Injuries of peripheral nerves occur in wounds due to Projectiles of high velocity with great frequency, and their successful treatment is of the highest importance in the prevention of permanent disabilities of the most serious kind.. It may be said at once that we are not yet in a position to make positive statements as to what the ultimate results of nerve injuries and the operations undertaken for their relief will be.

THE sixtlh and seventlh decades of life constitute a period whicll lias certain marked clharacteristics. The age of 45, which Dante fixed as tlle end of thte period of youtlh, miglht lhave been talken as thle lower limiit, but that would involve in most womeen the inclusion of the climacteric, wlhichl I tlhouglht it better to avoid. Maniy nervous diseases run a very long course, and we slhould tllerefore expect to find that the nervous affections of this period will be inade up of some wlich began at an earlier age, and of otlhers, fewer in number, -whose incidence is entirely contained witllin it. I do not propose to include miental affections.

Cases of " cryptogenetic " septicaemia are always of interest, and the B. pyocyaneus is not one of the common organisms in septicaemia, although it has been found more frequently with the improvement of bacteriological methods. Muir and Ritchie state that the B. pyocyaneus is generally found in association with other microorganisms , but that it has been found lately in some diseases in children as a general infection in pure culture, the chief symptoms being fever, gastro-intestinal disturbances, hemorrhages, petechial or pustular eruptions, and general marasmus. More recently it has been found in many cases in adults as the sole cause of a general infection (septicaemia).

In a disease like pernicious anaemia, which after all is not very common, it is difficult for one observer to get a sufficient number of examples from which to draw any general conclusions from his personal observations. Moreover, in hospital work, the opportunity to follow the course of a chronic disease for any considerable time is rare, and especially so in pernicious anaemia, in which the course of the illness is characterised by marked exacerbations, during which the patient comes into hospital and is lost to sight during the intervals. To get a full knowledge of pernicious anaemia frequent observations on the blood are necessary throughout the course of the illness, including the remissions. The majority of cases of pernicious anaemia occur between the ages of 35 to 55 years, but for some time I had noticed in a few cases in elderly people that the disease appeared to follow

In disseminated sclerosis, where the symptoms are particularly variable on account of the sclerosed areas b3ing so inconstant in their distribution, the patient's leCgs are weak and spastic with all the tendon-reflexes exaggerated, while his (or her) arms, also weak, may be paraesthetic. More striking than this, however, and more important in the diagnosis, are its three cardinal symptoms, tremor, nystagmus, and staccato speech. By these it may be known, althouglh in the earlier stages, before these three have fully developed, a hysterical counterfeit may lead us astray. Compression of the cord, the result usually of caries of the spine, an aneurysm or a secondary growth, produces twofold symptoms-those of spinal root irritation followed by root paralysis, and those of a transverse lesion of the cord itself. Apart from these, however, we may expect a third set due to whatever is causing the compression. If this last group is not to be found, we are then thrown back on the possibility of some primary new growth inside the spinal canal, or a patch of chronically thickened meninges; in either case, the site of the pressure is identified by the distribution of the symptoms. The distinction between the two, however, may be a matter of difficulty. Perhaps the most suggestive differences are that in chronic meningitis the course is slower and that the pain, even from the beginning, is bilateral and spreads over a wider area. Moreover, the meningitis may improve witho-ut surgical treatment.

The beneficial effects of the X-rays in the treatment of leukaemia are now well known ; unfortunately, they do not seem to be permanent. Although a cure is not to be expected, very decided improvement results for a considerable time. Cases of myeloid leukaemia do best. The most striking effect of the X-rays is a rapid reduction of the number of white cells, especially of mye-locytes, in the blood, generally, but not invariably, accompanied by a remarkable shrinking of the enlarged spleen and a concomitant improvement in the general condition. The patients soon feel stronger and lose the sense of lassitude which so often attends this disease, or they feel more easy from the reduction of the splenic tumour. The subjective sense of improvement often precedes the other evidences of benefit from the treatment. As to the mode of action of X-rays in leukaemia, the interpretation will necessarily vary according to the view held of the pathology of the disease. It is now generally accepted that the marrow is affected in all cases of leukaemia, and is the chief seat of the enormous production of white cells. There is less unanimity as to the part played by the spleen in myeloid, and by the lymph-glands in lymphatic leukaemia. It is known that the spleen sorts out from the blood and destroys effete leucocytes. Dr. Andrewes in his recent Croonian Lectures states that " the opinion that the spleen-pulp is the grave of the leucocytes is fully confirmed from my observations ; in no other tissue have I found these disintegrating leucocytes." The enlargement of the spleen in leukaemia may be primarily due to its attempting to carry out its normal functions and to sort out and destroy the ever-increasing number of white cells in the blood. The pathological

The Journal of Pathology and BacteriologyVolume 13, Issue 1 p. 92-98 Article A case of acute lymphadenoma J. Michell Clarke M.A., M.D.(Cantab.), F.R.C.P., J. Michell Clarke M.A., M.D.(Cantab.), F.R.C.P. Joint Professor of Medicine, University College, BristolSearch for more papers by this author J. Michell Clarke M.A., M.D.(Cantab.), F.R.C.P., J. Michell Clarke M.A., M.D.(Cantab.), F.R.C.P. Joint Professor of Medicine, University College, BristolSearch for more papers by this author First published: 1909 https://doi.org/10.1002/path.1700130117Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References Sternberg, “ Primärerkrankungen des lymphatischen und haematopoetischen Apparates,” in Lubarsch-Ostertag, Ergebnisse der allg. Path. u. Path. Anat., Wiesbaden, 1905, neunter Jahrg., Abth. 2, S. 360. Reed, Johns Hopkins Hosp. Rep., Baltimore, 1902, vol. x. p. 133. Citing Literature Volume13, Issue11909Pages 92-98 ReferencesRelatedInformation