1774

the number ranged from 36 to 316 and averaged143. Moreover, not only was lymphocytosis present in

every case of these diseases but it was often wellmarked when other symptoms were slight. Thus, one

patient had no ataxia and his knee-jerks were presentbut the ankle-jerks were lost and the cerebro-spinal fluidcontained 214 lymphocytes to the field. In an early caseof general paralysis there were only slight loss of memory,some fibrillary tremors of the face, and a history oftransient aphasia and weakness of the right hand after anattack of unconsciousness (a congestive attack). But

there were 481 lymphocytes to the field. Cytological ex-amination of the cerebro-spinal fluid is a valuable meansof recognising tabes dorsalis and general paralysis in theirearly stages. If there is no excess of leucocytes these diseasescan be confidently excluded. Syphilis without nervous

lesions of the central nervous system produces little or noexcess of lymphocytes in the cerebro-spinal fluid. If suchis found careful examination for signs of organic disease-Argyll-Robertson pupils, loss of reflexes, and so on-shouldbe made. Even if none are found lymphocytosis is anindication for energetic anti-specific treatment to preventtheir development.

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THE INTERNATIONAL CONGRESS ON TUBER-

CULOSIS, 1905.

WE have received a copy of the report of Dr. C. TheodoreWilliams and Dr. H. Timbrell ,Bulstrode, the delegates ofHis Majesty’s Government to the International Congresson Tuberculosis held at Paris from Oct. 2nd to 7th,1905. A full account of the proceedings of the varioussections was published in our columns at the time

of the Congress ; we need therefore only refer to a

few of the’ points mentioned in this report which waspresented to both Houses of Parliament by commandof His Majesty. Attention is quite properly .drawn to

the excellent arrangement of the museum. It is noted

that many of the sp3cimens exhibited illustrated the

widespread influence of tuberculosis in the animal kingdomgenerally and shed considerable light upon the much-debatedquestion of the precise relationship obtaining betweenbovine and human tuberculosis ; indeed, the delegates con-sider that these specimens left no doubt that humantuberculosis can under certain conditions be transferred tothe bovine animal and that what is termed the bacillus ofbovine origin can at times be discovered in the human

subject. They further state that there seems to be a very Istrong body of evidence pointing to the conclusion that

human and bovine types of the tubercle bacillus are merelyvarieties of one species and not different species-a conclusionwhich, if accepted, at once indicates the desirability of pre-ventive measures being extended to bovine animals affectedby tuberculosis. With this conclusion we believe the

majority of observers will agree. Dr. Williams and Dr.

Bulstrode, in summarising the work of the Congress as awhole, consider that it was mainly helpful in educating thepublic as to the manifold causes which make for tuberculosis,as to the means which may be taken to render the systemrelatively immune through resistance, and as to themeasures to be adopted in order to avoid infec-tion." They also point out that the Congress accom-

plished useful work in focussing the progress whichhad been made in scientific knowledge relative to

tuberculosis since the London Congress in 1901 and in

reducing to their proper level certain factors upon whichundue stress was possibly laid in London. Another pointbrought to the notice of the public by this Congress was thewidespread prevalence of latent or " closed " tuberculosis

among school children. The delegates suggest that the

general prevalence of tuberculosis, both in children and

adults, indicates the need for differentiation between open"and " closed tuberculosis in the administrative measureswhich should be taken against the malady generally. This

opens up a wide and difficult question which will necessitatefull consideration and further research. We thoroughlyagree, with Dr. Williams and Dr. Bulstrode in another pointwhich they raise-namely, that in so far as special measuresare concernedj there would be advantage in greater coördina.tion between all the agencies, preventive and therapeutic,working against tuberculosis. The delegates express them-selves as much impressed with the progress which has beenmade in Germany during recent years-a progress whichthey consider is to be attributed in material degree to

compulsory insurance against sickness. Tuberculosisis a disease which exercises the greatest influence

upon the working classes and if these classes appre-ciate the necessity of aiding in the enforcement of at

least some of the reforms referred to in this report theywill be furthering not only the battle against tuberculosisbut also that against the acute infectious diseases and

against ill health generally. Dr. Williams adds to the

report a memorandum on considerations arising from thework of the Congress, dealing more especially with the rolewhich hospitals and sanatoriums play in helping to combattuberculosis and its spread.. The whole report forms anadmirable summary of the work of the Congress and fullyjustifies the action of Government in sending specialdelegates.

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COUNTRY ROADS AND BRIDLE-PATHS.

THE cordial thanks of medical practitioners resident inrural districts are due to Mr. A. 0. Haslewood of Buxtonfor his persistent efforts to bring about the proper main-tenance of country by-roads and bridle-paths. Such roads,bridle-paths, and rights-of-way are to be found in greatnumbers in many parts of England and although their

original formation has often been due torconditions whichhave been changed, or have even ceased-;: to exist, it by nomeans follows that the roads themselves have ceased to beof public utility. In the great majority of instances theywere short-cuts between places in frequent communicationwith each other and were valuable in saving the time andefforts of all who traversed them. Regarded from this pointof view they were, and are, of special importance to countrymedical practitioners and consequently also to their patients,abbreviating the time which would otherwise be requiredto enable- the medical man to reach his destination or to

pass from one outlying patient to another. In these daysof motor-cars, in which the main country roads are oftensmothered in: dust or crowded with vehicles calculated to

frighten horses, the utility of by-roads bids fair steadily toincrease, and it is nevertheless notorious that they areseldom popular with the actual occupants of the land whichthey traverse and that they have few friends, as a rule, in therural district council or other authority which may exercisejurisdiction over their state. In this case, as in so manyothers, there is urgent need of some public body bywhich the proceedings of local authorities could be super-vised and their defaults made good. For the last four orfive years Mr. Haslewood has been active in his endeavoursto bring the authorities of his locality to a sense oftheir duties with regard to by-roads and he has appealed, atpresent, it must be confessed, in vain, to the Local Govern-ment Board which, under the administration of Mr. GeraldBalfour, declared its inability usefully to intervene. Thereis some reason to believe that Mr. Burns is not at all unwillingto stimulate negligent local authorities to the full extent ofhis power and we trust that Mr. Haslewood will not be

weary of well-doing. He has been steadily supported by thepress of his county and he can hardly fail to carry his point