1909 The Lancet  
the representatives of the B9'itish Afedical J01l9'nal and THE LANCET. _____ INTERSTICE AND CREVICE. IT is not difficult to present cases which prove that the interstice and the crevice can be enemies of health. The man who allows particles of white lead to accumulate and to stay beneath his finger-nails sooner or later suffers from lead poisoning. To him the frequent application of the scrubbing brush may make all the difference between health and disease. The neglect, again, to remove
more » ... , to remove particles of decaying food lodged between the teeth may well give rise to a septic process. Once more the brush must be brought into hygienic service. As is well known, a factor of no little importance in infant feeding is the use of a bottle which can be easily and scrupulously cleaned and which contains, therefore, no crevices which make the cleaning process difficult and which harbour pabulum and provide a breeding ground for disease-producing organisms. The interstices of the common dining fork are similarly hygienically objectionable and require careful attention whpn the fork is cleaned. The moustache cup is an abomination, the inside surface of the guard being almost inaccessible for cleaning purposes, and the hollow-stemmed wine glass presents a similar objection. Hygienic practice suggests, in fact, that all articles in domestic use which are difficult to clean because of interstice and crevice should be banished. This tenet, however, may more reasonably be supported in the case of articles intended to convey food than in the case of other articles, as, for example, clothes. It would be difficult, for example, to abolish the interstices and crevices of our boots, and yet we have it on scientific authority that the boots of the Members of the House of Commons may be a contributory factor to the seasonal prevalence of influenza in that place. It would appear ridiculous to suggest that the boots be left outside the portal of our homes and offices, although that would clearly be a real remedy which no amount of cleaning on a mat can ever be. The interstices of the outdoor garment obviously afford excellent lodgement for micro-organisms and dust, which the application of the clothes-brush proves day by day, but clothes should be brushed out of doors. There are cases in which the dangers of the interstice and crevice can be avoided, and where they cannot they can be minimised by a regard for cleanly practices. -UTERINE CRISES IN TABES DORSALIS. REFERENCE was made in these columns some months ago to the extensive field of operation of the pathological process underlying tabes dorsalis, and an illustration was afforded by certain affections of the nose of an obscure nature which on examination turned out to be nasal crises, indicative of a more serious systematised disease of the spinal cord. The importance of the subject from the diagnostic and therapeutic standpoint may be further illustrated by a glance at a communication from Dr. Franz Conzen of the Polyclinic in Leipzig, which appeared in the Ne2.ro-logísehes Centralblait for January of this year. A healthylooking married woman, aged 33 years, came to the Clinic complaining that for some months she had experienced labour pains although she was not pregnant. It appeared that during her menstrual periods, which were quite regular, but solely on the one or two days when no discharge was visible, she was attacked by recurring pains, which felt exactly like those she had already experienced at her confinements, pains which seemed to be localised in the uterus and were accompanied by swelling and muscular contractions of the abdomen. In the course of two or three minutes they became unbearable, and at the height of the paroxysm she had a distinct sensation as though the child's head were passing through and distending the vagina. The total duration of these attacks was about four minutes, and they were always followed by general muscular trembling, especially of the lower extremities. The fact that the patient also complained of lightning pains in the limbs was significant, and careful examination revealed double Argyll-Robertson pupils and absent Achilles-jerks, though the knee-jerks were present. The diagnosis of tabes dorsalis was clearly correct. Visceral crises involving the uterus are not unknown. Abadie has described a case of "crises douloureuses de faux accouchement chez une tabetique." They are, however, probably very uncommon. The seat of the pathological process is the eleventh and twelfth dorsal segments of the cord, whence is derived both the motor and the sensory innervation of the uterus. The complex nature of the sensations thus aroused and referred to the uterus and vagina is of considerable interest from a psychological point of view. Muscular trembling during labour, a phenomenon reproduced in these uterine crises, is well known as a normal occurrence ; it has been dignified with the name of " dolores conquassantes." " VOLUNTARY WITHDRAWAL FROM THE MEDICAL REGISTER. WE publish in another column under this heading an interesting letter from a correspondent who quotes the recent decision of the General Medical Council in the matter and invites us to consider that the proposed standing order leaves both the Council and the medical profession insufficiently protected. We think that there may be ground for suggesting that the whole question should be reconsidered afresh, for undoubtedly there are the objections to voluntary withdrawals from the Register, even when no charge is officially known to be pending over the applicant's head, to which our correspondent has drawn attention. The standing order already drafted may be regarded as quite satisfactory so far as it goes, but does it go far enough ? Should it be supplemented, for example, by a further order, under which the Council could satisfy itself not only that nothing is known of a kind detrimental to the professional morale of the applicant, but also that in his case there are circumstances exceptional and peculiar to himself which make it quite natural that he should wish to disappear from the Register ? Liberty is a great thing, and we hesitate before setting any bounds to it, but it is impossible not to see that an unscrupulous person might do harm by continuing to practise medicine after withdrawal from the Register. He would be a fully qualified practi-
doi:10.1016/s0140-6736(01)11654-5 fatcat:iwnxy2mjgzgrzgzbtvvmm2cxsq