1775

in the long run. The powers of passive opposition are con- Isiderable but it is an error to regard them as inexhaustible.

THE PATHOLOGY OF SLEEPING SICKNESS.

IN an article on Sleep, Sleepiness, and Insomnia, contri-buted to the iJI.mt1Û.1/ Cyclopvdia of Practical Medicine

(Vol. IX., p. 145, 1906) Dr. Arnold Lorand of Carlsbad

suggests that the African sleeping sickness may have some-thing to do with thyroid degeneration. He had undar hiscare at Carlsbad an officer of the Belgian Congo State whowas suffering from sleeping sickness and whose cerebro-

spinal fluid contained trypanosomes. He is therefore

practically acquainted with the phenomena of the disease

and has come to the conclusion that it is dueto thyroid degeneration brought about by the action

of the toxins of the trypanosomes on the thyroid gland. i

One of his arguments in this connexion is to theeffect that sleeping sickness presents not only all the

clinical symptoms of myxoedema but also the saaiepatho-logical and anatomical alterations of the central nervous

system. Sleepiness is one of the cardinal symptoms ofmyxaeo:1ema and insomnia is a typical symptom of the

opposite-namely, Graves’s disease or hyperthyroidia. Dr.

Lorand, therefore, believes that the thyroid gland is a

powerful factor in the causation of sleep, its degenerationproducing sleepiness and its hyperactivity producing sleep-lessness. A further subject of interest in connexion with

sleeping sickness is the announcement that the King of theBelgians, as Sovereign of the Congo State, is offering a prizeof 200,000 francs, open to all nationalities, for the discoveryof a method of successfully treating the disease, and willmake a grant of 300,000 francs for the purpose of studyingthe disease with a view to its treatment and prophylaxis.

THE ROLE OF SALAD IN THE DIETARY.

THERE is no more agreeable or refreshing addition to acold meat collation, especially in the fine warm days of

summer, than a well-made salad. It is the experience of agood many persons that the appetite becomes lessened bythe sight of food, and more particularly of animal food, ona hot day, and that this is not so much the case when it isaccompanied by a fresh green salad which not only rendersthe outlook of a meal attractive, so far as regards thepalate, but encouraging also to the digestive organs. Whenthere is no inclination to eat or when, as it is com-

monly said, a person does not " fancy " his food, thereis, as a rule, torpidity of digestive function. Withthe sight of tempting food the work of the digestiveorgans is begun. "The mouth waters," and even the

gastric juice flows in response to a pleasant impression.The salad, therefore, may fill a special and important gap inthe dietary and when it is prepared with oil, as every goodsalad should be, it becomes an excellent and agreeablevehicle for conveying fat into the body. It is a singularfact that until quite recent years the salad was an almostignored dish in this country and its preparation was sobadly understood and its attractive qualities were therebyso impaired that few were tempted to include thesalad in the daily dietary. The demand for salad hassince happily grown, thanks perhaps to the experience ofan increasing elientele who have visited the countries ofthe salad connoisseur on the continent. But even nowfew English people realise that there is no country so

favoured as is England with materials for makingsalad-materials which grow wild abundantly and whichmay be possessed for the mere plucking. As a rule, a

salad conveys to the average English mind merely a dishof cultivated plants, such as lettuce, endive, cucumber,mustard, cress, onion, or radish. Such excellent wig vege-

tables as sorrel, dandelion, wild chicory, shepherd’s purse,lady’s smock, or even stone crop, all dignified by thename of weeds, are well known to our French neigh-bours as admirable ingredients of a salad, but such plants,though growing abundantly in every grassy meadow,are almost unknown as materials for a salad in this

country. Dressed by the discreet addition of soundolive oil and pure wine vinegar, no more excellent adjunctto the cold dish can be suggested. The oil modifiesand "smooths" the peculiar flavours of the juices of theplant, while the vinegar softens the tissues, rendersthem more digestible, and gives an agreeable piquancyto the whole. The use of salads prepared from tenderplants by those who possess normal digestive powersis undoubtedly salutary and the constituents of raw greenvegetables contain salts which have a favourable effect uponthe condition of the blood. In cooking, of course, a largeproportion of these salts is removed. It is probablythe abundance of alkaline salts in green vegetables whichmakes them of service in some diseases of the skin. Inthis connexion it is interesting to recall that scurvygrass, or more correctly scurvy cress, is the name given tocertain species of British plants belonging to the mustardfamily, the leaves of which have anti-scorbutic propertiesand are eaten for that purpose as a salad. It may also benoted that the expression, "I do not care a curse," wasoriginally, "I I do not care a cress," the word cress beingused much in the sense of " straw," that is, a substance ofcomparative worthlessnees. In conclusion, it may be observedthat great as are the attractions of salad to most peoplesome few on the contrary altogether fail to find it to theirliking. -

PRE-TUBERCULOUS HÆMORRHAGIC PURPURA.

AT a meeting of the Société Medicale des H6pitaux ofParis on April 6th M. P. Carnot, M. R. Bensaude, and M. P.Harvier reported the following important case. A woman,

aged 22 years, was admitted into hospital on Jan. 16th, 1906,presenting a purpuric eruption and hasmorrhage from thenose and gums. She had enjoyed good health until the endof December, 1905, when she caught cold, coughed a little,and began to waste. On the night of Jan. 13th, 1906,haemorrhage from the gums began and it continued on the

following day, when she noticed a violaceous spot on theright breast. On the night of the 15th there was abundantepistaxis which lasted ten minutes, and stopped spon-taneously. On the morning of the 16th the epistaxisrecurred and was slow but continuous. At the same timethe urine was red as if tinged with blood. On examinationshe was found to be very wasted and extremely pale, themucous membranes being completely decolourised; the

temperature was 101 - 31 F. ; the pulse was 112 andsmall. On the lips, the chin, and the temporal regions werepetechiae of the size of the head of a pin. Irregularlyscattered on the front of the chest were lenticular hasmor-

rhages. The abdomen was retracted and presented two orthree haemorrhages. The limbs were covered with petechise.On the lower limbs were slightly indurated ecchymoses ofthe size of a five-franc piece and petechise. The tongue wasfurred and rather dry and showed a few purpuric spots.Signs of pulmonary tuberculosis were carefully looked forbut none could be found and the patient neither coughed nor

expectorated. The anterior nares were plugged with pledgetscontaining adrenalin and 200 cubic centimetres of distilledwater were injected into the veins. On the 18th the hoemor-

rhage from the nose and gums recurred and at the pointwhere the injection was given there was a large ecchymosis.On the following days the epistaxis recurred from timeto time. On the 24th the liver was found to extendtwo fingers’ breadth below the ribs and the spleen