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REINFECTION IN SYPHILIS.
547
great increase in the number of reported and apparently authentic cases of reinfection. Benario, who collected 96 cases from the literature in 1914, laid down the following requirements to establish a diagnosis " Ne quid nimis." of reinfection: (1) a positive clinical diagnosis of the primary lesion ; (2) demonstration of Spirochæta pallida ;; INSURANCE MEDICAL RECORDS. (3) satellite adenopathy : (4) repeated performance of the Wassermann reaction ; and (5), if possible, IN the House of Commons on Monday last a cateof the source of infection. Forty-one of recognition Dr. was to Addison the put concerning gorical question Benario’s cases satisfied these requirements, and of the He was asked whether insurance medical records. 13 were probable and 28 possible examples he had received any complaints regarding the new remainder of reinfection. White in 1917 in a series of 10,500 form of medical card under the National Health of syphilis, observed ten instances of reinfection, Insurance scheme : whether he was aware that cases the diagnosis of which was based on the following objection was taken to the new card on the grounds (1) in the first attack spirochætes were found ground that it was too inquisitorial; and whether in the :chancre or in syphilitic lesions, or the blood this his To consideration. he would give objection a positive Wassermann reaction ; (2) in the second gave this question Dr. Addison replied that the number of attack the spirochaetes were found in a new chancre, complaints which he had received about the insurance which appeared at a site different from that of the first medical records was quite insignificant, consisting of the blood at the same time giving a negative chancre, from live out of Societies 10,000 Approved representations Wassermann reaction. In the cases reported by Dr. and branches, none from any of the insurance comWilliams the diagnosis in the first instance was made out of and on of the nine, mainly detail, mittees, points both by clinical and laboratory methods ; treatment by 150 panel committees representing the medical men on the panel. The card, he said, was in substitution for arsphenamin and mercury was carried out, and all the two others used since the commencement of the Act, symptoms, clinical and serological, disappeared. Two and had been designed mainly to give to insured patients years later exposure was followed by the development of a sore in which spirochætes were demonstrated. It the advantages enjoyed by private patients in those is true that a lesion may exactly simulate the practices where doctors kept records, and were thereby appearance oftertiary a chancre ; it may coexist with a perto be in enabled guided treating current symptoms by sistently negative Wassermann reaction, it may be reference to the patient’s previous medical history. To a further question he repudiated having invented contagious, although the demonstration of spirochaetes is rarely possible, and it may be accompanied by a the form of record card, or rather the revisions of the satellite adenopathy. But, as Dr. Williams remarks, the on a Committee concard, putting responsibility all these unusual phenomena rarely occur in the same sisting solely of members of the medical profession-a person at the same time, and such cases may with of them men in insurance being large percentage be as greater probability examples of practice. The accuracy of the latter reply has since reinfection in patients who regarded have been cured. been challenged on the grounds that there are three lay civil servants on the Committee, that the card was not THE R.A.M.C. ROLL OF HONOUR. designed wholly by doctors, and that 17 or 18 per cent. of panel doctors on the Committee could not be called a Roll of the officers of the R.A.M.C. who THE Official large percentage. The gist of Dr. Addison’s reply laid down their lives in the Great War is now published. should do away with the contentions in the lay The total number of names given is 709, divided as that the medical is with disprofession seething press content-as we have read in one quarter; and that follows :Old and New Armies. Territorial Force. many thousands of protests have been formally 2 Colonels ......... Major-Generals ... 1 registered-as we have read in another. There is a 8 Colonels......... Lieutenant -Colonels 13 certain amount of dissatisfaction, as our readers know, Lieutenant - Colonels 17 ; but there has been no reflection whatever of such a large 16 Majors Majors ............ 25 77 ’" ’" ’" agitation in the medical journals, where the improveCaptains Captains ......... 360 ment of public health, the advance of science, and the 5 Lieutenants Lieutenants 185 . maintenance of a right professional status form the 113 596 single programme for advocacy; and the inference is that this story of wide disapproval has its origin in, or is The Officers’ Roll, comprising over 40,000 names in all, supported by, political partisanship. When the Ministry may be purchased from His Majesty’s Stationery Office of Health came into being, as the result of unanimous through any bookseller. It would be invidious to select feeling that the institution of such a State Department any of the well-known names for particular mention; had been too long delayed, medical men hoped that all these men deserve our perpetual honour and on questions of public health the party politician would gratitude. be content to subordinate his views to the general good. That was sanguine, but even now the hope is ANTITUBERCULOUS VACCINATION. alive with some of us. Undoubtedly the early work of WE have previously drawn attentionto the antithe Ministry of Health has been hampered by comtuberculous vaccine prepared in Italy by Professor based of medical but in affairs, plaints upon ignorance Medicine the truth sooner or later always emerges from Martinotti, of the University of Bologna. Some new to hand in 4nnali di Medicina Navale, misrepresentation. We are not asking, because the evidence came organ of the Italian Naval Medical Department, at Ministry of Health is concerned with medical interests, the that its sayings and its doings should be regarded as the end of last year. The Director-General, Lieutenantwithout the pale of public judgment; nor can we be General F. Rho, was so much interested in this vaccine blind to the fact that every Ministry of Health must that he gave orders it should be examined in the Naval be associated with a Government, when the party Hospital at Spezia, and the report by Professor Medical politician will assuredly attack it, if by so doing that Lieutenant-Colonel (Surgeon-Commander) Dr. L. Sestini Government can be discredited. But we are urging is now published. Professor Sestini discusses the that such attacks should be taken at their value, when 23 cases that were treated at Spezia in 1918-19 by they will not be found to damage the public health Martinotti’s vaccine, of whom 3 were cured, 9 were more than temporarily. improved, 4 had no benefit (3 of these died), 1 patient was found unsuitable, and 6 withdrew themselves
Annotations.
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Captains
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......
......
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REINFECTION
IN
SYPHILIS.
ACCORDING to Dr. Charles Mallory Williams, associate professor of dermatology at the Post-Graduate Medical School, New York, who records an illustrative case, the improvement in the treatment of syphilis during the last ten years has been accompanied by a (
from treatment. The evidences of cure were disappearance of fever and tubercle bacilli, as well as gain in weight. Twenty-five further cases of phthisis also treated by this vaccine, but at Modena, are mentioned, of whom, all ambulant cases, 17 were cured 1 THE
LANCET, 1920, ii., 363 and 1106.
great increase in the number of reported and apparently authentic cases of reinfection. Benario, who collected 96 cases from the literature in 1914, laid down the following requirements to establish a diagnosis " Ne quid nimis." of reinfection: (1) a positive clinical diagnosis of the primary lesion ; (2) demonstration of Spirochæta pallida ;; INSURANCE MEDICAL RECORDS. (3) satellite adenopathy : (4) repeated performance of the Wassermann reaction ; and (5), if possible, IN the House of Commons on Monday last a cateof the source of infection. Forty-one of recognition Dr. was to Addison the put concerning gorical question Benario’s cases satisfied these requirements, and of the He was asked whether insurance medical records. 13 were probable and 28 possible examples he had received any complaints regarding the new remainder of reinfection. White in 1917 in a series of 10,500 form of medical card under the National Health of syphilis, observed ten instances of reinfection, Insurance scheme : whether he was aware that cases the diagnosis of which was based on the following objection was taken to the new card on the grounds (1) in the first attack spirochætes were found ground that it was too inquisitorial; and whether in the :chancre or in syphilitic lesions, or the blood this his To consideration. he would give objection a positive Wassermann reaction ; (2) in the second gave this question Dr. Addison replied that the number of attack the spirochaetes were found in a new chancre, complaints which he had received about the insurance which appeared at a site different from that of the first medical records was quite insignificant, consisting of the blood at the same time giving a negative chancre, from live out of Societies 10,000 Approved representations Wassermann reaction. In the cases reported by Dr. and branches, none from any of the insurance comWilliams the diagnosis in the first instance was made out of and on of the nine, mainly detail, mittees, points both by clinical and laboratory methods ; treatment by 150 panel committees representing the medical men on the panel. The card, he said, was in substitution for arsphenamin and mercury was carried out, and all the two others used since the commencement of the Act, symptoms, clinical and serological, disappeared. Two and had been designed mainly to give to insured patients years later exposure was followed by the development of a sore in which spirochætes were demonstrated. It the advantages enjoyed by private patients in those is true that a lesion may exactly simulate the practices where doctors kept records, and were thereby appearance oftertiary a chancre ; it may coexist with a perto be in enabled guided treating current symptoms by sistently negative Wassermann reaction, it may be reference to the patient’s previous medical history. To a further question he repudiated having invented contagious, although the demonstration of spirochaetes is rarely possible, and it may be accompanied by a the form of record card, or rather the revisions of the satellite adenopathy. But, as Dr. Williams remarks, the on a Committee concard, putting responsibility all these unusual phenomena rarely occur in the same sisting solely of members of the medical profession-a person at the same time, and such cases may with of them men in insurance being large percentage be as greater probability examples of practice. The accuracy of the latter reply has since reinfection in patients who regarded have been cured. been challenged on the grounds that there are three lay civil servants on the Committee, that the card was not THE R.A.M.C. ROLL OF HONOUR. designed wholly by doctors, and that 17 or 18 per cent. of panel doctors on the Committee could not be called a Roll of the officers of the R.A.M.C. who THE Official large percentage. The gist of Dr. Addison’s reply laid down their lives in the Great War is now published. should do away with the contentions in the lay The total number of names given is 709, divided as that the medical is with disprofession seething press content-as we have read in one quarter; and that follows :Old and New Armies. Territorial Force. many thousands of protests have been formally 2 Colonels ......... Major-Generals ... 1 registered-as we have read in another. There is a 8 Colonels......... Lieutenant -Colonels 13 certain amount of dissatisfaction, as our readers know, Lieutenant - Colonels 17 ; but there has been no reflection whatever of such a large 16 Majors Majors ............ 25 77 ’" ’" ’" agitation in the medical journals, where the improveCaptains Captains ......... 360 ment of public health, the advance of science, and the 5 Lieutenants Lieutenants 185 . maintenance of a right professional status form the 113 596 single programme for advocacy; and the inference is that this story of wide disapproval has its origin in, or is The Officers’ Roll, comprising over 40,000 names in all, supported by, political partisanship. When the Ministry may be purchased from His Majesty’s Stationery Office of Health came into being, as the result of unanimous through any bookseller. It would be invidious to select feeling that the institution of such a State Department any of the well-known names for particular mention; had been too long delayed, medical men hoped that all these men deserve our perpetual honour and on questions of public health the party politician would gratitude. be content to subordinate his views to the general good. That was sanguine, but even now the hope is ANTITUBERCULOUS VACCINATION. alive with some of us. Undoubtedly the early work of WE have previously drawn attentionto the antithe Ministry of Health has been hampered by comtuberculous vaccine prepared in Italy by Professor based of medical but in affairs, plaints upon ignorance Medicine the truth sooner or later always emerges from Martinotti, of the University of Bologna. Some new to hand in 4nnali di Medicina Navale, misrepresentation. We are not asking, because the evidence came organ of the Italian Naval Medical Department, at Ministry of Health is concerned with medical interests, the that its sayings and its doings should be regarded as the end of last year. The Director-General, Lieutenantwithout the pale of public judgment; nor can we be General F. Rho, was so much interested in this vaccine blind to the fact that every Ministry of Health must that he gave orders it should be examined in the Naval be associated with a Government, when the party Hospital at Spezia, and the report by Professor Medical politician will assuredly attack it, if by so doing that Lieutenant-Colonel (Surgeon-Commander) Dr. L. Sestini Government can be discredited. But we are urging is now published. Professor Sestini discusses the that such attacks should be taken at their value, when 23 cases that were treated at Spezia in 1918-19 by they will not be found to damage the public health Martinotti’s vaccine, of whom 3 were cured, 9 were more than temporarily. improved, 4 had no benefit (3 of these died), 1 patient was found unsuitable, and 6 withdrew themselves
Annotations.
............
Captains
.........
......
......
-
-
REINFECTION
IN
SYPHILIS.
ACCORDING to Dr. Charles Mallory Williams, associate professor of dermatology at the Post-Graduate Medical School, New York, who records an illustrative case, the improvement in the treatment of syphilis during the last ten years has been accompanied by a (
from treatment. The evidences of cure were disappearance of fever and tubercle bacilli, as well as gain in weight. Twenty-five further cases of phthisis also treated by this vaccine, but at Modena, are mentioned, of whom, all ambulant cases, 17 were cured 1 THE
LANCET, 1920, ii., 363 and 1106.