NASAL CRISES IN TABES DORSALIS.
1
1408 Warden’s suggestion might well be followed. Indeed, it is possible that this is what he intends to imply, and if such be the case we endorse his advice. The membranous laryngitis may be produced by pyogenetic cocci, but this can only be positively distinguished from diphtheritic membrane by bacteriological culture, and much valuable time would be lost in waiting for the result to be received from the laboratory. The success of the antitoxic treatment is con- siderably greater if it be employed at an early stage of the disease, and therefore practitioners would be taking a wise course in administering the antitoxin in cases of measles in which a membranous laryngitis makes its appearance. NASAL CRISES IN TABES DORSALIS. THE day is passed when tabes dorsalis was considered a disease to be limited to-the posterior columns of the spinal cord. The field covered by locomotor ataxia in its manifesta- tions has been very greatly extended, till now it is admitted there is no part of the nervous system, central or peripheral, which may not be the seat of the tabetic process. The aspects under which the disease may present itself are so variable that the clinician cannot afford to neglect any of them. In a recent number of La Semaine Médioale M. Klippel and M. Lhermitte have directed attention to a little known corner of the tabetic field, one which, however, concerns the general practitioner as much as the professed neurologist. They have written an instructive paper on affec- tions of the gustatory and olfactory apparatus in tabes, and the clinical cases which they quote emphasise once again the extreme importance of recognising that the symptoms for which the patient consults his physician may be but a purely local indication of a much more widespread condition. M. Klippel and M. Lhermitte consider that the nasal crisis of the tabetic may be represented by one of three differing types-viz., sensory, spasmodic, and secretory-although this division is somewhat schematic. The disturbance, of whatever type it be, may occur in those who show a permanent defect in their olfactory sense as well as in those whose smell is normal. The common impairment found in the subject of tabes is partial or complete anosmia, with hypoassthesia of the face and nasal mucosa, and vaso-motor or trophic changes in the olfactory mucosa itself. In the first variety of nasal crisis the patient feels a pricking sensa- tion at the root of the nose, a disagreeable tickling in his nostrils, and then suddenly experiences a strong and un- pleasant subjective odour commonly compared to that of rotten eggs. Occasionally it is associated with an equally unpleasant taste in the mouth. Among the many instances quoted by the authors are cited those described by Mr. Herbert Tilley’ 14 years ago as three cases of parosmia, and the suggestion is made that they were in reality cases of tabes in which the ordinary symptoms of the condition were not present or not recognised. They do not ignore the occurrence of similar phenomena in intracranial tumours of a particular localisation, but the diagnosis presents no real difficulty. The spasmodic type of nasal crisis is characterised ,, by attacks of sneezing ; one of their patients used to notice a sensation of coolness and of pins and needles over the left half of the face and then sneezing set in ; it was sometimes accompanied by flashes in front of the left eye and bilateral tinnitus. An instance is given where this form of nasal crisis proved to be the first symptom of tabes. Sometimes the crisis is succeeded by a flow of tears or of mucus from the nose ; in practically every case some objective modification of facial or olfactory sensibility can be discovered, Where there are definite vaso-motor or secretory phenomena we are dealing with the 1 THE LANCET, Oct. 9th, 1895, p, 907. third or rhinorrhoeic form of nasal crisis. One of the cases concerned a patient with locomotor ataxia, whose ’attack’ always began with a series of short abrupt respirations, followed by a bout of sneezing of several minutes’ duration. As soon as these spasmodic phenomena ceased, a slightly viscid reddish fluid poured from the nose, soaking a handkerchief in very little time ; towards ’ the end of the flow it became clear and much more watery. Examination of the nasal fossag revealed no abnormality whatever, but there were changes in cutaneous, mucous, and olfactory sensibility. The differential diagnosis of these symptoms may no doubt be difficult, but the discovery of any of the classical signs of tabes is very significant, in particular any notable alteration in sensibility in the distribution of the trigeminal nerve. In one of their cases M. Klippel and M. Lhermitte have found unmistakeable histological changes in the olfactory bulbs. Of the en- cephalic manifestations of the tabetic process several are, of course, very well known, in particular optic atrophy.- Sir William Gowers has drawn attention to the occurrence of ’’ auditory atrophy" in the shape of constriction of the auditory field, and this latest contribution to the subject is equally suggestive and likely to repay research. AT a meeting of the Royal Society on May 6th the secretary announced that Colonel Sir David Bruce, who is in charge of the Sleeping Sickness Commission at present in Uganda, had cabled to the Society on April 3rd to report that the Commission had confirmed Kleine’s observa- tions on the period during which the tsetse fly was capable of transmitting a trypanosome infection. A letter had been received by the Society on April 30th from Sir David Bruce, dated Mpumu Chagwe, Uganda, April 3rd, confirming the telegram, and stating that the Commission had repeated Dr. Kleine’s experiments with ’l’l’ypanosoma gambiense and Glossina palpalis, also with a trypanosome of the dimorphon type and the same Tsetse-flies, and found the flies infective after 16, 19, and 22 days." THE EARLY RECOGNITION OF UTERINE CANCER. AT the annual meeting of the British Medical Association, at Exeter in 1907 the Section of Obstetrics and Gynascology adopted a resolution requesting the Council of the Associa- tion to appoint a committee to consider the best means of disseminating knowledge of the importance of the early recognition of uterine cancer. That committee presented a report which was considered, and generally approved, by the same section of the annual meeting of the British Medical Association in Sheffield in 1908. At its meeting on April 28th, 1909, the Council of the British Medical Associa- tion approved for publication the appeals to medical practi- tioners, and to midwives and nurses, and directed that they should be communicated to British and colonial medical and nursing journals. We have consequently received from the Editor of the British Medwal Journal the appended important document addressed in its main bulk to all medical practi- tioners, but with a brief and earnest note to midwives and nurses appended :- A. AN APPEAL TO MEDICAL PRACTITIONERS TO PROMOTE THE EARLIER RECOGNITION OF UTERINE CANCER. The attention of all medical practitioners is directed to the necessity of emphasising the curability by operation of uterine cancer in its early stages. The adoption of a more extensive operation by the abdominal route has made it possible to deal successfully with cases hitherto regarded as inoperable, and to remove more of the pelvic cellular tissue as well as a portion of the vaginal walls ; it is in these situations that recurrence is prone to develop.
Transcript of NASAL CRISES IN TABES DORSALIS.
1408
Warden’s suggestion might well be followed. Indeed, it ispossible that this is what he intends to imply, and if such bethe case we endorse his advice. The membranous laryngitismay be produced by pyogenetic cocci, but this can only bepositively distinguished from diphtheritic membrane bybacteriological culture, and much valuable time would belost in waiting for the result to be received from the
laboratory. The success of the antitoxic treatment is con-
siderably greater if it be employed at an early stage of thedisease, and therefore practitioners would be taking a wisecourse in administering the antitoxin in cases of measles inwhich a membranous laryngitis makes its appearance.
NASAL CRISES IN TABES DORSALIS.
THE day is passed when tabes dorsalis was considered adisease to be limited to-the posterior columns of the spinalcord. The field covered by locomotor ataxia in its manifesta-tions has been very greatly extended, till now it is admittedthere is no part of the nervous system, central or peripheral,which may not be the seat of the tabetic process. The
aspects under which the disease may present itself are sovariable that the clinician cannot afford to neglect any ofthem. In a recent number of La Semaine Médioale M.
Klippel and M. Lhermitte have directed attention to a littleknown corner of the tabetic field, one which, however,concerns the general practitioner as much as the professedneurologist. They have written an instructive paper on affec-tions of the gustatory and olfactory apparatus in tabes, andthe clinical cases which they quote emphasise once again theextreme importance of recognising that the symptoms forwhich the patient consults his physician may be but a purelylocal indication of a much more widespread condition.M. Klippel and M. Lhermitte consider that the nasal crisisof the tabetic may be represented by one of three differingtypes-viz., sensory, spasmodic, and secretory-althoughthis division is somewhat schematic. The disturbance, of
whatever type it be, may occur in those who show a
permanent defect in their olfactory sense as well as in thosewhose smell is normal. The common impairment found inthe subject of tabes is partial or complete anosmia, withhypoassthesia of the face and nasal mucosa, and vaso-motor ortrophic changes in the olfactory mucosa itself. In the first
variety of nasal crisis the patient feels a pricking sensa-tion at the root of the nose, a disagreeable tickling in
his nostrils, and then suddenly experiences a strong and un-pleasant subjective odour commonly compared to that ofrotten eggs. Occasionally it is associated with an equallyunpleasant taste in the mouth. Among the many instancesquoted by the authors are cited those described by Mr. HerbertTilley’ 14 years ago as three cases of parosmia, and thesuggestion is made that they were in reality cases of tabes inwhich the ordinary symptoms of the condition were not
present or not recognised. They do not ignore the occurrenceof similar phenomena in intracranial tumours of a particularlocalisation, but the diagnosis presents no real difficulty.The spasmodic type of nasal crisis is characterised
,,
by attacks of sneezing ; one of their patients usedto notice a sensation of coolness and of pins andneedles over the left half of the face and then sneezingset in ; it was sometimes accompanied by flashes in
front of the left eye and bilateral tinnitus. An instance is
given where this form of nasal crisis proved to be the firstsymptom of tabes. Sometimes the crisis is succeeded bya flow of tears or of mucus from the nose ; in practicallyevery case some objective modification of facial or olfactorysensibility can be discovered, Where there are definite
vaso-motor or secretory phenomena we are dealing with the
1 THE LANCET, Oct. 9th, 1895, p, 907.
third or rhinorrhoeic form of nasal crisis. One of the cases
concerned a patient with locomotor ataxia, whose ’attack’
always began with a series of short abrupt respirations,followed by a bout of sneezing of several minutes’ duration.As soon as these spasmodic phenomena ceased, a slightlyviscid reddish fluid poured from the nose, soaking a
handkerchief in very little time ; towards ’ the end
of the flow it became clear and much more watery.Examination of the nasal fossag revealed no abnormalitywhatever, but there were changes in cutaneous, mucous, andolfactory sensibility. The differential diagnosis of these
symptoms may no doubt be difficult, but the discoveryof any of the classical signs of tabes is very significant,in particular any notable alteration in sensibility in thedistribution of the trigeminal nerve. In one of their casesM. Klippel and M. Lhermitte have found unmistakeable
histological changes in the olfactory bulbs. Of the en-
cephalic manifestations of the tabetic process several are,of course, very well known, in particular optic atrophy.-Sir William Gowers has drawn attention to the occurrenceof ’’ auditory atrophy" in the shape of constriction of theauditory field, and this latest contribution to the subject isequally suggestive and likely to repay research.
AT a meeting of the Royal Society on May 6th the
secretary announced that Colonel Sir David Bruce, whois in charge of the Sleeping Sickness Commission at presentin Uganda, had cabled to the Society on April 3rd to
report that the Commission had confirmed Kleine’s observa-tions on the period during which the tsetse fly was capable oftransmitting a trypanosome infection. A letter had beenreceived by the Society on April 30th from Sir David
Bruce, dated Mpumu Chagwe, Uganda, April 3rd, confirmingthe telegram, and stating that the Commission had repeatedDr. Kleine’s experiments with ’l’l’ypanosoma gambiense andGlossina palpalis, also with a trypanosome of the dimorphontype and the same Tsetse-flies, and found the flies infectiveafter 16, 19, and 22 days."
THE EARLY RECOGNITION OF UTERINECANCER.
AT the annual meeting of the British Medical Association,at Exeter in 1907 the Section of Obstetrics and Gynascologyadopted a resolution requesting the Council of the Associa-tion to appoint a committee to consider the best means ofdisseminating knowledge of the importance of the earlyrecognition of uterine cancer. That committee presented areport which was considered, and generally approved, by thesame section of the annual meeting of the British MedicalAssociation in Sheffield in 1908. At its meeting on
April 28th, 1909, the Council of the British Medical Associa-tion approved for publication the appeals to medical practi-tioners, and to midwives and nurses, and directed that theyshould be communicated to British and colonial medical andnursing journals. We have consequently received from theEditor of the British Medwal Journal the appended importantdocument addressed in its main bulk to all medical practi-tioners, but with a brief and earnest note to midwives andnurses appended :-
A.AN APPEAL TO MEDICAL PRACTITIONERS TO PROMOTE THE
EARLIER RECOGNITION OF UTERINE CANCER.The attention of all medical practitioners is directed to
the necessity of emphasising the curability by operation ofuterine cancer in its early stages.The adoption of a more extensive operation by the
abdominal route has made it possible to deal successfullywith cases hitherto regarded as inoperable, and to removemore of the pelvic cellular tissue as well as a portion ofthe vaginal walls ; it is in these situations that recurrenceis prone to develop.
