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depression. 2. Anaemia of rapid onset and considerabledegree tends to produce convulsions and excitement. 3. Thecharacteristic feature of the general circulation in mentaldepression is high arterial tension, which helps to maintain,if it does not cause, the painful mental state ; but there is noconclusive evidence of the condition of the cerebral circula-tion. 4. In mental depression the blood is impoverished.5. Under experimental conditions high oxygen tension in theblood supplied to the nerve-cells produces excessive action andpossibly exhilaration ; but there is no real evidence that suchsymptoms are ever due to this cause under ordinary circum-stances. 6. The characteristic feature of the general cir-culation in excitement, and probably in exaltation, is low

arterial tension. Here again there is no direct evidence of thestate of the cerebral circulation. 7. This low arterial tensionhelps to maintain, if it does not cause, the mental state.At the conclusion of the address Dr. W. A. Turner,after proposing a vote of thanks to Dr. Dawson, alludedto the importance of the scientific study of insanityand to the fact that mental disease had as sufficienta physical basis as any other bodily affliction. He men-

tioned that the almost universal recognition of this truth

nowadays was about, as he understood, to lead verysoon to the establishment of a pathological institutein connexion with the public asylums of Ireland.

Whatever be the cause the fact that insanity is largely onthe increase is undeniable. The attention of administrativebodies and of legislators is forcibly drawn to the necessityof facing the lunacy problem. Diffusion of medical andscientific knowledge would prepare the way for future socialand legislative measures to deal with the crux of the

problem-viz., the gradual prevention of the preventableinsanities, the better classification on a medico-economicbasis of the chronic insanities and allied infirmities, and theprovision of 6 hospital" treatment and cure for the curableinsanities. Pathological institutions for research would beattached to the last class of institutions. Dr. Turner’s state-

ment is tlerEfore a very welcome one, for it is only by carefuland prolonged study that we have any hope of unlocking thesecrets of mental disease.

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SENSORI-MOTOR PALSIES OF THE FACE AND

EYES.

DR. JOSEPH FRAENKEL, of the Cornell University MedicalSchool, has published in the Journal r>f Nervous and MentalDisease for October, 1899, a lengthy and detailed paper onthe above subject. Two of the cases were instances ofdisease of the trigeminal nerve presenting a rather fortunategrouping of symptoms and 22 others were cases of tabes inwhich special attention was devoted to the relation betweendisorder of function of the facial and oculo-motor nervesand disease of the trigeminal nerve. The following case is

referred to in detail. A man, aged 42 years, a musician,of Roumanian nationality, was said to have suffered two

years before admission from tic douloureux. At that time

he complained of attacks of severe pain in the left sideof the face (areas of distribution of the fifth nerve) and ofa sensation of constriction as by a heavy helmet on his head.On admission to hospital on Oct. 6th, 1898, the followingfurther facts were ascertained. He was of temperate habitsand had enjoyed good general health till his twentieth year.He was married at the age of 18 years and was the father offive children. He had a venereal sore" at the age of 21

years. When he was a boy he had an affection (probablyglaucoma) of the eye which resulted in vision being destroyedin his left eye. The symptoms of tic douloureux and of the"helmet" above referred to followed and eventually thevision of the right eye began to fail until the patientbecame totally blind. The sexual appetite had been

considerably diminished during the present illness and

,araesthesiae were experienced in the extremities. 11 He-s poorly nourished, station and gait are uncertain anc5

.taxic, is moaning and groaning day and night withmbearable pain and parsestbesiae in the head and face,)articularly on the left side." When he was made to laugh)r to cry only the upper branches of the left and the lower-)ranches of the right facial nerve came into play. This gave!0 the face an indescribably contorted expression, while theeft frontalis and orbicularis oculi and the right buccalnusculature showed a disproportionate overaction. The left

)alpebral fissure varied, being at times almost closed and atiimes very widely open. Passive movements of the head were-tttended with a little pain. Both taste and smell were con-

;iderably impaired on both sides. The eyes showed a divergent;trabismus and exhibited complete bilateral optic atrophy.rhe temporal and masseter muscles of the left side were

ltrophied and the soft palate was impaired as regards.mobility, so that both swallowing and speech were imperfectm execution. The patient lost all his teeth, without pain,curing the present illness. No paralyses or atrophies were

found on the trunk, but scattered areas of anaesthesia,..,

analgesia, and delayed conduction were met with. The-

knee-jerks were absent, but the plantar reflexes were lively.Considerable disturbances of tactile, painful, and thermal

sensibility existed on the feet and legs. A careful con-sideration of all the facts rendered the diagnosis of tabes’with early involvement of the trigeminal nerve highlyprobable in this case. Of the remaining 22 cases examinedl-10 gave distinct evidences of a previous venereal infec-

tion ; in four cases an infection could be assumed’from the symptoms and in eight no reliable informationcould be got. Eight out of the 22 cases gave a history ofocular disturbance prior to the date of examination, but inr

14 no such history was obtainable. Thus it appeared that.ocular disturbances (palsies, &c.) were present in 364 percent. of the cases of tabes examined. Of the 14 cases whichhad enjoyed immunity from ocular derangements six gave a.history of derangement of the fifth nerve, but two of these-were complicated by optic atrophy. Of these six cases two-were certainly and one was protably syphilitic. After dis-

cussing the theories of physiologists and neurologists on the-phenomena of motor palsies as consequent upon sensoryparalysis Dr. Fraenkel points out the probability that someat least of the oculo-motor palsies referred to in his paperwere consequent upon sensory paralysis of the trigeminalnerve in one or more of its branches, and combining thesefacts with those of the case above noted in detail he con-cludes that some of the ocular and facial palsies of tabes are.sensori-motor palsies.

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THE METROPOLITAN WATER-SUPPLY.

THE Water Committee of the London County Council are-waiting for the report of the Royal Commission before theycan recommend legislation on the question of the future

water-supply of the metropolis. In their report to the

Council, however, the committee point out that the eventsof the past summer have again forced the question of thewater-supply to the front. If the drought of 1898 was suchas to render it advisable for the Council to attempt toobtain legislation in 1899, the drought of 1899, which hasbeen far more severe, appears to the committee to makeit absolutely essential that the Council should not loseanother year in pressing forward its proposals. It

is shown that the average daily flow of the Thames hasfallen very seriously below the estimate of the Balfour Com--mission. The committee feel forced again to the conclusion,in view of this datum "that the ultimate supply of the.

metropolis can only be assured by resorting to a source otherthan the valleys of the Thames and the Lee and moreover-that it is urgently necessary that a scheme for this supply,

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should be set on foot without even a single year’s delay."They propose accordingly that the Council’s Welsh schemeshall be again presented to Parliament and that the wholeof the scheme shall be embodied in one Bill. Finally, thecommittee suggest that it is possible that when the RoyalCommission shall have reported the Council may have toreconsider its position, but at the present moment. thecommittee feel that they can only recommend that a Bill bedeposited for compulsory purchase in the same form as thatof last year, subject possibly to certain alterations in detailsas to which the Parliamentary Committee would advise theCouncil at a later period. According to the Finance Com-mittee the latest estimate of the Welsh scheme is givenby the chief engineer at 17,000,000. As the whole

financial question in regard to the acquirement of the

London water undertakings has been gone into by LordLlandaff’s Commission the Finance Committee have not

thought it necessary to have the figures revised with a viewto bringing them up to date.

THE PARISH OF ST. GEORGE, HANOVER SQUARE.

WE have received a copy of the report on the sanitary con-dition of this parish for the year 1898 by Dr. W. H. Corfield,the medical officer of health. Apart from the ordinarystatistics dealing with the sanitary condition of the parish,which is satisfactory, and a tribute to the administrationDr. Corfield publishes in the same number a special report onthe water-supply, together with the correspondence followingupon his animadversion on the quality of the water as

reported by the public analyst which brought repliesfrom the late Sir Edward Frankland and Sir WilliamCrookes. We dealt with this interesting discussionat some length in THE LANCET of May 20th, 1899

(p. 1377). It refers to the relation of the increase in theamount of organic matter to the augmentation of cases ofenteric fever.

A VETERAN POOR-LAW MEDICAL OFFICER.

ON Dec. 1st at the meeting of the Congleton Board ofGuardians a letter was read from Mr. Charles Latham re-

signing the office of medical officer to the union work-

house, Arclid, in the district of Sandbach. Mr. Latham

mentioned that being now in his eighty-fourth year hethought that the time had come for him to retire. For

58 years he had been a public official and he could

truthfully say that throughout that period he had neverreceived an unkind word or look from those to whom he was

responsible. The resignation was accepted with great regret.Mr. Latham was educated at St. Bartholomew’s Hospital andis a nephew of Dr. John Latham, who was President of theRoyal College of Physicians of London from 1813 to 1819.He is probably the oldest member of the Poor-law medicalservice and has practically passed his whole life in Sandbach,where his name is a household word because of his acts ofkindness and charity.

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CONGENITAL IDIOPATHIC DILATATION OF THECOLON.

THE Arnerican Journal oftlw Medical Sciences for Septembercontains an important paper on this rare condition by Dr.J. P. Crozer Griffith. The expression " congenital idiopathhicdilatation of the colon" is applied to cases in which there is aninnate tendency to dilatation not dependent on any organiccause. Thus cases of dilatation secondary to constipationand cases dependent on congenital stenosis are excluded. In

idiopathic dilatation constipation is a result and not a cause."Congenital" is applied not only to cases in which thedilatation is present at birth, but also to those (probably themore common) in which a tendency to dilatation exists.

In some cases there are distension and constipation fromearliest infancy ; in others, less severe, distension is resistedfor a time, but there is always deficient expulsive power ; instill others there are periods of improvement in which dis-tension disappears, although relapses almost always occur.In the absence of a necropsy idiopathic dilatation cannot bedistinguished from dilatation from stenosis, nor when thesymptoms appear late can it always be determined whetherthe constipation is a cause or a result of the dilatation.Dr. Griffith relates the following case. A boy sufferedmore or less since birth from constipation, for which

very strong purgatives were required. At the age offive months distension of the abdomen, accompanied bypain, began. Sometimes for a week there was no action ofthe bowels; diarrhoea then occurred for several days witheven increased distension. Sometimes the distension wasrelieved by a rectal tube which allowed the gas to escape.At the age of three years purgatives and enemata ceased toafford much relief and he was admitted to hospital. He was

a well-nourished slightly pale child. The abdomen protrudedenormously and was tympanitic. It measured 69 8 centi-metres (2’72 in.) in circumference. The umbilicus was pout-ing and peristalsis was visible. At times the outline of the

greatly enlarged colon could be seen. The costal marginswere everted by the pressure. Treatment consisted in hot

fomentations (to relieve pain), the insertion of a rectal

tube, enemata sometimes containing turpentine or assafoetida,.and the administration of strychnine. Watery, greenishdiarrhoea developed ; the temperature rose to 105’2° F. the;

pulse to 140, and the respirations to 37..; As the child grewweaker and the tympanites persisted right inguinal colotomywas performed. After an injection into the opening muchsemi-liquid faeces and gas came away through it andthe abdomen diminished to its natural size. But thechild’s strength failed and he died on the fifth dayafter operation. At the necropsy no stenosis of thecolon was found. Analysis of 24 recorded cases showa very characteristic group of symptoms. The principaland the first to appear are constipation and abdominal dis-tension. In 22 cases one or both were observed within threemonths and generally within a few days of birth. In a small

minority several weeks or even three months elapsed beforeintestinal troubles began. Relief of the constipation bypurgatives or enemata usually produced diminution in thesize of the abdomen. The stools only exceptionally werescybalous. Evidently the colon was unable to propel soft.contents and not blocked by scybala. The prognosis.is bad. Eighteen out of the 24 cases proved fatal; ;.

only two patients are known to have recovered.As to treatment massage and electricity seem indicated.The bowels must be emptied by purgatives or enemata.

Both tend to further weaken the muscular power but theycannot be avoided. The rectal tube by removing the gashas afforded great relief. In three cases the intestines were

punctured with a fine trocar. In one of the cases in which

recovery took place an artificial anus was formed. The

operation performed by Mr. Treves in a case of dilatationsecondary to congenital stenosis-excision of the colon anduniting the small intestine to the anus 1-might be useful

in an idiopathic case. -THE CONTAGIOUSNESS OF INHERITED

SYPHILIS.

DR. Louis KOLIPINSKI of Washington, D.C., describes inthe Marylaib4 Medical Journal of Nov. 25th two instances inwhich a syphilitic infant was the means of conveying thedisease to healthy persons. In the first of these cases a

young man gave syphilis to his wife who a year later was

1 THE LANCET, Jan. 29th, 1898, p. 276.