493 In the first, so extraordinarily premature, the child was born alive, and lived more than half an hour without respi- ration, unless we assume, physiologically, from the action of the heart, that this process necessarily existed, though too feebly to be observed by the senses; but then, in ordinary cases, we must be guided by the senses, and judge of a child’s state by them. In the second, the pulsation of the funis ceased between eight and ten minutes before the head was born, and no signs of arte- rialization were evident for full twenty minutes after it was born, and respiration was not established until three quarters of an hour after birth. In this case, if the artificial respiration had been discontinued at the end of forty minutes, the child would have been re- ported " still-born, "-as hundreds undoubtedly are,-and Dr. Robert Lee would have been complacently satisfied with a cer- tificate to that effect; but it was continued five minutes longer, and the child breathed. Dr. Lee says that " respiration is necessary to establish the fact of live-birth." If so, it is clearly not necessary to the existence of life; and this child, now alive and well, was dead in law, if not in fact, for nearly one hour after it was born. T am Sir vmir obedient servant JAMES HURD, L.R.C.P. Edin. To t7te Editor of THE LANCET. SIR,—If a child is born, but neither moves nor breathes, and shows no other sign of life except " a slight pulsation at the cord" (funis), ought I to consider such a child to be born alive, and write a certificate accordingly ? I am, Sir, vour obedient servant, ROBERT LEE, M.D. THE RECENT EPIDEMIC AT HARROW. To the Editor of THE LANCET. SIR, —Should you deem the following account of an epidemic which has lately broken up the School at Harrow of sufficient’ interest, may we beg you to give it insertion in an early num- ber of your journal. The first case which came under our notice, and from which we date the origin of the epidemic, was a boy aged twelve. A week after his return to school we saw our patient for the first time, and found him suffering from an attack of unmistakable scarlet fever, with its characteristic rash well developed, and with ulcerated throat. After an illness of unusual severity and of somewhat malignant type, attended with almost un- broken delirium during thirty-six hours, and with other symp- toms of disordered sensorium, he slowly recovered, but not before two of his attendants had imbibed the poison, which developed itself as true scarlet fever in the one, and as ulcer- ated throat, with fever, but without any eruption, in the other. ’, This case was followed by twelve other examples of genuine scarlet fever, occurring at various intervals during the progress of the epidemic. In some of these the disease ran a severe, and in one, where the patient was a weakly and delicate boy, a fatal course. But in the remainder (which amounted to upwards of a hundred cases) the malady assumed a very ano- malous character, and was attended in its onset, progress, and decline by symptoms of great variety and irregularity. Onset.-In several, febrile disturbance more or less severe, languor, lassitude, and slight sore-throat ushered in the com- plaint ; in others, a feeling of giddiness, slight headache, nausea, and in two or three cases actual syncope, marked the com- mencement of the affection; while in a third and much larger class the eruption was preceded by no premonitory symptoms, but developed itself while its victim was in the enjoyment of apparently perfect health, the remark of a companion, " How red your face is !" being often the first intimation of its pre. sence. Eruption. - Nor were the features of the epidemic, con- sidered in its cutaneous aspect, less varied than its modes of onset. In some few the eruption presented a great resemblance to that of measles, and an experience of it limited to these instances would have unhesitatingly said that it was rubeola; but these were the exceptions. Between this extreme and the genuine cases of scarlet fever mentioned above there existed several varieties-slight indeed, and almost inappreciable in individual cases, but which, shading off one into the other, formed, when viewed in reference to the whole, connecting links in the chain of an epidemic which clearly began as scarlet fever. Thus, commencing with cases in which the eruption consisted of numerous patches of aggregated, scarcely raised points, of a reddish hue, scattered over the face, trunk, and extremities, with interspaces of healthy skin, the affection appears to have passed through a second phase, in which slight redness occupied the intervals between the spots, to a third form, in which the patchy appearance was lost in a general and diffused redness, and finally merged into the genuine scarlet fever eruption. , Course.-Amongst the cases distinguished by a true scarlet- fever rash, some ran their course with, some without, fever; in a few, fever and ulcerated throat were developed without any eruption; while the irregular forms were attended for the most part by no febrile disturbance. The duration of the anomalous rash was uncertain : in some cases it disappeared in twenty-four hours or sooner; but in most cases it continued four or five days, and then gradually faded. Frequently slight enlargement of the tonsils, and oc- casionally swelling of the cervical glands, accompanied the eruption; a previous attack of scarlet fever secured no immu- nity from it; youth was especially susceptible of the poison, yet a maturer age was by no means free from it; its subsidence left the subjects of its attacks weak and depressed, though its course was for the most part mild and unattended by any con- stitutional disturbance; desquamation in the anomalous forms was the exception-it occurred, however, in several instaaces; the period of incubation varied from eight to fourteen days; albuminuria was never discovered. A careful consideration of these facts, with due attention to the features and character of the collective whole rather than to the peculiarities of individual cases, can leave little doubt, we think, that the affection was not roseola, as affirmed by some, nor rubeola, as asserted by others; but an anomalous and modified form of scarlet fever: and we may, in conclusion, press the consideration of the following points in confirmation of this view :- 1. No case was known to have occurred until ten days after the return of the boy who suffered, as mentioned above, from undoubted scarlet fever, and whose attendants were taken ill, . one with the genuine fever, the other with scarlat’ina sine i eruptione. 2. Throughout the whole course of the complaint, from time to time, and in various houses, cases of true scarlet fever sprang up. 3. Of these last, many could be traced to no other source than contact with an individual suffering from the anomalous rash; and, conversely, many irregular cases appeared to ori- ginate from the contagion of regular ones. The most remark- able instance of this was the case of two brothers and a sister. During the convalescence of the latter from genuine scarlet fever, the younger brother became affected with an anomalous variety; upon which it was ascertained, for the first time, that the elder brother had some weeks previously suffered from a similar rash, but, from feeling and seeming quite well, he had been allowed to go out, and no medical advice had been taken. 4. The irregular eruption was attended by no coryza or catarrh, the usual concomitants of measles; and developed itself, in two or three cases, in individuals who had suffered from rubeola a few months previously. It is somewhat diffi- cult to believe that the system should be liable to infection by the same poison after so short an interval. 5. In a few cases the irregular variety came out fully, but in the course of a day, or two days, passed into the genuine scarlet-fever rash. We are, Sir, yours obediently, THOMAS HEWLETT, THOMAS BRIDGWATER, Surgeons to the Harrow School. MILITIA SURGEONS. To the Editor of THE LANCET. SIR,—I would trespass but for a few lines to bring before the notice of the profession and the general public the way in which the present Secretary for War seems determined, in every way he can, to lower and insult the medical men, both in the Army and Militia. I need not allude to the recent circular which has caused so much indignation amongst the medical officers throughout the army. I wish to mention a. similar instance, on the part of this Minister, whereby he en- deavours to lower the position of the Militia surgeon. Several of the regiments are this year called out for pre- liminary training of recruits; and a circular has been ad. dressed to the commanding officers, informing them that cer.
Transcript
493
In the first, so extraordinarily premature, the child wasborn alive, and lived more than half an hour without respi-ration, unless we assume, physiologically, from the action ofthe heart, that this process necessarily existed, though toofeebly to be observed by the senses; but then, in ordinarycases, we must be guided by the senses, and judge of a child’sstate by them.
In the second, the pulsation of the funis ceased between eightand ten minutes before the head was born, and no signs of arte-rialization were evident for full twenty minutes after it wasborn, and respiration was not established until three quartersof an hour after birth.In this case, if the artificial respiration had been discontinued
at the end of forty minutes, the child would have been re-ported " still-born, "-as hundreds undoubtedly are,-and Dr.Robert Lee would have been complacently satisfied with a cer-tificate to that effect; but it was continued five minutes longer,and the child breathed. Dr. Lee says that " respiration isnecessary to establish the fact of live-birth." If so, it is
clearly not necessary to the existence of life; and this child,now alive and well, was dead in law, if not in fact, for nearlyone hour after it was born.
T am Sir vmir obedient servant
JAMES HURD, L.R.C.P. Edin.
To t7te Editor of THE LANCET.
SIR,—If a child is born, but neither moves nor breathes, andshows no other sign of life except " a slight pulsation at thecord" (funis), ought I to consider such a child to be born alive,and write a certificate accordingly ?
I am, Sir, vour obedient servant,ROBERT LEE, M.D.
THE RECENT EPIDEMIC AT HARROW.To the Editor of THE LANCET.
SIR, —Should you deem the following account of an epidemicwhich has lately broken up the School at Harrow of sufficient’interest, may we beg you to give it insertion in an early num-ber of your journal.The first case which came under our notice, and from which
we date the origin of the epidemic, was a boy aged twelve. Aweek after his return to school we saw our patient for the firsttime, and found him suffering from an attack of unmistakablescarlet fever, with its characteristic rash well developed, andwith ulcerated throat. After an illness of unusual severityand of somewhat malignant type, attended with almost un-broken delirium during thirty-six hours, and with other symp-toms of disordered sensorium, he slowly recovered, but notbefore two of his attendants had imbibed the poison, whichdeveloped itself as true scarlet fever in the one, and as ulcer- ated throat, with fever, but without any eruption, in the other. ’,This case was followed by twelve other examples of genuinescarlet fever, occurring at various intervals during the progressof the epidemic. In some of these the disease ran a severe,and in one, where the patient was a weakly and delicate boy,a fatal course. But in the remainder (which amounted toupwards of a hundred cases) the malady assumed a very ano-malous character, and was attended in its onset, progress, anddecline by symptoms of great variety and irregularity.
Onset.-In several, febrile disturbance more or less severe,languor, lassitude, and slight sore-throat ushered in the com-plaint ; in others, a feeling of giddiness, slight headache, nausea,and in two or three cases actual syncope, marked the com-mencement of the affection; while in a third and much largerclass the eruption was preceded by no premonitory symptoms,but developed itself while its victim was in the enjoyment ofapparently perfect health, the remark of a companion, " Howred your face is !" being often the first intimation of its pre.sence.
Eruption. - Nor were the features of the epidemic, con-
sidered in its cutaneous aspect, less varied than its modes ofonset. In some few the eruption presented a great resemblanceto that of measles, and an experience of it limited to theseinstances would have unhesitatingly said that it was rubeola;but these were the exceptions. Between this extreme and thegenuine cases of scarlet fever mentioned above there existedseveral varieties-slight indeed, and almost inappreciable inindividual cases, but which, shading off one into the other,formed, when viewed in reference to the whole, connectinglinks in the chain of an epidemic which clearly began as scarletfever. Thus, commencing with cases in which the eruption
consisted of numerous patches of aggregated, scarcely raisedpoints, of a reddish hue, scattered over the face, trunk, andextremities, with interspaces of healthy skin, the affectionappears to have passed through a second phase, in which slightredness occupied the intervals between the spots, to a thirdform, in which the patchy appearance was lost in a generaland diffused redness, and finally merged into the genuinescarlet fever eruption.
, Course.-Amongst the cases distinguished by a true scarlet-fever rash, some ran their course with, some without, fever;in a few, fever and ulcerated throat were developed without anyeruption; while the irregular forms were attended for the mostpart by no febrile disturbance.The duration of the anomalous rash was uncertain : in some
cases it disappeared in twenty-four hours or sooner; but inmost cases it continued four or five days, and then graduallyfaded. Frequently slight enlargement of the tonsils, and oc-casionally swelling of the cervical glands, accompanied theeruption; a previous attack of scarlet fever secured no immu-nity from it; youth was especially susceptible of the poison,yet a maturer age was by no means free from it; its subsidenceleft the subjects of its attacks weak and depressed, though itscourse was for the most part mild and unattended by any con-stitutional disturbance; desquamation in the anomalous formswas the exception-it occurred, however, in several instaaces;the period of incubation varied from eight to fourteen days;albuminuria was never discovered.A careful consideration of these facts, with due attention to
the features and character of the collective whole rather thanto the peculiarities of individual cases, can leave little doubt,we think, that the affection was not roseola, as affirmed bysome, nor rubeola, as asserted by others; but an anomalousand modified form of scarlet fever: and we may, in conclusion,press the consideration of the following points in confirmationof this view :-
1. No case was known to have occurred until ten days afterthe return of the boy who suffered, as mentioned above, fromundoubted scarlet fever, and whose attendants were taken ill,
. one with the genuine fever, the other with scarlat’ina sinei eruptione.
2. Throughout the whole course of the complaint, from timeto time, and in various houses, cases of true scarlet fever
sprang up.3. Of these last, many could be traced to no other source
than contact with an individual suffering from the anomalousrash; and, conversely, many irregular cases appeared to ori-ginate from the contagion of regular ones. The most remark-able instance of this was the case of two brothers and a sister.During the convalescence of the latter from genuine scarletfever, the younger brother became affected with an anomalousvariety; upon which it was ascertained, for the first time, thatthe elder brother had some weeks previously suffered from asimilar rash, but, from feeling and seeming quite well, he hadbeen allowed to go out, and no medical advice had been taken.
4. The irregular eruption was attended by no coryza orcatarrh, the usual concomitants of measles; and developeditself, in two or three cases, in individuals who had sufferedfrom rubeola a few months previously. It is somewhat diffi-cult to believe that the system should be liable to infection bythe same poison after so short an interval.
5. In a few cases the irregular variety came out fully, but inthe course of a day, or two days, passed into the genuinescarlet-fever rash.
We are, Sir, yours obediently, --
THOMAS HEWLETT,THOMAS BRIDGWATER,
Surgeons to the Harrow School.
MILITIA SURGEONS.To the Editor of THE LANCET.
SIR,—I would trespass but for a few lines to bring beforethe notice of the profession and the general public the way inwhich the present Secretary for War seems determined, inevery way he can, to lower and insult the medical men, bothin the Army and Militia. I need not allude to the recentcircular which has caused so much indignation amongst themedical officers throughout the army. I wish to mention a.similar instance, on the part of this Minister, whereby he en-deavours to lower the position of the Militia surgeon.
Several of the regiments are this year called out for pre-liminary training of recruits; and a circular has been ad.dressed to the commanding officers, informing them that cer.
494
tain pay and allowances are to be granted to the adjutant,quartermaster, and the other officers who are called up for thispreliminary training; but the unfortunate surgeon finds him-self excluded from all participation in such pay, the circularinforming him that he is, forsooth, to receive, not the lls. 4d.a day he is entitled to, but in lieu thereof the munificentsum of 3d. per head per week. Now, independent of the pecu-niary injury this inflicts upon the surgeon, I consider the ex-clusion of him from any rank or pay during this period is adeliberate insult. His duties are quite as laborious and his serevices as necessary as those of any of the other officers ; besideswhich, it is a direct violation, on the part of the Secretary ofWar, of the Militia Act, under which these trainings takeplace, as it is there stated, that whenever a regiment, or pa7.tthereof, is called out for training or exercise, the officers soemployed shall, in all respects, receive the same pay andallowances as in the Line, and enjoy the same rank, &c. &c.Now, the surgeon is clearly an officer, and if called on torender services during such period, he cannot legally be deprivedof his usual training-pay and allowances.
This is no solitary instance of the way in which (despiteevery remonstrance and positive promise on the part of theWar Secretary to redress our grievances) Militia surgeons aretreated-nay, actually cheated of their just and hard-earnedemoluments ; and the reply that has been given to them byone or two over-paid officials was, " If you do not like howyou are treated, why resign, and we can get plenty to takeyour appointments, and submit to even scu7’vier treatment, thesupply being just now in the profession greater than the de-mand." My object in penning these few lines is to warnthose about entering the public service to hesitate before theydo so, the advice I would give them being similar to that givenby P2cnclz regarding marrying-" Don’t do anything so foolish."
I am, Sir, your obedient servant,May, 1861. A VICTIMIZED MILITIA SURGEON.
FRUITLESS SUCKING AND IDIOCY.To the Editor of THE LANCET.
SIR,—In reading your report of Mr. Thos. Ballard’s paperread at the Royal Medical and Chirurgical Society on the 23rdult., which is headed " On a Previously Unobserved Prevent-able Cause of Idiocy, Imbecility, and the Allied Affections," afew thoughts occurred to me, for which I shall be glad if you,can find space in your valuable journal.From the heading of the paper referred to, we are led to
understand that the author has made a new discovery, whichno one will doubt would have been a great boon to humanity.I fear that his theory falls far short of the mark. He believes"fruitless sucking"—i. e., sucking the thumb-" to be prin-cipally engaged in producing them." If such were the case,what a host of idiots and imbeciles would be found in thiscountry! as the greater number of dry-nursed children aremore or less addicted to this pernicious habit. Mr. Ballardtakes sucking of the thumb to be the cause, and not the effect,of gastric and intestinal derangements. From my observationof such cases, which has not been very limited, I maintain thatthis habit is merely the efect of irritation in the alimentarycanal, brought on by improper food or injudicious feeding.Food that is indigestible is either soon rejected by the stomach,or, if retained, will pass by the pylorus unfit for assimilation.It irritates the bowels and the intestinal glands, and producesdiarrhcea., the dejections being of a green colour and exceed-ingly offensive. The child looks pale and emaciated, its coun-tenance is discontented, with the lineaments of age, and itsentire aspect is that of perfect wretchedness. Having avoracious appetite, it will eat constantly; the food, however,is soon vomited, or it may pass by the bowels unchanged.But still the child will eat again, as eagerly as ever, and if notfed, it will suck its thumb, or any article of clothing. It isevident that the child takes to this habit by an instinctivesympathetic act of satisfying hunger, as it derives no benefitfrom its food in this state; and, if not relieved, it dies at lastfrom inanition, or it may linger, a spectacle of retarded de-velopmental vegetation.The author of the paper merely proves this retained habit of
’" fruitless sucking" to be the cause of deformity of the jaws,in the same manner, I should suppose, as a child that criesmuch may have deformity of the vocal organs. He attributesthis habit to three causes-
"1st. The mother’s breast when it does not yield as muchmilk as the infant requires.
" 2ndly. The ’sugar teat, which is frequently placed in-the
child’s mouth by the nurse to keep it quiet. This is probablymuch practised on the Continent, where idiocy is very com-mon.
" 3rdly. The prevalent custom of feeding infants through arti-ficial teats, which collapse under the pressure which is neces-sarily exercised upon them in the act of sucking."
I shall make a few remarks upon these three conclusions.1. I should consider it more in accordance with the physio-
logy of digestion to say that the mother’s milk is inadequate inquality or quantity for the nourishment of the infant; hencethe sympathetic act of sucking the thumb.
2. Instead of " sugar teats" being the cause of idiocy on theContinent, it would be more probable to attribute it to endemicdispositions, as that of cretinism and idiocy in Switzerland.
3. Rather than considering collapsed artificial teats as thecause of fruitless sucking, it would be more logical to say thatit arises from the quality and quantity of food given throughthem, which primarily deranges the assimilative process, andbrings on sympathetically this habit of relieving hunger.
Your obedient servant,R. RICHARDSON, L.R.C.P. ED.
PALSY OF THE CILIARY MUSCLE.To the Editor of THE LANCET.
SIR,—In THE LANCET of last week, p. 458, I observe a paperby Mr. Lawson, on " Palsy of the Ciliary Muscle," with cases,in which relief was obtained by the employment of convexglasses, and a cure effected by rest of the eyes, along withpurges, cold sponging, iron, and quina.The name of palsy of the ciliary muscle is new certainly; but
the phenomena so designated have long been noticed, as maybe seen by referring (which Mr. Lawson does not do) to thewritings of Ware,* James Hunter,t and Mackenzie.--,’- Thepith of all that has been said on the subject (except Mr. Law-son’s new name for an old disease) seems to be contained in thefollowing passage rom Mackenzie :-
" A loss of the power to adjust the eyes to the vision of nearobjects, which is equivalent to presbyopia, sometimes suddenlyoccurs in subjects under the age of forty, or even in children.I have seen this affection, in children, follow influenza in somecases, and in others inflammation of the tonsils, with consider-able febrile excitement. The patients could not read at all atthe usual distance, but held the book eighteen inches or morefrom the eyes, and saw better with convex glasses. In someinstances there was a dimness even over remote objects..Acomplete cure was effected by leeches to the temples, blistersbehind the ears, and small doses of calomel followed by quinine.Dr. James Hunter relates a case in which a cure was effectedby purgatives.
" That this affection, in children, was the result of thefeverish complaint by which it was preceded could scarcely bedoubted; and it seemed more likely to be the result of disturb-ance of the nervous power, upon which the adjusting apparatusof the eye depends for its activity, than of any immediatechange in the eyeball, such as might cause a shortening of itsaxis, or of any derangement in the curvatures or densities ofits dioptric media.
" This variety of presbyopia, if we may be allowed to call itso, is easily distinguished from asthenopia, by the deficiencybeing constantly experienced till it yields to medical treatment;whereas the fits of long-sightedness in asthenopia occur onlyafter the eyes have been exercised for an appreciable time,perhaps for half an hour or longer, upon near objects, andduring a short period of rest subside of themselves. The casesrelated by Mr. Ware, as occurring in young persons, seem topartake more of the character of asthenopia than of presbyopia."
I am, Sir, yours, &c.,May, 1861. A STUDENT.
* Philosophical Transactions, vol. ciii., p. 48. London, 1813.t Edinburgh Medical and Surgical Journal, January, 1840, p. 121t Practical Treatise on Diseases of the Eye, p. 923. London, 1854.
CAMBRIDGE.—The Cambridge University Council of theSenate have had under their consideration the opinion of theBoard of Medical Studies, and recommend-(1.) That a Doctorof Medicine be annually appointed as assessor to the RegiusProfessor of Physic when presiding in the schools at acts forthe degree of Doctor of Medicine, and with him determine uponthe merits of the exercises, and their sufficiency for qualifyingthe candidate for proceeding to that degree. (2.) That the saidassessor be nominated by the Board of Medical Studies, andappointed by the Senate in the Michaelmas Term. (3.) Thathe receive five guineas for each act from the University cheat.
