981

is, the periphery is converted into spermatozoa, while thecentral mass remains undifferentiated. This stage is to be

called "sperm mother cell," while the corresponding femalebody is termed the "egg cell.

" The result of the fertilisa-

tion of the last by the first is the "zygote." The zygotegrows and becomes vermiform in shape, exhibiting fairlyactive movements. To this stage, which is the largest in

point of bulk, the term "vermicule" is applied. Up tothis point the parasite has remained within the stomach ofthe gnat. But the vermicule by the help of its active

movements pushes or bores its way out of the stomach

and gains access to blood-spaces, enveloping that organ,where it acquires a spherical form, enlarges greatly,and surrounds itself with a structureless membrane.

This may be called the "cyst" " or " spore-cyst.

"

From the breaking up of the protoplasmic contents of ithis enlarged cell the exotospores arise and the cycle is Icompleted. This latter process is not, however, direct. The Icyst at first breaks up into smaller "spore mother cells"

"

from which latter the needle-like exotospores are formed bysubsequent division. Professor Lankester’s paper concludeswith a useful tabular comparison of the stages in the life-history of this hsemosporidian, as the group of the order

sporozoa which contains the malaria parasite is called, withthe corresponding stages exhibited by the two other sub-divisions of the order-viz., the gregarinidea and coccidiidea.

GLAUCOMA FROM A LAYMAN’S POINT OF VIEW.

A COMMUNICATLON which will be found in anothercolumn of our present issue demonstrates the advantage thatmay be obtained from an account by an educated laymanof his own symptoms in cases of disease. In this instancethe affection was diagnosed by the ophthalmic surgeon,Dr. C. E. Glasscott of Manchester, under whose care thepatient placed himself, as one of chronic glaucoma, anda grave forecast of the result was given. This view was

subsequently supported by Professor A. Maitland Ramsayand was fully borne out by the progress of the disease.The patient, who seems to have been one of the

victims of the struggle for existence in these days, was

originally strong and vigorous and could, he tells us,cover 30 miles in a day without distress. He attributesthe onset of the glaucomatous symptoms to a combinationof constant mental worry and excitement, over-exertion ofthe eyes in literary work, and the damp and cold climate ofthe North-west of England. He gives a graphic account ofthe early stages of the disease, including the ciliary neuroses,fogs, and obscurations of vision and flashes of light that areso commonly observed. Various symptoms mentioned, how-ever, seem to show that the case was not one of pure

glaucoma, but that the central nervous system was

more or less implicated, as, for example, the kind

of paralysis of the nose, the lips, and the chin,making speech occasionally quivering, the periodicalnumbness of the forehead, and the occurrence of

fantastic designs, figures, and phantasmagoria which do notr commonly accompany glaucoma. No mention is made

throughout of increase of tension in the eyes, though thepatient must often enough have been tested to determinethis point and must have perceived the importance attachedto it by his medical attendants. Presuming the globes tohave been normal or subnormal we think that a wise con-clusion was arrived at in abstaining from the performance ofiridectomy or any of the substitutes for that operation. Atthe same time it is easy to conceive that differences of

opinion in regard to the cause and nature of the diseasemight have led to different modes of dealing with it in thehands of different practitioners. We have, however, no

desire to comment on the treatment pursued, but we have pub-lished the case as extremely interesting because it is rare to

meet with a clear account of the progress of any disease fromthe patient himself, and where such patient is intelligentsymptoms may be noticed which the surgeon might easilyoverlook but which might afford valuable hints in regard totreatment.

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SMALL-POX IN LONDON.

THE returns of small-pox for the past week are as follows :On Saturday, March 29th, there were 48 fresh cases notifiedand removed; on Sunday, the 30th, there were 46 fresh

cases ; on Monday, the 31st, there were 61 fresh cases ; onTuesday, April lst, there were 62 fresh cases; and on

Wednesday, the 2nd, there were 57 fresh cases.

THE CONTINENTAL ANGLO-AMERICAN MEDICALSOCIETY.

i A PROPOSAL by Dr. F. H. Burton-Brown (of Rome) was laidbefore the annual meeting of the Continental Anglo-AmericanMedical Society that a luncheon of the society should beheld every year at the meeting of the British MedicalAssociation. A special committee was then appointed toconsider how far the proposition could be carried out with aprospect of success. Any members of the society whopropose to be present at the annual meeting of the BritishMedical Association to be held at Manchester in July, 1902,are requested to write to that effect before leaving theirwinter quarters to one of the members of the special com-mittee : Dr. D. W. Samways, Place St. Roch, Mentone;Dr. Leonard N. Robinson, 1, rue d’Aguesseau, Paris ; andDr. StClair Thomson, 28, Queen Anne-street, London, W.

ACHONDROPLASIC DWARFS, HISTORICAL ANDPREHISTORIC.

DR. FELix REGNAULT has recently published an interest-ing study of the action of achondroplasia in producingdwarfism not only in the human subject but among the

lower animals as well. His article, which is profuselyillustrated and fills 24 pages of the February number of theArohives Générales de Méde&bgr;ine, does not deal with livingexamples but with museum specimens, individuals of whomhistorical accounts or portraits are extant, ancient Greek orRoman statues, and pictorial representations on Egyptianmonuments. In the achondroplasic foetns the long bones areshortened and thickened and the deviations from the normalstraightness which they present are not gradual curvaturesbut are obviously angular ; the resulting appearances are

distinguished from the effects of intra-uterine fractures bythe fact that in achondroplasia the bendings of the bones aresymmetrical on each side at the same level; the deformitiesproduced by intra-uterine rickets differ also from thoseof achondroplasia, for the former are gradual curvaturesof considerable radius. In achondroplasia the facial bonesseem to recede and the forehead to project, the nasal

bones being at the same time flattened. In adult subjectsthe shortening of the long bones is more pronounced in thehumerus and the femur than in the radius and the tibia and

the three middle fingers are of equal length ; the skull is largeand brachycephalic ; the facial and nasal bones are as alreadydescribed. Among the dwarfs whose likenesses have beenpreserved from past generations Dr. Regnault distinguishesthose whose condition was due to achondroplasia on the onehand or to myxcedema on the other. Two of his achondro-

plasic dwarfs are (1) Owen Farrel, an Englishman who diedin 1742 and whose portrait is in the Royal College of

Surgeons of England; and (2) Sebastien de Morra, a servitorof Philip IV. of Spain. Two of his myxoedematous dwarfsare Tom Thumb and Simon de Paap, a Dutchman who wasexhibited in the early years of the nineteenth century.Among the ancient Egyptian deities the figure of Phtah is

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.

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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.