1389JOINT LESIONS IN SYRINGOMYELIA.

moment in St. Thomas’s Hospital. Apparently the pro-tective corset (she was a lady) was not in fault but onlythe marksman. Be that as it may, the result of the

experiment has been that the unfortunate girl was struck bya bullet on the right side of the cervical spine, a swellingbeneath the left clavicle indicating the dangerous course

which the bullet took. The ulnar nerve and the cervical

sympathetic have been injured, while there are signs of

extravasation of blood behind the trachea and in the deepstructures of the neck. It is no exaggeration to say thatshe has escaped with her life by a miracle-indeed, it maybe somewhat premature to say that she has escaped withher life at all. Now this kind of thing may be entertain-ment for the spectator, but it cannot be so droll for the

object shot at, and we can understand that the marksmanmay find it easy to be a little blind to the ridiculous side ofthe affair.

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JOINT LESIONS IN SYRINGOMYELIA.

IN a recent number of THE LANCET we referred to theoccurrence of the curious affection of the joints which hasbeen regarded as peculiar to locomotor ataxy, under thename of "Charcot’s joint," in cases of syringomyelia. Wethen referred to a case recorded by Dr. Charles K. Mills ofPhiladelphia, in which the knee was affected, to one pub-lished in our columns by Dr. Hughlings Jackson and Dr.Galloway in which the elbow was affected, and to another,recently brought before the Clinical Society by Mr. Lunn, inwhich the affection was multiple. Another case, in whichthe shoulder was affected, has also been published byProfessor Sonnenburg, to which reference is made in a recentnumber of the Neurolorisc7e Cent’l’alblatt. The patient wasa man aged fifty, who had loss of sensibility of heat andpain in the left extremities, with considerable muscular

atrophy, but little or no change in electrical irritability. Theseft shoulder was the one affected ; and unduly free passivemovement could be carried out, apparently because the headof the humerus was entirely gone. The elbow- and wrist-

joints seemed to be normal, but the finger-joints appeared tohave enlarged capsules. The occurrence of this trophiccondition of the joints in this disease is interesting. It

seems to occar with considerably greater frequency than inocomotor ataxy, and considering the other manifestations ofthe disease this is, perhaps, what was to be expected.

EPIDEMIC OF SCARLET FEVER AT RICHMOND-HILL.

THE county medical officer of health of Surrey, Dr. EdwardSeaton, has recently reported to the county council on anoutbreak of scarlet fever which occurred at Richmond-hill in

February last, and concerning which his advice was soughtby Dr. John Rowland, the medical officer of health of

Richmond. It appears that, after a period of comparativeimmunity of the district from scarlet fever, there took placeduring the ten days following Jan. 29th a sharp outburst ofthe disease, no less than fifty-five attacks occurring, whileout of this number fifty-two obtained their milk-supply froma common source. There were twenty-six households invaded,the number of houses supplied by the milk in question being416 and the total number of houses in the borough about6000. Dr. Rowland, therefore, pointed out to his sanitaryauthority that seventeen-eighteenths of the cases were withinthe area of a milk-supply which served less than one-fourteenthof the total number of houses in Richmond, a condition ofaffairs which certainly constitutes, as Drs. Seaton andRowland remark, a very strong Prama faci.e case againstthe milk. The dairyman on request at once changed hismilk-supply, and a searching inquiry was instituted as to

1 THE LANCET, May 19th, 1894.

the existence of any scarlet fever among the employés of thedairy ; but none could be discovered. It was subsequentlyascertained that scarlet fever had been recently prevalent inthe rural sanitary district of Buckingham, where the threefarms supplying the milk were situated, and after "a con-siderable amount of correspondence " it was arranged thatDr. Seaton should visit these farms. He was, however,unable to discover any evidence of the existence of scarletfever among those directly connected with the milk business,though, as he himself suggests, this was not altogether to bewondered at, since his visit was paid some five or six weeksafter the outbreak occurred. Obviously, too, after this lapseof time there would not have been much advantage inendeavouring to trace the milk supplied to the infectedhouses to any one farm or to any group of cows, even assum-

ing such a thing had been Epossible, nor would the inspec-tion of the cows by a veterinary surgeon have been of muchvalue. Dr. Seaton draws attention to the insanitary con-ditions of some of the dairy farms he visited in Buckingham-shire, and he describes how, in one, " some thirty-six cowshad to wade through filth, liquid and semi-liquid, aboutknee-deep on their way to the milking sheds."

A CURIOUS SUPERSTITION.

NOTWITHSTANDING the fact that an Education Act hasbeen in force for nearly a quarter of a century a good dealof ignorance exists and manifests itself in the crudest formof superstition. In nothing more glaringly than in thepopular conceptions of disease and its treatment is this

ignorance shown, and the claims of quacks confirm thisbeyond contradiction. A curious case heard lately bythe Chorley (Lancashire) magistrates reveals a state of

ignorant superstition that we might have well believed haddied in Elizabethan days or sooner. A young man twenty-two years of age was paying his addresses to a young womanof the same age, and fell into ill-health, and in consequenceconsulted a gipsy woman in the neighbourhood of his home;in prosecution of the treatment prescribed by this wisefemale he did the thing which procured for him his positionas defendant in an assault case. On May 9th he went to hisfaancee’s house and invited her to walk abroad with him.After they had proceeded about a mile he took out a needleand pricked her so severely with it that he drew blood. Hethen struck her on the face several times. The defendantdid not deny the charges, but he gave a most remarkablereason for his conduct. He said that he was pining away,and he was obliged to do it to ease his mind. He had beentold she carried about her or had buried somewhere near thehouse where she lived something which attracted him, andthat from the moment that " he drew her blood " she wouldcease to have any power over him. It was elicited in defencethat the defendant was a respectable young man and aregular attendant at chuich and religious classes. The

young lady only sought protection from further annoyance.The magistrates bound the defendant over, the chairman

adding that his people ought to keep a watchful eye uponhim, for actions like his accounted for in such a mannerlooked more like insanity than bodily illness.

ACUTE INFECTION WITH THE DIPLOCOCCUSLANCEOLATUS.

A CASE of unusual interest is recorded by Dr. W. H.Prescott in a recent number of the Boston Medical and

Surgical Journal. It occurred in an infant shortly afterbirth. The mother of the child was a primapara and per-fectly healthy. Nothing wrong was noticed with the infantuntil forty-eight hours after delivery, Then it appearedto be rather dull and slightly cyanosed. It died suddenlyfifty-six houis after birth. The necropsy was made by Mr,J. R. Poor. In each pleural cavity there was a slight amount

1390 EPIDEMIC OF HEMERALOPIA IN ASIA MINOR.

of heamorrhagic exudation. The entire lobe of the rightlung was consolidated. The pleural surface of the lungwas sprinkled with fine eccbymoses. The consolidated

lung was of a dark red colour, the cut surface being dryand smooth. Ecchymoses were found in the pericardiumand in the muscular tissue of the heart. Cover-glass pre-parations made from the lungs showed enormous numbers oftypical diplococci with well-defined capsules. Similar

organisms were found in the blood from the heart and inscrapings from the other organs. Cultures made from the

organs gave pure cultures of diplococci from the lungs, heart,blood, liver, spleen, and kidneys. A rabbit inoculated with

scrapings from the consolidated lung died in three days fromtypical diplococcus septicsemia. Examination of the con-solidated portions of the lung showed an absence of the

typical appearance of fibrinous pneumonia, the consolidationbeing due almost entirely to haemorrhage into the lung. Thecase is of especial interest from the early age of the child andthe character of the infection produced by the diplococcuslanceolatus. In this case there was a general infection ofthe entire organism, similar to that which is usually pro-duced in rabbits by inoculation with virulent cultures ofthe diplococcus. In spite of the child being so young it is

not at all probable that the infection took place in utero.The mother was absolutely free from pneumonia or from anyother pathological condition at the time of birth. The

character of the exudation in the lungs was also of interest.It was to a large extent hsemorrhagic in character, and thecondition most resembling that produced by the organisms inthe adult was a fibrinous exudation on the pleura. Therecan be little doubt, from the extent of the lesions in the lung,that the organisms had entered the lungs first, and probablyat the time of birth.

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EPIDEMIC OF HEMERALOPIA IN ASIA MINOR.

A SOMEWHAT widespread epidemic of hemeralopia is re-ported by Dr. Voskresenski, writing in the Voenno-MeditsinskiZhurnal, as having occurred among the Russian troops inSarikamish, an elevated district in the neighbourhood ofKars, lying some 7000 ft. above the level of the Black Sea.Altogether 258 men were affected. The cause could not wellbe malaria as there is no malaria in the locality, and thewriter, who has of course seen a great deal of malaria inother places, has scarcely ever known it to be asso-

ciated with hemeralopia. He has no doubt that in-

sufficient nourishment was the chief, if not the only,cause of the epidemic, the large majority of the

cases occurring during the great fast (Lent). Someconnexion appeared to exist between the hemeralopiaand scurvy, for as the nutriticn of the men was improvedboth the affections decreased. Indeed, so far as treatmentwas concerned, drugs did not appear to be required-restand good nourishment in hospitalgenerally relieving the patientsin three days. When the patients were allowed to continueat their duty it was sometimes nearly three weeks before acure was eftected. When cod-liver oil, however, was givenmost of the cases recovered in six days. The glare of thesnow was probably to some extent a factor in the productionof the disease. It is remarkable that soldiers arriving in

the district with incipient phthisis, notwithstanding their

living the ordinary barrack life, completely recovered, no

physical signs remaining. It would appear, therefore, thatSarikamish may some day come to be recommended as asecond Davos.

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ENTERIC FEVER IN INDIA.

THE announcement of the deaths from enteric fever ofthree young officers of the East Surrey Regiment stationed atAgra within the brief period of a week once again drawsforcible attention, says the Pioneer Mail, to the ravages

caused by this disease in India, and to the inquiry how it i3that so many young European officers recently arrived in thecountry are to be found among its victims. It is a verystrange fact that of the number of regiments and batteries ofRoyal Artillery arriving every year from England and disembarking at Bombay to become dispersed over the variousmilitary stations of the Indian Empire scarcely any alto.gether escape being attacked by this disease during thefirst year or so of their Indian service. Few districts inIndia can claim immunity from it. Its causes-whetheressential, predisposing, or exerting-have been studied andexamined by numbers of medical officers and others; butunder the short service system, with its more frequentrenewal of the European garrison of India by drafts of menand young officers from home, the prevalence of enteric feverhas been constantly increasing of late years. It proves fata)every year to a number of young and apparently strong andhealthy Europeans and destroys many bright and promisinglives. We have so frequently called attention to the subjectthat only a sense of its grave importance can excuse ourreiteration. If the essential cause of the disease be a

bacillus, and water be its vehicle, we venture to make thepractical suggestion to the Government of India to make anexperimental trial of the new forms of sterilising filters usedby the Germans and French, and which the latter have foundso efficacious in reducing the amount of enteric fever in theFrench army. The cost of such an experiment would surelynot be great, even supposing it to prove unsuccessful.

EPIDEMIC OF CEREBRO-SPINAL MENINGITIS.

IN a recent number of the Archives of Pediatrics Dr. Berggives in some detail an account of the various phenomena,apparent in an epidemic of this disease which occurred inNew York last year. As is well known cerebro-spinal menin-gitis is always present in New York to some extent. Thus in

. 1892 the number of deaths was 230, while in 1893 the number

,

rose to 469, so that it may correctly be regarded as epidemic: in the latter year. There were as many as 107 deaths in themonth of May, and in the later part of the year the epidemicgradually declined. Of the cases seen by himself in private

.

practice, seventeen in number, Dr. Berg tabulates the

most prominent symptoms under three headings, (1) thosel due to the poison of the acute infectious disease, (2) those.

due to the inflammation of the cord and its meninges,.

and (3) those due to the inflammatory process in the brainand its membranes. Under the first heading the chiel

symptoms are chill or convulsion, vomiting and affec-tions of joints, and, as a rule, eruption of a herpeticcharacter. The usually described petechial eruption Dr. Berg did not see in any of his cases. Under the second heading’

are included stiffness of neck, pain in the spinal column,’

hypersestbesia of surface, and difficulty with the bladder and!

bowels ; and under the third heading are included headache,’

slow pulse, vertigo, convulsions, respiratory phenomena, eye

t symptoms, and various paralyses. The most constant andI

severe symptoms in Dr. Berg’s cases were apparently the

affections of the joints and headache. The joint troublesappeared early, varied in severity, and affected chiefly the

1 knees and hips, and it is this affection of joints which

r determines the attitude in bed. The duration of the disease

varied very much. Dr. Berg’s shortest case was over in

1 twelve days, while another lasted as long as eight weeks.

NORTH BRITISH VANDALISM.

THE many lovers of the beautiful who number among their

pleasures a recollection of the Scottish metropolis will regardwith something like dismay a proposed architectural altera-tion in that classic city. In consequence of a much-increased

railway traffic it has become necessary to remove the North