METROPOLITAN WATER BOARD RESEARCHES.
1
309 complicated. He also found that out of 238 cases of haemoptysis 182, or 76 per cent., harboured the spiro- chsete, whereas of the 172 cases without haemoptysis only 74, or 43 per cent., harboured the spirochsete. Thus, the presence of Vincent’s spirochaete in the sputum makes haemoptysis a comparatively probable complica- tion. The author also argues that in the treatment of haemoptysis the presence of this micro-organism is an indication for special restriction of exercise and general freedom. His contentions will certainly stimulate others to examine tuberculous sputum for the presence of a mixed spirochaetal infection. TARTAR EMETIC IN SURRA. THE Agricultural Research Institute at Pusa has issued a bulletin dealing with the treatment of surra in camels by intravenous injection of tartar emetic. The author of the pamphlet is Mr. H. E. Cross, M.R.C.V.S., described as camel specialist at Sohawa, Punjab. Surra is a very fatal disease among camels, due to infection with trypanosomes. Mr. Cross, who has conducted a number of valuable investigations into other diseases of camels, injected six camels suffering from surra with a 1 per cent. solution of tartar emetic, and four of them were cured. Great care was taken to ensure the solution entering the vein, since in camels, as in human subjects, sloughing is liable to ensue if any of the solution passes into the subcutaneous tissues. The fluid was injected slowly at blood temperature. Mr. Cross found that 600 c.cm. of the solution could be given in the day if divided into three injections spaced out at 2-3 hour intervals. In four of the six camels treated no trypanosomes appeared in the blood after the injections. - METROPOLITAN WATER BOARD RESEARCHES. WE have received the thirteenth research report issued by the authority of the Metropolitan Water Board from the chemical and bacteriological labora- tories under the control of Sir Alexander Houston, Director of Examinations to the Board. An outstand- ing feature of this report is the study that has been given to the question of rapid filtration. This sugges- tion of speeding up is described as a contentious but most important subject, and by rapid filtration, we are told, is meant any apparatus, installation, or process, which filters at a much faster rate than is found in connexion with slow sand filters in which " washing " is effected by mechanical means. Without entering into the details of the process, except to say that it involves usually the use of a coagulant- e.g., aluminium sulphate-we may briefly refer to Sir Alexander Houston’s opinion on the subject, which is, to speak generally, that in cases when a water is epidemiologically satisfactory but highly coloured, as in the case of moorland supplies, rapid filtration with the use of a coagulant achieves the most satis- factory results. He makes, however, important reser- vations, and asks whether it is permissible to filter stored water so rapidly, for though it may lead -to material economic gain and the saving of filtration area, it is well established that ante-filtration or post- filtration sterilisation processes produce a water which is epidemiologically safe, innocuous, tasteless, and reasonably satisfactory from a physical and sentimental standpoint. The suggestion seems to be that so far rapid filtraton has not the evidence of experience behind it in regard to safety for the water-consuming public, though it might be combined with a chlorination process without adding seriously to the expense of treatment. The proposed changes in treating our raw water-supplies need to be very carefully studied lest any innovation is introduced at the price of health. The results of chemical analysis are, at all events, shown to be less satisfactory obtained with rapid filtration than with slow sand percolation, and the bacteriological results are not encouraging. Security, however, seems to reside in a chlorination process added to old-time procedure, and Sir Alexander Houston states that it is debatable whether the policy of substituting in connexion with new works a less expensive rapid for a more costly slow sand-filtration process is sound. The point has evidently arisen out of the increased demand of labour and cost of working materials. The use of chlorine has led to the nuisance of evil taste, but this bids fair to be overcome, while an interesting outcome of the water laboratory researches has been that when filtration has proved unsatisfactory this has been shown to be due not to floods, but to a seasonal development of diatoms governed by bright weather and temperature. The report is most interesting, and contains an admirable series of reproductions of photographs of deposits from raw and filtered supplies, demonstrating the efficiency or discrepancies of the filtration processes. HEREDITARY SPASTIC PARAPLEGIA. Dr. V. R. Mason and Dr. W. F. Rienhoff, jun.,! of the Medical Clinic, Johns Hopkins Hospital, report four cases of the rare hereditary disease of the central nervous system known as hereditary spastic paraplegia which affected members of one family for three genera- tions. The condition was first described by Strumpell, who reported two cases in 1880, and a few years later was able to demonstrate the pathological basis of the syndrome. Since then the records of about 60 affected families have been published. The malady usually affects individuals in only one generation, but in seven of the families recorded characteristic sym- ptoms were present in more than two genera- tions. Etiological factors, other than heredity, are not known. The symptoms may become manifest at any age, although it is characteristic of hereditary diseases of the central nervous system that the age of onset is about the same in individuals of the same generation. There is no evidence that sex plays an important role either in the occurrence or the trans- mission of the disease. The fundamental symptoms from which the disease derives its name is a spastic paraparesis which may involve the upper extremities to some extent after the condition has progressed for many years. The most important subsidiary symptoms are tremor of the tongue, as a rule intentional in type, disturbances of speech, optic atrophy, nys- tagmus, ocular palsies, bulbar disturbances, scoliosis, pes equinovarus, ataxia, muscular atrophies, and occasionally some mental impairment. Sensation and the sphincter functions are usually unaffected. The condition closely resembles both Marie’s and Friedreich’s hereditary ataxia in its aetiology, and pathological anatomy. All three diseases begin usually about puberty, progress slowly to a certain point, and then become stationary. Moreover, typical or pure cases of any of the three affections are rare. Symptoms common to all three diseases have been observed, such as nystagmus, tremor, and pes equinovarus. In each disease there is a marked combined sclerosis of the postero-lateral tracts of the cord of the type charac- teristic of hereditary disease of the nervous system. The differential diagnosis is in some cases impossible, but in the majority the presence or absence of para- plegia, or ataxia, is distinctive. EMBOLIC ANEURYSM OF PERIPHERAL ARTERIES. EMBOLIC aneurysm of peripheral arteries is rare. In the Glasgow lVled-ica.l Jo2srnal Mr. Douglas K. Adams has reported two cases which, by a curious coincidence, occurred in the same wards within a month of one another. In the first case the patient was a metal- polisher, aged 29 years. He was admitted on Dec. 3rd, 1919, complaining of dyspnoea of four years’ duration. For some years he had " rheumatic pains in the legs " and the ankles occasionally swelled. On admission he was found to be poorly nourished and pale. The fingers were clubbed. - The apex beat was in the fifth interspace an inch outside the nipple line, and cardiac dullness extended half an inch to the right of the sternum and to the upper border of the third rib. A soft blowing mitral systolic murmur was heard, and a 1 Bulletin of the Johns Hopkins Hospital, June, 1920.
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Transcript of METROPOLITAN WATER BOARD RESEARCHES.
309
complicated. He also found that out of 238 casesof haemoptysis 182, or 76 per cent., harboured the spiro-chsete, whereas of the 172 cases without haemoptysisonly 74, or 43 per cent., harboured the spirochsete. Thus,the presence of Vincent’s spirochaete in the sputummakes haemoptysis a comparatively probable complica-tion. The author also argues that in the treatment ofhaemoptysis the presence of this micro-organism is anindication for special restriction of exercise and generalfreedom. His contentions will certainly stimulateothers to examine tuberculous sputum for the presenceof a mixed spirochaetal infection.
TARTAR EMETIC IN SURRA.
THE Agricultural Research Institute at Pusa hasissued a bulletin dealing with the treatment of surrain camels by intravenous injection of tartar emetic.The author of the pamphlet is Mr. H. E. Cross,M.R.C.V.S., described as camel specialist at Sohawa,Punjab. Surra is a very fatal disease among camels,due to infection with trypanosomes. Mr. Cross, whohas conducted a number of valuable investigations intoother diseases of camels, injected six camels sufferingfrom surra with a 1 per cent. solution of tartar emetic,and four of them were cured. Great care was taken toensure the solution entering the vein, since in camels,as in human subjects, sloughing is liable to ensue if anyof the solution passes into the subcutaneous tissues.The fluid was injected slowly at blood temperature.Mr. Cross found that 600 c.cm. of the solution could begiven in the day if divided into three injections spacedout at 2-3 hour intervals. In four of the six camelstreated no trypanosomes appeared in the blood afterthe injections. -
METROPOLITAN WATER BOARD RESEARCHES.
WE have received the thirteenth research reportissued by the authority of the Metropolitan WaterBoard from the chemical and bacteriological labora-tories under the control of Sir Alexander Houston,Director of Examinations to the Board. An outstand-ing feature of this report is the study that has beengiven to the question of rapid filtration. This sugges-tion of speeding up is described as a contentious butmost important subject, and by rapid filtration, weare told, is meant any apparatus, installation, or
process, which filters at a much faster rate thanis found in connexion with slow sand filters in
which " washing " is effected by mechanical means.Without entering into the details of the process, exceptto say that it involves usually the use of a coagulant-e.g., aluminium sulphate-we may briefly refer to SirAlexander Houston’s opinion on the subject, whichis, to speak generally, that in cases when a wateris epidemiologically satisfactory but highly coloured,as in the case of moorland supplies, rapid filtrationwith the use of a coagulant achieves the most satis-factory results. He makes, however, important reser-vations, and asks whether it is permissible to filterstored water so rapidly, for though it may lead -tomaterial economic gain and the saving of filtrationarea, it is well established that ante-filtration or post-filtration sterilisation processes produce a water whichis epidemiologically safe, innocuous, tasteless, andreasonably satisfactory from a physical and sentimentalstandpoint. The suggestion seems to be that so far rapidfiltraton has not the evidence of experience behind it inregard to safety for the water-consuming public, thoughit might be combined with a chlorination process withoutadding seriously to the expense of treatment. Theproposed changes in treating our raw water-suppliesneed to be very carefully studied lest any innovation isintroduced at the price of health. The results ofchemical analysis are, at all events, shown to be lesssatisfactory obtained with rapid filtration than with slowsand percolation, and the bacteriological results are
not encouraging. Security, however, seems to reside ina chlorination process added to old-time procedure,and Sir Alexander Houston states that it is debatablewhether the policy of substituting in connexion with
new works a less expensive rapid for a more costlyslow sand-filtration process is sound. The point hasevidently arisen out of the increased demand of labourand cost of working materials. The use of chlorine hasled to the nuisance of evil taste, but this bids fair to beovercome, while an interesting outcome of the waterlaboratory researches has been that when filtration hasproved unsatisfactory this has been shown to be duenot to floods, but to a seasonal development of diatomsgoverned by bright weather and temperature. Thereport is most interesting, and contains an admirableseries of reproductions of photographs of deposits fromraw and filtered supplies, demonstrating the efficiencyor discrepancies of the filtration processes.
HEREDITARY SPASTIC PARAPLEGIA.
Dr. V. R. Mason and Dr. W. F. Rienhoff, jun.,! of theMedical Clinic, Johns Hopkins Hospital, report fourcases of the rare hereditary disease of the centralnervous system known as hereditary spastic paraplegiawhich affected members of one family for three genera-tions. The condition was first described by Strumpell,who reported two cases in 1880, and a few years laterwas able to demonstrate the pathological basis of thesyndrome. Since then the records of about 60 affectedfamilies have been published. The malady usuallyaffects individuals in only one generation, but inseven of the families recorded characteristic sym-ptoms were present in more than two genera-tions. Etiological factors, other than heredity, are
not known. The symptoms may become manifestat any age, although it is characteristic of hereditarydiseases of the central nervous system that the age ofonset is about the same in individuals of the same
generation. There is no evidence that sex plays animportant role either in the occurrence or the trans-mission of the disease. The fundamental symptomsfrom which the disease derives its name is a spasticparaparesis which may involve the upper extremities tosome extent after the condition has progressed formany years. The most important subsidiary symptomsare tremor of the tongue, as a rule intentional intype, disturbances of speech, optic atrophy, nys-tagmus, ocular palsies, bulbar disturbances, scoliosis,pes equinovarus, ataxia, muscular atrophies, and
occasionally some mental impairment. Sensation andthe sphincter functions are usually unaffected. Thecondition closely resembles both Marie’s andFriedreich’s hereditary ataxia in its aetiology, andpathological anatomy. All three diseases begin usuallyabout puberty, progress slowly to a certain point, andthen become stationary. Moreover, typical or purecases of any of the three affections are rare. Symptomscommon to all three diseases have been observed, suchas nystagmus, tremor, and pes equinovarus. In eachdisease there is a marked combined sclerosis of the
postero-lateral tracts of the cord of the type charac-teristic of hereditary disease of the nervous system.The differential diagnosis is in some cases impossible,but in the majority the presence or absence of para-plegia, or ataxia, is distinctive.
EMBOLIC ANEURYSM OF PERIPHERAL ARTERIES.
EMBOLIC aneurysm of peripheral arteries is rare. Inthe Glasgow lVled-ica.l Jo2srnal Mr. Douglas K. Adams hasreported two cases which, by a curious coincidence,occurred in the same wards within a month of oneanother. In the first case the patient was a metal-polisher, aged 29 years. He was admitted on Dec. 3rd,1919, complaining of dyspnoea of four years’ duration.For some years he had " rheumatic pains in the legs "and the ankles occasionally swelled. On admission hewas found to be poorly nourished and pale. Thefingers were clubbed. - The apex beat was in the fifthinterspace an inch outside the nipple line, and cardiacdullness extended half an inch to the right of thesternum and to the upper border of the third rib. Asoft blowing mitral systolic murmur was heard, and a
1 Bulletin of the Johns Hopkins Hospital, June, 1920.
