INTRACTABLE HICCOUGH DUE TO LATENT TUBERCULOSIS OF THE PONS AND MEDULLA.

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750 latter sometimes having to be removed altogether, is a real hardship to householders served by a very hard water- supply. There can be little doubt that such being the case the risk of an explosion occurring in the kitchen boiler is immensely increased. We have seen pipes which were taken out of a house in the district supplied by the Kent Company and which had only been in use a few months so thickly lined with chalk as hardly to permit of the passage of a pen- holder through them. The waste caused by hard water is enormous, the life of utensils and pipes is considerably shortened, and the loss of heat is very great. The deposition of lime salts practically destroys the conducting power of the metal of cooking vessels, kitchen boilers, and pipes. For cooking purposes, also, hard water is objectionable; it hardens the tissues of vegetables and meat and thus tends to make them indigestible. These facts furnish ample reason for giving serious consideration to the proposal to soften, or partly to soften, certain of the very hard water-supplies in England. If it can be done in some places, of which the Colne Valley is an example, with economy and with great advantages to the consumers it can be done in all. HATPINS IN PUBLIC VEHICLES. A FREQUENT correspondent writes: " Most men, even those least acquainted with the details of feminine attire, are aware that women who wear hats retain them in position by transfixing them with two or more ’hatpins,’ or fine steel skewers, about eight inches in length, having more or less ornamental knobs or buttons at one end and tapering to sharp points at the other. These pins now and again figure in the accounts of proceedings at the police courts as weapons used by women of violent temper either in attack- ing an enemy or in defending themselves against arrest by the police. I consider that they are besides a source of danger to the general public through the negligence rather than the malevolence of their wearers. In the headdress of a well-dressed woman they are useful for the purpose for which they are intended and are not con- spicuous except as ornaments, the button or knob alone being exposed to view, the point either concealed or omy sugnny projecting, danermy ana umioy women, however, not exclusively of the poorer classes, wear them in such a manner that two or three inches, or even more, of their sharp ends project beyond the hat or protrude themselves through the coils of hair which the hats surmount. When the wearers are nursemaids mistresses II will do well to see that their children’s eyes and features i are not exposed to danger through the slovenliness of their servants, but, of course, when the mistresses are slovenly also no such supervision is to be expected. The adult public, including the sex to which hatpins are not a necessity, are principally concerned with those worn by persons with whom they are, literally, thrown in contact when travelling in omnibuses, tramway cars, and trains. In all these means of conveyance the tendency is towards increased speed and rapid stopping and starting, so that we frequently see those entering or leaving a carriage stagger against one another. or against those seated, and scarcely less often a sudden jerk causes a row of seated passengers to sway more or less violently according to their I individual weight and stability. It may be suggested that I if all sway in unison, actuated by the same impulse, their heads will remain at unchanged distances from one another ; but, in fact, all are not affected alike, and a man who remains tolerably rigid may have the head of a less stalwart neighbour brought into very close proximity with his own. I speak from personal experience and hence this letter. He may receive nothing more serious than a blow from a well-padded skull, but if there is a spear as sharp as a needle to accentuate such a blow, a needle, moreover, which has certainly not been sterilised in the ill-kept hair through which it has passed, he may quite conceivably be hurt." We have drawn attention to the dangerous contingency before in our columns and the risk has not decreased with the advent of motor omnibuses, the passengers of which are more liable to be rolled against one another than are those in any other class of public vehicle. As a matter of fact, no serious accident has, so far as we know, yet happened, but as motor omnibuses are increasing we may some day hear of a traveller summoning up courage to remonstrate with a dangerous neighbour. On such an occasion he might fittingly point out to her that her hatpin is but a means to an end and is no more intended for ex- hibition, so far as its mechanical details are concerned, than the other apparatus by which she and her masculine fellow travellers retain their garments generally in sitrc. More often, however, bashfulness will prevail and the threatened person, after an apprehensive glance or two at the danger, will either resign himself to his fate. hoping for the best, or will take an early opportunity of changing his seat. Some day-it will not be till after an accident has occurred- we may see a negligent lady figuring as a defendant in a court of law, and in this connexion we may remind married men of their own liability to pay damages incurred by their wives. Pins are obtainable, we believe, having counter-knobs to screw on to their points, but they are unpopular because they are difficult to u"e and also more expensive, although, on the other hand, they afford a double opportunity for the display of ornament. In the absence of any more ingenious device than these the careful adjustment of pins of a suitable length would appear to be the only remedy possible. - INTRACTABLE HICCOUGH DUE TO LATENT TUBERCULOSIS OF THE PONS AND MEDULLA. AT a meeting of the oooete Medicale des Hôpitaux of Paris on Jan. 18th M. Henri Lamy and M. Maurice Cleret reported the following interesting case. A man, aged 43 years, was admitted into hospital on Oct. 26th, 1906. He had enjoyed good health until four years previously when he had left pleurisy. Subsequently he suffered from cough and grew thin. On admission he was emaciated and coughed and expectorated considerably. The sputum was purulent. Examination of the chest showed dulness at the left apex in front and behind and at the right base. The respiration was cavernous at the left apex and there were numerous moist rales at the right apex. At the right base there were pleural friction and diminished vesicular murmur. The case ran the ordinary one of fatal pulmonary tuberculosis, but about a fortnight before death, which occurred on Dec. 28th, the patient complained of persistent hiccough. This con- tinued until the last two days of life, when delirium and vomiting appeared. Coma followed and Kernig’s sign was obtained. Thus there were typical symptoms of meningitis on these days. The necropsy showed extensive pulmonary tuberculosis and no other visceral lesions. There was recent miliary tuberculosis of the cerebral membranes. A large tubercle of the size of a small pea was found on the posterior surface of the inferior part of the left inferior cerebellar peduncle. It had hollowed out a cavity by pressing aside the fibres of the peduncle. Its internal and superior extremity was in contact with the floor of the fourth ventricle. Sections of the brain showed no other lesions except a tubercle of the size of a hazel-nut at the lower part of the pons. It is noteworthy that these tumours remained quite latent until a fortnight before death when the intractable hiccough occurred. At the following meeting of the society M. C. Gandy and M. Lévy-Yalensi reported a similar case in a man of the same age, who

Transcript of INTRACTABLE HICCOUGH DUE TO LATENT TUBERCULOSIS OF THE PONS AND MEDULLA.

Page 1: INTRACTABLE HICCOUGH DUE TO LATENT TUBERCULOSIS OF THE PONS AND MEDULLA.

750

latter sometimes having to be removed altogether, isa real hardship to householders served by a very hard water-supply. There can be little doubt that such being the casethe risk of an explosion occurring in the kitchen boiler isimmensely increased. We have seen pipes which were takenout of a house in the district supplied by the Kent Companyand which had only been in use a few months so thickly linedwith chalk as hardly to permit of the passage of a pen-holder through them. The waste caused by hard water isenormous, the life of utensils and pipes is considerablyshortened, and the loss of heat is very great. The depositionof lime salts practically destroys the conducting power ofthe metal of cooking vessels, kitchen boilers, and pipes. For

cooking purposes, also, hard water is objectionable; it

hardens the tissues of vegetables and meat and thus tends tomake them indigestible. These facts furnish ample reasonfor giving serious consideration to the proposal to soften, orpartly to soften, certain of the very hard water-supplies inEngland. If it can be done in some places, of which theColne Valley is an example, with economy and with greatadvantages to the consumers it can be done in all.

HATPINS IN PUBLIC VEHICLES.

A FREQUENT correspondent writes: " Most men, even

those least acquainted with the details of feminine attire,are aware that women who wear hats retain them in positionby transfixing them with two or more ’hatpins,’ or fine steelskewers, about eight inches in length, having more or lessornamental knobs or buttons at one end and tapering tosharp points at the other. These pins now and again figurein the accounts of proceedings at the police courts as

weapons used by women of violent temper either in attack-ing an enemy or in defending themselves against arrest bythe police. I consider that they are besides a source of

danger to the general public through the negligence ratherthan the malevolence of their wearers. In the headdressof a well-dressed woman they are useful for the

purpose for which they are intended and are not con-

spicuous except as ornaments, the button or knob

alone being exposed to view, the point either concealed oromy sugnny projecting, danermy ana umioy women,

however, not exclusively of the poorer classes, wear themin such a manner that two or three inches, or even

more, of their sharp ends project beyond the hat or protrudethemselves through the coils of hair which the hats ’surmount. When the wearers are nursemaids mistresses IIwill do well to see that their children’s eyes and features iare not exposed to danger through the slovenliness of theirservants, but, of course, when the mistresses are slovenlyalso no such supervision is to be expected. The adult

public, including the sex to which hatpins are not a

necessity, are principally concerned with those worn

by persons with whom they are, literally, thrown in

contact when travelling in omnibuses, tramway cars, andtrains. In all these means of conveyance the tendencyis towards increased speed and rapid stopping and starting,so that we frequently see those entering or leaving a

carriage stagger against one another. or against those seated,and scarcely less often a sudden jerk causes a row of seatedpassengers to sway more or less violently according to their Iindividual weight and stability. It may be suggested that Iif all sway in unison, actuated by the same impulse, theirheads will remain at unchanged distances from one another ;but, in fact, all are not affected alike, and a man whoremains tolerably rigid may have the head of a less

stalwart neighbour brought into very close proximitywith his own. I speak from personal experience and

hence this letter. He may receive nothing more seriousthan a blow from a well-padded skull, but if there is a

spear as sharp as a needle to accentuate such a blow, a

needle, moreover, which has certainly not been sterilised inthe ill-kept hair through which it has passed, he may quiteconceivably be hurt." We have drawn attention to the

dangerous contingency before in our columns and the riskhas not decreased with the advent of motor omnibuses, the

passengers of which are more liable to be rolled against oneanother than are those in any other class of public vehicle.As a matter of fact, no serious accident has, so far as weknow, yet happened, but as motor omnibuses are increasingwe may some day hear of a traveller summoning up courageto remonstrate with a dangerous neighbour. On such anoccasion he might fittingly point out to her that her hatpinis but a means to an end and is no more intended for ex-

hibition, so far as its mechanical details are concerned, thanthe other apparatus by which she and her masculine fellowtravellers retain their garments generally in sitrc. More

often, however, bashfulness will prevail and the threatenedperson, after an apprehensive glance or two at the danger,will either resign himself to his fate. hoping for the best,or will take an early opportunity of changing his seat.Some day-it will not be till after an accident has occurred-we may see a negligent lady figuring as a defendant in acourt of law, and in this connexion we may remindmarried men of their own liability to pay damages incurredby their wives. Pins are obtainable, we believe, havingcounter-knobs to screw on to their points, but they areunpopular because they are difficult to u"e and also more

expensive, although, on the other hand, they afford a doubleopportunity for the display of ornament. In the absence of

any more ingenious device than these the careful adjustmentof pins of a suitable length would appear to be the onlyremedy possible.

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INTRACTABLE HICCOUGH DUE TO LATENTTUBERCULOSIS OF THE PONS AND

MEDULLA.

AT a meeting of the oooete Medicale des Hôpitaux ofParis on Jan. 18th M. Henri Lamy and M. Maurice Cleretreported the following interesting case. A man, aged 43years, was admitted into hospital on Oct. 26th, 1906. He

had enjoyed good health until four years previously when hehad left pleurisy. Subsequently he suffered from cough andgrew thin. On admission he was emaciated and coughedand expectorated considerably. The sputum was purulent.Examination of the chest showed dulness at the left apex in

front and behind and at the right base. The respirationwas cavernous at the left apex and there were numerousmoist rales at the right apex. At the right base there werepleural friction and diminished vesicular murmur. The caseran the ordinary one of fatal pulmonary tuberculosis, butabout a fortnight before death, which occurred on Dec. 28th,the patient complained of persistent hiccough. This con-tinued until the last two days of life, when deliriumand vomiting appeared. Coma followed and Kernig’ssign was obtained. Thus there were typical symptoms ofmeningitis on these days. The necropsy showed extensive

pulmonary tuberculosis and no other visceral lesions. Therewas recent miliary tuberculosis of the cerebral membranes.A large tubercle of the size of a small pea was found on theposterior surface of the inferior part of the left inferiorcerebellar peduncle. It had hollowed out a cavity bypressing aside the fibres of the peduncle. Its internal and

superior extremity was in contact with the floor of the fourthventricle. Sections of the brain showed no other lesions

except a tubercle of the size of a hazel-nut at the lower

part of the pons. It is noteworthy that these tumoursremained quite latent until a fortnight before death whenthe intractable hiccough occurred. At the followingmeeting of the society M. C. Gandy and M. Lévy-Yalensireported a similar case in a man of the same age, who

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was admitted into hospital on Dec. 13th, 1906. He had

had sero-fibrinous pleurisy five months previously. After

this he suffered from cough and loss of flesh. Eight or tendays before admission continuous headache began. In the

streets the patient forgot his way. Three days beforeadmission hiccough began. Five, six, or eight times a

minute violent contractions of the diaphragm occurred

accompanied by characteristic closure of the glottis andquivering of the whole abdominal wall and lower part ofthe thorax. The patient was apathetic and with difficulty Icould be made to answer "yes" " or "no" " to questions. He Imuttered more or less incomprehensible words. At night hewas delirious. There was slight tremor of the upper limbs.The temperature was a little raised and the pulse was rapid

, and regular. There was no stiffness of the neck and the

pupils were regular. On the following day Kernig’s signwas obtained. The patient became torpid and died comatoseon Dec. 19th. Intractable vomiting persisted by day and bynight until the end. Hiccough is evidently a rare variety ofthe disturbances of the respiratory rhythm which may occurin meningitis, such as pauses, polypncea, and Cheyne-Stokesrespiration.

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FEBRUARY AT HOME AND ABROAD.

* A day on which at least 0 04 in. has fallen.

The above figures represent the temperature and rainfall forlast month at certain selected places in this country andabroad. If they are compared with the correspondingfigures for January which were published in THE LANCET 1it will be seen that at all the foreign stations except Berlin,Paris, Palermo, and Algiers there was a rise of temperature,while in this country a fall was experienced. As is invari-

ably the case in winter, the nights at the Scilly Isles weremuch milder than in any other part of this country and, ascan be seen by the mean minimum temperatures, they werealso considerably milder than those at Nice, Florence, andBiarritz, and only a little cooler than those at Naples andPalermo. Visitors to Malta and Algiers, however, en-

joyed a night temperature as mild as, or milder than, thatof the afternoons at nearly every place in this country,

1 THE LANCET, Feb. 16th, 1907 p. 445.

and visitors to Lisbon experienced the same temperatureat night as that prevailing during the day-time at Bath,Nottingham, and Jersey. The days at Nice and Florencewere several degrees warmer than they were at Bourne-

mouth, Sandown, and Torquay but after sunset the

English resorts retained their warmth to a much greaterextent, so that the nights were no cooler than those of theirsouthern rivals. The average diurnal range of temperaturewas in nearly every instance less at our own southern andsouth-western resorts than abroad, but the range of only tendegrees at Naples and Malta was no larger than that at

Sandown and Torquay and a degree less than it was at

Bournemouth. At all the foreign resorts except Naples,Malta, Algiers, and Lisbon the sheltered thermometer

touched, or fell below, the freezing-point, and the onlyplace in the whole of the United Kingdom that escaped thefrost was Scilly. At Nice and Biarritz there were nine

frosty nights and at Florence 12. Except at Algiers themonth was nowhere very rainy ; the driest spots abroad werethe Riviera, Northern Italy, and the coast of Portugal, whilein this country London was amongst the driest. The sunshineis not recorded at the foreign stations, but in this country,especially along the south and south-west coasts, the monthwas particularly bright, most places registering an averageof about three and a half hours per day. It is, however,probable that most of the Mediterranean resorts enjoyed alonger duration considering that the sun in that latitude wasabove the horizon for a much longer period.

MEDICINE AND THE UNIVERSITY OF OXFORD.

As will be seen by particulars given in another column,the Master and Fellows of the College of the Great Hall ofthe University, commonly called University College in theUniversity of Oxford," have decided to endow a prize forresearch in any medical science. It is to be called theRadcliffe Prize in memory of that Dr. John Radcliffe whowas so bright an ornament of the society in question andwho gave so generously towards the funds thereof.This endowment from University College is one more

instance of the desire lately shown by various collegesto do something to facilitate the study of medicineso far as their respective finances will allow. The

University itself is poor but many of the colleges whichmay be called constituents of the University are rich, andsuch as can afford to do so help in many ways those membersof the University who are not members of their own society.Research is perhaps more needed in the science of medicine,--------- r .1:"-----.-

---- -------- -- --- .------- -- ---------

than in any other, for in no other science are there moreproblems awaiting solution or problems the solution of whichwould more powerfully affect human happiness, and it is

fitting that University College, which was traditionallyfounded by King Alfred, should try to increase the sum ofhuman knowledge, for, as Alfred himself said, " Though wethink upon many things, we have but little perfect under-standing free from doubt."

SILVERED SILK SUTURES.

I IN the Centralblatt für Ohirnrgie, 1906, No. 35, HerrWitzel and Herr Wederhake describe the properties and themode of preparation of silk sutures impregnated with silver.Silver wire is smooth, unabsorbable, non-absorbent, andeasily sterilised, but its stiffness is disadvantageous. Silk

impregnated with silver and afterwards treated with an anti-septic and made waterproof with caoutchouc is cheaply andeasily prepared ; it is one-third stronger than ordinary silk,it is flexible, antiseptic, easily sterilised, and non-absorbent.It is said, in a word, to combine the advantages of silk

and silver wire without possessing their disadvantages.The silk is silvered in the following way. The silk is wound