982

that of an achondroplasic dwarf and the figure of Bes that ofa myxoedematous dwarf. Achondroplasic workers in metalare represented on the Egyptian monuments, a circumstancewhich is interesting in connexion with the lameness and

deformity of Hephaistos or Vulcan in classical mythology.

THE FOURTEENTH INTERNATIONAL CONGRESSOF MEDICINE.

THE present rate of exchange makes it worth while for allthose who propose to attend the Madrid meeting of the

International Medical Congress to pay their subscriptions atonce as the value of the peseta varies from time to time andit is now low. The necessary forms of application for

membership can be obtained from the honorary secretaries ofthe National Committee for Great Britain and Ireland-viz.,Mr. D’Arcy Power, 10A, Chandos-street, Cavendish-square,London, W. and Dr. P. Horton-Smith, 15, Upper Brook-street, Grosvenor-square, W., who are prepared to transmitthe subscriptions to Madrid and to supply receipts and cardsof membership as soon as they are issued, in return for apostal order of .81 from each member. Ladies if theyaccompany a member will pay 6s. 3d. for their tickets, whichsum is said to entitle them to reductions of fare on the

Spanish railways (probably a useless concession for Englishtravellers who take through tickets) and will give themadmission to the various fetes held during the congress.

THE TOPOGRAPHY OF THE CORTICAL DEGENE-RATIONS IN GENERAL PARALYSIS OF THE

INSANE, WITH SPECIAL REFERENCE TOFLECHSIG’S ASSOCIATION-CENTRES.

AN important research by Professor Karl Schaffer of

Budapest on the topography of the cortical degenerations ingeneral paralysis of the insane in relation to Flechsig’sassociation-Centres of the brain is recorded in a recent issueof the Nenrologisches Centrcalblatt (No.2, 1902). A detailed

microscopical investigation was made of the entire brains ofthree patients who had died from general paralysis, tabeticsymptoms having been also present in one of the three cases.Serial sections of the entire brain (cerebral hemispheres,brain-stem, and cerebellum) were made in the sagittaland horizontal planes and were stained with Wolter’s modi-fication of Weigert’s method to determine the situationof degenerated medullated nerves. All three patients weretypical examples of general paralysis with the characteristicsymptoms of early dementia, grandiose delusions (megalo-mania), impairment of speech (dysarthria), and paralysis ofpupillary and of facial movements, and they terminated inparalysis, coma, and death. Sagittal sections taken closeto the mesial aspect of the cerebral hemisphere showeddegenerations of medullated nerves, chiefly in the pre-frontalarea (pre-genual and sub-rostral regions)-i.e., Flechsig’santero-mesial and supra-orbital association-centres, slightlyaround the lips of the calcarine fissure and moderately in thesupra-callosal convolutions (gyrus fornicatus). Sectionsmade in other planes showed various areas of degeneration.The degenerations are classed as "slight" and marked" "and their distributions are summarised as follows. (a) Slightdegenerations : these were observed in the Rolandic convolu-tions and adjacent parts of the frontal gyri (kinasstheticarea) in the cuneo-lingual gyri which border the calcarinefissure (visual region) and in the lower temporal gyrus.

(b) Marked degenerations. These were observed in the pre-frontal lobe (polar and orbital regions), in the parietal lobe(superior and inferior gyri), in the ascending parietal con-volution, in the insular and in the temporal convolutions.(e) An intermediate degree of degeneration was. present inthe occipital lobe. A special examination of the brain ofthe patient whose symptoms were complicated with tabesshowed that .sligbt.degenel’atÌ@1lt wM"pPeSent.mthecaseending.

frontal convolution and adjacent parts of the frontal gyri,in the cuneus, in the first and last temporal convolutions,and in the nerve-tracks or bundles of the cornu Ammonis.Marked degeneration was present in the pre-frontal lobe,in the entire parietal lobe (including the ascendingparietal convolution), in the insula, gyrus fornicatus, andsecond and third temporal convolutions. A comparison ofthese regions with the areas delineated by Flechsig in hisclassical work 1 as "association-centres" " of the brain willshow the close correspondence that exists between the two.Professor Schaffer concludes that his observations tend to

support Flechsig’s localisation of the association-centres ofthe brain, and that the morbid process (degeneration ofmedullated nerve-fibres) affects chiefly Flechsig’s centres-viz., those in the pre-frontal, parietal, insular, and supra-callosal regions of the hemisphere. " The cortical degene-ration in general paralysis is not an irregular, diffuse process,but, on the contrary, a regular, localised, selective morbidaffection of the cortex." The research is of great import-ance and must naturally form the starting-point for furtherobservations of similar nature to be made on other forms of

insanity. --

VACCINATION DIFFICULTIES.

IN THE LANCET of March 29th, p. 906, we referred tocertain difficulties which had arisen between the Board ofGuardians of Great Yarmouth and Dr. Henry Blake, the

public vaccinator. Shortly the story was as follows. About

the middle of March Dr. Blake, in view of the approachingEaster holidays and the Yarmouth fair, thought that itwould be well to have power to employ assistants as the workof- vaccination and revaccination was growing very heavy.He therefore wrote to the Local Government Board andthis body wrote to the guardians and recommended themto confer with Dr. Blake. However, at a meeting ofthe guardians held on March 18th the guardians refused toconfer. A special meeting was then called on March 25thwhen it came out that Dr. Blake had asked the clerk to the

board of guardians what he should do to get assistance.The clerk advised him to write to the Local Government

Board. Only the clerk forgot to mention this to the

guardians. Hence the talk about discourtesy to the boardon the part of Dr. Blake which made the guardians refuse to’confer with that gentleman after the meeting on the 18th.Peace, however, now reigns and at the next meeting of theguardians Mr. Cass is going to move that the board fix anearly date for consultation with Dr. Blake. This is all veryorthodox and ceremonious, no doubt, but epidemics will notwait for ceremony and we should like to see some more

rapid method by which a public vaccinator could getassistance in time of need than that which Dr. Blake has.

to employ. Dr. Blake was invited to attend the meeting onMarch 25th. Why could not the conference have been heldthen and there ? The whole matter could have been settledin five minutes.

____

COEXISTENCE OF INFANTILE CEREBRAL PARA-

PLEGIA AND INFANTILE SPINAL PARALYSIS.

AT the meeting of the Société Médicale des H6pitaux ofParis on March 7th M. Pierre Marie showed an interestingcase in which infantile cerebral paraplegia and infantile

spinal paralysis coexisted. The patient was a man, aged34 years. At the age of six months he had convulsions andfrom this time his paraplegia probably dated. The rightlower limb was semi-flexed and adducted and couldnot be completely extended ; the foot was in the

position of equinus. The -knee-jerk was increased; the

plantar renex was -of the extensor type. All the symptoms.

1 Gehirn und Seele, 1895.

983

were those of typical cerebral infantile paraplegia. The

left lower limb presented a very different appearance. The

’entire limb showed atrophied and completely flaccid muscles.The condition was that of infantile spinal paralysis. This

case bears out the view advocated both by Strumpell andM. Marie that infantile cerebral paraplegia is due to a

lesion of the motor area of the brain-polio-encephalitis-analogous to the spinal lesion-anterior poliomyelitis-ofinfantile paralysis. This analogy is borne out by someother cases. Mobius has described the case of a girl, aged18 months, who was attacked with infantile spinal paralysisat a time when her brother was suffering from cerebralinfantile hemiplegia. In 1894 M. Ramy published in

the Rernr YfmroZofliqlle the case of a man, aged 43

years, who had infantile spinal paralysis of the rightleg. At the necropsy there were found patches of

meningo-encephalitis affecting various convolutions and a

focal spinal lesion in the lumbar region, with atrophy of theanterior roots of the lumbar and sacral nerves on the sameside. In the same year Neurath of Vienna in a necropsy on

an infant, aged five months, found lesions of the internal- capsule and centrum ovale with the lesions of infantile spinalparalysis. Beyer, in 1895, published the case of a woman,aged 22 years, who had had since the age of five years leftspasmodic hemiplegia and who had suffered since the age of12 years from attacks of epilepsy. At the necropsy, in

addition to porencephaly of the right hemisphere there was afocus of anterior poliomyelitis. M. Marie pointed out thathis case was a new example of the coincidence of infantilespinal paralysis and the cerebral lesions which in the childproduce almost indifferently hemiplegia, diplegia, and para-plegia, and that from the point of view of general pathologythe case showed the analogy, it might almost be said theidentity, between the cerebral and spinal lesion.

BALDNESS AND DISEASE IN THE BARBER’S

CHAIR.

FROM time to time we have called attention to the riskof contamination arising from the promiscuous use of

brushes, scissors, razors, and other implements, at hair-

dressers’ establishments. Recently the New York Board ofHealth have confirmed such warnings by issuing an official

statement, pointing out that a number of diseases canbe communicated by barbers. The suggestion is even

thrown out-and this is more likely to alarm the generalpublic-that barbers are perhaps the cause of pre-mature baldness. When this occurs a germ is supposedto attack the roots of the hair and this microbe may be

conveyed from one head to the other by a brush. Manyyoung men are bald who cannot be accused of riotous

living, and it is often difficult to account for such cases of

alopecia. Perhaps it was the hair-dresser’s fault. In anycase, the New York Board of Health urges that greater pre-cautions should be taken-that barbers should constantlywash their hands in antiseptic solutions, should sterilise

their razors and scissors, should protect their utensils from- dust, and throw away their alum-sticks. If rubbed on a.cut or pimple the alum-stick may convey blood, pus, andpathogenic bacteria to the next person to whom it is

òapplied. Thus loathsome diseases may be contracted fromthe surface of the alum ointment stick used in America.The question therefore arises whether the barbers willendeavour to meet these new exigencies. Historicallyspeaking, the barbers, whose precursors used to be barber-surgeons, should readily appreciate the advantage of anti-

septic surgery and be willing to apply its principles to theminor and painless operations which they now perform.Trivial as these operations may seem they are not absolutelyfree from danger ; and to our knowledge some barbers, both

in Paris and in London, have already introduced antisepticprinciples into their hair-dressing saloons. They sterilise

their .metallic combs, their scissors, and their razors bypassing them through a flame each time that they are used,and it would be well if these and other precautions were

more generally applied. -THE DISTRIBUTION OF PLAGUE.

A TELEGRAM from the Governor of The Mauritius, receivedat the Colonial Office. on March 29th, states that for theweek ending March 28th there were 5 cases of plague,of which 4 proved fatal. As regards the Punjab, assum-ing that there is no mistake in the figures, the news

from India, as will be seen from our Indian correspondent’sletter at p. 993 regarding the presence of plague in

the Punjab, is somewhat appalling. According to the tele-graphic intelligence through Renter’s Agency the numberof deaths from plague in the Punjab is now averaging

nearly 70,000 monthly. Special measures, it is stated, havebeen taken to prevent the epidemic from reaching Simla.As regards Egypt, during the week ending March 23rd7 cases of plague and 2 deaths from the disease have beenreported throughout all Egypt. 1 case occurred at Kom (I 1

Nour, 3 cases and 1 death at Dechneh, and 3 cases and 1death in 2 nomadic camps near Benha. All these cases

occurred among the native population.

THE HISTORY OF ATROPINE.

VERY nearly a century ago it was just being realised thatcertain plants contained definite bases yielding definite saltswhen treated with acids. These bases are, of course, well

recognised now as the alkaloids, containing amongst theirnumber some of the most powerfully poisonous bodies knownto us. In about the twentieth year of the last century thesenew weapons of the poisoner were on the eve of being dis-covered as chemically definite principles. According to

THE LANCET of March 28th, 1824, as will appear from a glanceat the Looking Back " column in our issue last week, atropinehad evidently been isolated in that year although probablynot in a state of purity. Still, a definite chemical principle

was recognised, for in this column we read as follows : ’’ The

property of dilating the pupil, peculiar to these plants [bella-donna, datura, &c.], depends on a chemical principle, each ofthem containing an organic alcaline substance, which canneutralise acids, and form with them salts capable of crystalli-sation, and possessing very powerful properties. This chemicalprinciple has been named koro)7iegine, from its power of

dilating the pupil." The existence of the active principleor alkaloid of Atropa belladonna was first announced in

1819 by Brandes, although apparently it was not obtainedin its pure state until 1833 by Mein, a German pharmacist.In the excerpt from THE LANCET of Sunday, March 28th,1824, which was printed in our columns last week it is

stated that at the Royal Institute of France Dr. Runges,Professor at the University of Berlin, described, amongstother things, a new method of detecting the narcotic

principle of the Atropa belladonna, -Myoseya7iiits niger, andDatura stramonium in cases of poisoning by those plants.The method was simple and crude and consisted merely inboiling the stomach or intestines of the animal poisonedby these vegetable substances and evaporating the aqueoussolution to the consistence of an extract and applying it

with a camel-hair pencil to the eye of an animal. Nowadays,of course, better and more delicate means are employedfor isolating the ’alkaloid from complex organic mixtures.The method, shortly, is to exhaust the mixture withacidulated alcohol. After straining through muslin the

1 Vide THE LANCET, Feb. 8th, 1902, p. 419.