an example of direct infection of children with human tuberculosis

94

AN EXAMPLE OF DIRECT INFECTION OF

CHILDREN WITH HUMAN

TUBERCULOSIS.

IN no department of medicine is there more urgent needfor distinguishing between theory and fact than in respect totuberculosis. The nation stands committed to a campaignagainst this disease, but it cannot be maintained that the

plan of campaign which has been resolved upon is based

entirely upon ascertained facts. There are many notable

gaps in our knowledge, and it is to the provision which hasvery wisely been made for research that we must look for thefilling up of these. One aspect of the disease in which a

better understanding is urgently needed is that of the

incidence of tuberculosis in infancy. How often does it occur,by what criteria may we distinguish its presence, and how dothe bacteria gain access to the body of the host ? A piece ofresearch which, though small in extent, is thorough in

execution, and therefore convincing in its conclusions, hasbeen published by Dr. Alfred F. Hess, of New York, in theJournal of the American Medical Association for May 24th.Ten children, varying in age from 2 to 3 years and occupyingone ward in an infant asylum, were on May 15th, 1912, putunder charge of a new nurse who had recently been treatedin a sanatorium for phthisis. Towards the end of Junethis fact, together with evidences of recrudescence of

the infection (including the presence of bacilli in the

sputa), was discovered, and on July 1st, 1912, she wasremoved from the ward. It happened that all the

children had been subjected in April to a routine

von Pirquet test, to which three (one of them the child

of a tuberculous mother) had reacted positively. These

tests were repeated about the middle of July, soon after thenurse left, with precisely similar results. At the next

repetition of the test in October, however, a remarkable,alteratio n was observed ; all the children reacted positivelyand the same result was obtained when the test was repeatedin January, 1913. It is noteworthy that with one doubtfulexception not one of these children has shown any symptomor sign of active tuberculous infection apart from the positivecutaneous reaction. The connexion between the alterationin the reactions of this group of children and the diseased

attendant is further established by the exclusion of othersources of infection. The milk-supply is thoroughlypasteurised, the rest of the attendant staff is entirely freefrom the disease, the children do not leave the premises atall, and there has been no alteration in the tuberculin

reactions of any other of the children in the institution.

Finally, it seems possible that the fact that the childrenwere suffering from stomatitis while under the care of theinfected nurse may give some hint of the path of invasion.

SPEECH WITHOUT A LARYNX.

NORMAL speech, of course, depends upon the productionof sounds in the larynx which are modified in the throat,nose, and mouth. In the Journal of the A me?’iean MediealAssociation for May 24th Dr. E. W. Scripture has reporteda case in which he accomplished the apparently impossiblefeat of rendering speech possible in the absence of the

larynx. The patient was a man whom he saw three monthsafter the larynx had been removed for carcinoma. The

passage of the mouth to the trachea was entirely closed.He breathed through a tracheotomy tube. He was taught ito speak in the following manner. To produce "p

" he was

told to close his lips and compress the air in the mouth andpharynx by tension on the cheeks and the back of the throat.On opening the lips there was a puff of air that produced anunusually audible " p." " Fo, " t he placed the point of

the tongue against the palate and compressed the air in themouth and pharynx ; when the closure by the tongue was.released a I I t " more distinct than normal was produced.For " k " the same mechanism was used except that theback of the tongue was raised. For the fricatives" f," " s," "

" sh " (as in "shoe "), and th " (as in "thin") in normalspeech a narrow passage is formed between the lips, teeth,tongue, palate, &c., and air is emitted without vibration ofthe vocal cords. Hence these sounds are called surds.The patient produced them by means of a blast of airfurnished by mouth and throat compression. Normallythe explosives "b," "d,"and "g," and the fricatives ‘° v, "’

‘° z," " sh" " (in pleasure), and "th" (in "thine") are pro-duced by the same movements as the surds mentioned above,but in them the larynx vibrates. They are called " sonants." "

Without the laryngeal vibrations there is no difference

between "p" and Ilb," 11 t "and I’d," "f" and" v. " To

make a difference that would introduce the laryngeal tone

Dr. Scripture adopted the ingenious device of using the airfrom the tracheal cannula. Any expiration produced a

rushing sound. The patient was taught to produce a faintrushing sound during the production of all the sonants whichmade a marked difference between them and the surds. In

normal speech the vowels are due to vibrations from the

larynx which arouse resonant vibrations in the cavities of themouth and throat, varying according to the position of thelips, tongue, and velum. With no vibrations from the larynxspoken vowels cannot be produced, though whispered vowels-can be produced by the air which has rushed through thelarynx. In the patient the rush of air through the pharynxand mouth when an explosive was ended gave an indica-tion of the following vowel, but the sound was weak, brief,and wanting in distinctness. To remedy this to some degreehe was taught to expire through the tracheotomy tube foreach vowel. The vowels were thus more clearly distinguish-able from pauses which otherwise occurred. The mechanismof each sound was thus explained to the patient. He foundthe work interesting, and carried it out so successfully thatspeech could be heard distinctly across a large room.

THE London County Council has accepted a tender of43,248 for the erection of the Maudsley Hospital for MentalDisease at Denmark Hill, Camberwell.

Dr. Cyril Hartley Durrant has been appointed an officialmember of the Legislative Council of the Island of St.Vincent.

BRITISH OTO-LARYNGOLOGICAL SOCIETY. - Aclinical meeting of this society will be held at the MedicalSociety’s rooms, 11, Chandos-street, W., on Wednesday,July 16th, at 5 P.M. Cases 4.30.

THE MusEUMS ASSOCIATION.—The annual con-ference of the Museums Association, which is to be held atHull this year, will open on Monday next, July 14th, underthe presidency of Mr. E. Howarth, F.Z.S., curator of therSheffield Public Museums and Art Gallery. Many interestingsubjects are to be discussed, among them being the

possibility of showing our museums and art galleries to therblind, arising out of experiments made by Mr. J. A. CharltonDeas at Sunderland Museum and Art Gallery. The

peripatetic guides at the British Museum (both Bloomsburyand South Kensington) will attend to give their experiencesin the personal conduction of visitors around these greatinstitutions ; and Professor Rathgen, of Berlin, is to-discourse on the decay and preservation of antiquities. Thelocal secretary for the meeting is Mr. Thomas Sheppard,F.G.S., the Hull Museum. The secretary of the associationis Mr. E. E. Lowe, B.Sc., F.L.S., curator of the LeicesterMuseum and Art Gallery. :-= -.-