60 DR. H. KE~EI)Y on a Disease JLike Measles.

original source of irritation. Of this class of cases some account is given in a paper which was read by me, before the Birmingham Branch of the British Medical Association, on April 9th, 1857, and published in the journal of that society for June 13th (p. 496) of the same year.

Careful observation of a large number of instances of reflex ophthalmia--a disease of great frequency in Birmingham, and the neighbouring mining districts--has led me to the following, among other conclusions, namely :--that the primary traumatic irritation is conveyed to the sound eye through branches of the fifth nerve; that soon afterwards, and sometimes simultaneously, the vaso- motor nerves take on disordered action, and, as a consequence, intraoeular congestions and their results occur; that, if the disease be not arrested, the optic nerve fibres become inflamed, or affected with such other changes as induce atrophy, and which lead to similar degeneration of the opposite nerve, attended by an amaurosis, which is incurable. In this stage of the complaint the commisural arrangement of the optic nerve fibres is probably the channel through which the disorder is conveyed.

When the state of the eye admits of its fundus being examined by the ophthalmoscope, in the early stage of reflex ophthalmia, the most constant appearance is congestion of the vessels of the retina, and more especially of the veins; but where there is an advanced amaurosis-the usual signs of atrophy of the optic nerve entrance, which are sufficiently familiar to render description in this place needless, are revealed.

ART. V . - - A Case in w]deh a Disease, llke Measles, arose f rom an unusual cause; with some brief remarks, a By H ~ R : ~ KENNEDr, A.B., M.B., one of the Physicians in Ordinary to Sir P. Dun's Hospital.

THE following case, though but a solitary one, I wish to bring under notice; as it presented some points of curious interest, or even importance. I should state that, at the time of its occurrence, some five months since, I was in total ignorance of its nature. But thanks to our periodical literature, a paper has, since then, come

i Read before the l~Ied. Association of the King and Queen's College of Physicians.

DR. It. KENNEDY on a Disease L ike Measles. 61

under my notice, which has helped to remove the difficulty and make light where darkness had existed. There will be occasion to speak of this paper further on. The case was briefly as follows : - -

A young gentleman of fifteen years of age, rather under-sized, but of a high order of intelligence, returned to school after the summer holidays, being then in perfect health. As he entered the school-room one of his play-mates met him, holding a paper bag, with some kind of powder in it, in his hand, and before he was aware, had dashed a handful of the powder in his face; and there can be no doubt that some of it got not only into his eyes, but down his throat---for he was laughing at the moment. The powder turned out to be flaxseed-meal, which, by some accident, the other boy had found in the room.

The result was truly remarkable; the boy was at once seized with smarting and watering of the eyes, running from the nose, cough, and dyspnea. With some difficulty he made his way home - - a distance of an English mile. By the time he reached it his face had become much swollen, the eyelids and eyes very red, and the dyspnea urgent. The excitement, too, of the system generally was very great; and all this within two hours of the accident. When seen the following day he had, except the rash, all the look of a boy suffering from a sharp attack of measles. His face was still swollen, his eyes were injected, and had a strange dark-red line round them, giving a very peculiar expression to the countenance; and he had a constant loud cough, with dyspnea. His pulse was 120. Two years previously I had attended him in a well-marked attack of measles, with cough.

On hearing the history of the case, I confess I thought that quiet and a little time would suffice to get him well; and so he was only directed to inhale the steam of boiling water; and, as his distress was referred mainly to the larynx, a small mustard poultice was directed to be applied over that organ night and morning. In this expecta- tion, however, I was much disappointed; and finally, after waiting a few days, when a considerable amount of general bronchitis had supervened, I was compelled to treat the case as if it were ordinary measles, by salines, including tartar emetic, and blisters ; and by the end of three weeks, and not till then, could he be pronounced well. The last symptom which remained was dyspnea ; for this he got small doses of the oxide of zinc with markedly good effect. The boy is now perfectly well.

This case I set down at the time of its occurrence as anomalous--

62 DR. H. KENNEDY on a Disease Like Measles.

for I could scarcely believe that such symptoms would follow such an accident ; but, on the other hand, the accurate history given me, and the direct connexion between the accident and the immediate supervention of the symptoms, could barely leave a doubt that the two stood to each other as cause and effect. And so matters re- mained, and the case had got quite well, when the paper already referred to came under my notice. This paper will be found in the American Medical Journal for July, 1862, its title b e i n g - "Remarks on Fungi, with an Account of Experiments, showing the Influence of the Fungi of Wheat Straw on the Human System ; and some Observations which point to them as the Probable Source of ' Camp Measles,' and perhaps of Measles generally. By J. H. Salisbury, M.D., of Newark, Ohio." Some of the cases given in this paper had been transferred to the Dublin Medical Press, and there caught my eye. Its general tenor is to show that soldiers are very liable to a form of measles when obliged to sleep on straw which is old or musty; and two striking examples are given where large numbers of men were so attacked, measles not being in the camp at the time. The author then goes on to state that he treated straw in such a way that it became mouldy within 48 hours ; in other words, fungi, of which accurate drawings are given, were produced. With these fungi he then inoculated some 13 persons, the result being that, within two days, a disease exactly like measles in some, including the rash, followed.

These experiments appear to me to prove conclusively that the fungi of musty straw are capable of generating a disease which it seems next to impossible to distinguish from measles. I t may be well to give one or two of the cases, condensed for the sake of brevity :--

"CAsE. - -At 10 o'clock, p.m., February l l th , 1862, I inoculated my arm with the spores of the fungi of wheat straw. The straw was the same kind as that used for beds at the camp.

"Wednesday 12th.--Perfectly well; no inflammation at the point of inoculation.

" 13th.--Very slight redness and itching at inoculated point. " 14th.--Got up with a feeling of lassitude and nausea; redness

and itching on the increase; had difficulty in keeping warm; occa- sional sneezing; eyes sensitive; a peculiar feeling about the scalp.

" Saturday 15th.--Lassitude, sneezing, &c., continue, with flashes of heat over the whole body ; inflammation of wound on the increase ; the peculiar burning congested feeling over the scalp has also in-

DR. H. KElCNEDY on a Disease Like Measles. 63

creased, with pains through the forehead and temples; a few blotches have made theh" appearance on the face and neck; eyes weak and inflamed; a heavy oppressive feeling about the chest; and the throat dry and irritated, as if I had a severe cold."

I t is enough to say, that all the symptoms detailed continued with considerable intensity till Wednesday, 19th February, when the writer found himself much better. He then again inoculated himself, but with no result whatever. The next case he gives is that of his own wife, who, on the second day after the inoculation, began to suffer from severe cold, causing hoarseness and great eonstrict4on of the throat, with very considerable fever, sneezing, and sore eyes; also a slight rash visible. These symptoms lasted a week, and subsided gradually ; the attack having passed downwards, as it were, to the stomach and bowels.

There are also cases given in the paper where this artificial inoculation, as it may well be caUed, seemed to act as a prophy- lactic, by saving children from the ordinary measles, which disease was in the house at the time. But this point is only alluded to here to show the extent to which the author has carried his investigations. I t is now very many years since Darwin, if I recol- lect right, proposed that the tears of those affected with measles should be used for a similar purpose.

To the facts detailed in this paper the case which came under my own notice is now to be added; and, no matter in what aspect it is viewed, it seems to me to open up a question of the greatest interest and extent. For if there be other agents than the fhngi of wheat straw capable of generating a disease like measles, where will such powers end. All vegetable and animal substances, too, while in a state of decay, are known to become mouldy--producing fungi or spores; and to such an extent does this go, that even living beings, including ourselves, when in bad health, almost constantly produce them. The revelations of the microscope are, in this point of view, truly startling; showing us that diphtheria, and some of the most inveterate diseases of the scalp have the closest connexion with eryptogamie growths. The potato and vine-blights, too, come exactly within the same category; many other examples might be enumerated; and I would refer any one particularly interested in the subject to a paper published in M'Millan's Magazine, for October, 1862. True it is, that in all these instances the fungi are the result, not the cause, of disease. But what I now wish to call attention to is the great nniversality

64 DR. H. KENNEDY on a Disease L i k e Measles.

of these bodies, whether of animal or vegetable origin, coupled to the fact, which may be considered as absolutely established, that some of them, at least, axe capable, when applied to the human frame, of generating disease. A n d if we farther reflect on the great facility with which these bodies may gain access to our frames, either in our food or the air we breathe, we have a source of disease opened up of which the importance can scarcely be over- estimated. For a long period the opinion has prevailed that epidemics are caused by some such bodies as these. But proof was wanted in support of this idea; and here now we have gained the first step. For it must be repeated again, the experiments of Dr. Salisbury are conclusive : - -Tha t certain bodies which are being constantly generated in vegetable matter, are capable of causing certain diseases when inoculated into the human frame. Nay, further, that inoculation is not essentially necessary; and on this point the case detailed by myself seems to be most important, for it shows that the mere contact of fungi with the mucous membranes is sufficient to cause disease, and of a very severe character, a The case also proves that other fungi than those of wheaten straw are capable of inducing an affection very llke measles. This last point opens out a field of the very widest for investigation. Thus measles presents itself to our notice under different forms. W e have this disease with and without cough; a distinction long recognised,

a Some may think that the case given by myself may be explained in a different way ; that the symptoms may have been caused by the mechanical effects of the meal, and arose too soon to attribute them to the effects of fungi. This view of the case may, of course, be held ; but the following reasons induce me to keep to that stated in the text : - - I t was clearly established that the meal thrown in the patient's face was mouldy ; and since then, my friend Dr. Kidd, the present editor of this Journal, has succeeded in bringing meal of the same kind into a similar state, and, by means of the microscope, detecting in it fungi very like, if not identical with, some of those figured in the plate of Dr. Salisbury. These fungi Dr. Kidd showed myself ; so that the fact is absolutely established, that fungi may have existed in the meal used by the boy in the school. But then, it will be said, the effects of the fungi arose too soon, for the symptoms were immediate. This I think may be questioned. There is certainly no comparison whatever between the effects of inoculation on the skin and on a mucous surface. I f a poison, like putrid pus, be applied to the eye, will it not begin to act at once ; and so of the mouth, nose, and stomach. I have seen a sore throat begin at once, from inspecting the same in another. Are not all the stronger poisons, such as corrosive sublimat% arsenic, &c., instantaneous in their action~ provided the dose be large and the stomach empty. Nor is it to be forgotten, that in the case detailed, the dose, if I may so speak of it, was large, and applied to the eyes, nose, and mouth at the same moment. For these reasons, the% I consider this case an example of a disease, like measles, being caused by the application of the fungi which are produced in flaxseed-meai which had become mouldy.

DR. H. KENNEDY on a Disease L ike Measles. 65

and, I believe, correctly. Again, at some periods the throat is very much engaged, and at others quite free; and I myself have seen measles rendered most serious by its complication with acute dysentery. May not such differences, or more correctly varieties, arise from different fungi ? One kind prevailing at one period, and a different kind at another. Or may not the way by which the fungi get into the system cause a difference in the results ? Thus, in the case I have just detailed, the eyes, mouth, fauces, and wind- pipe were naturally the parts which suffered the irritation thence spreading to the lungs. But if, in place of this mode of ingress, some of the meal had been at once taken into the stomach, what might not then have been the consequence ? Would it have been dysentery or other intestinal irritation? Though, with our present knowledge, these questions cannot be answered, they yet seem to me all-lmportant; and, no doubt of it, the time will come when they will be cleared up, and so a great step gained in practical medicine.

Other considerations arise out of the foregoing statements. Thus they afford a reasonable solution of the cause of certain diseases-- as, for instance, the hay-fever or asthma; and may not the affection known as influenza come into the same category? The strange effects, too, of certain substances in the form of powder, of which ipecacuanha is a good example, may result from the same agency; and when smells or odours are of such a kind as to create fainting, nausea, or even vomiting, are there not good grounds now for supposing these may be due to certain particles floating about in the air, and necessarily taken into our frames ?

Nor, in a practical point of view, are the preceding facts of less moment; and the following deductions may, I think, be fairly drawn from them :--

1. That certain acute diseases affecting the throat and air passages may be caused either by inoculation of certain vegetable fungi or by direct contact of the same with the mucous membranes.

2. That, as far as is yet known, the diseases so produced seem to have the closest resemblance to measles,

3. That the Vegetable fungi which have been long admitted to exist in certain chronic diseases, as those of the skin, show an impaired state of the constitution; and hence the importance of combining a constitutional with a local treatment in their manage- ment.

4. That when vegetable fungi cause disease by coming in contact VOL. XXXV., 1~o. 69, 1~. S.

66 REV. S. HAUGHTON on Diabetes Mellitus.

with the mucous membranes of the head and chest, we have now fixed data for the administration of emetics; which, by their diree~ effects, may thus cut short disease in its early stage.

P . S . - - A second paper, by Dr, Salisbury, has, I find, been pub. fished in the American Journal for October, 1862, I t is also a very valuable communication, as showing, and in a very clear way, the prophylactic power which the inoculation of straw fungi exercises over the human frame, even when exposed to the contagion of ordinary measles. But as this part of the subject does not come within the scope of my present remarks, I can only refer my readers to the paper itself for the details, which are of high interest,

ART. VX.--On the Phenomena of Diabetes Mellitus. By the REv. SAMUEL HAUGHTON, M.D,, F.R,S., Fellow of Trinity College, Dublin.

PART II ,

(Gont~uedfrom VoL xxxii., p. 277.)

I~ the former part of this paper a I gave an account of three cases of diabetes meUitus, in which I attempted to ascertain the excre- tion, both of sugar and of urea, and from which I deduced certain conclusions, to which, of course, the same value cannot be attached as to the observations themselves.

I shaU now add three more cases of this disease, from which the same general conclusions may be inferred : -

For the clinical observations on these eases I am indebted to A. W. Foot, M.B. ; and to Doctors Stokes and Hudson, Physicians to the Meath Hospital, for permission to make my observations, and for many valuable suggestions during their progress. I made, myself, all the determinations of sugar and urea in the laboratory oi Trinity College.

CASE IV.- -Thomas Cooke, aged 40, admitted into the Meath Hospital October 1st, 1861, under Dr. Hudson.

a D. Q. J. M. S., Vol. xx.xi., p. 317, and Vol. xTxli., p. 265.