TUBERCULOSIS IN THE FRENCH ARMY.

2
1445 CEREBRAL CONDITIONS ASSOCIATED WITH SACOHARINE DIABETES. refuse must be placed on the footway the hour for the removal of the refuse shall be 9 o’clock and not 10 o’clock as at present." Another recommendation was that with regard t the clearing away of snow the old rule which entailed that duty on the householder should be reverted to. This recom- mendation was rejected. Nothing further was recommended as regards street cries, and as regards street music the committee reported that they considered it undesirable that street musicians should be required to take out a police licence. They recommended, however, "that wherever two-thirds of the householders in any road, street, terrace, or collection of houses sign a notice to the Chief Commissioner of Police that they desire to be unmolested by itinerant musicians the police should be instructed to order such street musicians to move from such locality." The recommendation was adopted. Other recommendations dealt with the placing of the names of streets so that they can be seen-a sorely-needed reform-and the attention of the police was " invited to the delivery of barrels." We consider that the atten- tion of the police might be profitably called to the delivery of a great many other things besides barrels-biscuits, soap, hampers, flour, and the like, to say nothing of barrows laden with ladders, spikes, and coils of wire with which the National Telephone Company block the footway. The Mayor of Westminster might also draw the attention of his brother of Holborn to the filth and mess caused by Covent Garden Market. Bat until that market becomes as great a nuisance as Smithfield we suppose it will linger on. The Augean stable of London needs a very Hercules to cleanse it, but we are glad to see that at least the existence of nuisances is recognised. We are sorry to see no reference made to the perfectly avoidable mess made by waste paper such as news posters and omnibus and tramway tickets. ON THE CEREBRAL CONDITIONS ASSOCIATED WITH SACCHARINE DIABETES. DR. Louis DESBONNETS (These de Paris, 1900) gives a long account of the above subject, based on the study of 29 cases whose clinical history and symptoms are recorded at some length. But little attention has been paid in text- books to the cerebral troubles associated with diabetes, Bouchard having stated in 1885 that the nervous symptoms of diabetes though frequent are but little known." Among the more frequent symptoms recorded by Dr. Desbonnets are general muscular feebleness and proneness to fatigue, temporary and transient (sometimes permanent) attacks of hemiplegia and monoplegia which are of an atypical character, neuralgias (Buzzard) affecting by preference certain nerves, such as the sciatic, crural, trigeminal, inter- costal, and occipito-cervical, and probably indicating com- men jing peripheral neuritis. Visual disturbances, diplopia from weakness and incoordination of the ocular muscles, and temporary attacks of amblyopia are not uncommon. The general cerebral state is one of apathy and loss of all individuality and initiative in conduct. Later, ideas of ruin, hypochondriacal melancholia, and delusions of persecution may appear, the particular form of mental disturbance taking its special colouring from any neurotic tendency which may be present (Westphal). Vertigo, headache, insomnia (Pierre Marie), and nightmare are frequent in diabetics. The tendency to apathy and torpor may at times deepen into narcolepsy and this may occur periodically. The following is one of the surgical cases recorded in the Tlcese. A young shoemaker, of stout build (a tendency which he inherited), had since 1896 suffered from polyuria, especially during the night. One morning on waking he was surprised to find that his left leg was paralysed and insensible and could not be moved. The following day the arm became similarly affected, and finally the left side of the body grew hemiplegic and hemiansesthetic. He was unable to close the left eye and could not see objects in the left half of the visual field (hemianopsia). The eyelid re- covered soon after but the general hemiplegia persisted. The urine was found to contain 3’3 per cent. of sugar and to have a specific gravity of 1035. Poly- dipsia and dryness of the mouth were present in a marked degree. Power returned partially to the left arm and leg. The knee-jerks were absent. Ophthalmoscopic examination showed a normal fundus in each eye. Both smell and taste were diminished on the left side and hearing was impaired in the left ear. The diagnosis was doubtful, but the symptoms pointed to a partial damage of nerve-fibres in the posterior part of the internal capsule of the light cerebral hemisphere. Fursterer has found minute capillary embolisms (supposed to be produced by granules of glycogen) in the brains of patients dying from diabetes with symptoms of temporary paresis or paralysis, the more grave cases of persistent hemiplegia showing distinct cerebral foci of softening, and Dr. Desbonnets inclines to the same belief. TUBERCULOSIS IN THE FRENCH ARMY. IN a short article published in the rchives de Médeaine et de Pha’l’macie Militaires for October Inspector-General Kelsch recapitulates his views regarding the incidence of tuberculous diseases in the French army. The admirable labours of Villemin, of Koch, and of their followers have, he says, reduced the etiology of tuberculosis to an expression as simple as it is luminous. Monopolised by experimentation, which has constituted its pathogeny upon the image of the disease as observed in animals, forsaken in a great measure by clinical observation, which has been compelled to efface itself before the brilliant notions of the laboratory, tuberculosis in man has become a disease of inhalation and ingestion. This being so, the director of Val-de-Graoe is convinced that the situation is fraught with danger. To begin with, in spite of the incessant anti-microbic warfare during the last 10 years, tuberculosis is still progressing. All the artifices of statistics cannot conceal this painful fact. The disease causes more damage than ever among young soldiers of less than a year’s service, whereas amongst veterans it is stationary or even decreasing. Why should there be this discrepancy ? 7 Are not all ages equally liable to microbic attack ? 2 Moreover, young soldiers suffer chiefly during their first six months which are also the most inclement of the year. If tuberculosis were communicable solely by contact from man to man all ages should suffer alike, and no season should be exempt more than another. Inspector-General Kelsch is firmly of opinion that it is the conscript who infects himself. Many conscripts when they reach barracks are the hosts of latent tuberculosis ; fibro-caseous nodules, solitary or multiple, scattered amongst the mediastinal or the mesen- teric ganglia, in the lungs or in some other organ-a con- dition of things that is perfectly compatible with a vigorous constitution and flourishing health, and one that is not to be detected by ordinary examination. In fully a third of the necropsies which he has conducted on subjects who died from other causes than tuberculosis Inspector-General Kelsch has met with these hidden lesions, and they were likewise present in 51 out of 120 unselected conscripts whom he inspected on joining by means of the radioscope. He believes that the deposits may take place in utero and that most certainly they are of very frequent occurrence during childhood. Although latent they are by no means defunct, but, on the contrary, retain the elements of vitality, spores ready at any moment to evolve, veritable sparks which brood beneath the ashes 1 and constitute a 1 Ev’n in our ashes live their wonted fires.—Gray.

Transcript of TUBERCULOSIS IN THE FRENCH ARMY.

Page 1: TUBERCULOSIS IN THE FRENCH ARMY.

1445CEREBRAL CONDITIONS ASSOCIATED WITH SACOHARINE DIABETES.

refuse must be placed on the footway the hour for the

removal of the refuse shall be 9 o’clock and not 10 o’clock asat present." Another recommendation was that with regardt the clearing away of snow the old rule which entailed thatduty on the householder should be reverted to. This recom-

mendation was rejected. Nothing further was recommendedas regards street cries, and as regards street music thecommittee reported that they considered it undesirable thatstreet musicians should be required to take out a policelicence. They recommended, however, "that wherever

two-thirds of the householders in any road, street,terrace, or collection of houses sign a notice to the

Chief Commissioner of Police that they desire to beunmolested by itinerant musicians the police should beinstructed to order such street musicians to move

from such locality." The recommendation was adopted.Other recommendations dealt with the placing of the namesof streets so that they can be seen-a sorely-neededreform-and the attention of the police was " invitedto the delivery of barrels." We consider that the atten-

tion of the police might be profitably called to the deliveryof a great many other things besides barrels-biscuits,soap, hampers, flour, and the like, to say nothing ofbarrows laden with ladders, spikes, and coils of wire withwhich the National Telephone Company block the footway.The Mayor of Westminster might also draw the attention ofhis brother of Holborn to the filth and mess caused byCovent Garden Market. Bat until that market becomes as

great a nuisance as Smithfield we suppose it will linger on.The Augean stable of London needs a very Hercules to

cleanse it, but we are glad to see that at least the existenceof nuisances is recognised. We are sorry to see no referencemade to the perfectly avoidable mess made by waste papersuch as news posters and omnibus and tramway tickets.

ON THE CEREBRAL CONDITIONS ASSOCIATEDWITH SACCHARINE DIABETES.

DR. Louis DESBONNETS (These de Paris, 1900) gives along account of the above subject, based on the study of 29cases whose clinical history and symptoms are recorded atsome length. But little attention has been paid in text-books to the cerebral troubles associated with diabetes,Bouchard having stated in 1885 that the nervous symptomsof diabetes though frequent are but little known." Amongthe more frequent symptoms recorded by Dr. Desbonnets aregeneral muscular feebleness and proneness to fatigue,temporary and transient (sometimes permanent) attacks ofhemiplegia and monoplegia which are of an atypicalcharacter, neuralgias (Buzzard) affecting by preferencecertain nerves, such as the sciatic, crural, trigeminal, inter-costal, and occipito-cervical, and probably indicating com-men jing peripheral neuritis. Visual disturbances, diplopiafrom weakness and incoordination of the ocular muscles, and

temporary attacks of amblyopia are not uncommon. The

general cerebral state is one of apathy and loss of all

individuality and initiative in conduct. Later, ideas of ruin,hypochondriacal melancholia, and delusions of persecutionmay appear, the particular form of mental disturbance

taking its special colouring from any neurotic tendencywhich may be present (Westphal). Vertigo, headache,insomnia (Pierre Marie), and nightmare are frequent indiabetics. The tendency to apathy and torpor may at timesdeepen into narcolepsy and this may occur periodically.The following is one of the surgical cases recorded in theTlcese. A young shoemaker, of stout build (a tendencywhich he inherited), had since 1896 suffered from polyuria,especially during the night. One morning on wakinghe was surprised to find that his left leg was paralysed andinsensible and could not be moved. The following day thearm became similarly affected, and finally the left side of the

body grew hemiplegic and hemiansesthetic. He was unableto close the left eye and could not see objects in the lefthalf of the visual field (hemianopsia). The eyelid re-

covered soon after but the general hemiplegia persisted.The urine was found to contain 3’3 per cent. of

sugar and to have a specific gravity of 1035. Poly-dipsia and dryness of the mouth were present in a

marked degree. Power returned partially to the left armand leg. The knee-jerks were absent. Ophthalmoscopicexamination showed a normal fundus in each eye. Bothsmell and taste were diminished on the left side and hearingwas impaired in the left ear. The diagnosis was doubtful,but the symptoms pointed to a partial damage of nerve-fibresin the posterior part of the internal capsule of the lightcerebral hemisphere. Fursterer has found minute capillaryembolisms (supposed to be produced by granules of glycogen)in the brains of patients dying from diabetes with symptomsof temporary paresis or paralysis, the more grave cases ofpersistent hemiplegia showing distinct cerebral foci of

softening, and Dr. Desbonnets inclines to the same belief.

TUBERCULOSIS IN THE FRENCH ARMY.

IN a short article published in the rchives de Médeaine etde Pha’l’macie Militaires for October Inspector-GeneralKelsch recapitulates his views regarding the incidence oftuberculous diseases in the French army. The admirablelabours of Villemin, of Koch, and of their followers

have, he says, reduced the etiology of tuberculosis toan expression as simple as it is luminous. Monopolisedby experimentation, which has constituted its pathogenyupon the image of the disease as observed in animals,forsaken in a great measure by clinical observation, whichhas been compelled to efface itself before the brilliantnotions of the laboratory, tuberculosis in man has becomea disease of inhalation and ingestion. This being so,the director of Val-de-Graoe is convinced that thesituation is fraught with danger. To begin with,in spite of the incessant anti-microbic warfare duringthe last 10 years, tuberculosis is still progressing. All the

artifices of statistics cannot conceal this painful fact. Thedisease causes more damage than ever among young soldiersof less than a year’s service, whereas amongst veterans it isstationary or even decreasing. Why should there be this

discrepancy ? 7 Are not all ages equally liable to microbic

attack ? 2 Moreover, young soldiers suffer chiefly during theirfirst six months which are also the most inclement of the

year. If tuberculosis were communicable solely by contactfrom man to man all ages should suffer alike, and no seasonshould be exempt more than another. Inspector-GeneralKelsch is firmly of opinion that it is the conscript who infectshimself. Many conscripts when they reach barracks are thehosts of latent tuberculosis ; fibro-caseous nodules, solitary ormultiple, scattered amongst the mediastinal or the mesen-teric ganglia, in the lungs or in some other organ-a con-dition of things that is perfectly compatible with a vigorousconstitution and flourishing health, and one that is not

to be detected by ordinary examination. In fully a third ofthe necropsies which he has conducted on subjects who diedfrom other causes than tuberculosis Inspector-General Kelschhas met with these hidden lesions, and they were likewisepresent in 51 out of 120 unselected conscripts whom heinspected on joining by means of the radioscope. Hebelieves that the deposits may take place in utero and thatmost certainly they are of very frequent occurrence duringchildhood. Although latent they are by no means defunct,but, on the contrary, retain the elements of vitality,spores ready at any moment to evolve, veritable sparkswhich brood beneath the ashes 1 and constitute a

1 Ev’n in our ashes live their wonted fires.—Gray.

Page 2: TUBERCULOSIS IN THE FRENCH ARMY.

1446 THE HOWARD ASSOCIATION AND STREET RUFFIANISM.

perpetual menace for the individual. Inspector-GeneralKelsch failed in his attempts to implant tuberculosis in 80guinea-pigs which in the course of one and a half years heinoculated from the sweepings of barrack-rooms at Lyons,but he is nevertheless far from disregarding the dangerousnature of floor-dust and fully appreciates the importanceof the sputum as a vehicle of contagion. We should not,however, refuse to acknowledge the possibility of auto-

infection or fail to adopt measures for the alleviation of sogreat an evil. The virus of rabies or of anthrax once

implanted is strong enough to triumph over all resistance ofits own accord, being equal to the task of conquering humanvitality unaided ; but in the case of phthisis pulmonalisthe bacillary enemy is feeble enough to require an ally inthe citadel itself, it cannot subdue the garrison unless thereis complicity amongst the defenders. Before the bacillus ofKoch can effect a serious lodgment in the human organismit must have the assistance of a traitor, and unfortunatelythe disaffected are numerous, chief among the number

being insufficiency of proper food, surmenage, defectivecleanliness of body and habitation, impure air, dark rooms,and, above all, alcoholism. The only solid prophylactic basiswhereon to build in the case of tuberculosis consists in the

development of the soldier’s physical vigour together withthe amelioration of his hygienic and social surroundings.

THE HOWARD ASSOCIATION AND STREETRUFFIANISM.

THAT excellent society the Howard Association has issuedits annual report dated October, 1900. In dealing with thework of the year the report treats of many subjects, such asreparation to the injured as well as punishment for the

injurer, the International Prison Congress recently held atBrussels, admonition and punishment, the housing of the

poor, and the roral exodus. In addition to these the questionsof juvenile roughs and truants, the Juvenile Offenders Bill,and the temperance question are discussed. With regardto the first of these the association speaks in terms of praiseof the children’s courts existing in Australia, in which

school attendance cases and children’s offences in generalare dealt with. Such courts would, we think, do good workhere, provided, of course, that they were quite independentof the School Board. With regard to the Juvenile OffendersBill, which was dropped owing to the weakness of the

Government in giving way to the cries of faddists, the asso-ciation considers that if the birching clauses were not to

apply to children under 10 years of age the Bill would be a

good one. Even Mr. J. A. PICton prefers the birch to the

gaol. We can only hope that the Bill will be carried throughby the present Parliament and that a pistol clause will beembodied in it. With regard to Hooliganism the reportsay s :-

11 W13il,t whipping is a useful check to the worst formsof ’ Hooliganism,’ the prevention of the evil at its s(Jurces isof far greater importance. Idleness, parental neglect, andwant of occupation and of healthful physical exercises areamongst these causes, together with frequent magisteriallaxity in failing to support the police."With this we certainly agree. Magisterial laxity is re-

sponsible for much of the excess of violence which has oflate been evident in the streets. For instance, at South-wark Police-court on Oct. 24th two oung roughs, agedrespectively eighteen years, were brought before Mr. Kennedyon a charge of " using insulting behaviour." Evidence was

given that prisoners belonged to a gang who austled footpassengers and menaced shopkeepers. Mr. Kennedy is re-

ported as saying that "such ruffianism must be put down."And what followed ? 2 A fine of five shillings or five days’imprisonment. We can almost hear Mr. Kennedy saying,11 D’you know, I shall really have to give you a good hard

knock." Such trivial punishment will never check crime. By iall means let us use every means of prevention, but the full-

blown Hooligan, as we have said over and over again, must.be severely dealt with. ’

THE CARDIFF INFIRMARY.

WE have upon several occasions drawn attention to the

unsatisfactory financial position of the Cardiff IDfirmary andhave expressed astonishment that so excellent and well-administered an institution should meet with such inadequate-support from the inhabitants of the district as to leave an

ever-increasing burden of debt upon the managers. There is-

perhaps at the present time no more prosperous town in the.country than this South Wales port, and as all classes are

participating in the good times there should be littlecr no difficulty in liquidating the debt of 10,000, theamount which the adverse balance of the past few years.has now reached. The erection of the new seamen’s accident

hospital has no doubt adversely affected the revenues of the-infirmary, but now that the establishment of the formerinstitution is assured by the munificence of the late Marquis.of Bute the claims of the infirmary may deservedly beconsidered. The newly-elected mayor of Cardiff, CouncillorThomas Andrews, has already evinced a desire to raise-

during his term of office a sufficient sum to enable the

infirmary to be placed upon a firm financial footing, and at-the mayoral banquet held on Nov. 9th last he obtained sub-scriptions for this purpose amounting to several hundred

I pounds. We congratulate the mayor upon his benevolent

e resolve and trust that long before next November we may be.

; able to felicitate him upon the success of his enterprise.

CACODYLIC MEDICATION.

WE have previously referred to this mode of administer-ing arsenic, which has been recently introduced by M.Armand Gautier. 1 A lecture on the subject which was.

delivered at the Medical Graduates’ College and Polycliniaby Dr. William Ewart and which is published in the

September and October numbers of the journal of that-institution well describes the present knowledge on the

subject. Cacodyl is a dimethyl arsenide obtained from

AsH3 by substituting methyl for hydrogen. It is a highlypoisonous fluid with an unpleasant odour. In oxide of

cacodyl thel’e objectionable features are still present. Byfurther oxidation the metal passes from the triad into-

the pentad stage forming cacodylic acid. In sodium

cacodylate it loses virulence and smell. This organic.compound contains 46 per cent. of arsenic and has the

great advantage over ordinary preparations of relativefreedom from irritating and poisonous properties. In it.

arsenic can be administered in quantities previously unheardof without misgivings or risks. Dilute solutions are welltolerated by the stomach. Cacodylate of sodium is a highlysoluble deliquescent solid free from smell and taste. In

consequence of its deliquescence pills cannot be prepared inthe ordinary way. Cacodylate of sodium may be given bythe mouth or rectum or subcutaneously. Tne two latter-methods have been advocated in preference to the formerbecause they are less liable to lead to the formation ofredaction compounds. By the mouth half-grain pills may begiven three or four times dai!y or the equivalent in solu-

tion either at or between meals. By the rectum an

initial dose of half a grain may be given to adults anda third of a grain to children suffering from chorea.From one to four drachms of water may be used as a

vahicle. Hypodermically one-third of a grain in 10 minimsof water is an initial dose and may be increased to one grainor more. Moderate doses of the drug may be given for long

1 THE LANCET, Nov. 18th, 1899, p. 1408, and March 10th, 1900, p. 736.