711

infantile form day show 11 juvenile " localisation or pseudo-hypertrophy; pseudo-hypertrophy may have later a juvenilelocalisation, and all may be hereditary. Finally, formsmay occur which cannot easily be assigned to any one ofthese four types. Another argument in favour of unityis that in one and the same family several of these

types may be found. From the harmony in all theessential clinical features and from the occurrence

of transition forms in the same family, Erb con.

cludes that clinically these four forms are essentiallyone. On the pathological side Erb has collected therecords of eighteen necropsies and twenty-three examina-tions of excised muscles. He finds the following charac-teristic changes : Hypertrophy of the muscular fibre, presentin post-mortem examinations as well as in the excised por-tions, and therefore not due, as Oppenheim and Siemerlinghave claimed, to the results of excision ; atrophy of fibres ;alteration in the shape of the fibre, which loses its anglesand becomes rounded ; an increase of nuclei, with the pre-sence of nuclei in the centre of fibres ; a fissuring and divi-sionof the fibres and the formation of vacuoles. These changesoccur in various combinations, but it is impossible to makeany anatomical distinction between the four forms. In all, forinstance, hypertrophy and fissuring may be rare or frequent,and the fibres may be equal or may vary greatly in size.The interstitial tissue is usually increased in amount, anda deposit of fat is common in it. In general, this prolifera-tion of connective tissue and fatty infiltration are pronouncedin pseudo-hypertrophy ; but it is also observed in the otherforms, and some of the muscles in pseudo-hypertropby showit only in a slight degree. The complete necropsies show,as a rule, that the nervous system is intact. The muscular

changes are the same in these cases as are found in theexcised muscles. Erb concludes, therefore, that we do notfind in the different forms of muscular dystrophy any essentialand comprehensive distinction in the histological changesin the muscles, and that these types form one morbidentity-dystrophia muscularis progressiva.

ROYAL COMMISSION ON VACCINATION.

WE understand that the Royal Commission on Vaccina-tion have been considering the terms of an ad interimreport, which has been drawn up by Lord Herschell. Thestatements that have been made public as to the supposedtenour of this report are, we are informed, unauthorisedand inaccurate.

__

CRUEL USAGE OF A BRITISH PRACTITIONERIN CHINA.

IT is not often that we have to notice an instance of such

wilful, unprovoked, and methodical barbarity as that re-corded in the following narrative, which is taken from theletter of an agent of the British and Foreign Bible Society.Dr. Greig, a medical man connected with the Society’smission in North China, while sleeping at an inn wassuddenly seized by soldiers, insulted, kicked, and severelybeaten. His hands were then tied together behind his back,and he was slung up by them to a beam till he fainted. Hewas afterwards imprisoned for four days in a miserablehovel, gazed at and abused by the rabble of the place.When at last his release was accomplished at the requestof the British Consul he was reduced to a mere wreck ofhis former self. The alleged reason for this extraordinarytreatment is that Dr. Greig was accused, on the evidence ofseveral children, of kidnapping these latter. The charge,which the mere presence of the children must have sufficedto disprove, was of course a baseless one, It is not difficult,indeed, to see that it was a piece of wilful mendacity,probably concocted by some enemy, on purpose to injure aninnocent man. Dr. Greig’s hard experience does not

encourage a belief in Chinese justice. Here we have a man

who, as is clearly shown in the letter quoted, has wellearned the gratitude and esteem of the Chinese populationby his professional skill and kindness. By way of returnhe is shamefully maltreated on a false accusation of themost trumpery character. It is worth noting also that hischief tormentors were soldiers, and that they are said tohave acted under instructions from the local military com-mandant. These facts, if capable, as we cannot doubt thatthey are, of legal proof, must reduce considerably the areaof responsibility for the abominable treatment he expe-rienced. The onus of blame rests upon official shouldersand the case is evidently one where all possible satisfactionshould be exacted by our consular representative.

POLLUTION OF THE THAMES.

IN the annual report of the medical officer of health tothe Local Government Board, which has been issued withinthe last few days, a most important article by Dr. Blaxallon the Sanitary Condition and Administration of the RuralSanitary District of Staines occupies an important place.In 1887 we published a report by our Sanitary Com-missioners on the Thames as a Water-supply for London,and in it we commented somewhat. strongly on the

sanitary condition of Sbaines and on the probabilitythat its sewage contaminated the Thames at no greatdistance above the intake of the water companies nearHampton. Dr. Blaxall has given a much more alarm-ing description of the danger to London from thiscause than we ventured upon. Some of our own strongsuspicions were suppressed, as we had no wish that injuryshould be unfairly inflicted upon vested interests. Bub Dr.

Blaxall, armed with the powers of a Government inspector,gives an account of the way in which the cesspools ofStaines drain into the river, the sewage sometimes passingdown through the foul and porous subsoil as far as Sunburybefore it is discharged, which will give unpleasant thoughtsto those who still maintain that the Thames between

Hampton and Sunbury affords a proper water-supply to

London. The subject is too large to be discussed in detailhere, but we commend Dr. Blaxall’s report earnestly to ourreaders.

___

TREPHINING FOR RELIEF OF INTRACRANIALPRESSURE.

THAT in cases in which an intracranial growth is presentmuch relief is at times given by trephining is now wellknown, but the number of cases as yet reported is too smallto allow of its being recognised as a certain, and at thesame time a safe, means of treatment. Such treatment, ofcourse, is only applicable to cases in which either the newgrowth is too large for removal, or its locality cannot bedefinitely diagnosed. As regards growths in the cere-

bellum, clinical observation is still at fault. While insome cases it may enable us to say with a fair amount ofdefiniteness that there is a cerebellar tumour, in very fewcan it be predicted on which side of the cerebellum thegrowth lies. Every recorded case, therefore, is of extremeimportance, as enabling a judgment to be formed of thedifficulties and drawbacks which follow such an operation,as well as of the relief experienced and the nature of thecases in which the operation may b,3 expected to have afavourable result. In the last number of the Jmtrnal o,rNervotts and Mental Diseases Dr. Knapp of Boston reportsa case in which diagnosis was very difficult, and in whichan operation was undertaken chiefly for the purpose of

relieving symptoms resulting from increased intracranialpressure. The patient had been fairly well till October,1889. He then began to suffer from occasional severe head-aches, and at times dimness of sight. He was seen at this