RECOVERY FROM BLINDNESS DUE TO CEREBROSPINAL MENINGITIS

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deformed, and even perhaps hideous. Can surgeryoffer a greater comfort to any man than to be ableto tell such an one that it can ease his pain, restorehis face, remodel his jaw ? Yet cold comfort

would it be to him if he knew of others to whomthese words had also been whispered, but the

promise had not been kept. And that soldier may,in these days of national service, be our own kithand kin." These words put the situation terselyand eloquently.That very much may be done to cure, or at any

rate alleviate, the terrible injuries resulting fromgunshot wounds of the jaws is proved from a

perusal of the many papers that have recentlyappeared on the subject, and it is also certain thatthe happiest results are those obtained by a closecooperation between surgeon and dental surgeon.Is all being done in this country that should bedone for such injuries ? We do not think it is.In Germany we know that as early as August, 1914,a hospital of 225 beds was opened at Dusseldorf,and that by April of last year similar institutionshad been opened in other parts of the German

Empire. The French early realised the import-ance of bringing these injuries under the care

of those capable of treating them, and they rapidlyorganised special hospitals. In England no attemptwas made to concentrate such cases until July oflast year, when the Eastern Command opened aspecial hospital at Croydon, and now nearly twoyears after the outbreak of the war fresh centresare being formed in connexion with a few of themilitary hospitals. If these special hospitals are togive the soldiers the best treatment their surgical

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staff should be chosen from those with a specialaptitude for plastic operations, and the dentalsurgeons from those who have had experience of injured jaws in our great civilian hospitals. Gunshot 2

injuries of the jaws require the most skilful treat- I

ment, and the treatment of these cases cannot be handed over to any accessible dental surgeon without a chance of disastrous results. This is now, ofcourse, widely recognised, but we have only lately come to look at the facts in their right proportion. I

c

Lack of appreciation of the importance of these Iinjuries has meant that in the first place there are tnumbers of our wounded soldiers who will pass the o

remainder of their days with permanent facial a

deformities which might have been remedied if the P

best special treatment had been available. As a n

letter of fact such detailed forethought would havecompletely impossible, but no doubt many Isoldiers have had to be invalided out of the army it

for wounds of this character who could have been vrestored, we now know, as

" efficients." Again,

neglect of treatment has of necessity added consider- rE

ably to the period of stay in hospital and placed a sl

greater incubus on the Pension Fund. To those d:

unacquainted with the work that can be done to fegunshot injuries of the jaw we would recom- wmend a valuable paper by Mr. DOLAMORE’in the tcJune lst issue of the British Dental Journal; in

Bi

which he describes and illustrates the methods pIused in the hospitals of Germany, and to a paper to

y Mr. J. F. COLYER in the April issue of the

Royal Army Medical Corps Journal. th

Annotations."Ne quid nimis."

AUXILIARY ROYAL ARMY MEDICAL CORPSFUNDS.

THE movement inaugurated on June lst at theRoyal Army Medical College to consider the de-sirability of establishing a benevolent fund forthe Services auxiliary to the Royal Army MedicalCorps is now taking definite shape. A meetingwill be held at 2.45 P.M. at the Royal Army MedicalCollege on Monday next, June 26th, when a schemeformulated by the provisional committee will bediscussed. The three auxiliary branches of theRoyal Army Medical Corps-namely, the SpecialReserve, the Territorials, and those holding Tem-porary appointments in the R.A.M.C.-will beincluded in the administration of the funds, undertwo headings : (a) an officers’ benevolent branch,and (b) a relief branch ; the establishment of a loanfund to help medical officers of the auxiliary forceswho find themselves in temporary difficulty onreturning to civil practice is also under considera-tion. In another column the proposals under thescheme are more fully set out.

RECOVERY FROM BLINDNESS DUE TO CEREBRO-SPINAL MENINGITIS.

o AT a meeting of the Societe Medicale dess Hopitaug of Paris, M. Arnold Netter showed thepossibility of recovery from blindness due to

cerebro-spinal meningitis, even when accompanied1by ocular lesions. He related the case of a child,

aged 21 months, who was admitted into hospitalunder his care on Dec. 20th. She had been ill1 since Nov. 24th, and various diagnoses had been made. On admission she was thin and cachectic.t Neither rigidity of the neck nor Kernig’s sign was. present. The abdomen was retracted and the tache; cerebrale was obtained. Lumbar puncture yielded

a purulent fluid containing many meningococci,: and 30 c.c. of antimeningococcic serum were

. injected. The puncture and injection were repeatedon the two following days. The liquid yieldedby the third puncture was clear and sterile.Recovery appeared to take place, but on Jan. 9ththe child was found to be blind. Examinationof the eyes, including the fundi, showed nothingabnormal, but the amaurosis was absolute, and thepupils did not react to light. Though there wereno symptoms of accumulation of fluid in theventricles lumbar puncture was performed on

Jan. 15th. The cerebro-spinal fluid rushed outin a jet, indicating high tension, but it was limpid,its chemical composition was normal, and onlyvery few cells (mononuclears and lymphocytes)were present. Puncture was not followed by anyreturn of vision. On Jan. 22nd 15 c.c. of cerebro-

spinal fluid were withdrawn, and on the followingday the lumbar region was swollen, which was mani-festly due to infiltration of the connective tissuewith cerebro-spinal fluid. On the 23rd vision beganto return and by the 28th objects could be recognised.But vision again deteriorated. On Feb. 3rd puncturewas again performed. On the next day vision im-proved again and on the following days it continuedto do so and was definitely regained. M. Rochon-

Duvigneaud, the ophthalmologist who examined

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the optic tracts by hydrocephalus. The recoveryof vision after the punctures bore out this view.In another case, in an infant aged 13 months,M. Netter observed a similar return of vision. Hereferred to a third case reported to the Academicde Medecine by MM. Triboulet, Rolland, andFenestre. A child, aged 2 years, had cerebro-spinal meningitis. Notwithstanding repeated in-jections of serum into the spinal canal and cerebralventricles, the head became enormously increasedin size and there were convergent strabismus anddilated pupils. The child appeared to be blind andan idiot. Examination of the eyes by M. Dupuy-Dutemps showed well-marked double optic atrophy.However, complete recovery took place.

IN ARTICULO MORTIS.

AN idea prevalent among the lay public is 1that medical men when they fall ill deserve pity,seeing that they know the ins and outs of theirdisease, can foresee its course, and estimate its

pains and penalties. The popular notion was

embodied with startling clearness and charm of ]style by the late Ernest Dowson in the fourth number of the Savoy, published 20 years ago a(August, 1896). In " The Dying of Francis Donne " ]Dowson imagines his hero, a rising young surgeon-noted among other things for the brilliancy of hislectures, which detractors pronounce " mere litera-

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ture,"-to be suddenly confronted with the know- ledge that he is doomed to die shortly of a terrible disease-presumably cancer. (A similar situation, ]by the bye, is imagined by Paul Bourget in his last novel.) Donne looks at himself in ]his mirror and reflects : " I, Francis Donne, am going to die," and presently, "I am going to die soon: in a few months, in six perhaps, certainlyin a year." He notices lines in his face and a ]certain greyness. He is only 35, but has for sometime been suffering from " a dull immutable pain," ]which has now declared its nature. He tries to ]make- believe-cheats himself almost into thenotion that he is suffering from nerves and thata long holiday will set him right. But he becomes ithe victim of a morbid self-consciousness. It seems that his acquaintances, pupils, and colleagues have adopted "an attitude of evasion, a hypocriticalair of ignoring a fact that was obvious and un- l

pleasant." He comes to the conclusion that it will ]be best to die among strangers. Like a dyinganimal, he shuns the world he has known. Hedrops suddenly out and goes to a remote village in ]Brittany, on the Atlantic coast. Was not death, too, inevitable and natural an operation as ]

it was, essentially a process to undergo apart and hide 1jealously, as much as other natural and ignoble processes of ithe body? And the animal, who steals away to an utter- imost place in the forest, who gives up his breath in asolitude and hides his dying like a shameful thing,-might he not offer an example that it would be well for the dignityof poor humanity to follow? He finds a summer world in Finistere, steeps ihimself in lethargy, almost regains hope at times. But if the days were not without their pleasantness, the

nights were always horrible-a torture of the body and anagony of the spirit. Sleep was far away, and the brain, which had been lulled till the evening, would awake, would i

grow electric with life, and take strange and abominable flights into the darkness of the pit, into the black night ofthe unknowable and the unknown.

At last, from a longer and more tortured night thanall the others, he awakes to full consciousness. He opened his eyes, and seemed to discern a few blurred

figures against the darkness of the closed shutters through which one broad ray filtered in; but he could not distinguish i

their faces, and he closed his eyes once more. An immenseand ineffable tiredness had come over him, but the pain- oh, miracle! had ceased ....... And it suddenly flashedover him that this-this was death; this was the thingagainst which he had cried and revolted; the horror fromwhich he would have escaped; this utter luxury of physicalexhaustion, this calm, this release.He would have smiled, but could not. His lifeflashes before him in review-the death of hismother from an ill which later he could havecured, the friend who had shot himself withoutcause, the girl whom he had loved, but who didnot love him. " All that was distorted in life wasadjusted and justified in the light of his suddenknowledge. Beati Mortui ......."And then the great tiredness swept over him once more,

and a fainter consciousness, in which he could yet just dimlyhear, as in a dream, the sound of Latin prayers.It is doubtful whether any but a man of letters,a poet, as Ernest Dowson himself was, would diethus.

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PARALYSIS FROM FRIGHT.

IN the Journal of the Canadian Medical AssociationLieutenant-Colonel R. D. Rudolf has recorded a caseof hemiplegia produced in a previously healthy ladby sudden fright, which, in addition to its medicalinterest, is not without a comic element. A private,aged 20 years, was admitted into the CanadianGeneral Hospital, France, with the diagnosis of"boils and facial paralysis." The family historywas good and he had never suffered from any illnessuntil he went to India four years ago as a bugler.He had been there eight weeks, when on the eveningof a very hot day he went on duty for the first time.He was sentry on the deadhouse, and his orderswere to kick at the door every 15 minutes to scareaway the rats. He was very nervous, but at 9 o’clockkicked at the door and nothing happened. At 9.15he did so again, when to his horror a voice criedfrom within, " W’at the ’ell are you kicking about?"In terror he fled to the guard-room, but fell beforehe reached that haven. It appears that before hewent on duty a guard had placed a drunken soldierin the mortuary to get sober and omitted to informthe new sentry. The lad was picked up uncon-scious and taken to hospital. He remainedunconscious for six days, and when he recoveredhe could not speak, the left side of the body wasparalysed, he could not shut the left eye, and theleft side of the body was anaesthetic. He remainedin this condition for about six months, the lastthree of which were spent in England. Thenhe gradually improved and re-enlisted. Onexamination he was a well-grown, healthy-looking lad. He could not close the left eye,but otherwise facial paralysis was not manifestuntil he smiled or tried to show his upperteeth. He could wrinkle the left brow almost asmuch as the right. The muscles of the left limbswere well developed but distinctly weak. The gripof the left hand was poor and he could not stand onthe toes of the left foot. The left knee-jerk wasslightly greater than the right. The plantar reflexwas absent on the left side. The tongue was notdeflected to either side. The fields of vision and thefaucial reflex were normal. Sensibility to touch wasdiminished and to heat, cold, and pain absent allover the left side, including the tongue, left nostril,and genitals. The patient stated that the leg firstrecovered from the paralysis, then the arm, andfinally the face. Lieutenant-Colonel Rudolf regardsthe condition as of the same nature as hysteria,andcompares it to the symptoms produced by shell