1397

of several regions of the brain was made, but only in oneregion examined were there the histological appearancescharacteristic of the disease-viz., increased vascularity, well-marked infiltration of the small vessels of the cortexwith plasma cells and lymphocytes, also the membranes,proliferation of the glia cells, absence of the tangentialfibres, distortion of Meynert’s columns and atrophy of theconstituent ganglion cells; lastly, the existence of the" rod cells of Alzheimer." All these conditions showed thatthis man was suffering with acute mania of general paralysisin its earliest stage ; it is therefore highly probable that thesevere injury had been the exciting factor in the productionof the disease. We are able to decide two points by thisexamination-viz., that the man had general paralysis, adisease that is invariably fatal ; that he had syphilis, whichis an essential cause. That the evidence post mortem was tothe effect that it was in its earliest stage and might thereforenever have occurred if he had not had the severe accident.The fact of the existence of the scar of the chancre andantecedent syphilis should not weigh in the minds of the juryif they were satisfied that the man in all probability was notsuffering with general paralysis prior to the accident, for

only a very few syphilitic subjects die from general paralysis.Another case has recently occurred which from a medico-

legal point of view is of interest in showing how necessary itis to examine various parts of the brain histologically to con-firm the diagnosis of general paralysis. Dr. C. H Bond, ofLong Grove Asylum, recently gave evidence in a trial in whichthe wife of one of his patients alleged that traumatism was thecause of her husband’s mental breakdown. Dr. Bond con-sidered that the case was clinically one of general paralysisof the tabetic variety, although he said there were certainanomalous bodily symptoms. He sent me the central nervoussystem of this patient when he died. I found a typicaltabetic lesion of the posterior columns of the spinal cord.Examination of the prefrontal and central convolutions didnot show the typical lesion of general paralysis. The tip ofthe first temporal convolution, especially on one side, showedall the characteristic lesions which I have just described.

In conclusion, I beg to thank you for so kindly listening tome so long, and yet I feel there are many things left unsaidwhich I might have said. However, many eminent authoritiesare about to follow who will be able to fill up the gaps and

very probably also from their wide experience modify andcorrect some of the statements I have made. Finally, I wishto acknowledge my indebtedness to my assistants, Dr. J. P.Candler and Mr. Sydney Mann, who have carried out re-searches on the blood and cerebro-spinal fluid to which I havereferred and upon which I have based my opinion as to thevalue of the reaction. These researches have been fullydetailed by Dr. Candler in THE LANCET of Nov. llth, p. 1320.Nottingham-place, W.

A SPHYGMOGRAPHIC METHOD FOR THEESTIMATION OF SYSTOLIC ANDDIASTOLIC BLOOD PRESSURE.

BY J. DAVENPORT WINDLE, M.D. VICT.

THE instrumental methods in use for the clinical estima-tion of diastolic blood pressure are based on Marey’s observa-tion, that the maximal pulse wave occurs when the pressureabout an organ is equal to the pressure within the arterysupplying it. To determine the arterial pressure he deviseda hand plethysmograph connected with a bottle for raisingthe pressure, and recorded the size of the pulse wave bymeans of a sphygmoscope tambour. He found that themaximal pressure corresponded with the disappearance of thepulse wave, and the minimal-i.e., the diastolic-with itslargest oscillation. 1A similar means for estimating systolic and diastolic

pressures is available by using the Mackenzie ink polygraph,and an ordinary Riva-Rocci blood pressure apparatus. Thearmlet is first fixed up in the usual way and connected to themanometer. The radial tambour is then applied and thepressure of the spring button carefully adjusted so that themaximal pulsation of the artery is obtained. While a

tracing is being taken air is gently pumped into the bag, so1 E. J. Marey: Nouvelles Recherches sur la mésure manométrique

de la pression du sang chez l’homme Travaux du Laboratoire de M. Marey, Paris, 1878, iv., 126.

that the pulse becomes progressively smaller until it ceasesto be recorded ; at this moment the systolic pressure is readoff. Air is then released very slowly from the armlet, whenthe pulse wave gradually grows more ample until full

pulsation is again reached. The escape of air is then stoppedand the diastolic pressure read off.

This method is very convenient in the routine use of thepolygraph, and sufficiently accurate for general purposes.It is a far more reliable index of actual pressure than thatobtained by timing the obliteration, or moment of reappear-ance of the pulse by the finger. It will be found that thesystolic reading is usually from 10 to 15 mm. higher thanwith the ordinary method, due to the fact that escapeimperceptible to the finger may take place near the oblitera-tion point. I have checked the diastolic readings by theauscultatory method devised by Korotkoff,2 taking thediastolic pressure by this method at the moment when thesound ceases to be heard on releasing air from the bag.The maximal oscillation of the pulse curve with thesphygmographic method is true, as a rule, within 5 mm.of the auscultatory reading.

Southall, W. ___________________

PRELIMINARY REPORT ON

THE TREATMENT OF THE VACCINATIONSITE WITH PICRIC ACID SOLUTIONS.

BY JAY FRANK SCHAMBERG, M.D.,PROFESSOR OF DERMATOLOGY AND INFECTIOUS ERUPTIVE DISEASES,

PHILADELPHIA POLYCLINIC AND COLLEGE FOR GRADUATES IN

MEDICINE; CONSULTING PHYSICIAN TO THE PHILADELPHIAHOSPITAL FOR CONTAGIOUS DISEASES;

AND

JOHN A. KOLMER, M.D.,PATHOLOGIST, PHILADELPHIA HOSPITAL FOR CONTAGIOUS DISEASES;

ASSISTANT BACTERIOLOGIST, BUREAU OF HEALTH,PHILADELPHIA.

(From the Laboratory of the Philadelphia Hospital forContagious Diseases, Bureau of Health.)

THE influence of vaccination as a protective measureagainst small-pox is a fact proven beyond cavil. The

opponents of vaccination who deny this proposition are

clearly in error. The only genuine argument of the anti-vaccinists is that vaccination is not unattended withrisk. The individual risk, of course, is minute, and doubtlessmuch less than the peril of remaining unvaccinated. Butin the aggregate a considerable number of undesirable com-plications occur. These are in many instances due toinfection of the vaccinal lesion or site subsequent to theintroduction of the virus. Any procedure, therefore, whichwould aid in lessening wound infections should be welcomed.The best possible protection to the vaccinal ulceration isafforded by the formation of a hard, concrete crust due todesiccation of the contents of the vaccine vesicle and

pustule. Such a crust will form, unless there is undueinflammation and suppuration and unless the crust is sub-

jected to mechanical violence calculated to loosen or todetach it.

Constricting shields which make peripheral pressure aboutthe vaccinal site lead to the formation of a friable crust

easily detached by various trauma. The adhesion of thecrust to the sleeve or to a piece of protective gauze willoften lead to forcible decrustation when the sleeve or gauzeis removed. There does not seem to be an ideal dressing forthe vaccinal lesion-i.e., one that will lessen the liability ofthe vesicle to rupture, and one that of itself will act as anantiseptic.

In view of the property of solutions of picric acid of enter-ing into chemical union with the keratin of epithelial tissueand thus hardening the roof of the vesicle, and in view ofour experience with this drug in certain vesicular skin

affections, we determined to try it as a dressing aftervaccination. Synchronously with our clinical trials on

vaccinated children we endeavoured to determine the

germicidal value of picric acid in vitro and in vivo, as

well as its penetrative qualities.The laboratory investigations of the germicidal properties2 This method is described in an address by Sir Lauder Brunton,

Brit. Med. Jour., Nov. 5th, 1910, p. 1390.