1026

feeding on materials which contain pathogenic organismspractically in pure culture. It would, he adds, be prematureto conclude that these experiments and observationsdescribed in the report do more than indicate that underexceptionally favourable conditions certain bacteria can berecovered from the contents of the alimentary canal andfaecal deposits of infected flies for some days after infection,and that these flies are capable for several days of infectingcertain materials on which they may feed. The experimentswith tubercular sputum and anthracic blood alone afford evi-dence as to the duration of life, in the contents of the ali-mentary canal, of pathogenic bacteria taken up under naturalconditions. After quoting a number of instances recorded byother observers, at home and abroad, in which flies have beenshown to have become grossly infected under natural condi-tions, it is pointed out that even these observations onlyprove that cultures of pathogenic organisms may occasionallybe obtained from naturally infected flies ; they do not affordconclusive evidence that such flies are a frequent source ofdisease in man by infecting his food. We are glad to learnthat Dr. Graham-Smith hopes to continue these valuable

investigations with naturally infected materials, not onlywith musca domestica, but with other non-biting flies.

Appended to Dr. Graham-Smith’s report is a summary of

literature relating to the bionomics of the parasitic fungus offlies (Empusa muscse) by Dr. J. M. Bernstein ; and also anote by Dr. S. M. Copeman as to the work in hand, but notyet published, and as to proposed further work in referenceto flies as carriers of infection.

THE CASE OF SURGEON-MAJOR FARMARBRINGHURST.

WE have been favoured with a statement from Surgeon-Major Farmar Bringhurst, a retired member of the ArmyMedical Staff, who was recently indicted at the GuildfordAssizes upon the grave charge of manslaughter based uponallegations of neglect upon his part, and arising out ofthe death of his wife at Egham. The grand jury, beforewhom the indictment was laid, declined to find a truebill upon the evidence adduced by the prosecution, anda verdict of " Not guilty " was formally returned bythe direction of the Lord Chief Justice upon the coroner’s

inquisition, with the result that Surgeon-Major Farmar

Bringhurst was discharged without having the opportunityto give evidence in his own behalf and to corroborate it bythat of other medical men. This he was prepared to do, thegist of the testimony at his disposal being that the treatmentwhich he applied upon his own responsibility, and particularlythe use of morphia, were proper in view of the symptomsevinced by Mrs. Farmar Bringhurst. He was, moreover,

desirous of establishing on oath the fact that it was throughyielding to his wife’s urgent wish that he abstained

from obtaining the services of a trained nurse, undertakinghimself the duties which would have been assigned to herand performing them devotedly to the end. The difficultcircumstances in which the husband is placed in a case inwhich his wife is the patient, and in which alcoholism andthe drug habit have induced her condition or contributed torender it almost hopeless, will be borne in mind. We have

referred to the accused as not having had the opportunity oftendering evidence owing to the case not coming to trialbecause, although we are aware that, strictly speaking,he might have done so when before the magistrates,we realise how seldom counsel permits his client to

go into the witness-box at this early stage of the

proceedings, if committal is likely to take place in anyevent, and how impossible it is, owing to the expense,for a person of moderate means to call witnesses before the

aoroner, before the magistrates, and yet a third time at the

assizes. It is to be observed, therefore, that although the"throwing out " of a bill of indictment by a grand jury isoften treated as an emphatic declaration of a prisoner’sinnocence, and although it spares him the painful ordeal

of trial by a petty jury, it may operate as a hardship.The accused person may welcome the grand jury’s opinionthat there is not a sufficient primd-faaie case againlithim to justify his being put upon his trial, but at the

same time may feel aggrieved that as the accusation hasbeen publicly brought, has resulted in his being committed,and has been kept hanging over his head until the assizes, hehas not been allowed to do his utmost to establish his com-

plete innocence. Surgeon-Major Bringhurst is entitled to everysympathy in his regret that this opportunity should nothave been afforded to him, and we are glad to record thathe was willing and ready to make the fullest use of it.

THE TREATMENT OF FRACTURES OF THE BASEOF THE SKULL BY REPEATED LUMBAR

PUNCTURE.

A FRACTURE of the base of the cranium is universallyregarded as a very serious condition, one in which the

prognosis must of necessity be guarded. According to

Chudovszky the mortality in fractures of the cranial vaultis 45’ 3 per cent. and in fractures of the base 64’2 2 per cent.More recent figures furnished by Maclaren are 20’ 2 percent. for the former lesion, and 60 per cent. for the latter.It is true that within the last few years surgeons haveadvocated active interference in such cases to a greaterextent : Cushing of Baltimore, for instance, recommends

trephining subtemporally, and subarachnoid draining has alsobeen employed. In the hands of skilful surgeons no doubtsuch procedures are justified, and in some published caseshave been attended with remarkable success. Unfortunately,however, the condition of the patient is frequently so desperatethat surgical measures only add to the shock from which he issuffering. A much more simple method, preferable to the purepassivity of medical treatment on the one hand and to theseverity of surgical treatment on the other, consists in thereduction of the hasmorrhagic effusion by repeated lumbarpuncture. Both in England and abroad cures by this meanshave been reported. Of course, in the case of cranial fracturesthe interpretation of statistics is a delicate manner, for amongthe " cures " it is difficult to exclude the possibility of spon-taneous recovery whatever be the therapeutic measures

adopted. It can scarcely be doubted, however, that the haemor-rhage accompanying the fracture, both from its volume andfrom the chemical phenomena associated with its absorption,constitutes the chief danger for the patient, and it is

precisely this danger which is minimised by recourse tolumbar puncture. In La Presse Medicale for August 10thDr. Apostolos G. Apostolides, physician to the Ottoman civilhospital in Smyrna, has published the details of two cases offracture of the cranial base in each of which a complete curewas effected, the credit for which seems to be due to repeatedlumbar puncture. The first of these concerned a young man,

aged 22 years, who fell a distance of about 36 feet on to hishead, and was picked up unconscious, bleeding freely thoughslowly from the nose, and presenting all the features of frac-ture of the base. His condition remained so grave thatlumbar puncture was suggested more as a palliative thanas a remedial measure. Forty cubic centimetres of cherry redsanguineous fluid were withdrawn under considerable pres-sure, the result being an immediate improvement in the

patient’s condition. During the next few days the procedurewas repeated three times, the cerebro-spinal fluid beingperfectly clear on the last occasion. The patient madean uninterrupted recovery. The other case was somewhatsimilar, and the success was equally striking. Whatever be

1027

the verdict of the future, cases such as these are sufficientlyencouraging to warrant recourse to lumbar puncture insteadof the adoption of a waiting policy merely, thus allowingtime for the development of infection of the meninges.Hasmorrhagic effusions are excellent media for bacterial

germination. -

FAMILIAL HYPERTROPHIC NEURITIS.

IN La Semaine Medieale Dr. Boveri of Pavia has describeda comparatively rare disease to which the term pro-gressive hypertrophic interstitial neuritis " has been applied.In 1889 Gombault and Mallet published an account of acurious case, under the title 11 A Case of Tabes dating fromChildhood," concerning a man aged 58 years who presentedwhat were considered to be characteristic symptoms of tabes,but the anomalous feature was that the disease commencedalmost in infancy and was associated with muscular

wasting of the Aran-Duchenne type. In 1893 Dejerineand Sottas described the cases of a brother and sisterwho showed the classical symptoms of tabes in the

shape of myosis, Argyll-Robertson pupil, ataxia, light-ning pains, marked disturbance of sensibility, and loss

of deep reflexes, to which, moreover, were added nystag- Imus, scoliosis, and gross amyotrophy. The result ofa post-mortem examination in one of these cases was

quite unexpected : the peripheral nerves were found to be

greatly thickened, as were the spinal roots, especially thoseof the cauda equina. Evidently a new morbid entity hadbeen discovered. Clinically, there appeared to be an

amalgam of tabes and muscular atrophy, the underlyingpathological stratum of which was hypertrophic interstitialneuritis. In 1908 Professor Pierre Marie described a familyof six, no fewer than four of whom were afflicted with hyper-trophic neuritis, but in a special form. The symptoms oftabes were not present to the same extent; the muscularatrophy was practically confined to the lower extremities;intentional tremor was noted, and a staccato articula-

tion not unlike what is found in disseminated sclerosis.

Otherwise, the clinical symptoms and signs were the

same-scoliosis, wasting of the legs, with the 11 tabeticfoot" well marked (a combination of pes equinovarusand pes cavus), absent deep reflexes, loss of sensi-

bility, and in particular palpable enlargement of the super-ficial branches of peripheral nerves. That these cases maybe more common than is usually supposed is to be inferredfrom the fact that Dr. Boveri mentions another which bad

been diagnosed as one of Friedreich’s ataxia until the dis-covery that the peripheral nerves were greatly thickenedrevealed the true nature of the condition. From both the

clinical and the pathological aspect the disease is remark-

able. Hypertrophic neuritis is a definitely familial

disease that may occur in either of two types (theDejerine and the Marie variety). The features common to

both are loss of deep reflexes, gross defect of sensibility,amyotrophy of the distal type, scoliosis, club-foot, and theunderlying pathological condition. In the Dejerine type,however, further symptoms analogous to those of tabes are pre-sent-viz., lightning pains, myosis, Argyll-Robertson pupil,true ataxia, also nystagmus and fibrillary contractions. All

these are absent in the Marie type, but there are found, onthe other hand, intention tremor, dysarthria, and a muscularatrophy which is limited to the feet and legs, not generalisedas in the first form. Pathologically the peripheral nervesare enormously thickened-in one case the sciatic nerve,

5 centimetres below its point of exit from the pelvis, was19 millimetres in transverse diameter. The increase is due

almost entirely to great overgrowth of the sheath of

Schwann ; there is less actual interstitial change, while

the axis-cylinders themselves seem to be more slender than

usual and the myelin sheath also is reduced. Degenerationin the posterior columns of the spinal cord, and to a lessextent in the lateral columns, is described by Dr. Boveri.

PRECOCIOUS PARENTAGE.

OUR correspondent in China writes as follows: "Theenclosed photograph is of a young couple whose precociousassumption of parentage has created some stir even amongthe Chinese. The characters round the photograph statethat the mother is 8 years and the father 9 years old,but as a child is always reckoned in China as 1 yearold at its birth this makes the parents each a year younger.Their names and village are given and the notice also statesthat in the first month of this year a child was born to them.In the photograph the mother can be seen suckling herchild which measured one foot long at birth. The Governor

of Shansi, the province in which the birth took place, sentofficial particulars to Peking, but in order to make more sureI made further inquiries through a Chinese friend who livesin the neighbouring city of Tai-yuan-fu. He reports that thefacts are as stated and that the boy is the father of the

child, but I have been unable to obtain particulars of thedevelopment of his or her generative organs, whether themother had previously menstruated, &c. In Taylor’s MedicalJurisprudence’ a case is mentioned of a mother 9 years old,but there is no record of so juvenile a father."

CHRONIC ECZEMA FOLLOWED BY FATALGANGRENE.

IN the British Journal of Dermcctology for July Dr. G. H.Lancashire has reported a very rare sequel of eczema-

gangrene of the skin. A married woman, aged 54 years, wasadmitted into the Manchester and Salford Hospital for SkinDiseases in December, 1909, suffering from acute weepingeczema of the cruro-genital regions extending over the hypo-gastrium and inner and upper parts of the thighs. On the

face and neck there was a subacute seborrhoeic dermatitis.A chronic aural discharge was present. The patient waswell nourished and did not appear to have lost strength.

She had been treated for the eczema for over a year, duringwhich there had been improvement and exacerbations. A

few days after admission the eczema had disappearedfrom the upper part of the body, but in the cruro-

genital region it remained obstinate. On Dec. 31st there