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CONGENITAL ABSENCE OF THE SPLEEN.
UNQUALIFIED MEDICAL MEN IN BENGAL.
close, and in a few days the wound healed pletely. Permanent recovery followed. This
to
comcase
as it corresponds in several of Vincent’s cases in which a polyvalent typhoid vaccine was given to a patient who had contracted typhoid fever six years earlier and who, after infection with paratyphoid B, had developed osteitis of the lumbar vertebrae. Vaccine treatment of typhoid bone disease is the more worthy of trial as the results of surgical and medicinal treatment often leave much to be desired. Altogether about 30 cases have been recorded in which vaccines have been given for typhoid bone disease.
is the
more
convincing
points
with
one
UNQUALIFIED
MEDICAL MEN
IN
OF recent years there appears to have been a in the number of unqualified medical in Calcutta. Their shops are found scattered all over the city, sometimes well stocked with patent medicines. The less prosperous members of the fraternity have invaded the districts of Bengal, creating many jealousies among the practitioners of the indigenous system of medicine. The Government can do nothing to deal with this large army of quacks so long as the quacks keep on the right side of the law. There are many " kavirajes " and other doctors using indigenous systems who are not registered by law. These are free to practise and, in fact, there is no restriction on those who choose to follow the medical profession according to any system-Western,
Ayurvedic, Unani,
or
Homoeopathic-so long
as
they
do not break the law either in the treatment of cases or in the supply of drugs. The Bengal Medical Act of 1914, which provides for the registration of duly qualified medical practitioners through the Bengal Council of Medical Registration, is working well. Registration is optional at present, but the Govern1
American Journal of the
Medical Sciences, November,
1922.
PIONEER
MENTAL HOSPITAL
report of The Retreat, York, registered hospital * for the treatment of mental diseases, records the retirement of Dr. Bedford Pierce in the early part of 1922, and includes a short retrospect of the far-reaching changes which have taken place during his 30 years of office as medical superintendent. An example of these changes is the institu.tion of systematic training for mental nurses, whose efficiency and status at the present day owe much THE 125th annual
a
to Dr. Pierce’s influence. As the first institution in England to merit the description of " mental hospital," unknown though this term was at the foundation in 1796, the Retreat is a place where high tradition has been maintained and amplified over more than a century. We wish Dr. Henry Yellowlees every success on his appointment as Dr. Pierce’s successor. Interesting features in the report are a clear pronouncement on the vexed question of certifying voluntary boarders, and a summary of the conclusions as to the correlation between the causative factors in insanity furnished by compiling a table of setiological factors in first-attack cases over a period of 17 years-a feature of statistical work which elsewhere is commonly neglected. Millfield is a large country house, adapted for the treatment of borderland cases, situated at some distance from The Retreat, and entirely distinct from it, although staffed by the same medical officers. We are glad to read that this annexe, although not hitherto a success financially, is to continue its work. It represents a type of enterprise which deserves success ; the class of patient is by no means small for whom a compromise between mere rest at home and strict supervision in a mental hospital is the ideal treatment.
BENGAL.
rapid growth practitioners
ment intend eventually to make it compulsory. An examination of a table showing the number of persons whose names were entered on or removed from the official list of registered practitioners for the period 1915 to 1920, inclusive, shows that a high standard is maintained in Bengal. Out of 3538 names registered during those years only 138 were removed, of which 137 were on the grounds provided for in Section 28 of the Act (evidence of death) and one for ceasing to practise. There were no erasures for fraudulent or incorrect entry, or for criminal non-bailable offences ending in conviction, or for infamous conduct. A
CONGENITAL ABSENCE OF THE SPLEEN. ACCORDING to Dr. S. McLean and Dr. H. R. Craigl of the Babies Hospital, New York, who report an illustrative case, congenital absence of the spleen is It may occur as one of the rarest visceral anomalies. an isolated abnormality, or, as more frequently happens, be associated with other congenital malformations. In nine of the cases collected by the writers the individual with this defect reached middle life without recognisable disturbance, and one woman who had four normal pregnancies died of pulmonary tuberculosis at the age of 73. Adami and Nichols, who state that the place of the spleen is more often taken by nodules of splenic tissue in various parts, allude to Albrecht’s case in which the normal spleen was absent, but nearly 400 splenunculi ranging in size from a pin’s head upwards were found scattered throughout the abdominal cavity. In the case reported by the present writers, and in the four other infants recorded with congenital absence of the spleen, there was apparently no hyperplasia of lymphoid tissue, while in only two out of the nine adult cases was there a definite lymphoid hyperplasia which was regarded as compensatory. The present case was that of a male infant, aged 3 months, admitted to hospital for broncho-pneumonia. Death took place three weeks later, and in addition to broncho-pneumonia the autopsy revealed congenital absence of the spleen, congenital malformation of the heart (patent auricular and ventricular septa and transposition of veins), supernumerary lobes in the lungs (three lobes in the left and four in the right), and transposition of the right and left lobes of the liver. In spite of a prolonged search no supernumerary spleens were found. The coeliac axis had been removed, so that search for the splenic vessels could not be made. From a review of the literature and a study of their own case the writers conclude that congenital absence of the spleen is not a serious handicap.
1395
I
EPIGASTRIC PAIN IN APPENDICITIS. THE recognition of epigastric pain in appendicitis is now universal. Although absent in some cases, it is present in the great majority, and a detailed attention to the history will reveal it as a forerunner of the right-sided appendix pain. Dr. J. Vorschutz, of Eberfeld,lattempts to explain this epigastric pain. It is, in his opinion, due to irritation of the solar plexus, brought about by a lymphangitis originating in the appendicular inflammation. He has drawn this inference from the results of certain animal experiments. First, he demonstrates that the solar plexus of rabbits contains sensory nerve fibres, by exposing the plexus and then pulling or squeezing it. Splanchnic anaesthesia also demonstrates satisfactorily that the sensory impulses passing to the cord from the solar plexus can be interrupted and pain prohibited by the injection of novocaine into the region of the splanchnic nerves. Secondly, Dr. Vorschutz seeks to explain how the solar plexus is stimulated in appendicitis. The answer is to be found in a study of the anatomy of the lymphatics. The latter can be seen in the rabbit to run from the appendix, the ascending colon, and from the right half of the transverse colon radially towards the solar plexus, and from the rest of the intestine and from the pelvis along the vessels towards this central point, where they unite to form the receptaculum chyli. After injecting Indian ink into the region of the appendix, black lymph-vessels 1
Deutsche medizinische Wochenschrift, August 11th, 1922.
close, and in a few days the wound healed pletely. Permanent recovery followed. This
to
comcase
as it corresponds in several of Vincent’s cases in which a polyvalent typhoid vaccine was given to a patient who had contracted typhoid fever six years earlier and who, after infection with paratyphoid B, had developed osteitis of the lumbar vertebrae. Vaccine treatment of typhoid bone disease is the more worthy of trial as the results of surgical and medicinal treatment often leave much to be desired. Altogether about 30 cases have been recorded in which vaccines have been given for typhoid bone disease.
is the
more
convincing
points
with
one
UNQUALIFIED
MEDICAL MEN
IN
OF recent years there appears to have been a in the number of unqualified medical in Calcutta. Their shops are found scattered all over the city, sometimes well stocked with patent medicines. The less prosperous members of the fraternity have invaded the districts of Bengal, creating many jealousies among the practitioners of the indigenous system of medicine. The Government can do nothing to deal with this large army of quacks so long as the quacks keep on the right side of the law. There are many " kavirajes " and other doctors using indigenous systems who are not registered by law. These are free to practise and, in fact, there is no restriction on those who choose to follow the medical profession according to any system-Western,
Ayurvedic, Unani,
or
Homoeopathic-so long
as
they
do not break the law either in the treatment of cases or in the supply of drugs. The Bengal Medical Act of 1914, which provides for the registration of duly qualified medical practitioners through the Bengal Council of Medical Registration, is working well. Registration is optional at present, but the Govern1
American Journal of the
Medical Sciences, November,
1922.
PIONEER
MENTAL HOSPITAL
report of The Retreat, York, registered hospital * for the treatment of mental diseases, records the retirement of Dr. Bedford Pierce in the early part of 1922, and includes a short retrospect of the far-reaching changes which have taken place during his 30 years of office as medical superintendent. An example of these changes is the institu.tion of systematic training for mental nurses, whose efficiency and status at the present day owe much THE 125th annual
a
to Dr. Pierce’s influence. As the first institution in England to merit the description of " mental hospital," unknown though this term was at the foundation in 1796, the Retreat is a place where high tradition has been maintained and amplified over more than a century. We wish Dr. Henry Yellowlees every success on his appointment as Dr. Pierce’s successor. Interesting features in the report are a clear pronouncement on the vexed question of certifying voluntary boarders, and a summary of the conclusions as to the correlation between the causative factors in insanity furnished by compiling a table of setiological factors in first-attack cases over a period of 17 years-a feature of statistical work which elsewhere is commonly neglected. Millfield is a large country house, adapted for the treatment of borderland cases, situated at some distance from The Retreat, and entirely distinct from it, although staffed by the same medical officers. We are glad to read that this annexe, although not hitherto a success financially, is to continue its work. It represents a type of enterprise which deserves success ; the class of patient is by no means small for whom a compromise between mere rest at home and strict supervision in a mental hospital is the ideal treatment.
BENGAL.
rapid growth practitioners
ment intend eventually to make it compulsory. An examination of a table showing the number of persons whose names were entered on or removed from the official list of registered practitioners for the period 1915 to 1920, inclusive, shows that a high standard is maintained in Bengal. Out of 3538 names registered during those years only 138 were removed, of which 137 were on the grounds provided for in Section 28 of the Act (evidence of death) and one for ceasing to practise. There were no erasures for fraudulent or incorrect entry, or for criminal non-bailable offences ending in conviction, or for infamous conduct. A
CONGENITAL ABSENCE OF THE SPLEEN. ACCORDING to Dr. S. McLean and Dr. H. R. Craigl of the Babies Hospital, New York, who report an illustrative case, congenital absence of the spleen is It may occur as one of the rarest visceral anomalies. an isolated abnormality, or, as more frequently happens, be associated with other congenital malformations. In nine of the cases collected by the writers the individual with this defect reached middle life without recognisable disturbance, and one woman who had four normal pregnancies died of pulmonary tuberculosis at the age of 73. Adami and Nichols, who state that the place of the spleen is more often taken by nodules of splenic tissue in various parts, allude to Albrecht’s case in which the normal spleen was absent, but nearly 400 splenunculi ranging in size from a pin’s head upwards were found scattered throughout the abdominal cavity. In the case reported by the present writers, and in the four other infants recorded with congenital absence of the spleen, there was apparently no hyperplasia of lymphoid tissue, while in only two out of the nine adult cases was there a definite lymphoid hyperplasia which was regarded as compensatory. The present case was that of a male infant, aged 3 months, admitted to hospital for broncho-pneumonia. Death took place three weeks later, and in addition to broncho-pneumonia the autopsy revealed congenital absence of the spleen, congenital malformation of the heart (patent auricular and ventricular septa and transposition of veins), supernumerary lobes in the lungs (three lobes in the left and four in the right), and transposition of the right and left lobes of the liver. In spite of a prolonged search no supernumerary spleens were found. The coeliac axis had been removed, so that search for the splenic vessels could not be made. From a review of the literature and a study of their own case the writers conclude that congenital absence of the spleen is not a serious handicap.
1395
I
EPIGASTRIC PAIN IN APPENDICITIS. THE recognition of epigastric pain in appendicitis is now universal. Although absent in some cases, it is present in the great majority, and a detailed attention to the history will reveal it as a forerunner of the right-sided appendix pain. Dr. J. Vorschutz, of Eberfeld,lattempts to explain this epigastric pain. It is, in his opinion, due to irritation of the solar plexus, brought about by a lymphangitis originating in the appendicular inflammation. He has drawn this inference from the results of certain animal experiments. First, he demonstrates that the solar plexus of rabbits contains sensory nerve fibres, by exposing the plexus and then pulling or squeezing it. Splanchnic anaesthesia also demonstrates satisfactorily that the sensory impulses passing to the cord from the solar plexus can be interrupted and pain prohibited by the injection of novocaine into the region of the splanchnic nerves. Secondly, Dr. Vorschutz seeks to explain how the solar plexus is stimulated in appendicitis. The answer is to be found in a study of the anatomy of the lymphatics. The latter can be seen in the rabbit to run from the appendix, the ascending colon, and from the right half of the transverse colon radially towards the solar plexus, and from the rest of the intestine and from the pelvis along the vessels towards this central point, where they unite to form the receptaculum chyli. After injecting Indian ink into the region of the appendix, black lymph-vessels 1
Deutsche medizinische Wochenschrift, August 11th, 1922.