"ACUTE TREMOR" IN CHILDREN
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947 lited from 41 to 133 days. There were no recurrences and trypanosomes were not found after death. It was found in other experiments that this substance took two and a half hours to drive out all trypanosomes from the blood. This oil was also given to several rats for recurrences after treat- ment by several doses of the lactates mentioned above, but with much less marked effects, which accords with the general experience of Mr. Plimmer and Captain Fry that recurrences are more difficult to treat than the initial infection. A suspension of the antimony in velk of egg appeared to act better in rats than in any other form, but in dogs the results were variable. Experiments with quassia gave entirely negative results. In regard to arsenophenyl- glycin, with which Professor Ehrlich was able to cure nagana mice in practically every case, they find that with rats the results are not so satisfactory. They have found a similar variability in regard to the effects upon different animals with other drugs-e.g., with the antimony tartrates-with which they can cure surra in rats, but which have much less effect upon rabbits, guinea-pigs, and dogs. In regard to the effect of these various drugs upon the trypanosomes in the living body, the first change noticed is usually a great increase in the motility of the trypanosomes followed by a gradual slowing-down to less than normal. At this stage the organism tends to swell, and this process continues until it becomes almost spherical, or more frequently" battledore " in shape, The protoplasm becomes indistinct, the macro- nucleus eventually breaks up, and the swollen mass dis- integrates. The action of the various trypanocidal substances upon trypanosomes in vitro was also investigated, and from these experiments useful estimates of their probable actions when given to an affected animal were formed. The report is an interesting and useful record of laborious work directed to finding effective treatment for the various forms of disease due to trypanosomes. - "ACUTE TREMOR" IN CHILDREN. THE disease known as encephalitis, a more or less acute inflammation, presumably of toxic origin, of the grey matter of the brain in one or other of its many regions, is by no means uncommon, especially among children. The familiar "infantile paralysis," or acute inflammation of the anterior horns of grey matter of the spinal cord, is recognised to-day to be a disease of infective origin, with a seasonal variation of incidence, occurring not infrequently in epidemics, and in all probability attributable to a definite pathogenic organism possibly entering the body by the respiratory tract. There is evidence to show that the same or an allied morbific agent may attack the grey matter of the central nervous system at higher levels, and certain clinical types have been clearly differentiated according to the area affected. If the nuclei of the cranial nerves are singled out, we have the condition described by Wernicke as polioencephalitis superior or inferior, as the case may be, though doubt- less other agents than the one here considered may produce the same symptoms. Encephalitis cerebelli, II pathological condition of much interest, is responsible for certain cases of acute ataxia, more particularly among children. The clinical history of these cases is very similar to that of many cases of poliomyelitis. In a recent number of Brain, Dr. Reginald H. Miller, of Paddington Green Children’s Hospital, has reported six instances that have come under his own notice of acute tremor developing in children as the result of an illness which closely resembles, in its clinical features, poliomyelitis anterior acuta. The child who is attacked by the latter disease is often strong and fat, and this rule held good in Dr. Miller’s cases. They were all children between the ages of 18 months and five and a half years, who fell ill in summer or autumn. After a varying degree of constitutional disturbance, with or without convulsions and unconsciousness, tremor appeared in the limbs or trunk or head and neck, or all, and was continuously present, except during sleep, in the severer cases, although increased by voluntary movement, while in the slighter cases it showed itself only on voluntary movement or during periods of excite- ment. Its rate was about five to the second, more or less rhythmical and regular, the appearance of the child being not unlike that of one shivering all over from cold. In addition, a certain amount of hypertonicity of the affected limbs was observed, but the plantar responses were always flexor in type. Dr. Miller considers that the tremor is occasioned by a disturbance in the function of the cerebello- rubro-spinal system. This is a motor system which links the dentate nucleus of the cerebellum viâ the superior cerebellar peduncle with the red nucleus of the opposite side, thence crosses again to the spinal cord on the same side, being known in the latter section as Monakow’s bundle. It has been shown that the post-hemiplegic tremor so characteristic a feature of the crossed hemi- plegia described by Benedikt, and called after him Benedikt’s syndrome-ophthalmoplegia on one side and tremor on the opposite side of the body-is probably due to interruption of this system of fibres, and Dr. Miller aptly suggests that the symptoms in his cases, sudden onset of tremor after a brief period of typical malaise, point to an affection in the neighbourhood of the red nuclei of the nature of encephalitis, with consequent impairment of the cerebello- rubro-spinal system in some part of its extent. There is no pathological confirmation of this view at present, for the illness is usually recovered from, and indeed this is true of very many cases of encephalitis, rendering it difficult to adduce data of a pathological nature on which to base the well-recognised clinical types of the disease in question. Until more definite knowledge is available Dr. Miller’s symptomatological term of "acute tremor affords a con- venient and useful label for this unusual condition. THE Home Secretary has signified to the Council of the Royal College of Surgeons of England his approval of the by-laws concerning the admission of women to the exa- minations for the diplomas of the College, and will sign the formal document which will be submitted to him after the next meeting of the College. Women will accordingly be admitted to sit for the examinations of the College in January. - Sir Richard Douglas Powell, who is abroad, but who will return home at the beginning of October, has given up his house in Wimpole-street. His private and professional address will be henceforth, llB, Portland-place, London, W. Dr. E. A. Wilson of Cheltenham, who was the medical officer, geologist, and artist on the Discovery, has accepted the post of medical officer for Captain Scott’s expedition to the South Pole. ___ A TELEGRAM from the Governor of Mauritius to the Secre- tary of State for the Colonies states that nine cases of plague with six deaths were reported during the week ending Sept. 16th. ROYAL DENTAL HOSPITAL OF LONDON.-The medical staff and lecturers of this hospital have issued invitations to a conversazione and distribution of prizes by Sir Victor Horsley, F.R.C.S. Eng., F.R.S., on Wednesday, Oct. 20th, at 8 for 8.30 P.M., at the Royal Institute Galleries, Princes Hall, Piccadilly, W.
Transcript of "ACUTE TREMOR" IN CHILDREN
947
lited from 41 to 133 days. There were no recurrences and
trypanosomes were not found after death. It was found in
other experiments that this substance took two and a halfhours to drive out all trypanosomes from the blood. This
oil was also given to several rats for recurrences after treat-ment by several doses of the lactates mentioned above,but with much less marked effects, which accords with
the general experience of Mr. Plimmer and Captain Frythat recurrences are more difficult to treat than the initial
infection. A suspension of the antimony in velk of egg
appeared to act better in rats than in any other form, but indogs the results were variable. Experiments with quassiagave entirely negative results. In regard to arsenophenyl-glycin, with which Professor Ehrlich was able to cure naganamice in practically every case, they find that with rats theresults are not so satisfactory. They have found a similarvariability in regard to the effects upon different animalswith other drugs-e.g., with the antimony tartrates-withwhich they can cure surra in rats, but which have
much less effect upon rabbits, guinea-pigs, and dogs.In regard to the effect of these various drugsupon the trypanosomes in the living body, the first
change noticed is usually a great increase in the
motility of the trypanosomes followed by a gradualslowing-down to less than normal. At this stage the
organism tends to swell, and this process continues until itbecomes almost spherical, or more frequently" battledore
"
in shape, The protoplasm becomes indistinct, the macro-nucleus eventually breaks up, and the swollen mass dis-
integrates. The action of the various trypanocidal substancesupon trypanosomes in vitro was also investigated, and fromthese experiments useful estimates of their probable actionswhen given to an affected animal were formed. The reportis an interesting and useful record of laborious work directedto finding effective treatment for the various forms of diseasedue to trypanosomes.
-
"ACUTE TREMOR" IN CHILDREN.
THE disease known as encephalitis, a more or less acute
inflammation, presumably of toxic origin, of the grey matterof the brain in one or other of its many regions, is by nomeans uncommon, especially among children. The familiar
"infantile paralysis," or acute inflammation of the anteriorhorns of grey matter of the spinal cord, is recognised to-dayto be a disease of infective origin, with a seasonal variationof incidence, occurring not infrequently in epidemics, and inall probability attributable to a definite pathogenic organismpossibly entering the body by the respiratory tract. Thereis evidence to show that the same or an allied morbific agentmay attack the grey matter of the central nervous system at
higher levels, and certain clinical types have been clearlydifferentiated according to the area affected. If thenuclei of the cranial nerves are singled out, we havethe condition described by Wernicke as polioencephalitissuperior or inferior, as the case may be, though doubt-less other agents than the one here considered mayproduce the same symptoms. Encephalitis cerebelli, IIpathological condition of much interest, is responsible forcertain cases of acute ataxia, more particularly amongchildren. The clinical history of these cases is very similarto that of many cases of poliomyelitis. In a recent numberof Brain, Dr. Reginald H. Miller, of Paddington GreenChildren’s Hospital, has reported six instances that havecome under his own notice of acute tremor developing inchildren as the result of an illness which closely resembles,in its clinical features, poliomyelitis anterior acuta. Thechild who is attacked by the latter disease is often strongand fat, and this rule held good in Dr. Miller’s cases. Theywere all children between the ages of 18 months and five
and a half years, who fell ill in summer or autumn. Aftera varying degree of constitutional disturbance, with or withoutconvulsions and unconsciousness, tremor appeared in the limbsor trunk or head and neck, or all, and was continuously present,except during sleep, in the severer cases, although increased byvoluntary movement, while in the slighter cases it showeditself only on voluntary movement or during periods of excite-ment. Its rate was about five to the second, more or lessrhythmical and regular, the appearance of the child beingnot unlike that of one shivering all over from cold. In
addition, a certain amount of hypertonicity of the affectedlimbs was observed, but the plantar responses were alwaysflexor in type. Dr. Miller considers that the tremor is
occasioned by a disturbance in the function of the cerebello-rubro-spinal system. This is a motor system which links thedentate nucleus of the cerebellum viâ the superior cerebellarpeduncle with the red nucleus of the opposite side,thence crosses again to the spinal cord on the same
side, being known in the latter section as Monakow’sbundle. It has been shown that the post-hemiplegictremor so characteristic a feature of the crossed hemi-
plegia described by Benedikt, and called after him
Benedikt’s syndrome-ophthalmoplegia on one side andtremor on the opposite side of the body-is probably due tointerruption of this system of fibres, and Dr. Miller aptlysuggests that the symptoms in his cases, sudden onset of
tremor after a brief period of typical malaise, point to anaffection in the neighbourhood of the red nuclei of the natureof encephalitis, with consequent impairment of the cerebello-rubro-spinal system in some part of its extent. There is no
pathological confirmation of this view at present, for the
illness is usually recovered from, and indeed this is true of
very many cases of encephalitis, rendering it difficult to
adduce data of a pathological nature on which to base thewell-recognised clinical types of the disease in question.Until more definite knowledge is available Dr. Miller’s
symptomatological term of "acute tremor affords a con-venient and useful label for this unusual condition.
THE Home Secretary has signified to the Council of theRoyal College of Surgeons of England his approval of theby-laws concerning the admission of women to the exa-minations for the diplomas of the College, and will sign theformal document which will be submitted to him after thenext meeting of the College. Women will accordingly beadmitted to sit for the examinations of the College in
January. -
Sir Richard Douglas Powell, who is abroad, but who willreturn home at the beginning of October, has given up hishouse in Wimpole-street. His private and professionaladdress will be henceforth, llB, Portland-place, London, W.
Dr. E. A. Wilson of Cheltenham, who was the medicalofficer, geologist, and artist on the Discovery, has acceptedthe post of medical officer for Captain Scott’s expedition tothe South Pole.
___
A TELEGRAM from the Governor of Mauritius to the Secre-
tary of State for the Colonies states that nine cases of plaguewith six deaths were reported during the week endingSept. 16th.
ROYAL DENTAL HOSPITAL OF LONDON.-Themedical staff and lecturers of this hospital have issuedinvitations to a conversazione and distribution of prizes bySir Victor Horsley, F.R.C.S. Eng., F.R.S., on Wednesday,Oct. 20th, at 8 for 8.30 P.M., at the Royal InstituteGalleries, Princes Hall, Piccadilly, W.
