tuberose sclerosis of the brain

1
1738 case-mortality, however, is probably primarily dependent upon 1 the varying type of the disease which may locally prevail. The provision of additional hospital accommodation for the isolation and treatment of epidemic diseases in Stafford- shire is in progress, but it is evident that such existing accommodation is not fully turned to account where it is available. The use made of existing isolation hospitals varies very considerably in different sanitary districts within the county, and Dr. Reid notes in his report that "in most cases it is evident that they can be of little practical value in curtailing epidemics-the chief purpose for which they are intended." It is much to be desired that other county medical officers should include in their reports statistics relating to the hospital isolation and treatment of epidemic diseases similar to those given by Dr. Reid for Staffordshire, which would materially assist in the formation of a trustworthy estimate of the beneficial effect of this branch of public health organisation. THE SKIDDING MOTOR CARRIAGE. IN two more cases since our last reference to the subject county-court judges have expressed the opinion that the owners of motor omnibuses are liable for damage done through " skidding " without evidence of any definable act of negligence on the part of the driver. In one of these Sir William Selfe observed that " these machines were permitted on the streets while they were in an experimental state, and although regulations had been drawn up with regard to noise, smell, and vibration nothing seemed to have been done with regard to the much greater danger of skidding." In the case before his honour there seems to have been evidence of negligence, but he went on to say that, apart from this he would have been prepared to hold the defendants responsible on the ground of " nuisance " for " putting a conveyance on the public thoroughfares which was admittedly uncontrollable under certain conditions." " In the other case referred to his honour Judge Willis said that "people must put vehicles on the road that would not skid, and if they could not do that they must withdraw motor omnibuses from use." In both these instances damage to property, not to human beings, was the subject of the action, the former being the claim of the Metropolitan Railway Company for the breaking down of a lamp-post outside its station at Edgware-road. The falling lamp-post is so dangerous and so frequent a result of the vagaries of the motor omnibus that a return of the number so broken during the past year would be of public interest. TUBEROSE SCLEROSIS OF THE BRAIN. IN our issue of Dec. 8th, p. 1583, there appeared a description by Dr. Margaret B. Dobson of a case of epileptic idiocy associated with tuberose sclerosis of the brain which serves to call attention to an interesting and little-known pathological condition practically never met with outside asylum work and but rarely found even in that sphere. The case referred to was that of a "low-grade idiot " who died at the age of ten years from the combined effects of epilepsy and pneumonia. At the post-mortem examination there were discovered in the brain a number of what are described as " white, granular-looking, and exceedingly hard areas." Under the designation " sel6rose hypertrophique " Bourneville in 1880-81 gave an account of similar cases in the A’l’chives de Neurologie and he has since added other instances, but his cases exhibited also certain changes in the kidneys to which no allusion is made in Dr. Dobson’s paper. It is, how- ever, noted in the paper that the child " suffered from the somewhat rare skin affection known as adenoma sebaceum," though no special stress is laid on this fact. Dermatologists have for a long time been aware of a relation. ship between adenoma sebaceum and low mental development and Dr. Dobson’s observation is noteworthy as conforming to this experience, but it has apparently a still wider applica- tion. We have received from Dr. E. B. Sherlock a report printed for private circulation on a series of 18 cases of adenoma sebaceum collected by him from the records of Darenth Asylum. From this it seems probable that the case mentioned in our columns is an example of a definite patho- logical entity for which Dr. Sherlock suggests the name " anoia and which presents in its fully developed form the following striking characteristics : (1) idiocy with severe epilepsy; (2) adenoma sebaceum ; (3) tuberose sclerosis of the brain ; and (4) new growths in the kidneys. THE TREATMENT OF WOUNDS AND BURNS BY EXPOSURE TO INTENSE HEAT. IN La &maine Médioale of Oct. 24th Dr. E. Asbeck describes a method of treating wounds and burns which he has employed in over 500 cases during the last five years with uniform success. The wound or burn is first dressed in the ordinary way with sterilised iodoform gauze, a pad of wool, and a bandage. It is then exposed to a source of intense heat, such as a kitchen fire, for about half an hour or until the dressing is rendered perfectly dry. In the case of small wounds the heat from an ordinary Bunsen burner is sufficient. Dr. Asbeck has found that this mode of treatment induces rapid healing without setting up complications. He was led to adopt it from observations made in the tropics of the accelerating action of the intense heat of the sun on the healing of wounds. Exposure to heat from the boiler on a steamboat has the same effect. ___ MEAT INSPECTION AT THE CENTRAL MARKETS. WE have received a copy of the report of the medical officer of health of the City of London (Dr. W. Collingridge), in which he deals with the questions dis- cussed by the Court of Common Council in June last as to the sufficiency of the present inspection of food at the Central Markets and whether any, and if so what, altera- tions are necessary or desirable in reference thereto. Dr. Collingridge points out that of the plans adopted for the detection of unsound meat that of individual carcass inspection-i.e., inspection of every animal at the time of slaughter with all its organs, preferably at public abattoirs- is the only one that affords complete protection for the public, as no inspection can be deemed entirely satisfactory unless the organs are available for examination. As a matter of fact, the "detective system "-i.e., inspection after slaughter and when exposed for sale-has perforce to be relied upon in the City. Legislation would be required for the enforcement of the inspection of the carcass together with the organs. Inspection on arrival in the market or on exposure for sale is sufficient to deal with the question of decom- position or unsoundness but not with that of disease. By far the largest proportion of meat seized in the City is condemned on account of putridity. Thus of the 2128 tons of meat condemned in 1905 no less than 88’4 per cent. was putrid, 3’ 7 per cent. was unwholesome through injury during life or other causes, and only 7’9 9 per cent. is recorded as being diseased. With regard to the quality of foreign consignments, much of the meat is marked with a label that professes to indicate that it has been subjected to a proper inspection before export to this country. Salesmen, however, have learned by experience that they can best con- sult their own interests by not relying upon the label in the case of meat imported from the United States as a guarantee that they can safely offer the meat for sale to the same extent

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Page 1: TUBEROSE SCLEROSIS OF THE BRAIN

1738

case-mortality, however, is probably primarily dependent upon 1the varying type of the disease which may locally prevail.The provision of additional hospital accommodation forthe isolation and treatment of epidemic diseases in Stafford-

shire is in progress, but it is evident that such existingaccommodation is not fully turned to account where it

is available. The use made of existing isolation hospitalsvaries very considerably in different sanitary districtswithin the county, and Dr. Reid notes in his report that

"in most cases it is evident that they can be of little

practical value in curtailing epidemics-the chief purposefor which they are intended." It is much to be desired thatother county medical officers should include in their reportsstatistics relating to the hospital isolation and treatment ofepidemic diseases similar to those given by Dr. Reid for

Staffordshire, which would materially assist in the formationof a trustworthy estimate of the beneficial effect of thisbranch of public health organisation.

THE SKIDDING MOTOR CARRIAGE.

IN two more cases since our last reference to the subjectcounty-court judges have expressed the opinion that theowners of motor omnibuses are liable for damage done

through " skidding " without evidence of any definableact of negligence on the part of the driver. In one

of these Sir William Selfe observed that " thesemachines were permitted on the streets while theywere in an experimental state, and although regulationshad been drawn up with regard to noise, smell, and

vibration nothing seemed to have been done with regardto the much greater danger of skidding." In the casebefore his honour there seems to have been evidence of

negligence, but he went on to say that, apart fromthis he would have been prepared to hold the defendantsresponsible on the ground of " nuisance " for " putting aconveyance on the public thoroughfares which was

admittedly uncontrollable under certain conditions." " In

the other case referred to his honour Judge Willis said that"people must put vehicles on the road that would not skid,and if they could not do that they must withdraw motoromnibuses from use." In both these instances damage toproperty, not to human beings, was the subject of the action,the former being the claim of the Metropolitan RailwayCompany for the breaking down of a lamp-post outside itsstation at Edgware-road. The falling lamp-post is so

dangerous and so frequent a result of the vagaries of themotor omnibus that a return of the number so broken duringthe past year would be of public interest.

TUBEROSE SCLEROSIS OF THE BRAIN.

IN our issue of Dec. 8th, p. 1583, there appeared a

description by Dr. Margaret B. Dobson of a case of

epileptic idiocy associated with tuberose sclerosis of thebrain which serves to call attention to an interesting andlittle-known pathological condition practically never met

with outside asylum work and but rarely found even in thatsphere. The case referred to was that of a "low-gradeidiot " who died at the age of ten years from the combinedeffects of epilepsy and pneumonia. At the post-mortemexamination there were discovered in the brain a number ofwhat are described as " white, granular-looking, and

exceedingly hard areas." Under the designation " sel6rosehypertrophique " Bourneville in 1880-81 gave an accountof similar cases in the A’l’chives de Neurologie andhe has since added other instances, but his cases

exhibited also certain changes in the kidneys to whichno allusion is made in Dr. Dobson’s paper. It is, how-

ever, noted in the paper that the child " suffered fromthe somewhat rare skin affection known as adenoma

sebaceum," though no special stress is laid on this fact.

Dermatologists have for a long time been aware of a relation.ship between adenoma sebaceum and low mental developmentand Dr. Dobson’s observation is noteworthy as conformingto this experience, but it has apparently a still wider applica-tion. We have received from Dr. E. B. Sherlock a reportprinted for private circulation on a series of 18 cases of

adenoma sebaceum collected by him from the records ofDarenth Asylum. From this it seems probable that the casementioned in our columns is an example of a definite patho-logical entity for which Dr. Sherlock suggests the name" anoia and which presents in its fully developed form thefollowing striking characteristics : (1) idiocy with severe

epilepsy; (2) adenoma sebaceum ; (3) tuberose sclerosis ofthe brain ; and (4) new growths in the kidneys.

THE TREATMENT OF WOUNDS AND BURNS BYEXPOSURE TO INTENSE HEAT.

IN La &maine Médioale of Oct. 24th Dr. E. Asbeckdescribes a method of treating wounds and burns whichhe has employed in over 500 cases during the lastfive years with uniform success. The wound or burnis first dressed in the ordinary way with sterilisediodoform gauze, a pad of wool, and a bandage. It is then

exposed to a source of intense heat, such as a kitchen fire,for about half an hour or until the dressing is rendered

perfectly dry. In the case of small wounds the heat froman ordinary Bunsen burner is sufficient. Dr. Asbeck hasfound that this mode of treatment induces rapid healingwithout setting up complications. He was led to adopt itfrom observations made in the tropics of the acceleratingaction of the intense heat of the sun on the healing ofwounds. Exposure to heat from the boiler on a steamboathas the same effect.

___

MEAT INSPECTION AT THE CENTRAL MARKETS.

WE have received a copy of the report of the medicalofficer of health of the City of London (Dr. W.

Collingridge), in which he deals with the questions dis-

cussed by the Court of Common Council in June last

as to the sufficiency of the present inspection of food atthe Central Markets and whether any, and if so what, altera-tions are necessary or desirable in reference thereto. Dr.

Collingridge points out that of the plans adopted for

the detection of unsound meat that of individual carcass

inspection-i.e., inspection of every animal at the time ofslaughter with all its organs, preferably at public abattoirs-is the only one that affords complete protection for the

public, as no inspection can be deemed entirely satisfactoryunless the organs are available for examination. As a matterof fact, the "detective system "-i.e., inspection after

slaughter and when exposed for sale-has perforce to berelied upon in the City. Legislation would be required for theenforcement of the inspection of the carcass together with theorgans. Inspection on arrival in the market or on exposurefor sale is sufficient to deal with the question of decom-position or unsoundness but not with that of disease. Byfar the largest proportion of meat seized in the City is

condemned on account of putridity. Thus of the 2128tons of meat condemned in 1905 no less than 88’4 percent. was putrid, 3’ 7 per cent. was unwholesome throughinjury during life or other causes, and only 7’9 9 per cent. isrecorded as being diseased. With regard to the quality offoreign consignments, much of the meat is marked with alabel that professes to indicate that it has been subjected toa proper inspection before export to this country. Salesmen,however, have learned by experience that they can best con-sult their own interests by not relying upon the label in thecase of meat imported from the United States as a guaranteethat they can safely offer the meat for sale to the same extent