ANÆSTHETIC LEPROSY: CHANGES IN THE NERVES AND SPINAL CORD: NECROPSY
1
1243 company may be congratulated on the successful result of their action and it must also be a source of gratification to the more enlightened of the inhabitants of Havant that their I health and the good name of their town are, at any rate so far as they depend on modern drainage, no longer to be left to the mercy of such incapable sanitarians as the Havant District Councillors have proved themse!ves to be. SIR WILLIAM TURNER, D.Sc. THE following were the words of the Public Orator, Dr. Sandys of St. John’s College, in presenting Sir William Turner for the honorary degree of Doctor of Science at Cambridge on Thursday, April 27th:- Virum regni totius medicorum concilio praepositum, virum bonoribus academicis plurimis cumulatum, etiam noster .8enatus titulo suo decorare anno proximo decrevit. Inter Lancastrienses natus, inter Londinienses educatus, inter Edinenses. medicinae in schola celeberrima, quam tot ’coloniae Britannicae studiorum medicorum quasi p:fJTp6rro^L" venerantur, anatomiae scientiam per annos plus quam triginta praeclare professus, non modo Universitati suae aedificiis jiovis instruendae operam insignem dedit, sed etiam studiorum suorum actis per seriem edendis iamdudum maxima cum laude praefuit. Idem, rerum naturae spoliis olim in Britanniam feliciter reportatis, Australasiae praesertim anthropologiam opere in magno accuratissime expositam luculenter illustravit. Nuper societatis Britannicae scien- tiarum finibus proferendis praeses in annum proximum designatus, ab eadem disputationibus de anthropologiae scientia etiam inter Canadenses habendis haud ita pridem praepositus, hominum omnium plausus propterea praesertim meritus est, quod simiarum superbiam recentem repressit et generis humani dignitatem veterem denuo vindicavit. Duco ad vos generis humani vindicem, equitem insignem, anatomiae professorem illustrem, WILLELMUM TURNER. Dr. Sandys’s introductory speeches are always conspicuous not only for elegant Latinity but also for the happy way in which the Public Orator seizes on the salient points in the career of him whom the University delights to honour. Such honour was never better or more worthily bestowed than in the case of Sir William Turner the " vindex humani generis," and we may hope the bearer of this proud title in his capacity of President of the General Medical Council will continue his" vindication" as regards the rights and liberties of that portion of the race which practises or wishes to practise the noble art and science of medicine. ANÆSTHETIC LEPROSY: CHANGES IN THE NERVES AND SPINAL CORD: NECROPSY. ONLY a few histological investigations of anaesthetic leprosy have been recorded in literature and examination uf the spinal cord and ganglia has been still rarer. In a case described by Samgin 1 this disease began with chronic rhinitis and was soon followed by pain and then byanaes- thesia in the arms and legs. The body also became almost entirely anaesthetic. The form of the anesthesia in the affected areas was as follows. There were complete analgesia and thermo-ansesthesia, but tactile sensibility was retained though in diminished degree. The disease pursued the .usual course with smooth desquamative skin changes and with atrophic patches which in the anaesthetic areas became connuent and finally underwent destruction and cicatrisa- tion. The facial nerve was paralysed on both sides in its upper part, but there were no bulbar symptoms. Claw- .hand was present on both sides. The peroneal nerves were paralysed. The ulnar nerves felt thickened and hardened. The symptoms pointed on the whole to anaesthetic leprosy and excluded syringomyelia. The necropsy revealed a variety of instructive conditions.. In the affected patches of skin lepra bacilli were present and they were also 1 Deutsche Medicinische Wochenschrift, No. 30,1898, p. 475. found in the peripheral nerves, but not in the spinal cord, posterior root ganglia, or brain cortex. The nerves examined (ulnar and peroneal) showed inter- stitial neuritis, with an almost entire disappearance of the myelin. In the spinal cord there was found secondary degeneration of the posterior roots and of the columns of Goll (sensory tract). Degenerated nerve fibres were also found within the ganglia of the posterior roots and these were apparently continuous with those occurring in the peripheral nerves. The cells of the grey matter of the cord in the anterior cornua were not degenerated. Samgin believes that the degenerative process began in the peripheral ends of the sensory nerves of the skin and passed upwards into the spinal cord vii the posterior roots, consti- tuting thus a degeneration of the entire sensory neuron. The changes seem to be analogous to those occurring in the peripheral neuritis of alcoholism and they suggest the action of a toxic agent elaborated by the bacilli during their growth in the cutaneous and subcutaneous tissues and in the nerve- trunks. ___ TRADE-STAMPS AND DEFECTIVE SANITARY FITTINGS. IN a recent letter addressed by a correspondent to our con- temporary the P1lblic Health Engineer headed Trade- Marks " attention is called to the desirability of stamping by some properly constituted authority the various fittings and materials used in plumbers’ work. The idea is excellent but not by any means new. At the Congress of Plumbers and others interested in sanitary matters held in London in 1884 the question after considerable discussion formed the subject of a resolution. It was proposed that the ancient practice of marking lead and solder formerly exercised by the Worshipful Company of Plumbers should be revived. Since then many by-laws have been passed by various local authorities regulating to some extent the nature and quality of material to be used in such work, but very much still remains to be done. Many if not all the water companies stamp or restrict the use of the fittings relating to the water-supply; this does not in all cases tend to the improvement of the sanitary condition of a building but merely to the prevention of waste of water and for this reason is not of much value from a sanitary standpoint. The whole question deserves very serious attention, but from its gigantic proportions it is far from being one easy of solu- tion. Even supposing that such a body as the Plumbers’ Company undertook to mark as efficient all sanitary appliances or materials voluntarily submitted to them they would require depots for the purpose throughout the kingdom, whilst the difficulty of making any such arrange- ment one of compulsion would be enormous. Apparently the best plan would be some increased development of local by-laws. - ’THE DEVELOPMENT OF DENTINE. THE Transactions of the Odontological Society of Great Britain for March contain a paper by Professor F. T. Paul which throws a good deal of fresh light upon the develop- ment of hard unvascular dentine. To a great extent the conclusions arrived at confirm the view held by Mr. J. H. Mummery-namely, that the development of dentine is practically similar to the formation of bone in mem- brane. Several interesting points were, however, demon- strated by Professor Paul. Chief amongst these was the fact that the young pulp contains a complete fibrous basis composed of delicate wavy fibres interlacing in every direction. These fibres are found to be directly derived from the cells and are of a gelatin-yielding character. He also showed that the first layer of cells formed on the surface of the pulp beneath the ameloblasts
Transcript of ANÆSTHETIC LEPROSY: CHANGES IN THE NERVES AND SPINAL CORD: NECROPSY
1243
company may be congratulated on the successful result oftheir action and it must also be a source of gratification tothe more enlightened of the inhabitants of Havant that their Ihealth and the good name of their town are, at any rate sofar as they depend on modern drainage, no longer to be leftto the mercy of such incapable sanitarians as the HavantDistrict Councillors have proved themse!ves to be.
SIR WILLIAM TURNER, D.Sc.
THE following were the words of the Public Orator, Dr.Sandys of St. John’s College, in presenting Sir WilliamTurner for the honorary degree of Doctor of Science at
Cambridge on Thursday, April 27th:-Virum regni totius medicorum concilio praepositum, virum
bonoribus academicis plurimis cumulatum, etiam noster.8enatus titulo suo decorare anno proximo decrevit. InterLancastrienses natus, inter Londinienses educatus, interEdinenses. medicinae in schola celeberrima, quam tot’coloniae Britannicae studiorum medicorum quasi p:fJTp6rro^L"venerantur, anatomiae scientiam per annos plus quam trigintapraeclare professus, non modo Universitati suae aedificiisjiovis instruendae operam insignem dedit, sed etiam studiorumsuorum actis per seriem edendis iamdudum maxima cumlaude praefuit. Idem, rerum naturae spoliis olim inBritanniam feliciter reportatis, Australasiae praesertimanthropologiam opere in magno accuratissime expositamluculenter illustravit. Nuper societatis Britannicae scien-tiarum finibus proferendis praeses in annum proximumdesignatus, ab eadem disputationibus de anthropologiaescientia etiam inter Canadenses habendis haud ita pridempraepositus, hominum omnium plausus propterea praesertimmeritus est, quod simiarum superbiam recentem repressit etgeneris humani dignitatem veterem denuo vindicavit.Duco ad vos generis humani vindicem, equitem insignem,
anatomiae professorem illustrem, WILLELMUM TURNER.Dr. Sandys’s introductory speeches are always conspicuousnot only for elegant Latinity but also for the happy wayin which the Public Orator seizes on the salient points in thecareer of him whom the University delights to honour.Such honour was never better or more worthily bestowedthan in the case of Sir William Turner the " vindex humani
generis," and we may hope the bearer of this proud titlein his capacity of President of the General Medical Councilwill continue his" vindication" as regards the rights andliberties of that portion of the race which practises or wishesto practise the noble art and science of medicine.
ANÆSTHETIC LEPROSY: CHANGES IN THENERVES AND SPINAL CORD:
NECROPSY.
ONLY a few histological investigations of anaesthetic
leprosy have been recorded in literature and examinationuf the spinal cord and ganglia has been still rarer. In a
case described by Samgin 1 this disease began with chronicrhinitis and was soon followed by pain and then byanaes-thesia in the arms and legs. The body also became almostentirely anaesthetic. The form of the anesthesia in the
affected areas was as follows. There were complete analgesiaand thermo-ansesthesia, but tactile sensibility was retainedthough in diminished degree. The disease pursued the.usual course with smooth desquamative skin changes andwith atrophic patches which in the anaesthetic areas becameconnuent and finally underwent destruction and cicatrisa-tion. The facial nerve was paralysed on both sides in itsupper part, but there were no bulbar symptoms. Claw-.hand was present on both sides. The peroneal nerves wereparalysed. The ulnar nerves felt thickened and hardened.The symptoms pointed on the whole to anaesthetic leprosyand excluded syringomyelia. The necropsy revealed a
variety of instructive conditions.. In the affected patchesof skin lepra bacilli were present and they were also
1 Deutsche Medicinische Wochenschrift, No. 30,1898, p. 475.
found in the peripheral nerves, but not in the spinalcord, posterior root ganglia, or brain cortex. Thenerves examined (ulnar and peroneal) showed inter-stitial neuritis, with an almost entire disappearanceof the myelin. In the spinal cord there was found
secondary degeneration of the posterior roots and of thecolumns of Goll (sensory tract). Degenerated nerve fibreswere also found within the ganglia of the posterior rootsand these were apparently continuous with those occurringin the peripheral nerves. The cells of the grey matter ofthe cord in the anterior cornua were not degenerated.Samgin believes that the degenerative process began in theperipheral ends of the sensory nerves of the skin and passedupwards into the spinal cord vii the posterior roots, consti-tuting thus a degeneration of the entire sensory neuron. The
changes seem to be analogous to those occurring in theperipheral neuritis of alcoholism and they suggest the actionof a toxic agent elaborated by the bacilli during their growthin the cutaneous and subcutaneous tissues and in the nerve-trunks.
___
TRADE-STAMPS AND DEFECTIVE SANITARYFITTINGS.
IN a recent letter addressed by a correspondent to our con-temporary the P1lblic Health Engineer headed Trade-Marks " attention is called to the desirability of stamping bysome properly constituted authority the various fittings andmaterials used in plumbers’ work. The idea is excellentbut not by any means new. At the Congress ofPlumbers and others interested in sanitary matters held inLondon in 1884 the question after considerable discussion
formed the subject of a resolution. It was proposed thatthe ancient practice of marking lead and solder formerlyexercised by the Worshipful Company of Plumbers should berevived. Since then many by-laws have been passed byvarious local authorities regulating to some extent the natureand quality of material to be used in such work, but verymuch still remains to be done. Many if not all the watercompanies stamp or restrict the use of the fittings relatingto the water-supply; this does not in all cases tend to
the improvement of the sanitary condition of a building butmerely to the prevention of waste of water and for thisreason is not of much value from a sanitary standpoint.The whole question deserves very serious attention, but fromits gigantic proportions it is far from being one easy of solu-tion. Even supposing that such a body as the Plumbers’Company undertook to mark as efficient all sanitaryappliances or materials voluntarily submitted to them theywould require depots for the purpose throughout the
kingdom, whilst the difficulty of making any such arrange-ment one of compulsion would be enormous. Apparentlythe best plan would be some increased development of localby-laws.
-
’THE DEVELOPMENT OF DENTINE.
THE Transactions of the Odontological Society of GreatBritain for March contain a paper by Professor F. T. Paulwhich throws a good deal of fresh light upon the develop-ment of hard unvascular dentine. To a great extent theconclusions arrived at confirm the view held by Mr. J. H.Mummery-namely, that the development of dentine is
practically similar to the formation of bone in mem-
brane. Several interesting points were, however, demon-strated by Professor Paul. Chief amongst these was the
fact that the young pulp contains a complete fibrousbasis composed of delicate wavy fibres interlacing in
every direction. These fibres are found to be directlyderived from the cells and are of a gelatin-yieldingcharacter. He also showed that the first layer of cellsformed on the surface of the pulp beneath the ameloblasts
