946

- the x ray atmosphere. The whole apparatus except the tubeshould be in one room and the tube and the couch for the

patient in an adjoining room. The wall separating the

rooms should be covered with sheet lead not less than ndof an inch thick. Through this should pass the wires to thetube. In the wall should be a peep-hole, which might beprotected with the glass from which are made cut glassarticles (containing as much as 20 per cent. of lead). Orthe hole might be protected by means of two mirrors facingone another at an angle with the perpendicular of 45°, onecovering the opening and the other above it. The silver-covered mirror would prevent the non-reflectable x raysfrom striking the operator but he could see by the ordinaryrays of light reflected from the mirrors everything in theroom. The mirror covering the opening could be depressedby means of a handle and the fluoroscope used to judge thetube and the character of the light which it gave off. The

- only objection to this plan is that fluoroscopy would beabolished but Dr. van Allen does not consider this a dis-

advantage, as he thinks that it is less trustworthy thanradiography.

-

INEQUALITY OF THE PUPILS IN PLEURISYWITH EFFUSION.

INEQUALITY of the pupils in diseases of the chest has beenTecently described by French writers. In 1902 M. Souquesreported three cases of inequality of the pupils in pulmonarytuberculosis. 1 He attributed the inequality to pleuriticthickening and adhesion which involved and paralysed thepupil-dilating fibres of the sympathetic as they passed outfrom the cord in the ramus communicans of the first dorsal

nerve. More recently inequality of the pupils in diseases ofthe lungs and the pleurae has been discussed by Deherain.2 Thesubject of inequality of the pupils in pleurisy with effusionis almost entirely new. All that Deherain says of it is that"in four cases of tuberculous pleurisy with serous effusioninequality of the pupils was constant for several weeks."He says nothing of the nature or the degree of the

inequality or of its relation to the quantity and the natureof the effusion. M. A. Chauffard and M. L. Laederichhave contributed an important paper on Inequality of thePupils in Pleurisy with Effusion to the Archives Générales.de Méàecine of March 7th, in which they throw considerablelight on these and other points. In pleurisy with effusionthey found inequality of the pupils in seven out of 17

cases-i.e., in 41 per cent. of the cases. The larger pupil i

was almost always on the side of the effusion. The in-

equality varied much from day to day, sometimes even

disappearing on certain days to return later. It wasnever found after the effusion was completely absorbed.

’

The inequality was always moderate and never attained themagnitude observed in diseases of the brain and the spinal,cord; sometimes it was so slight that it had to be looked forcarefully by exposing the eyes to equal amounts of light witha medium condition of accommodation. On looking at a

very near object the inequality disappeared ; the pupils con-tracted to their maximum extent and became equal. The

seven cases in which the inequality was observed comprised’one case of "cardiac pleurisy" and six of tuberculous

pleurisy. The 10 negative cases consisted of six cases oftuberculous pleurisy, one case of hæmorrhagic pleurisy (prob-ably cancerous), two cases of pleurisy following pneumonia,and one case of "cardiac pleurisy." In these 10 cases all

degrees of effusion were observed. Comparing the positive.and the negative cases no relation could be traced betweenthe amount of the effusion or the presumed condition ofthe apex of the lung in the tuberculous cases and the

1 Bulletins de la Société Médicale des Hôpitaux, May 23rd, 1902,p. 484.

2 La Presse Médicale, Oct. 1st, 1904.

inequality. Paracentesis thoracis, even when 1250 cubiccentimetres of fluid were removed, had no effect on the

inequality. Discussing the cause of the inequality M.Chauffard and M. Laederich do not accept the mechanicaltheory put forward by Deherain, that it is due to pressureof enlarged lymphatic glands or of the effused fluid on thepupillary fibres of the sympathetic. The fact that it variesfrom day to day is opposed to the former theory and the factthat paracentesis does not affect it is opposed to the latter.The inequality seems to be a functional phenomenon. Its

explanation appears to lie in the dictum of Schiff : "All

peripheral sensory irritation causes dilatation of the pupil."Probably it is due to irritation of the branches of the

vagus distributed to the lung on the affected side. Theunilateral character of the phenomenon is explained byPfluger’s law : "Reflex movements are first manifested onthe side of the irritation."

____

THE HEALTH OF MARGATE.

IN his report for the year 1904, Mr. Bertram Thornton,medical officer of health of Margate, draws attention to thehealthiness of the town and the excellence of the water-

supply. As is well known the population of Margate isliable to great variations on account of the immense influxof visitors during the summer months. The estimated

population on which the birth-rate, the death-rate, andother numerical averages are based is computed yearlyfrom the data obtained at the decennial census which isheld in the month of March. In Margate the estimated

population to the middle of 1904 was 24,263, but for afew weeks during the summer season the populationprobably exceeds 100,000. The birth-rate in the boroughwas 19’ per 1000 and the corrected death-rate was 12’ 8per 1000, both of them being below the correspondingaverages of the last ten years ; by excluding the deaths ofvisitors the general death-rate would be reduced to 10’7

per 1000. The water-supply from local sources had becomeso impregnated with salt (as much as 170 grains to the

gallon) that a new supply obtained from the chalk hasbeen brought from the district of Wingham, 14 miles fromMargate. The chemical and the bacteriological analyses of

, this water have given very satisfactory results and the

: yield is more than equal to the demand.

MILK-BORNE SCARLET FEVER.1 AN outbreak of scarlet fever which occurred in the Little-

Woolton sanitary district in Lancashire is described in a1 recently issued report by Dr. C. Stuart Pethick, thes medical officer of health, who inclines to the view that’ the infection was milk-borne. Little Woolton is a small

township which in 1901 contained 218 inhabited houseswith a population of 1091 persons. Between November,

r 1903, and March 29th, 1904, no cases of scarlet fever

were notified, but between March 29th and April 16tha there occurred 30 cases and of these patients 28 received-

their milk from the same dairy farm ; in some of theme the initial throat symptoms were severe and there werei two deaths. On April 10th handbills were delivered ats each house advising that the milk should be boiled andf that no cans should be admitted to the premises. The,- farmer also ceased to supply milk from his own farm for a’ period of six days from April 12th. In Dr. Pethick’s opinion

the dates above mentioned point to the probability (1) thate the outbreak was due to some infection of the milk whichn came into operation about March 25th, and (2) that for 10f or 11 days the milk was receiving a continuous supply ofe infection. The district then remained free from the disease-

until June 13th. On April 6th the farm was visited and a’ careful examination of all the persons residing or employed

there was made without eliciting any explanation of the