1313PURIFORM CEREBRO-SPINAL FLUID IN URÆMIC COMA.

may act as centres of education in infant hygiene, for, asLady Helmsley says, although every woman is supposed toknow how to manage a baby by instinct, we know, alas, howuntrue is this supposition. The only natural instinct is tosuckle the child, all else has to be learnt." " The fact that

illegitimate children are not refused in these creches is to

be commended. The President of the society is H. R. H.

Princess Christian, and the address of the secretary, Mr.W. A. Lawton, is 1, Upper Montague-street, Russell-

square, London, W.C. The other charity of which we speakis the Jewish Sick Room Help Society for supplying district.nurses to the Jewish poor. Its work is noteworthy in that a,provident department has been introduced, and during thepresent year no less than £517 out of the £1705 expended onthe 1543 cases attended by the society’s nurses has been

collected in pennies from 2450 members in a limited area inthe East-End of London, which, the committee truly observes,"is a remarkable evidence of the possibilities of thrift workamongst our people." The secretary of the society is Mrs.Alice Model, of 105, Fellows-road, London, N.W., who wasits joint foundress with Miss Lowy.

PURIFORM CEREBRO-SPINAL FLUID IN URÆMICCOMA.

LUMBAR puncture, an operation which has come into useonly in recent years, has revealed many facts concerningthe condition of the cerebro-spinal fluid in disease. At a

meeting of the Société Medicate des Hôpitaux of Paris onJuly 24th M. Caussade and M. Willette reported a caseof ursemic coma in which they were surprised to find the.cerebro-spinal fluid puriform. A man, aged 26 years, wasadmitted into hospital on the evening of May 31st last.

On that day he was suddenly seized with convulsions and

soon after admission he became comatose. On examinationon the following day he was inerte" " and did not answerquestions. The pulse was 100 and the temperature wasnormal. There was no rigidity of the neck and Kernig’s andBabinski’s signs were absent. The knee-jerks were normal.There was complete incontinence of urine and fasces. The facewas a little swollen and there was slight cedema of the eye-lids and lower limbs. There was more pronounced oedema ofthe lumbar region. Auscultation of the heart revealedmarked "bruit de galop." " A little urine was obtained with

the catheter and found loaded with albumin. Ursemic coma

was diagnosed and bleeding to 400 grammes was performed,after which the patient recovered from the coma. On the

following day he could speak ; he remembered no previousillness but had suffered from headache for some time. i

Improvement continued and at his request he was dischargedon July 15th. At this period two litres of urine containing.a gramme of albumin per litre were passed in the 24 hours,headache occurred at times, there was slight cedema ofthe ankles, and the left ventricle was hypertrophied, butthe "bruit de galop " had disappeared. At the time the

patient was bled lumbar puncture was performed and yieldedturbid cerebro-spinal fluid under high pressure. Chemical

analysis showed that it contained 0’ 4 gramme of urea and8 grammes of chlorides per litre, and traces of sugar andalbumin. The fluid contained an abundance of cells which were’made up as follows: polynuclears, 90 per cent. ; lymphocytes,.8 per cent. ; and large mononuclears, 2 per cent. The fluidwas sterile and the polynuclears were intact. Five days laterlumbar puncture was again performed and the cerebro-spinalfluid was found free from cells. Only one similar case

.appears to have been reported: M. Chauffard has described i" Ur6mie Aigue et Polynucléose Rachidienne." " It is to benoted that in spite of the oondition of the cerebro-spinalfluid the case narrated above cannot be termed an example of

1 Semaine Médicale, 1907, p. 361.

meningitis in uræmia, for there were no symptoms whateverof meningitis. Moreover, the effusion of polynuclear cellswas a transitory phenomenon. The symptoms of meningitisare due to a superficial alteration of the cerebral cortex.In this case there was no alteration ; the phenomena wereessentially vascular. The polynuclears were intact and nomicrobes were present. This condition-an aseptic puriformeffusion containing intact polynuclears-was first described

by M. Widal. a He found it in the cerebro-spinal fluid in

syphilis of the central nervous system and in aseptic purulentpleural effusion after pneumonia. He attributed the integrityof the polynuclears to the fact that they were not damagedin the phagocytosis of microbes. M. Chauffard ascribed the

puriform cerebro-spinal fluid in his case to the retention ofnitrogenous substances which acted as toxins and also to theincreased blood pressure paroxysmally increased by the con-vulsions which produced venous stasis. In the diapedesis ofleucocytes the polynuclears were predominant because theyare the most mobile elements. M. Caussade and M. Willette

suggest that the complex poisons which are retained in thesystem in uraemia produced congestion of the pia mater anddiapedesis from chemotaxis. It is known that certain poisonscause congestion of the pia mater. This condition has beenfound in poisoning by salicylate of sodium.

RABIES IN PRUSSIA.A

DURING the last few years there seems to have been a

e considerable increase in the number of persons bitten bye rabid animals in Prussia, according to the Allgemeines ivedicinische Central-Zeitung of Oct. 17th. In the year 1902

,. the officially reported cases were 250. In each of the four

d following years between 300 and 380 were reported, and inn 1907 no less than 405. In 274 of these cases the animals

r were proved to have been really suffering from rabies.

s Most of the persons bitten were taken to the Pasteur stations

i which have been established at Berlin and Breslau. Of the

. 266 who were inoculated two died, and of the six who were

e not inoculated two also died. Three of the four fatal bites- were on the face. The mortality of the inoculated cases wasf thus 0 ’ 75 per cent., which is a more favourable result thand that obtained in 1906, when four cases out of 236 inoculated2 proved fatal, a mortality of 1 . 69 per cent. Of course, most

a of the wounds were inflicted by dogs but there were 12 cases,

of cat-bite and one of a hog-bite.

NEW REGULATIONS FOR THE PREVENTION OFGRINDERS’ PHTHISIS.

THE Home Secretary has issued a draft of the new

regulations which he proposes to enforce for the grinding ofmetals and racing of grindstones. These have been recom-mended to Mr. Gladstone by the Cutlers’ Company, theSheffield Chamber of Commerce, and the Sheffield CutleryCouncil which represents the workmen. The draft has been

printed and circulated in accordance with Section 80 of theFactory and Workshop Act, 1901, in order that any personsinterested may suggest their amendment, and that competentinquiry may be held into any reasonable objections whichmay be thus lodged against the new regulations. These

are directed against the heavy mortality from grinders’phthisis, which is a matter of the gravest concern to bothmen and masters, and which came under full discussion at

the Sheffield meeting of the British Medical Association.

The processes which it is desired to amend are the manu-

facture of cutlery, of tools, and of cutting and piercinginstruments and appliances of iron or steel ; the pro-cesses of dry rough glazing in which emery or similar

2 THE LANCET, May 25th, 1907, p. 1446.

1314 THE ELECTROLYTIC ADMINISTRATION OF DRUGS.

abrading material is used without the admixture of grease ;and any other finishing process after grinding in which dustis created to an extent liable to be injurious to health. Thenew regulations are thus summarised in the Home Officecircular :-

Regulation 1 requires, in dry grinding of metal (that is, "the dryabrasion of metal, with the aid of mechanical power, by means of agrindstone or of a grinding wheel made of compressed emery or othersimilar composition") and in dusty finishing processes, adequate meansfor intercepting and removing the dust given off. These means includeefficient hoods, ducts, exhaust draught, and arrangements for thedisposal of the dust. The exhaust can be produced either by a fan, orby any other equally efficient means that can be devised. Recentexperiments indicate that some assistance in this direction can beobtained by utilising the draught from the revolving grindstone orwheel itself. Regulation 2 deals with the racing of grindstones, whetherused’ for wet or dry grinding. The requirement is that this processshall not be carried on without effectual means for preventing theescape of dust into the room, and two modes of compliance are

suggested : (1) racing under a cover, with exhaust draught, and (2) wet-racing, that is directing a stream of water upon the point of contact ofthe racing tool with the grindstone. The former mode is used in

Germany, the latter has been successfully tried experimentally atSheffield. The Regulation, however, admits of any other mode ofracing, equally efficient in suppressing dust, that can be devised.Regulation 3 is concerned with the general sanitary condition of theworkrooms.

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THE ELECTROLYTIC ADMINISTRATION OFDRUGS.

IN the Pharmaceutical Journal of Sept. 19th Mr. T. MaltbyClague contributes some useful suggestions regarding theelectrolytic administration of drugs recently referred to inTHE LANCET under the name cataphoresis.

" It dependsupon the decomposition of a solution of a salt by an electriccurrent and applying one of the poles to the part of the bodywhere the local action of a particular element is desired. In

the case of sodium salicylate, for example, the sodium ionspass to the negative pole and the salicylic ions to the positive.Considerable impetus was given to this line of work by somestriking experiments of Professor Leduc of the University ofNantes. Two rabbits were taken and an ear of one was

strapped to an ear of the other by a pad of moist lint. To

the outer ears were attached pads moistened with a solutionof strychnine and joined to a battery of cells. On passingthe current the rabbit connected with the positive pole diedimmediately through receiving an electrolytic charge of

strychnine, and on reversing the current the second rabbitdied. The experiment was repeated with potassium cyanide,with the result that the rabbit connected with the negativepole died. Drugs administered in this form act with

rapidity in relatively small quantities and good results havebeen obtained by various investigators with quinine, lithiumsalts, salicylates, iodides, local anaesthetics, and other sub-stances. Dr. Lewis Jones found that warts could be removed

electrolytically by using magnesium sulphate without causingpain or leaving a scar. Corns, too, readily yield to sodiumsalicylate. It is interesting to note that ions may be removedfrom the body with equal ease. A patient had several blackpatches on the face produced many years before by anointment containing arsenic. The patient’s hand was placedin a vessel of water with the positive pole from a battery ofsix cells. A pad of wet lint was then placed over one of theblack spots and connected for 15 minutes with the negativepole. It was then noticed that the disfiguring patch had dis-appeared from the skin while the pad readily showed thepresence of arsenic. ’ Mr. Clague suggests that the positivewire in contact with the patient should be one that does notelectrolyse under the conditions of the work ; platinum is

always safe and aluminium is very useful, but poles of iron,copper, or silver are to be avoided. A milliampere-meter inthe circuit is a convenience, especially to a new worker. It

is of great importance to use simple salts as far as possible.In illustration, if a weak alcoholic solution of strychninehydrochloride be put into a dialyser standing in a vessel of

water and a small current of from 10 to 15 milliamperes bepassed, strychnine will be detected in the outer vessel within

a few minutes and on reversing the current it will as quicklybe driven back. But if a stronger current be used paralde-hyde will be formed by decomposition of the alcohol. The

intensity of the electric current required in cataphoresis is solow that patients rarely experience any difficulty in bearingthe process.

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UNCERTIFIED CAUSES OF DEATH.

THE neglect of successive Governments to take any legislativeaction for securing the due certification of causes of death,the necessity for which was so strongly urged in the reportof Sir Walter Foster’s departmental committee, we mustcontinue to regret. It is, however, satisfactory to be able tonote that the proportion of uncertified causes of death in

England and Wales is constantly declining, and further thatthe mean percentage of uncertified deaths in the 76 largest.English towns is now under 1 per cent. The Registrar-General’s weekly returns show that during the 13 weeks oflast quarter the causes of 473 deaths in these 76 towns werenot certified, equal to 0 9 per cent. of the total deaths, andcorresponding with the mean proportion in the third quartersof the three preceding years. The wide variations, however,in the proportion of uncertified deaths among these 76 townsare very noteworthy and accentuate what has been so oftenurged in these columns, that, desirable as legislative actionin this matter undoubtedly is, due cooperation between localauthorities and coroners may, even under present legislativeconditions, secure due certification of all causes of death, atany rate in urban populations. During last quarter the causeof every death was duly certified in West Ham, Croydon,Willesden, East Ham, Walthamstow, and Tottenham amongthe metropolitan urban districts ; and also in Brighton,Derby, Southampton, Plymouth, York, Devonport,Ipswich, West Hartlepool, and Great Yarmouth. In

the county of London the causes of all but 17of the 14,984 deaths during the quarter were dulycertified, and the proportion of uncertified causes didnot exceed 0 ’ 2 per cent. in Leeds or in Newcastle-on-Tyne,and was but 0 - 3 per cent. in Bristol and in Bradford. In

striking contrast to these satisfactory low percentages ofuncertified causes the following figures call for notice and

for the special attention of the several local authorities. In

Liverpool 2’ 1 per cent. of the causes of death last quarterwere uncertified, and in Bootle the proportion was equal to2’ 9 per cent. In other Lancashire towns the percentage ofuncertified causes was equal to 2 - 8 in St. Helens and to noless than 4 - 5 both in Preston and in Warrington. In Sheffieldthe percentage of these uncertified causes was equal to 2 8 andin Birmingham to 3’ 5; in South Shields and Gateshead to 3’ 7and 4’2 per cent. respectively. Why the proportion of un-certified causes of death should be more than 20 times as

high in Liverpool as in London and 14 times as high inSheffield as in Leeds, under identical legislative conditions,seems to call for explanation. Can it be solely, due to

the exercise of individual discretion on the part of localcoroners as to the desirability of holding inquests con-

cerning uncertified deaths ? It may be noted that com-

pared with the mean proportions in the three precedingcorresponding quarters, the percentage of uncertifiedcauses showed a slight reduction in Liverpool, St. Helens,South Shields, and Gateshead; while, on the other hand,the proportions last quarter showed a more or less decidedincrease in Sheffield, Birmingham, Bootle, Preston, and

Warrington. It is a well-known fact that a very largeproportion of uncertified causes of death occur amonginfants and young children, and in view of much neglectand consequent, waste of child-life, especially in urban

districts, and of the practically universal adoption of

child insurance in our industrial population, it should be