1232

may have no subsequent prejudicial effect; and as regardsthe Prince we may join in the national wish that his presenceat St. Petersburg may aid in bringing about the internationalblessing of an amicable understanding between Russiaand this country. Bat we desire, before finally dismissingthe subject of the late Czar’s fatal illness, to say a

few words regarding the late Emperor’s physician, Dr.

Zacharin, who has addressed a letter to the lIIo8coro 6’esetting forth his description and views of the late Czar’sillness. We were never able to understand the grounds onwhich any exception was taken to Dr. Zacharin’s professionalmanagement’ of the case, and the account which he has nowpublished of the medical history of his late illustrious patientseems to us to prove how entirely baseless and unfounded alladverse allegations have been. The account which Dr.Zacharin gives of the late Czar’s state of health generally andof the slow and gradual development of the symptoms of themalady at the beginning of the illness, with their reappearancein a more pronoanced form in August last, is a perfectly clearand consistenc one. It appears that Dr. Zacharin did notattend the Czar from the end of January till August, whenDr. Hirsch wrote to mention the reappearance of nephriticsymptoms. The nature and probable cause of the diseasewere diagnosed by Dr. Zacharin, and subsequently verified byDr. Leyden and other physicians, as well as by the results ofthe post-mortem examination, and there was no truth what-ever in any rumours to the effect that bleeding or any lower-ing treatment had been pursued. The advice that was givenand the recommendations that were made under the circum-stances in the Czar’s case, so far as they have been madeknown, appear to have been wise and sagacious in every way,and we feel confident that everything that could have beendone was done to diagnose the nature and to avert the fatalissue of the late Czar’s illness.

INDICANURIA IN INFANTILE TUBERCULOSIS.

THE present state of our knowledge on the subject ofindicanuria in relation to infantile tuberculosis is wellreviewed in L’Union Médicale of Oct. 23rd. Severalobservers have at different times studied the subject andobtained varying results. Thus Hochsinger in 1890, from hisexperiments, came to the conclusion that the presence ofindican is constant in the urine of children who are the

subjects of tuberculosis. He found indican present in a

larger or smaller amount in all his cases ; it bore no rela-tion to the stage of the disease or the state of nourish-ment or age of the child, or whether gastro-intestinaltroubles were present or absent. In 1892 Kahane

brought forward new facts confirming the results obtainedby Hochsinger. Jonk of Amsterdam, however, in 1893,from his investigations disagreed with the above observers,and maintained that indicanuria was frequently absent intuberculosis, and that, therefore, as a diagnostic sign it wasworthless. Steffen gives his figures as follows. He made1200 examinations of urine from nineteen children of the agesof eighteen months to fifteen years, who were suffering fromvarious forms of tuberculosis. He found that indicanuriain these patients occurred in a greater proportion of casesthan in measles (1 in 3), but less frequently than indiphtheria (1 in 5), and in typhoid fever (1 in 5). In

tuberculous children also the amount varied considerably-one day a large quantity might be found, whilst on the

following only a trace might be present. The question hasrecently been studied in France by Mdlle. Djouritch.2 Theconclusions of this observer agree with that of Hochsingerand Kahane. She finds that indicanuria is constant and

permanent in infantile tuberculosis. The quantity of indicanpresent varies considerably at different times, and even from

1 Jahrb. f. Kinderheilk., 1892.2 Thèse de Paris, 1893, and Revue Mensuelle des Maladies de l’Enfance.

1894.

one day to another, but may always be found, and is,therefore, a valuable test in cases of doubtful diagnosis.After trying various tests Mdlle. Djouritoh found the

following as simple and as trustworthy as any: Equalquantities of urine and hydrochloric acid are agitated withchloroform ; the latter takes up the colouring matter, andforms a violet layer floating on the surface of the mixture.

RAILWAY AMBULANCE IN AUSTRIA.

THE Austrian railway companies are to be congratulatedon the forethought and energy with which they have pro-vided for the possibility of accident. Their system, as

recently described by a contemporary, is of its kind as

complete as it can well be made. It is similar to that

suggested by Professor Annandale and referred to in our

issue of Oct. 20th, and includes the employment of a shortspecial train consisting of goods vans adapted to the require-ments of medical aid. Two of these vans are made to actas extemporised ambalance waggons, and are equipped withmedical and surgical appliances and with light cots for theconveyance of the injured, the rest being used as extra

transport waggons. Recently special hospital cars have

been constructed and are stationed in readiness for serviceat convenient points on the lines of traffic. Medical officersand ambulance men in the service of the company are avail.able when called upon to accompany the train which is

despatched as a first instalment of succour to the scene of anaccident. This method, if less ready in its application thanthat suggested in our former article, presents as its chiefdifference and advantage an arrangement for the transportof the injured which could hardly be possible by means ofcarriages belonging to the wrecked train. In this respect theAustrian system may well serve as a copy to companies inthis country, and there should be no great difficulty in

devoting certain carriages, at least one very main line of rail,to the purposes of medical relief, and maintaining them ina state of readiness for any possible emergency.

A PECULIAR CASE OF SO-CALLED NEURITIS.

IN a recent number of the Jowrnal of the AmericanMedioal Association Dr. Harold N. Moyer of Chicago recordsa case of some interest which he apparently regards as ananomalous one of peripheral neuritis. The patient was ayoung woman twenty-one years of age, who presented herselfcomplaining of loss of power and wasting in the hands andarms. This had commenced four years before with severe

darting pains in the hands and forearms. Loss of powergradually took place, and later the hands and arms

were found to be diminished in bulk. As the diseaseadvanced the pain and numbness ceased, being replacedby loss of sensation. When she came under observationthere was marked wasting, especially of the thenar and hypo-thenar eminences and of the interosseous muscles. The fore-arms also were much wasted, the atrophy being symmetrical.Fibrillary tremors were also present. Above the elbow therewas no wasting or loss of motor power, nor were the supinatorlongus or pronator radii teres involved in the wasting,Sensibility to all forms of stimulation was diminished or lostas high as the middle third of the left arm. Sensibility wsssimilarly involved on the right side, but reached as far asthe shoulder, spreading also to a slight extent over thefront of the chest on this side. The electrical reactions werealtered in different degrees. In the interossei no faradaic

reaction could be obtained, but in a few of the muscles it

seemed to be increased. Nystagmus was present, the visionwas good, and no change was found in the fundi. Therewas marked exaggeration of the knee-jerk and ankle-clonuswas present on both sides. If this is, as Dr. Moyerbelieves, a case of peripheral neuritis, it is certainly avery anomalous one. Nystagmus, no doubt, does occur in