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RADIOGRAPHY OF LIVER AND SPLEEN
530
Committee, and the Epidemiological Intelligence Service. The second of these is a purely League organ, the first being identical with the pre-existing Office’
prevent an artificial pneumothorax it is as a rule impossible to collapse the dilated and rigid bronchi and the danger of empyema cannot be ignored if an effusion is provoked by pleural puncture. The risk of the latter complication is avoided when phrenic avulsion takes the place of pneumothorax, but at best it can only be expected to produce a partial collapse of a bronchiectatic lower lobe. It is seldom followed by apposition of the walls of the diseased tubes without which permanent healing cannot be obtained. The pain attending this little operation is however negligible and its risks are slight.
international d’hygiene publique, and the third a joint emanation of the League and the Rockefeller Foundation. Twenty-six subcommittees work for the Standing Health Committee, with such various spheres of activity as physical education, penal administration, malaria, sleeping sickness, and price of radium. The personnel of these organs is given in full. In the topical section of the year book medical and hygienic subjects are but briefly referred to. For cases of basal bronchiectasis which are not The recognition given by the-Eighteenth Assembly relieved by such means as posture, the creosote (1931) to the current work of the Health Organisation chamber, and medicinal treatment this method is in general is reported, but from this the reader can worth a trial. only gather that rural hygiene is the zone of the, Organisation’s most successful labours. Similarly the, RADIOGRAPHY OF LIVER AND SPLEEN work of the .League Medical Inquiry in China is EARLY last year we referred to a method of render- only touched upon. Against this, three full pages ing the liver and spleen opaque to X rays 1 ; it is are devoted to the constitution of the new Interbased on the fact that the reticulo-endothelial system national Leprosy Centre at Rio de Janeiro, of which has the property of taking up certain foreign colloids the League is a sort of honorary patron. Perhaps ____
in a selective manner. The various thorium preparations used for the purpose are given intravenously, and the dose is spread over several days, during which the drug accumulates in the spleen and liver,2 so that the outlines of these organs become visible on radiography. The question arises at once, of course, whether there is any danger of toxic effects, but work carried out at Toronto University on behalf of the manufacturers of Thorotrast is encouraging in this respect. D. A. Irwin3 states that large quantities injected into rabbits were quite innocuous and caused no reactions. While these experiments were proceeding, the drug was only given to patients past medical or surgical aid, but as it appeared to be harmless its use has been extended. Even in a few patients with advanced cirrhosis it is said to have caused no damage of any kind. The Canadian workers give no contra-indications, but others may prefer to wait for more clinical reports before relaxing their discrimination. Incidentally, W. H. Dickson4 quotes authority for saying that thorotrast is effective in the arteriography of the limbs and brain, and he considers it superior to the iodine solutions for retrograde pyelography, since it is more opaque and produces no cramps. ____
HEALTH ORGANISATION AT GENEVA IN issuing the first annual number of the League
in the year book for 1933 the current work of the Health Organisation may be more fully discussed. In the first year the bulk of the narrative is devoted to the work of the International Labour Office, the Disarmament Conference, and The Hague Court. Evidently the greatest care has been taken to render it accurate and authoritative. NERVOUS DISEASE FOLLOWING SMALL-POX AND VACCINATION
THE observation of cases of post-vaccinal encephalduring the last decade has drawn attention to the occasionally recorded cases of nervous disease associated with small-pox. The whole subject has lately been reviewed by Dr. J. P. Marsden and Dr. E. Weston Hurstwho have also described cases in detail. They point out the want of uniformity in the symptoms and pathology of the older records, but they themselves have collected a group of 11recent cases, of which at least seven resemble the typical syndrome and pathology of post-vaccinal encephalitis. In the present state of uncertainty regarding the ’immediate cause and pathogenesis of this group of diseases, they have decided to classify by their pathological anatomy and histology those cases which have been examined prefer carefully post mortem. On these grounds they " the name " acute perivascular myelinoclasis for thetypical so-called post-vaccinal encephalitis, with its, characteristic demyelination in the affected areas of the central nervous system. This pathological condi-tion undoubtedly follows other diseases besides. vaccinia and small-pox—especially measles-and may also be a sequela of anti-rabies inoculation. In the-
itis
Year Book 5 its joint editors, Miss Judith Jackson and Commander Stephen King-Hall, profess only to have made a first experiment on which, in later issues, they hope to improve. A year book of this sort must be a medley of basic information, for reference, and of chronicle of a more transient type. The reader wants to know what the organs of theseven definite cases reported, associated with variola League of Nations are, and also what they have beenminor, the onset was 5-13 days after the outcrop of doing in the period specially covered. Perhaps in thethe rash, a period almost the same as in the postfirst number proportionally more basic information vaccinal cases, and the age of the patients-i.e., 7 to. has been given than will be justified in the later21 years, in the post-variola cases, was also very editions. The constitution of the League health similar in the two groups. The recent cases followingorganisation is rather elaborately set forth, withvariola have had a remarkable distribution in time. references to the resolutions of the Council and, Six out of the seven occurred between September,Assembly of the League by which the various organs1929, and April, 1930, inclusive, and it is not apparent were set up ; and this letterpress is that this incidence was closely related to the prevalence with a table showing the ramification of committees of small-pox. The post-vaccinal cases also have not and subcommittees. The three main organs are the been clearly related to the maximal number of General Advisory Health Council, the Standing Health , vaccinations performed at a susceptible age ; more2 over, they are now very much rarer than a few 1 THE LANCET, 1931, i., 144. Ibid., 1932, i., 1256. 3 Canad. Med. Assoc. Jour., August, 1932, p. 130. A curiously local distribution is also to be 4 Ibid., p. 125. years ago. 5 The League Year Book, 1932. London : Ivor Nicholson and 1 Brain, 1932, lv., 181. Watson, Ltd. 12s.
,
supplemented
i
_
Committee, and the Epidemiological Intelligence Service. The second of these is a purely League organ, the first being identical with the pre-existing Office’
prevent an artificial pneumothorax it is as a rule impossible to collapse the dilated and rigid bronchi and the danger of empyema cannot be ignored if an effusion is provoked by pleural puncture. The risk of the latter complication is avoided when phrenic avulsion takes the place of pneumothorax, but at best it can only be expected to produce a partial collapse of a bronchiectatic lower lobe. It is seldom followed by apposition of the walls of the diseased tubes without which permanent healing cannot be obtained. The pain attending this little operation is however negligible and its risks are slight.
international d’hygiene publique, and the third a joint emanation of the League and the Rockefeller Foundation. Twenty-six subcommittees work for the Standing Health Committee, with such various spheres of activity as physical education, penal administration, malaria, sleeping sickness, and price of radium. The personnel of these organs is given in full. In the topical section of the year book medical and hygienic subjects are but briefly referred to. For cases of basal bronchiectasis which are not The recognition given by the-Eighteenth Assembly relieved by such means as posture, the creosote (1931) to the current work of the Health Organisation chamber, and medicinal treatment this method is in general is reported, but from this the reader can worth a trial. only gather that rural hygiene is the zone of the, Organisation’s most successful labours. Similarly the, RADIOGRAPHY OF LIVER AND SPLEEN work of the .League Medical Inquiry in China is EARLY last year we referred to a method of render- only touched upon. Against this, three full pages ing the liver and spleen opaque to X rays 1 ; it is are devoted to the constitution of the new Interbased on the fact that the reticulo-endothelial system national Leprosy Centre at Rio de Janeiro, of which has the property of taking up certain foreign colloids the League is a sort of honorary patron. Perhaps ____
in a selective manner. The various thorium preparations used for the purpose are given intravenously, and the dose is spread over several days, during which the drug accumulates in the spleen and liver,2 so that the outlines of these organs become visible on radiography. The question arises at once, of course, whether there is any danger of toxic effects, but work carried out at Toronto University on behalf of the manufacturers of Thorotrast is encouraging in this respect. D. A. Irwin3 states that large quantities injected into rabbits were quite innocuous and caused no reactions. While these experiments were proceeding, the drug was only given to patients past medical or surgical aid, but as it appeared to be harmless its use has been extended. Even in a few patients with advanced cirrhosis it is said to have caused no damage of any kind. The Canadian workers give no contra-indications, but others may prefer to wait for more clinical reports before relaxing their discrimination. Incidentally, W. H. Dickson4 quotes authority for saying that thorotrast is effective in the arteriography of the limbs and brain, and he considers it superior to the iodine solutions for retrograde pyelography, since it is more opaque and produces no cramps. ____
HEALTH ORGANISATION AT GENEVA IN issuing the first annual number of the League
in the year book for 1933 the current work of the Health Organisation may be more fully discussed. In the first year the bulk of the narrative is devoted to the work of the International Labour Office, the Disarmament Conference, and The Hague Court. Evidently the greatest care has been taken to render it accurate and authoritative. NERVOUS DISEASE FOLLOWING SMALL-POX AND VACCINATION
THE observation of cases of post-vaccinal encephalduring the last decade has drawn attention to the occasionally recorded cases of nervous disease associated with small-pox. The whole subject has lately been reviewed by Dr. J. P. Marsden and Dr. E. Weston Hurstwho have also described cases in detail. They point out the want of uniformity in the symptoms and pathology of the older records, but they themselves have collected a group of 11recent cases, of which at least seven resemble the typical syndrome and pathology of post-vaccinal encephalitis. In the present state of uncertainty regarding the ’immediate cause and pathogenesis of this group of diseases, they have decided to classify by their pathological anatomy and histology those cases which have been examined prefer carefully post mortem. On these grounds they " the name " acute perivascular myelinoclasis for thetypical so-called post-vaccinal encephalitis, with its, characteristic demyelination in the affected areas of the central nervous system. This pathological condi-tion undoubtedly follows other diseases besides. vaccinia and small-pox—especially measles-and may also be a sequela of anti-rabies inoculation. In the-
itis
Year Book 5 its joint editors, Miss Judith Jackson and Commander Stephen King-Hall, profess only to have made a first experiment on which, in later issues, they hope to improve. A year book of this sort must be a medley of basic information, for reference, and of chronicle of a more transient type. The reader wants to know what the organs of theseven definite cases reported, associated with variola League of Nations are, and also what they have beenminor, the onset was 5-13 days after the outcrop of doing in the period specially covered. Perhaps in thethe rash, a period almost the same as in the postfirst number proportionally more basic information vaccinal cases, and the age of the patients-i.e., 7 to. has been given than will be justified in the later21 years, in the post-variola cases, was also very editions. The constitution of the League health similar in the two groups. The recent cases followingorganisation is rather elaborately set forth, withvariola have had a remarkable distribution in time. references to the resolutions of the Council and, Six out of the seven occurred between September,Assembly of the League by which the various organs1929, and April, 1930, inclusive, and it is not apparent were set up ; and this letterpress is that this incidence was closely related to the prevalence with a table showing the ramification of committees of small-pox. The post-vaccinal cases also have not and subcommittees. The three main organs are the been clearly related to the maximal number of General Advisory Health Council, the Standing Health , vaccinations performed at a susceptible age ; more2 over, they are now very much rarer than a few 1 THE LANCET, 1931, i., 144. Ibid., 1932, i., 1256. 3 Canad. Med. Assoc. Jour., August, 1932, p. 130. A curiously local distribution is also to be 4 Ibid., p. 125. years ago. 5 The League Year Book, 1932. London : Ivor Nicholson and 1 Brain, 1932, lv., 181. Watson, Ltd. 12s.
,
supplemented
i
_