1886 The Lancet  
1128 also did the third and fourth nerves of both sides. The only thing noticeable in the case of the fifth pair was that the sensory part of the right fifth was not so white as that of the left. The sixth nerve of the left side had its natural white appearance, but it seemed smaller than usual; the right sixth was reduced to a couple of small grey gelatinous filaments. The portio mollis of the seventh seemed to be alike on'both sides, and to be natural; but while the portio dura on the left
more » ... e was healthy, on the opposite side this portion of the nerve had the same wasted grey gelatinous appearance as the sixth of the same side. The right glosso-pharyngeal had also more or less of this grey gelatinous appearance. The other nerves did not appear to be altered. There was a marked deformity of the pons and medulla: the right side of both was about a third larger than the left; the enlargement was irregular and nodulated. The chief projection in the pons was towards its lower border, in a direction downwards and backwards. The left side of the pons did not seem to be very much altered. The left olivary body seemed to be a little more prominent than usual. Examined microscopically, the altered nerves were found to be in a state of extensive fatty degeneration. Attached to each olfactory bulb was a quantity of gelatinous material, which was found to be composed of small round cells, very much like those of a sarcoma. The tumour itself was caseous, and composed of a number of small round cells, the greater number of which were shrivelled and broken up. Aberdeen. PERHAPS the particulars of a typhoid outbreak occurring in my practice here may not be without interest to many of the readers of THE LANCET. On July lst I was called to visit a girl who had fallen ill in a caravan at the fair then being held in the outskirts of the east end of Folkestone, and found her suffering with premonitory symptoms of typhoid. At the same time I was asked to see several others of the fair p3op)e suffering from very similar symptoms. After three days typhoid spots appeared on three of the patients, but as the fair was at an end I could not find out if the others I had seen had typhoid, as they had left the ground. I was, however, given to understand that they recovered without being attacked. Of the three typhoid patients, one wis removed to Ashford by her friends before the medical officer had arrived. One was treated at the Sanatorium, and one in a caravan in the midti lo, of the field where the fair had been held. On one side of this field are two small cottages, in one of which a girl of seventeen was attacked with typhoid on July 23rd, and died a few days afterwards. A boy in the same cottage showed symptoms of failing health, but, being removed, recovered without having the disease. A month later I was called to see a lad in the town in whom the malady proved fatal. In August and September I had six other cases of typhoid, all at the eastern part of the town. In each case I have tried to trace the origin of the disease, with the following result. The people of the fair on their way to Folkestone passed through the village of Dymchureh, and, having a difficulty in obtaining sufficient well-water, several drank from a roadside pond, which was brackish to the taste and of a greenish colour. The three pers HJS that had typhoid drank some of this water, as also did the others that suffered from diarrboea and pyrexia; whilst amongst those of the company who did not have recourse to the pond-water there was no illness. In the case of the girl who died the water supplying the cottage in which she resided is an open spring and close to the tents of the fair people, and could therefore have easily become polluted. Again, the boy had been at the fair constantly and may have contracted the disease there; on the other hand, he was occupied daily packing fish in ice, and was constantly sucking ice. Of the other six cases I could obtain no clue as to the origin of the fever. The inspector or sub-inspector of nuisances inspected their residences, and could not find anything wrong with drains, and only in one instance watersupply; they had not been at or near the fair, and four had not been in contiguity with one another. The milk-supply was investigated, but nothing was discovered. Three patients drank water other than that supplied to the town by the water company ; this had been analysed some few months before, and reported as good. I think these cases go far to prove, first, that typhoid may rise de Mouo, for I cannot hear of any case of typhoid having occurred at Dymchurch; and, secondly, that it is contagious, which is quite contrary to my previous experience. 1 have seen much typhoid, but have always been able to find and remove the cause, and thus prevent the spread of the disease, even under most unfavourable circumstances. It is not my province to write with regard to the sanitary condition of Folkestone, but from a year's experience of the state of things existing at the eastern part of it Ishouldsayit is unsatisfactory. A mild form of diphtheria is mostly endemic in that quarter, and has been so, I understand, for some time. It may not be out of place to sound a slight note of warning----viz that a house-to-house inspection of the poorer pqrts of the town would show a condition of things that, to say the least, must be a cause of surprise when one contemplates how very near we may be to a cholera epidemic. Ontbe other hand, the western portion cannot be spoken too highly of. Folkestone.
doi:10.1016/s0140-6736(00)49533-4 fatcat:6drcwx27tbd4lbswfwcskkg5ya