Epitome Of Current Medical Literature

Source: The British Medical Journal , Jun. 28, 1930, Vol. 1, No. 3625 (Jun. 28, 1930), pp.
107-110
Published by: BMJ

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 june 28, i93o] , [?Ss?SK? 107

EPITOME OF CURRENT M
Medicine. 62 per cent, of cases of tuberculous meningitis gave a recent
history of an attack of measles. In some patients, before
tuberculosis can be excluded it is necessary to make not only
574. Anatoxin Prophylaxis in Diphtheria? a careful clinical study of the case, but also repeated labora
J. Lardier (Th?se de Paris, 1930, No. 22) states that although tory investigations as well as ?-ray examinations, since,
the value of immunization against diphtheria has been unless these are conducted systematically, tuberculosis may
proved, the method is not infallible, any more than that of any escape detection or may be wrongly diagnosed.
other form of immunization. Faucial diphtheria occurring
in children who have been given three injections of anatoxin 577. J. LUK?CS and Z. Dirner (Arch. f. Kinderheil?c,
presents the same clinical appearances as in those who have March 28fch, 1930, p. 116) remark that the question of the
not been inoculated, and the prognosis is about the same relation between measles and tuberculosis has recently
as in the non-immunized, severe and complicated attacks been the subject of numerous discussions. Noeggerath and
occurring in about a third of the cases. Deaths and paralysis, Eckstein, followed by Bisken, disputed the old view that
however, are slightly less frequent in those who have been measles increased the susceptibility to tuberculosis, or
immuuized. With rare exceptions serum treatment should roused a dormant tuberculous process into activity. Klein's
be conducted in the usual way without taking any notice of statistics indicate that it is only in young children ^hat
the previous inoculation. Faucial diphtheria occurring in measles has a pernicious effect, although in older children
children who have been given only two injections of anatoxin as well the possibility of a slight recrudescence of tuberculous
is apparently identical with that occurring in children who disease must be reckoned with in every case. Two explana
have been given three injections. On the other hand, faucial tions may be offered for this bad effect of measles : either a
diphtheria following a single injection of anatoxin appears change has taken place within the organism which renders
to be more severe than in those who have had two or three
the conditions more favourable for the growth of tubercle
injections, and possibly even moro severe than in the non bacilli, or the specific protective powers of the organism have
immunized. Practitioners, therefore, while still favouring decreased owing to the measles. All the existing knowledge
the principle of active immunization, should be made to supports the second explanation, and particularly the fact
realize the relative frequency and occasional gravity of diph that the tuberculous reactions become negative in the course
theria in those who have been immunized.
of measles, or at least much weaker than usual. Since the
authors held the view that the changes in the system took
575. R. CRUCHET (Journ. de M?d. de Bordeaux et du place chiefly in the tissue fluids and blood, they determined
Sud-Ouest, March 20th, 1930, p. 237) reports five cases of to investigate whether the addition of the blood serum of
the occurrence of diphtheria in children inoculated with patients in different stages of measles to cultures of tubercle
Ramon's anatoxin, and calls attention to certain possi bacilli favoured the growth of the organisms. Comparative
bilities of error, such as a leaky syringe, or an ill-fitting observations showed that the growth of tubercle bacilli in
needle-mount. Further, many children are given insuffi the presence of measles serum was exactly the same as that
cient doses of anatoxin. Among 365 children treated by of cultures not containing this serum. It also made no differ
the author only 242 had received three injections of ence whether the patient gave a positive or negative tubercle
anatoxin, while 58 had had two injections, and 68 reaction. The authors come to the conclusion that measles
had been given only one dose. After elimination of all does not favour the development of tubercle bacilli, but
sources of error, it is admitted by the advocates of this assists the tuberculous process by reducing the systemic
prophylactic method that 4 or 5 per cent, of all children defences.s
inoculated properly remain refractory to immunization; this
small percentage accounts probably for the small number of
cases of diphtheria which occur in patients who have received
a full course of injections. In the majority of these cases,
however, the disease runs a very mild course. Cruchet con
cludes that it is a mistake to regard anatoxin injections as
Surgery.
useless. The statistics of the Bordeaux area show a reduction
in the number of cases of diphtheria since the introduction 578. Primary Carcinoma of the Lung.
of routine injections. He considers that intensive prophy J. A. Miller and O. K. Jones (Amer. Review of Tubcrc,
laxis is indicated, three or even four injections being given January, 1930, p. 1) discuss the clinical aspects of primary
at intervals of two weeks, or, better still, of three weeks. carcinoma of the lung from a study of the literature and from
It has to be remembered that about 5 per cent, of cases their personal observation of thirty-two cases of which details
remain refractory. When diphtheria occurs among those who are given. The condition, more correctly designated primary
have previously received anatoxin injections, these patients bronchial carcinoma, comprises three groups of cases?
should be treated as if they had not had any prophylactic namely, carcinoma of the lining epithelium of the bronchi ;
treatment. of the mucous glands of the bronchi ; and that arising from
the pulmonary alveoli. The physical signs are varied and
576. Measles and Tuberculosis are not pathoguomonic. In early cases they may be absent,
P. Nob?co?rt, R. Li?ge, and A. Herr (Arch. 3I?d. ordes
be simply
Enf., those of a localized bronchitis with signs of con
solidation,to
February, 1930, p. 65) report that of 459 children admitted and, as the disease advances, with dullness and
tenderness
the measles block of the H?pital des Enfants Malades, Paris, over the area in which the patient complains of.
pain.showed
during the first six months of 1929, 33 (7.18 per cent.) An -ray examination is the most valuable single
a positive skin reaction for tuberculosis during themeans of diagnosing
course of the presence of a tumour, and broncho
scopy should be performed in all cases of chronic pulmonary
the disease, though in only 4 of them had there been definite
disease in patients over the age of 40, where the sputum
evidence of this disease before admission. The subsequent
history of the rest, none of whom had shown any findings
clinicalare negative for tuberculosis and the diagnosis is
obscure. Ten
symptoms of tuberculosis before their attack of measles, wasclinical types, distinguished by their pathology,
as follows. In 10 cases measles pursued a normal course,
symptomatology, physical sigus, and ?C-ray and brouchoscopic
3 died from the usual complications of measles, 5 findings,
died from are described, but the diagnosis of- the disease is
acute pulmonary tuberculosis, 7 developed subacute frequently pulnot made during life, and in its early stages is
monary tuberculosis as a sequel of measles, andrarely 2 of possible.
them The main lines of treatment are at present
died, the diagnosis being confirmed by necropsy ;symptomatic,
2 had peri though two cases have been recorded in which
early tumours
tonitis in convalescence, aud 2 meningitis. The authors con in the wall of the bronchus have been success
clude that tuberculosis has no definite influence onfully
the removed
course with no recurrence four and eleven years later.
of measles, but measles has an unfavourable effect X-ray
on treatment
the has so far shown no ability to arrest the
course of tuberculosis in some cases, though not in all.
progress of the disease, though it may afford relief to pain ;
in
Measles may give rise to an acute and fatal pulmonary one case it appeared to*produce a more chronic condition,
tubfrculosis in children who appeared to be in good so that the patient lived for a further two years. Where
health
bc'o e their attack. It is also possible that thethere is obstruction of the bronchus with atelectasis of the
ordinary
lung ic-ray
broucho-pneumonia of measles is particularly frequent in therapy may aggravate the symptoms, and in such
tuberculous children, and in such cases is usually cases it should not be used even to relieve pain. The thirty
fatal.
On the other hand, tuberculosis is not a very common sequel cases were observed during the past six years,
two reported
and(3.4S
of measles, since out of 459 cases of measles only 15 the diagnosis
per in each was substantiated by bronchoscopy
ceit.) definitely developed tuberculosis. Moreover, or necropsy.
only
V I024 A
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 108 June 28, 1930] EPITOME OF CURRENT MEDICAL LITERATURE. [Mjs^f *??*,,
579. Appendicitis and Pyosalpinx with a Vesical perineal palpation. (2) Examination of the urine. The
Fistula. anterior urethra should be irrigated with boric acid solution
Barbet and Pasteau (Bull, et Mem. Soc. des Chir. de Paris,
and the washings saved. The urine should then be passed
March 7th, 1930, p. 182) report a case of a girl, aged 21, who
into two glasses aud examined for shreds. If the wash-glass
was un 1er treatment for several years prior to operationcontains most of the shreds, they come from the anterior
for pyelonephritis by means of an auto-vaccine. When the urethra, and probably from Cowper's glands. (3) Urethro
symptoms became more severe a cystoscopy was performed scopy. The urethral mucous membrane is often much
and revealed a vesical fistula to the outside of the right reddened at the site of the opening of tho ducts of Cowper's
ureteric orifice. In addition, there was tenderness on pressure
glands. (4) Determination of the size of the urethra by
over the appendix, and on rectal examination a mass was a bougie, since occasionally an inflamed and enlarged gland
found on the right side of the pelvis. Consequently,may
a press on the urethra and narrow its calibre. The
diagnosis was made of appendicitis, with an abscess openingpresence of stenosis is of value if a stricture can be excluded.
into the bladder behind the right ureter. Laparotomy disTreatment consists in excising the diseased gland through
closed an appendix adherent to the mass in the pelvis anda perineal incision.
stenosed by au old attack ; the appendix was removed. There
was also evidence of an abscess localized by adhesions, With
a large pyosalpinx adherent to the bladder, and communi
cating with it by means of a vesical fistula. The right
ovary was partially destroyed and adherent to the Fallopian
Therapeutics.
tube. The right adnexa were removed, and a catheter was 533. Treatment of Vincent's Angina.
left in the bladder. The patient made an uninterrupted
recovery, was married six months after her operation, and G-. O. CUMMINGS (New England Journ. of Bled.. April 17th,
has since given birth to two healthy children.
1930, p. 768), who believes that the incidence of Vincent's
angina has much increased during the last ten years,
580. Nephroptosis. describes the condition as an ulcerated area on the tonsil or
mucous
G. Garry and A. Druckmann (Zeit. f. Urol., Band 24, Heft 4, membrane ; the edges are red and irregular, while
1930, p. 241) have made a radiological study of normal the base is firm and filled with adhesive grey necrotic tissue.
persons, cases where the kidneys are palpable, and patientsIt has to be distinguished from diphtheria, syphilis, and
malignancy. The infective organisms, a fusiform bacillus
with indefinite abdominal and lumbar pain, pyelograms being
and
taken in the sitting and lying positions. Theoretically thefroma spirillum, have been found in 50 per cent, of swabs
length, and the presence or absence of kinking or looping of tonsils before, and 40 per cent, of swabs from tonsillar
the ureter, should distinguish between nephroptosis of confossae three weeks after, operation in cases where there was
no reason to suspect Vincent's infection. There may be
genital or acquired origin ; in 80 per cent, of low kidneys they
found a short straight ureter, but this criterion cannot be severe pain or only discomfort on swallowing ; the lymph
nodes at the angle of the jaw are usually swollen and may
taken as absolute, since long kinked ureters can also be found
be intensely tender. Constitutional symptoms are usually
with high or normally placed kidneys. In 52 per cent, of cases
the position of the kidney was unaltered whether the patientpresent for a few days and may be aevere. The tonsil may
was sitting or lying ; in the rest it was 2 to 4 cm. lower slough away almost entirely in neglected cases. During the
in the sitting position. This movement however, was stage
as of invasion the patient should be kept in bed, with
commonly found in the high as in the low kidneys, so it laxatives,
is antiseptics, and bland diet. Hot or cold packs on
the swollen glands and gargles containing astringents, such
not necessarily a sign of ptosis. The movement of the kidney
on sitting was accompanied by bowing of the ureter in as glycerin of ta-?nic acid, and non-irritating antiseptics,
such as hydrogen peroxide, afford comfort. The gingival
46 per cent., angulation in 17 per cent., and marked kinking
sulcus about the teeth should be flushed out with a 1 in 500
in 37 per cent., the type of curve being constant in the same
patient on re-examination months later. Even a low kidney solution of hexyl-resorcinol, using a syringe having a blunt
accompanied by kinking of the ureter must be accepted with pointed needle set at an angle with tho long axis of the
syringe. Applications of 5 per cent, chromic acid are recom
great caution as a cause for pain, however, as shown mended,
by but no value is attached to silver nitrate or tincturo
some cases cited which were uninfluenced by nephropexy,
but were cured when the real cause of the pain was later of iodine. Pledgets of cotton-wool may be damped, rolled in
powdered sodium perborate, and left in position around the
discovered and treated. On the other hand, dilatation of the
renal pelvis in nephroptosis appears to cause definite symgums for five minutes, or the perborate may be used as a
dentifrice ; it liberates free oxygen. Intravenous injections
ptoms, but is not necessarily associated with kinking of the
ureter. In 7 out of 80 cases the ureter was found to arise of salvarsan are not advised nntil less drastic treatment has
not from the lowest part of the pelvis, but from a higher failed; in severe cases, resisting the ordinary local and
position, and this anomaly was associated with a dilated general medicaments, intravenous injections of 5 c.cm. of
a 1 per cent, solution of antimony potassium tartrate may
pelvis and renal symptoms in 5 of these, though only 2 had tried. In convalescence the danger of recurrence owing
nephroptosis. The authors suggest that in some casesbe to the use of an infected tooth-brush has to be borne in mind.
diagnosed as nephroptosis the pain is due not to the position
of the kidney, but to an anomalous ureter arising from an
abnormal situation in the pelvis and leading to interference 584. Liver Treatment in the Pernicious Anaemia of
with the outflow of urine. Pregnancy.
R. Peterson, H. Field, jun., and H. S. Morgan (Journ.
531. Haemolytic Streptococcal Septicaemia. Amer. Med. Assoc, March 22nd, 1930, p. 838) report three
cases of the pernicious or haemolytic anaemia of pregnancy
C. S. ROLLER (Amer. Jour n. Dis. Child., January, 1930, p. 156),
who records an illustrative case, has collected 43 cases which
of were treated with a high liver diet or liver extract.
general sepsis observed at the Children's Hospital, Los Though the results were complicated by transfusions in two
Angeles, of which 10 were proved by blood culture during cases, the response to liver treatment seems to have been
life to have been caused by the streptococcus. Five more quite analogous to that obtained by this therapy in primary
pernicious anaemia. One patient was relieved by the treat
cases were found to be streptococcal in origin by blood culture
after death. Of the 43 patients, 40 died?a mortality of ment, but did not become well until after the termination of
pregnancy; it is concluded that in this case the treatment
93.1 per cent. All methods of treatment met with consistently
poor responses. Roller's case was that of a male infant,
had made possible a more normal type of blood regeneration
aged 16 months, who developed acute haemolytic strepto but had not affected the underlying cause. In the majority
of these pregnancy anaemia cases the condition is severe
coccal septicaemia after mastoidectomy. Complete recovery
ensued as the result of whole blood transfusions, anti and often fatal. The colour index is high ; there is a high
streptococcal serum, and intensive supporting measures suchgrade poikilocytosis and anisocytosis with megalocytes and
as the subcutaneous injection of saline solution, enemata offrequently megaloblasts, and the blood bilirubin is increased.
In distinction to the primary type, the macrocytosis is less
dextrose, and the administration of caffeine sodium benzoate,
alternating with digitalis. marked, the leucocytes are more frequently normal or in
creased in number, and, if recovery occurs, there is little
582. Chronic Infection of Cowper's Glands. tendency to a relapse. A further difference is that achlor
hydria is not a necessary concomitant. Free hydrochloric
C. M. Whitney (Urol. and Cut. Rev., April, 1930, p. 233), who
records four illustrative cases in men aged from 28 to 34,acid was found in the gastric contents of each of the three
states that infection of Cowper's glands may occur in threepatients. Attention is drawn to the possible danger of high
forms : the acute type, either with or without abscess liver feeding during pregnancy when there is a tendency
formation; the subacute; and the chronic. The last form
towards nephritis or toxaemia. The authors recommend
probably follows an acute infection, and if this is of a mild
especially careful observation of the urine and blood pressure
type no symptoms may be observed, except a recurrent
when a high liver diet is given during pregnancy. One
urethral discharge. A chronic infection of Cowper's glands
case afforded some evidence that liver extract might be as
can often be diagnosed only by the occurrence of acute
efficacious as liver; if so, it would avoid the danger em
symptoms. The following diagnostic methods may also bephasized, and be the most desirable treatment during
of assistance. (1) Examination by combined rectal andperg nancy.
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 June 28, 1930] EPITOME OF CURRENT MEDICAL LITERATURE. [m J!*5?a* 109
585. Admiristrat'on of Strophanthin. uneventful recovery; four weeks after the occurrence the
vision had improved to 20/19, there being then no trace of
Strophanthin has been associated with the digitalis derivathe haemorrhages within the eye, while two and a half years
tives and its action has been erroneously compared with that
of digitalis ; E. E. Cornwall (Med. Journ. and Record, after the accident his vision was 20/12, and he had a normal
fuudus.
April 2nd, 1930, p. 355) enumerates some of the differences.
Iu contrast with the effect produced by digitalis, the heart,
587. Plasmoma of the Conjunctiva.
after strophanthin poisoning, is found to be rigidly con
P. S. SOUDAKOFP (China Med. Journ., March, 1930, p. 195)
tracted ; strophanthin does not affect the vagus mechanism,
records seventeen cases of conjunctival plasmoma which he
and appears to act by direct contact in increasing myocardial
has encountered during the last seven years. The disease
contractility and tonicity ; finally, it has no cumulative
begins as a small growth of the fornix, spreading thence over
action. If good results are to follow its administration,
the conjunctiva. Histologicaliy it is a diffuse subepithelial
strophanthin must be given in proper doses. It has generally
been considered that this drug should be employed onlyplasma-cellular
as infiltration with which is associated a slight
degree of hyaline degeneration of the connective tissue
an emergency method and in large doses; Cornwall, how
ever, maintains that in smaller doses it can be continued stroma.
for The condition is not a tumour, but a tissue reaction
due to chronic irritation. Most patients with plasmoma also
long periods, being often effective in prolonging life in cases
of myocardial degeneration with heart failure, especially suffer
if from trachoma, and the author believes that the toxins
its use is combined with a wise regulation of the physical of the latter play an important part in setting up the irritation
which eventually gives rise to plasmoma. Treatment consists
activity and diet. The method of administration is of prime
importance. Strophanthin is apparently used up in the body in ;early and complete excision of the growth, followed by
radium.
it is not eliminated by the urine, saliva, or faeces. It may
be given by intravenous, intramuscular, or hypodermic in
588. Ocular Lesions in Oxycephaly.
jections, or sublingually. In the majority of cases the
last-named method suffices, and hypodermic injectionsA.inCOLRAT (Journ. de M?d. de Lyon, March 20th, 1930, p. 179)
states that in oxycephaly the cranial deformity is accom
the bulk of the remainder, intramuscular and intravenous
injections being only emergency methods. It should notpanied
be by marked radiological signs and frequently by ocular
administered orally, since the amount which reaches troubles.
the The deformity is due to an abnormal height of
the cranial vault, but its configuration varies in different
heart muscle by this route is too uncertain. The indications
for the use of strophanthin and the dosage to be properly cases. Usually the forehead is almost vertical, descending
employed are dealt with. The great indication for its use nearly
is perpendicularly on the naso-frontal juncture ; some
myocardial insufficiency. Heart failure from an impending times it is slightly inclined behind ; and sometimes it is
prominent
arrhythmia, such as auricular fibrillation, calls for strophan and the vertical plane passes in front of the
thin only when there is also some intrinsic myocardial weakorbital arcades. In typical cases the curve of the vertex is
rounded from before backwards, making a marked prominence
ness, but it is indicated in all forms of myocardial disease
at the centre of the naso-inial line. The occipital region, as
with regular rhythm and signs of heart failure. In the cardiac
failure of pneumonia and chronic myocardial degeneration, a rule, is flat. A slight prognathism of the superior maxilla
exists, and the face and cranium in a general way are
including hypertensive heart failure, this drug is most effec
tive. It is also indicated in acute endocarditis with heart
elongated and retracted transversely. Radiographs show
particularly a falling-in of the middle portion of the base.
failure ; in the cardiac failure occurring in acute febrile
The eyes are often prominent, and a diminution of vision may
diseases ; in chronic valvular disease, particularly in aortic
and mitral incompetency ; and in mitral stenosis with occur at various periods. The ocular lesion commences as a
papillary oedema, bifb it is rarely noted at this stage when
auricular fibrillation and heart failure, if there is much
treatment would be of avail. Tbis diminution of vision is
intrinsic myocardial weakness. As a general rule, ambulant
caused by a post-neuritic atrophy, very often, more marked
patients should not receive more than 0.001 grain sublingually
in one eye, which ends in a more or less total blindness.
every four hours; if larger doses are necessary the patient
should be put to bed. The exophthalmos is often marked, and strabismus is very
irequenb.^ Other symptoms are not constant. Some children
show meningeal crises (headaches and convulsions), but
these are rare. Usually the intelligence is normal and the
Ophthalmology. development satisfactory, except in cases of early blindness.
These lesions appear to be due to a chronic meningitis of
vague etiology, which causes a premature synostosis of the
5?6. Sub hyaloid Haemorrhage. frontal and sagittal sutures, and secondarily an intracranial
F. O. Schwartz (Amer. Journ. of Ophthalmol., March, hypertension.
1930, This in its turn brings about the basal falling-in
and
p. 195) asserts that the presence of extravasated blood papillary oedema, and later atrophy of the optic nerve.
between
Early diagnosis
the retina and vitreous is uncommon ; it is very infrequent in is necessary to initiate successful treatment,
thus preventing blinduess ; decompressive trephining is the
adults and rare in children, except as a result of traumatism.
method of choice. Two allied conditions are described : the
These haemorrhages are usually of large size, covering the
cranio-facial
entire macular region, and including an area several disc synostosis of Crouzon, and the acrocephalo
syndactylia
diameters in the vertical and horizontal directions. The of Apert. The former is characterized by a
haemorrhage rarely reaches the temporal border of slightly analogous deformity of the cranium with a pseudo
the disc,
although cases have been known in which a portion acromegalic
of the aspect of the face, but without marked basal
nerve head was covered. More than one mass of bloodfalling-in.
may The latter shows a cranial malformation similar
tohaemor
be present in the eye at one time ; as many as three that of Crouzon's disease, but with total syndactylia of all
the extremities.
rhages have been found in one eye, one small haemorrhage
being on the optic disc, and accompanying two large sub
hyaloid ones. The condition appears suddenly in an
apparently normal eye without any premonitory symptoms ;
tuberculosis, syphilis, focal infections, hyperthyroidism, Obstetrics and Gynaecology.
and disease of the suprarenal^ are among the causes re
589. * The Time of Ovulation in the Menstrual Cycle.
sponsible for such effusions. Vision is greatly reduced,
and objects appear reddish-brown or grey-green. The Q. U.blood
Newell, E. Allen, J. P. Pratt, and L. J, Bland
spreads equally in all directions and forms a thin layer,
(Amer. Journ. Obstet, and Gynecol., February, 1930, p. 180)
frequently assuming a number of shapes. The pie-retinal
have made an investigation into the time of ovulation in
mass of blood may be separated into parts : a pale upper
women,part
the menstrual history being correlated with careful
and a dark lower. This division is caused by the settling of
macroscopical and niicroscopical observations of tho corpus
the corpuscles to the bottom of the still fluid blood. The An attempt was also made to recover the corre
luteum.
line of contrast formed is straight and may be maintained
sponding ovum from the Fallopian tube. The material was
upon inclination of the head; in rare cases this edge showsfrom routine operations. A technique was devised
selected
a concavity, but it may be convex. It is not difficult
wherebytothe tubes were irrigated with normal saline; the
recognize the condition.. A favourable prognosis can bewere collected in watchglasses, and were later
washings
searched for ova. The authors believe this method to be
giveu, since full recovery of sight often occurs. Treatment
is simple, comprising complete rest, supplemented by the
quite safe. Information about the pre?ence of ova can be
administration of diuretics, cholagogues, and diaphoretics.
obtained from tubes which show no pathological lesion and
Mercury and iodine are useful. Schwartz describes are thetherefore
case leit in situ. The method was also found useful
of a man, aged 23, who, while diving, struck the left in
temporal
determining the patency of the tubes. More than ninety
region of his head on the edge of a rock. Fifteen minutes
operations were performed at various stages of the menstrual
later he noticed a greyish-green scotoma in the line of sightNine
cycle. of specimens were removed from the Fallopian
the right eye ; vision of this eye became generally obscured,
tubes, five of which were definitely identified as tubal ova by
and was limited to light perception. The man examination
made an of seelious. From the data thus obt?iu?d th?
I.04 O
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 110 JUNE 28, 1930] EPITOME OF CURRENT MEBICAL LITERATURE, (?AS Mbdicax, JoomaIi

time of ovulation occurred on, or one or two days before, the incubated for ?fteen to twenty minutes at 37? C, and then
fourteenth (morning of the fifteenth) day following the onset examined under a low power. The letters O, A, B, and AB
of the previous menses. It appeared that the ovum had com were adopted for designating the four groups in accordance
pletely degenerated after the twenty-first day of the menstrual with the recommendation of the League of Nations. The
cycle, and, whether remaining in the tube or uterine cavity, A + AB
would probably be incapable of undergoing fertilization, biochemical racial index calculated from the ratio j. Ajj
590. Endometriosls. was 0.739, bringing the people of Shansi within the Indo
Manchurian group, though this index is slightly lower than
J. V. Meigs (New England Journ. Med., April 3rd, 1930, p. 672)
the previous figures reported for China. The table of find
records four cases of eudometriosis, each of which throws
ings for other provinces investigated by various observers is
some light upon the debatable questions as to the age of useful for comparison. The authors add that the examinations
incidence, conservation in treatment, atrophy after castration, made at the Penchow hospital were of great assistance in
and the etiology and prevention of growth in the operative obtaining data as regards possible donors for transfusion.
soar. While it is generally thought that endometriosls
usually occurs after the twenty-sixth year, the first case 593. Specific Antibody Absorption by the Viruses
occurred iu a girl aged 23, in whom the condition must have of Vaccinia and Herpes.
been present before the twentieth year. The second case
shows that conservative surgery may be a safe procedure, W. Smith (Journ. Path, and Bad., April, 1930, p. 273) has
though it is generally held that removal of all ovarian tissue performed experiments on the absorption of protective anti
in order to ensure cessation of growth is the wisest treatment. bodies from anti-vacoinial and anti-herpes serum. The general
In this case, from which a large cyst of the right ovary and technique was to mix the serum with large quantities of
a smaller one from the left ovary were removed, the remainder infected tissue suspension, incubate for three days in the
of the left ovary and the uterus being conserved, the meno presence of ether, centrifuge the mixture, filter the super
pause did not ensue till ten years later ; menstruation was natant fluid through L2 candles, and test the f?ltrate for
regular till then, and there were no signs of recurrence at protective power against the homologous virus. The results
the end of that time. The third case is quoted as proving showed that vacoinial and herpes testicular suspensions were
that endometriomas may atrophy and completely vanish capable of absorbing to some extent their homologous anti
following bilateral o?phorectomy, without leaving any bodies from immune serums. The specificity of the absorp
palpable or visible sign. The questions why some endo tion was shown by cross-absorption tests, in which vaccinial
metriomas occur in abdominal scars, and how such recurrence testis failed to remove the antibodies from a herpes immune
can be prevented, are answered by the fourth case, in which . serum, and herpetic testis failed to remove the antibodies
the tumour probably grew from the fundus of the uterus, from a vaccinial immune serum ; also by the fact that each
which had been sutured into the abdominal wound. When virus removed only its own antibodies from a mixture of the
ever, therefore, round ligament suspension, fixation, or two serums. When a vaccinial testis suspension, in which
intra-abdominal wall fixation of the uterus is contemplated the virus had been killed by heating at 58? to 60 C. for one
in such a case penetration of the endometrial cavities by the hour, was used for absorption, the antibodies were removed
stitches must be avoided if the risk of growth in the operative to only a slight extent. The author considers that these
scar is to be prevented. experiments suggest the probability of a direct union between
antigen and antibody vn vitro.
591. Radium Treatment of Carcinoma of the Cervix.
P. Petit-Dutaillis (La Gyn?col., February, 1930, p. 99), as 591. The Etiology of Oanoer.
a preliminary to radium treatment of cancer of the cervix, Citing Cramer to-the effect that freedom from cancer is
recommends removal by a sharp curette of as much as more likely to be attained by diminishing the susceptibili
possible of the growth, followed by thorough cauterization to this morbid change than by trying to hunt down variou
of the bleeding surface. He has not found that these forms of chronic irritation, J. A. Shaw-Mackenzie (Journ
measures are followed by serious haemorrhage, infection, or Trop. Med. and Hyg., May 1st, 1930, p. 117) recalls his sug
perforation of organs ; they have the further advantage that gestion made twenty-five years ago that cell proliferation
the subsequent insertion of radium in the corporeal canal alteration of the type of division may be dependent on som
(reconstructed by the cautery, if it has been destroyed by systemic condition, and that local irritation determines t
the neoplasm) or in the deepest parts of the growth is site ot growth. After testing the effects of injec'.ing differe
easy. From these situations radiation of the internal iliac tissue extracts, certain biochemical conclusions were reache
lymphatics and gland is secured, and slight filtration only the first of these being that variations in the action of ser
(1 mm. of platinum and a few layers of gauze) is necessary ; ou the ferment lipase occur in cancer and other disease
the radium, which is placed at the same time in the vaginal When normal serum is added to pancreatic extracts or
fornices, requires, however, very thorough filtration. The dose the secretion itself, fat-splitting is markedly increase
used is 10 millicuries destroyed daily for seven to eight serum does not split fats, but contains an activator. When
days. For the purpose of peripheral radiation in cases in carcinoma serum is added the fat-splitting is decreased ; t
which the parametrium is widely invaded, the radium is serum then contains some inhibiting factor. In cases o
inserted through the perineum and passes between the recovery the action of the serum returns to normal or is
obturator internus and its aponeurosis in front of the great increased. It was deduced from these experiments that th
sciatic notch, whence not only the internal but also the increased lipolytic activity is a factor which prevents the
external iliac glands are exposed to radio-activity. The para development of cancer, and favours its disappearance whe
metrium is subjected to cross-fire from this situation and present ; it is associated with the resistance of the body t
from radium placed in the utero-vaginal zone. Three cases cancer. Discussing profceolytic and peptolytic factors, the
of extensive parametrial carcinoma failed to respond to this author suggests that, in the case of lipase, a failure o
treatment; but in a fourth advanced case, that of a patient response in an organ other than that of the one affected b
aged 51 in whom radium treatment had been regarded as cancer may be a possible factor in the development of thi
useless aud probably harmful, curetting with cauterization condition, and also that as a result of deficient digesti
and the application of 66 millicpries of radium destroyed in ferments the cells of any focus of lesser resistance would
four days were followed by cure, which has been maintained become overcharged with peptone, glycogen, fats, carb
for more than six years. Two months after treatment the hydrates, etc., thus approximating to the foetal type of ce
patient had obturator neuralgia, and a fistula along the track with*its reproductive cell activity. Other points discus
of insertion of one of the radiferous tubes in the pelvic wall. are inhibiting factors, local aspects, the development
factor, fatty acid in immunization, and some reactions of
cancer in relation to diagnosis and treatment. Since i
Pathology. cancer there is not only deficient enzyme action in the ca
of lipase but of other enzymes, Shaw-Mackenzie sugges
that in the remarkable results obtained by Murphy an
592. Blood Groups in Shansi. Leitch in producing tumour by chemical substances fr
J. A. Curran, E. C. Rosenow, jun., and S. T. Feng (Nat.tissues, the substance isolated might be of the natu
normal
of an inhibitor or paralyser of normal enzyme action, a dire
Med. Joitrn. of China, February, 1930, p. 75) have investigated
the blood groups of the province of Shansi, an isolatedferment
country action not being concerned. In conclusion, he state
north-east of the Yellow River, where during recent that systemic defensive factors have been demonstrated i
centuries
emigration and immigration have been slight. One naturalthousandand induced tissue lipolysis, in striking contrast t
examinations were made from patients, members of the lipolysis in cancer and other diseases, and th
defective
staff, and students in the Fenchow hospital, all the persons
this knowledge applied to treatment in inoperable cases of
human carcinoma had met with some success. Wheth
tested being of Shansi origin. In the method employed
2 to 3 drops of blood were dropped into 5 c.cm. ofdefective
normal tissue lipolysis and utilization of fats or defectiv
saline^solution ; a drop of anti-A serum and one ofoxidation,
anti-B or both these factors, be the cause of the know
serum were pipetted on to separate marked cover-slips
excess.and
of unsaturated fatty material in cancer, it is a fact
a drop of the cell suspension was added to each;that considerable alteration in the metabolism of fats a
the pre
parations were well mixed, mounted on hollow-ground slides,
lipoids occurs in the blood and tissues in this disease.
I204 D
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