WHAT IS MÉNIÈRE'S DISEASE?

179 The dead lens when compressed left the galvanometer unaffected. When on holiday at the seaside Professor WALLER found that the lens of the fishes’ eye yielded definite reactions, but in London no result could be obtained until supplies were derived directly from the fishermen. Professor WALLER thus found himself in

possession of a his fish-supply ;

test for at

least,

determining

the

work which his master has carried out, but was the unoonscious cause of a wave ofmerriment that spread over the civilised globe when some 12 months ago his antivivisecting

friend

interrogated

passed into a state of fascinating experiments were carried out on leaves ; he selected them because they offered an opportunity of examining living matter spread out in a thin stratum. He found the galvanometer could measure the action of a passing sunbeam on a green leaf ; some leaves like those of the chestnut and ivy were sluggish and sulky"; others, like the "fresh young leaf of the iris, were "lively and communicative." Leaves vary in their reaction according to youth and age, the surrounding light, and heat; they can be made drunk and sober and the degree of their intoxication measured. He found that the vitality

seed should be, they gave a definite electrical tion when compressed ; if they were dead and useless,

good

pression left the galvanometer untouched. can

make

the sensitive

his behalf.

"Ne quid nimis."

MR.

no ear

reaccom-

The seed and the

movement whatsoever which will escape of the galvanometer. Nowadays man

Nature’s ways ; it looks’as if some day he may break through that barrier, hithertodeemed impassable, which separates him from the discovery of the nature of life itself.

Professor WALLER is

a poet among experimenters, as his seen from the references we have made to be may work, but his little book also shows that he is a philosopher among physiologists. He is not one who is

shocked when ni the his

course

of

pursuits desinged only

to

he stumbles across facts which may men. He is interested in more than

curiosity prove useful to practical the reactions of living matter and own

the

signs of life;

he wishes

closer and more amicable relationship between the physiologist and the physician. He recognises two kinds of medical men : those who want to know "-the workers

to establish

a

laboratory benches-and those who " want to help "the workers by the bedside. The two groups, we dare think, are not so antagonistic as Professor,-WALLER believes; medical men combining a desire to know:and a desire to help are not so uncommon. One has only to look round and see

at the

that the methods which Professor WALLER-as

a

manwho

wants to know "-applied in the laboratory some 20 years ago to the study of the human heart are being adopted by the menwho want to help " and have become the methods at the bedside to-day. The galvanometer supplies the clinician with the most delicate means of analysing disturbances in the action of his patient’s heart. There is no better introduction to this new chapter in the electro-

applied

of the heart than that now supplied by Professor WALLER’S little book. Our readers will also find there an introduction to "Jimmie." The bearer of this name is a

pathology

H. W. COX.

MEMBERS of our profession will learn with deep regret of the death of Mr. Harry W. Cox, one of the pioneers of X ray diagnosis, a distinction which practically cost him his life. His sad case was only recently brought into prominence in our columns by an appeal for funds for the sufferer and his family by Sir William Treloar. Several years ago he was compelled to relinquish his business owing to the terrible ravages of X ray dermatitis. He exhibited a marvellous patience in suffering, and in spite of the great infliction which early and repeated contact with the X rays brought him he continued to discuss the possibilities of their future application in ministering to the needs of humanity. Medicine’ owes Mr. Cox a deep debt of gratitude for the instruments which he has placed at its disposal. He was never happier than when he was an induction coil or getting maximum and steady results with his X ray apparatus. He was the author of a good many patents. Mr. Cjx studied also the practical application of wireless telegraphy, and in this field again his genius served him well in the improved results which he obtained by paying great attention to details. His disease, when once established, pursued an unrelenting course, and at length released him in his forty-seventh To his immediate friends, year from unspeakable pain. his wife and family, it must be a consolation to realise how universally his name is regarded as belonging to that illustrious roll of men who have laid down their lives for their fellows.

perfecting

pries very closely into

satisfy

on

But his most

of seeds could be measured ; there was no need to wait for the spring and the sowing to see if they would sprout. If they were all freely and fully alive as

leaf

Secretary

Annotations.

freshness of

he could detect the moment

at which the lens of the -fish had

death.

the Home

WHAT IS

MÉNIÈRE’S

DISEASE?

THERE seems to be considerable confusion on the subject of Meniere’s disease, if we are to judge by the widely varying conditions reported from time to time as instances of that affection : in fact, it may almost be said that the term is applied indiscriminately to any and every case of giddiness associated with a lesion of the ear. The usual description given of the disease is that it consists of a triad of symptoms - tinnitus, giddiness, and vomiting-and that in classical cases the onset is apoplectiform. Other symptoms may be included such as nystagmus, nausea, swaying, fainting, &c., but, as Dr. Alexander Bruce and Dr. J. S. Fraser, of the Royal Infirmary, Edinburgh, remark in a paper on the association of Meniere’s symptoms with facial paralysis, which will be found in the Review of Nemrology and Psychiatry for June, it cannot be too emphatically stated that this "disease picture" is merely that of a lesion of the membranous labyrinth or eighth cranial nerve. It would be preferable to discard the term altogether, since the pathological conditions which may give rise to Meniere’s symptoms are legion. Thus variations in labyrinthine pressure, or excessive movements of the labyrinthine fluid, electrical stimulatioj vascular congestion or ansemia, haemorrhage into the labyrinth

(in caisson disease, traumatism, bleeding diseases, acute or chronic arterio-sclerosis, the exanthemata, &c.), inflammatory conditions, neuritis of the auditory nerve, are pet bulldog and has not only played a part in the pioneer degeneration of the same, tumours, neuroses, &c.-such

180 of the factors producing the condition. As ultimately pathological classification is the only scientific one, and until our knowledge of the aural labyrinth in disease is more complete, we should adopt the suggestion of the authors and speak of M6ni6re’s symptoms rather than Meniere’s disease. It is an interesting fact that almost all the cases of sudden occurrence of Meniere’s symptoms in which a microscopic examination of the inner ear has been made have been cases of leukasmia ; the case here referred to, however, was non-leukaemic. The patient was a piermaster, aged 65 years, who, on Dec. 1st, 1907, had a long day of exposure to cold on the pier, but went to bed at night feeling quite well. The following morning he woke up suffering from extreme giddiness and from deafsome a

and noises in the left ear ; the left side of his face was paralysed, but no history of vomiting was forthcoming. While in bed he felt as if surrounding objects were moving round him, and when he did get up he had to hold on to various articles of furniture in order to get about the house. He tended to fall to the right side, the side opposite to the ear lesion. The diagnosis was made of neuritis of facial and auditory nerves in the internal auditory meatus ; haemorrhage in this situation was also mentioned as a possible cause of the symptoms. There was no evidence of middle-ear disease, and the sense of taste was retained on the tongue; further, herpes auricularis was not present. The patient died suddenly from syncope some months later. The left inner ear and facial and auditory nerves were subjected to a painstaking and detailed examination. Briefly summed up, the condition was as follows : The inner ear was almost normal ; the membranous labyrinth also was almost normal; there was no haemorrhage in the endo- or peri-lymphatic spaces of the cochlea, vestibula, or canals. In the internal auditory meatus there was a considerable amount of haemorrhage between the epineurium and the seventh and eighth nerves: this was most marked above the former. There was no haemorrhage between the dura mater and the epineurium. The vessels in the meatus were markedly thickened and the muscular coat had undergone a hyaline change. The haemorrhage did not extend into the Fallopian canal and did not therefore affeot the geniculate ganglion. ness

THE COLD BATH IN THE PREVENTION AND TREATMENT OF INFANTILE CONVULSIONS. IN the Sozcth frican Medieccd Record recently Mr. M. G. Pearson has brought forward a new view of the pathogenesis and treatment of infantile convulsions. He rightly points out that the long list of causes of convulsions given in the textbooks, ranging from teething and worms to epilepsy and Putting aside gross brain astigmatism, are not causes. disease such as meningitis, Mr. Pearson finds that in all cases of convulsions a high temperature precedes the fit or is present at its onset. The convulsions, therefore, cannot be the cause of the pyrexia. Either the pyrexia is the the convulsions or they both result from a cause of cause. common That the former alternative is true is suggested by the fact that by experimentally raising the temperature of animals convulsions are induced, and by Mr. Pearson’s experience that by keeping down the temperature of children convulsions can be prevented, or, when they have occurred, can be cut short by reducing the temperature. So certain has he become of this that he tells the parents of acutely ill infants that they need not have much fear of convulsions with a temperature under 102° F., that above 103°, no matter what the illness, there is a considerable chance of convulsions, and that it is for them to watch the temperature by means of a thermometer, and

lower it if necessary by cold baths. He compares convulsions to the boiling over of a kettle; they are produced and can be prevented in the same way. Among the cases given to prove this thesis are the following. A boy, aged 4 years, had a deep abscess in the neck. When seen he was unconscious, rigid, twitching, almost pulseless. The rectal temperature was 107°, and he was apparently on the point of death. He was put into a cold bath containing ice. After It then seven minutes the temperature had risen to 108°. began to fall rapidly ; in 12 minutes it was 106°, his limbs He was taken were relaxed, and he began to look around. from the bath and kept nearly naked on the bed with a wall of canisters of ice around him for over an hour. A quarter of an hour after the beginning of the bath he was perfectly conscious. The abscess was cut down upon, but pus could In the evening the temperature rose to not be obtained. 1050 and his hands and arms began to twitch. His father The temperature at once put him into an iced bath. A few hours later pus fell and the twitching stopped. burst through the incision and the trouble ended. A preliminary rise of temperature after putting the child into the cold bath was observed in other cases. It shows that a short bath is useless. The duration of the bath must be regulated by the thermometer in the rectum. But it should be remembered that once the temperature has begun to fall it will continue to do so. In another case, a boy, aged 5 years, had whoopingcough with bronchitis. While in bed his hands began to twitch and his eyes became fixed. The temperature was found to be 103°. The bed-clothes were removed and he was left with no covering except thin pyjamas. Almost directly the twitching ceased and in an hour the temperature fell to 101°. Mr. Pearson thus traverses the current treatment of convulsions by the warm bath and holds that to put a feverish child into a bath, say, 10° hotter than itself can only increase the pyrexia, even though cold be applied to the head." The extent to which a hot bath will raise the temperature, even of a healthy person, is not generally realised. In his own case Mr. Pearson finds that a bath of 106° will raise his temperature 3’5° in a quarter of an hour, and in the case of his son, aged 8 years, the same result is obtained in half the time. If, however, the bath used for convulsions is only warm, as some direct, it will, he thinks, do less harm than a hot bath, and the subsequent exposure in drying will The colder the bath the quicker cause some loss of heat. it will reduce the temperature ; shock may have to be considered and the bath gradually cooled, but in an urgent case there should be no delay. Such are the author’s conclusions, and the matter is one upon which the experience of others is invited.

THE

WORK OF THE GLASGOW PARISH COUNCIL.

WE have received two interesting pamphlets

compiled by Glasgow parish council, the first containing the statistical report of its inspector of the poor for the half year ending May 16th, to which are appended reports by the poorhouse medical officer and the medical superintendents of the parish hospitals ; and the second being a supplementary report by the inspector of the poor upon the work done by the council under the Children Act, 1908. The statistics strike us as commendably complete and as supplying facts and figures relating to a wide variety of subjects, with regard to which the exchange of information between local authorities should be extremely useful. This is likely to be the case more particularly where the working of a new the

authority

Act of

of the

Parliament is

concerned, and when the task of

administering it is necessarily more or less experimental. An example occurs in the reports before us, which shows