follow mumps.3 salivary the most serious Among complications are the socalled metastatic inflammations or metastases. These observed recorded
2
seven
1 La France Médicale, July 21st, 1900. Archiv de Médicine et de Pharmacie Militaire, 1899, p. 3 THE LANCET, June 23rd, 1883, p. 1087.
185.
THE report of Cockerton) on the
the district auditor
(Mr. T. Barclay County Council Monday. The report
accounts of the London
for the year 1904-05 was circulated on says : "In the course of the audit the British Medical Association, represented by their counsel, together with other 4
H. W. Jacob: Brit. Med. Jour., June 23rd, 1900, 5 THE LANCET, August 10th, 1889, p. 265.
p. 1532.