1899 The Lancet  
900 follows a return of cardiac efficiency owing to a rapid and almost sudden disappearance of the cardiac dilatation. The abnormal area and situation of the apex-beat now disappear and a slowing of the pulse and an increased power of the heart-beart are perceptible. 3. Henschen has called attention to a dilatation of the heart occurring in very weak and anaamic girls as the result of overwork. This condition develops slowly and persists for a long time and really trifling causes will then
more » ... about in these subjects symptoms of acute dilatation and distress. The constitutional symptoms of the former condition are loss of energy, palpitation, headache, dyspnoea on slight exertion, and loss of appetite for food. 4. Cardiac weakness and dilatation occur in children from a primary insufficiency of the cardiac muscle. This is found in weak and predisposed children. French physicians-e.g., Germain See and others-regard this condition as due to the rapid growth of body and of stature which takes place towards the close of childhood, a growth in which the heart-muscle also participates. Others have, however, noted that the essential cardiac condition is not one of true muscular increase of growth or hypertrophy but rather one of cardiac dilatation. Scrofulous children are especially predisposed to this, and it appears that the demands oe school life may be the exciting cause. Such children are pale and weak and suffer from headache and loss of appetite and learn with difficulty. Moderate ansemia and at times albuminuria are present. Various degrees of the affection can be clinically recognised. Highly characteristic is the effect of exercise on the heart. Climbing stairs may send the pulse up from 80-96 to 120-140, while the objective palpitation increases and the radial pulse is almost imperoeptible. In severe cases the apex-beat may reach laterally Agriculture in connexion with investigations of outbreaks of contagious diseases amongst animals. In the particular instance adduced by our correspondent the recent reappearance of rabies in Wales was quoted and it was pointed out that Captain MacIlwaine, R.N., who was sent by the Board to investigate the matter, has no scientific veterinary knowledge He appears to have been unaccompanied by an expert. The subject has excited a good deal of attention and comment in the veterinary periodicals during the past few years and it certainly does seem to us illogical that outbreaks of contagious disease amongst animals should be investigated by men who have no special qualifications for the task. The position is about on a par with that at present in vogue in many of our large towns whereby inspectors of animal flesh intended for human food are chosen from amongst plumbers, masons, and omnibus conductors. But because the position is not unique it is none the less an anomalous one. It is not so very long ago that the Government had a properly organised veterinary department with a veterinary surgeon at the head. Under its control cattle-plague, foot-and-mouth disease, and pleuro-pneumonia-three great scourges of the bovine race and sources of enormous annual loss to agriculturists and dairymen-disappeared permanently. Contrast with it the present state of affairs. The title " Animals " has been substituted for " Veterinary " Department, a proceeding which has given much umbrage to the members of the veterinary profession and an ex-army officer has been placed at the head instead of a properly qualified expert. The results have been only too obvious in the case of swine fever where nothing but failure can be reported, while the delay caused by unnecessary red tape procedures favours the spread of the disease before any efficient action is taken. The travelling non-veterinary inspector is not out of place where no diagnosis bas to be made, for he is fully capable of seeing that proper disinfection and modes of burial are carried out, but to send him in the first instance to investigate and advise regarding an outbreak of disease (as appears to have been done in the case referred to by our correspondent) is clearly putting him in a false position. Here the services of a veterinary surgeon surely are required. AT the meeting of the Society Medicale des Hôpitaux of Paris on July 21st, Dr. P. E. Launois described the following remarkable case in which very rare and severe complications of gonorrhoea-some of which are not at all recognised in this country-were found. A man, aged 40 years, was seen in March, 1899. He was pale, emaciated, incapable of making any movement, and suffered from pain everywhere. Most of his joints were the seat of deformity; his limbs were atrophied, the muscles having almost disappeared. The cause of these grave troubles was gonorrhoea. A history of rheumatism was obtained only in the case of his great-grandfather. The patient had never had syphilis but he had suffered many times from gonorrhoea. The first attack occurred at the age of 20 years and was complicated by orchitis. At the age of 30 years he had a second attack accompanied by arthritis of the right elbow and knee and of the joints of the feet. He became completely well in about three months. At the age of 33 years a third attack was accompanied by articular troubles of the metatarsus, ankles, and left knee. The muscles of the lower limbs rapidly atrophied. A quite characteristic deformity of the toes appeared, which were projected outwards with the great toes overriding the neighbouring ones. He completely reo covered in five months. Six months later he had another attack accompanied by arthropathy of the joints which had been first attacked. Recovery was slower on this occasion. In December, 1898, he had a fifth attack of gonorrhoea with arthropathy of the ankle-joints. The elbows, left wrist, and right knee were successively affected. He lost appetite and strength and became rapidly emaciated. The head appeared as if fixed on the shoulders and could not be moved; the vertebral joints were tender to pressure and flexion and extension of the trunk were impossible. The left knee was normal. The right knee was greatly enlarged; the deformity appeared especially to be due to hypertrophy of the femur and tibia.
doi:10.1016/s0140-6736(01)40222-4 fatcat:obob3yukxvf6noh7gvpmreqp2m