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THE RECENT SUDDEN HEAT.
1090 few cubic centimetres of sero-fibrinous fluid containing numerous polynuclears and some lymphocytes. In September another transient attack of polymorphous erythema occurred. A few days later hard nodules, at first tender, appeared over the patellas to which they appeared to adhere. In October a fresh attack of bilateral pleurisy occurred. During all this time the temperature ranged from 100’ 4° to 103’ 1° and the patient rapidly wasted and became extremely pale, but the pulmonary lesions showed no signs of In November the heart failed : the pulse progress. was thready and there was acute dyspnoea ; the liver was large and tender and a little ascites was present. Death occurred on Nov. 15th. Though tuberculosis was suspected it was not demonstrated during life. The oculoreaction was positive, but the cytology of the pleural effusion was not characteristic and cultures of the blood on various media and inoculations of guinea-pigs were negative. At the necropsy only one organ showed lesions which were tuberculous to the naked eye ; at the apex of the left lung was a grey translucent granulation of the size of a millet seed which microscopically showed the typical structure of a tubercle. Two tubercle bacilli were detected in it. At the base of the lung was a caseous tubercle of the size of a hemp seed. In none of the other organs were any lesions found which to the naked eye or to the microscope presented any nodular structure. The pleuras showed some adhesions. The heart was much hypertrophied (580 grammes) and dilated. It was completely united to the pericardium by fibrous adhesions without any nodular formation even to the microscope. On the free borders of the mitral valve was a collar of very fine papillomatous vegetations. On the tricuspid valve were similar but less developed vegetations. The with not so valve was covered aortic irregular vegetations as on the mitral Under the those valve. finely papillomatous microscope all these vegetations showed a loose slightly fibrillar tissue rich in cells (lymphocytes and large connective tissue cells). The tubercle bacillus could not be found in them. There was a large nutmeg liver. In the pericranium no trace of the nodules present during life could be found. Similarly, the synovial membranes of the knees showed no traces of inflammation. On the contrary, the patellar nodules were present. They consisted of a wall of connective tissue containing abundant cells and a cavity filled with a substance like that found in hygromas. In the wall two tubercle bacilli were found. This case, like many recent observations, enlarges our conception of tuberculosis and shows that lesions may be produced which differ widely from those recognised and may spontaneously disappear.
THE COMPOSITION AND PHYSICAL OF RENAL CALCULI.
although they are usually considered as only occasional con. stituents. In regard to the physical property of hardness, on which stress has been laid by earlier observers, Dr. Rowlands considers that this property is determined by the rate and process of formation of the stone, as a compactly deposited glossy stone is the most difficult to crush, irre. spectively of its composition. The degrees of smoothness and pigmentation appear to depend more on the rate of deposi. tion and the amount of pigment present in the urine than on the chemical nature of the stone. The calculi were collected from widely distributed districts in South-west Lancashire and North Wales and were analysed by Haller’s method.
THE RECENT SUDDEN HEAT. THE vagaries of the British climate are never ending and they afford such just cause for astonishment that the national custom of making the weather the preliminary subject of conversation is quite natural and excusable. September, which, meteorologically speaking, is one of the autumn months, gave much better and more summer-like weather last year than the three real summer months, while this year, after behaving in a manner no way remarkable for three weeks and more, it suddenly became so hot that few days and still fewer nights during the preceding three months can be compared with it, and so humid that the effect of the unseasonable height of the thermometer was extremely trying even to the most healthy and robust. And the heat did not end with September, but showed no decided diminution until some days after the birth of October. The figures below show the shade readings of the maximum and minimum thermometer at various places in England, Wales, and Scotland for the five days Sept. 29th to Oct. 3rd and also the difference from the average and the number of hours of bright sunshine. In Ireland the weather was warmer than usual and very humid, but the heat was not generally
excessive.
PROPERTIES
IN the Bioehe-nzicccl J016’J’nal for August Dr. J. Sydney Rowlands reports the results of his investigations of a series of 22 calculi, which show that there is nothing in the appearance of a calculus that will give a trustworthy clue to its composition. The pigmentation, surface, and hardness which are usually relied upon for the classification of calculi are exceedingly untrustworthy, and it is by chemical analysis alone that their nature can be determined. The work has resulted in the discovery, at least so far as this series is concerned, that uric acid and its salts are very rare In 19 of the stones examined constituents of calculi. they were absent and in the remaining three only traces were found. Of equal importance is the unexpected fact that oxalic acid, combined usually with calcium, was found in each case, although it has hitherto been regarded as a much more rare constituent than uric acid. Phosphates were also commonly present,
character of the weather was far more like the than the autumn type, for it was not until it had continued for two or three days that the temperature of the nights fell sufficiently low to permit the formation of the matutinal fog which is one of the characteristics of a fine September. As will be seen by the table, the mean of the daily maximum temperatures was from about 14° to 17° above the average and the mean of the minima about 70 to nearly 110 above. The mean temperature for the five days, which was nearly 670 in London and at Margate, and the extraordinary figure of 6811 at Aberystwyth, was everywhere much higher than the ordinary level for midsummer. The absolute maxima were 800 in some parts of London and also at Manchester, Bettws-y-Coed, and several places in the Midlands. The record for October, which goes back for The
general
summer
1091 l two and a half cubic centimetres) from a vein in the least a This suggests that the number of bacilli in the blood arm. heat was accompanied by extreme humidity. During an in i: the second and third weeks is much lower than in the average fine, hot day in summer the relative humidity (the ffirst. In the 22 cases admitted under the diagnosis of percentage of the possible amount of water vapour in the Eenteric fever, which proved to be incorrect, blood cultures B air) ranges from about 75 per cent. in the early morning were negative except in one, in which the staphylococcus to between 40 and 55 by the afternoon, increasing again1pyogenes aureus was found. The value of blood culture in to about 75 per cent. after sunset. Last week, however(diagnosis in the first week of enteric fever, when the Widal the figures were not far below 100 per cent., except occa- ireaction is generally absent, is therefore great. A cubic sionally for a short time during the afternoon, and then notcentimetre of blood is then sufficient for each culture, but in often below 70 per cent. In very dry countries the amount the second and third week a larger quantity gives a higher of humidity with such temperatures as are now under con- percentage of positive results. sideration ranges from about 20 to 40 per cent. The conditions that brought such great heat about were fairly A SCIENTIFIC PRIEST ON THE DANGERS OF simple and would have produced warm weather even in midHOLY WATER. winter. The United Kingdom was situated between a large THE sanitary dangers lurking in’’ holy water " have often high-pressure system or anticyclone, which lay over the been referred to by medical men. They have recently been central countries of Europe and the Baltic region and studied by a monk, Fr. Augustin Gemelli, extended across the North Sea, and a very extensive low- scientifically who is himself a highly qualified medical man. He pubpressure area which occupied the space on the Atlantic lishes his results in the Scitola Cattolica. Each cubic between the Azores and Iceland. Such a distribution of of holy water in the basins in the church pressure compelled the air from the southern regions of the of Santa Croce, Turin, taken from the surface contained Atlantic to flow in a steady stream over this country and as while a cubic centimetre taken from it encountered a cloudless sky when passing over the land 150,000 microbes, the bottom contained no less than 6,000,000 microbes. He its already high temperature became greatly accentuated. this water into animals and found that it always During the latter part of the period the stream of warm air injected killed them, the causes of death being tuberculosis, colitis, from the south ceased in the south and east of England, but He does not think a daily cleansing with or diphtheria. as it was succeeded by a gentle flow of warm air from the but recommends a new form of continent the temperature underwent very little modification. corrosive sublimate sufficient, holy water receptacle so constructed that persons instead of THE EARLY DIAGNOSIS OF ENTERIC FEVER BY dipping their fingers into it can obtain three drops of water by pressing a button. A vessel of this nature has been BLOOD CULTURE. placed in the church of Vergiate, Milan.l Fr. Gemelli IN 1906 Conradi showed that in enteric fever the bacillus turned his attention also to the grilles in the confessional could be cultivated from the blood in much larger perboxes. Water which had been used for washing these only centages of cases by using ox bile as a medium than by using contained 25 microbes per cubic centimetre and when the ordinary media. This has been confirmed by several , injected into animals only proved fatal to 10 per cent. of writers. In the Boston Medical and S‘tcrgicczl Jowrnal of them. June 4th Dr. 0. R. Mabee and Dr. A. E. Taft have reported a series of 120 consecutive cases in which the patients were RESULTS OF X RAY TREATMENT OF RINGWORM. admitted to the Boston City Hospital as suffering from THE recently issued report of the Metropolitan Asylums enteric fever during an epidemic in that city and cultures for 1907 contains some interesting statistics bearing on Board were made from the blood. Fresh ox bile was used as a the results of the x ray method of treatment of cases of ringmedium in 90 cases and inspissated bile in the other 30,with worm in the Downs Ringworm School provided by that Board. equally good results. Five cubic centimetres of the fresh It is stated that the duration of residence of these cases in bile were placed in tubes and sterilised in an autoclave for 30 the above-mentioned school before this new method of treatminutes at 15 pounds pressure. The blood was obtained from ment was introduced averaged about 18 months, whereas the the lobe of the ear. The skin was cleansed with soap and water of detention of 100 cases so treated in 1906 and then with 70 per cent. of alcohol. This was allowed to average period did not exceed 573 months, or, if calculated from the time evaporate and then a deep puncture was made with the this treatment actually began, was only 4’ 49 months. During point of a small scalpel. The blood was collected in sterile 1907 the average period of detention of the last 100 cases pipettes. It was at once transferred to the ox bile before treated by x rays and discharged prior to Dec. 31st last clotting could take place. After incubation at 370 C. was 6’21 months. The report states that owing to the for six hours platinum loops of the culture were transdemand made in this ringworm school on the apparatus, ferred to plain bouillon (as the dark colour of the bile which has since been enlarged, many cases had to wait some rendered detection of a few microbes difficult). In most time before being so treated, and if the period of detention in of the cases in which the bacillus was present it was found these 100 cases is calculated from the date of the comin the first transfer to the bouillon ; if not, other transfers mencement of the treatment it averaged only 5’ 33 months. were made from the bile culture after longer periods of incubation. If the fourth transfer showed no bacilli the case was It is pointed out that the slight increase of average detention in 1907, compared with that in 1906, was largely regarded as negative. Of the 120 patients 98 developed of cases due to delay in discharging cases last year caused by small typical symptoms of enteric fever. The percentage of positive results in the first week was 95, in the second outbreaks of whooping-cough and chicken-pox in these 17-7, and in the third 14-2. Comparing these results with schools. It is satisfactory to note that the number of cases the Widal reaction in the same cases the percentage of positive under treatment in the Downs school, which averaged 554 results in the first week was five, and in the second and third during the three years 1903-04-05, had declined to 339 on weeks 100. The percentage of positive results from cultures Dec. 31st, 1906, and on Dec. 31st last had further fallen to 329. This decrease was in great measure due to the in the first week corresponds with that of other observers, but in the second and third week is much lower than that of 1 An apparatus of this kind was described in THE LANCET of .some observers who took a much larger quantity of blood (at Jan. 27th, 1900, p. 252.
nearly forty
years,
was
Wales, and Scotland.
broken in several parts of England, As has been already remarked, the
centimetre
.
THE COMPOSITION AND PHYSICAL OF RENAL CALCULI.
although they are usually considered as only occasional con. stituents. In regard to the physical property of hardness, on which stress has been laid by earlier observers, Dr. Rowlands considers that this property is determined by the rate and process of formation of the stone, as a compactly deposited glossy stone is the most difficult to crush, irre. spectively of its composition. The degrees of smoothness and pigmentation appear to depend more on the rate of deposi. tion and the amount of pigment present in the urine than on the chemical nature of the stone. The calculi were collected from widely distributed districts in South-west Lancashire and North Wales and were analysed by Haller’s method.
THE RECENT SUDDEN HEAT. THE vagaries of the British climate are never ending and they afford such just cause for astonishment that the national custom of making the weather the preliminary subject of conversation is quite natural and excusable. September, which, meteorologically speaking, is one of the autumn months, gave much better and more summer-like weather last year than the three real summer months, while this year, after behaving in a manner no way remarkable for three weeks and more, it suddenly became so hot that few days and still fewer nights during the preceding three months can be compared with it, and so humid that the effect of the unseasonable height of the thermometer was extremely trying even to the most healthy and robust. And the heat did not end with September, but showed no decided diminution until some days after the birth of October. The figures below show the shade readings of the maximum and minimum thermometer at various places in England, Wales, and Scotland for the five days Sept. 29th to Oct. 3rd and also the difference from the average and the number of hours of bright sunshine. In Ireland the weather was warmer than usual and very humid, but the heat was not generally
excessive.
PROPERTIES
IN the Bioehe-nzicccl J016’J’nal for August Dr. J. Sydney Rowlands reports the results of his investigations of a series of 22 calculi, which show that there is nothing in the appearance of a calculus that will give a trustworthy clue to its composition. The pigmentation, surface, and hardness which are usually relied upon for the classification of calculi are exceedingly untrustworthy, and it is by chemical analysis alone that their nature can be determined. The work has resulted in the discovery, at least so far as this series is concerned, that uric acid and its salts are very rare In 19 of the stones examined constituents of calculi. they were absent and in the remaining three only traces were found. Of equal importance is the unexpected fact that oxalic acid, combined usually with calcium, was found in each case, although it has hitherto been regarded as a much more rare constituent than uric acid. Phosphates were also commonly present,
character of the weather was far more like the than the autumn type, for it was not until it had continued for two or three days that the temperature of the nights fell sufficiently low to permit the formation of the matutinal fog which is one of the characteristics of a fine September. As will be seen by the table, the mean of the daily maximum temperatures was from about 14° to 17° above the average and the mean of the minima about 70 to nearly 110 above. The mean temperature for the five days, which was nearly 670 in London and at Margate, and the extraordinary figure of 6811 at Aberystwyth, was everywhere much higher than the ordinary level for midsummer. The absolute maxima were 800 in some parts of London and also at Manchester, Bettws-y-Coed, and several places in the Midlands. The record for October, which goes back for The
general
summer
1091 l two and a half cubic centimetres) from a vein in the least a This suggests that the number of bacilli in the blood arm. heat was accompanied by extreme humidity. During an in i: the second and third weeks is much lower than in the average fine, hot day in summer the relative humidity (the ffirst. In the 22 cases admitted under the diagnosis of percentage of the possible amount of water vapour in the Eenteric fever, which proved to be incorrect, blood cultures B air) ranges from about 75 per cent. in the early morning were negative except in one, in which the staphylococcus to between 40 and 55 by the afternoon, increasing again1pyogenes aureus was found. The value of blood culture in to about 75 per cent. after sunset. Last week, however(diagnosis in the first week of enteric fever, when the Widal the figures were not far below 100 per cent., except occa- ireaction is generally absent, is therefore great. A cubic sionally for a short time during the afternoon, and then notcentimetre of blood is then sufficient for each culture, but in often below 70 per cent. In very dry countries the amount the second and third week a larger quantity gives a higher of humidity with such temperatures as are now under con- percentage of positive results. sideration ranges from about 20 to 40 per cent. The conditions that brought such great heat about were fairly A SCIENTIFIC PRIEST ON THE DANGERS OF simple and would have produced warm weather even in midHOLY WATER. winter. The United Kingdom was situated between a large THE sanitary dangers lurking in’’ holy water " have often high-pressure system or anticyclone, which lay over the been referred to by medical men. They have recently been central countries of Europe and the Baltic region and studied by a monk, Fr. Augustin Gemelli, extended across the North Sea, and a very extensive low- scientifically who is himself a highly qualified medical man. He pubpressure area which occupied the space on the Atlantic lishes his results in the Scitola Cattolica. Each cubic between the Azores and Iceland. Such a distribution of of holy water in the basins in the church pressure compelled the air from the southern regions of the of Santa Croce, Turin, taken from the surface contained Atlantic to flow in a steady stream over this country and as while a cubic centimetre taken from it encountered a cloudless sky when passing over the land 150,000 microbes, the bottom contained no less than 6,000,000 microbes. He its already high temperature became greatly accentuated. this water into animals and found that it always During the latter part of the period the stream of warm air injected killed them, the causes of death being tuberculosis, colitis, from the south ceased in the south and east of England, but He does not think a daily cleansing with or diphtheria. as it was succeeded by a gentle flow of warm air from the but recommends a new form of continent the temperature underwent very little modification. corrosive sublimate sufficient, holy water receptacle so constructed that persons instead of THE EARLY DIAGNOSIS OF ENTERIC FEVER BY dipping their fingers into it can obtain three drops of water by pressing a button. A vessel of this nature has been BLOOD CULTURE. placed in the church of Vergiate, Milan.l Fr. Gemelli IN 1906 Conradi showed that in enteric fever the bacillus turned his attention also to the grilles in the confessional could be cultivated from the blood in much larger perboxes. Water which had been used for washing these only centages of cases by using ox bile as a medium than by using contained 25 microbes per cubic centimetre and when the ordinary media. This has been confirmed by several , injected into animals only proved fatal to 10 per cent. of writers. In the Boston Medical and S‘tcrgicczl Jowrnal of them. June 4th Dr. 0. R. Mabee and Dr. A. E. Taft have reported a series of 120 consecutive cases in which the patients were RESULTS OF X RAY TREATMENT OF RINGWORM. admitted to the Boston City Hospital as suffering from THE recently issued report of the Metropolitan Asylums enteric fever during an epidemic in that city and cultures for 1907 contains some interesting statistics bearing on Board were made from the blood. Fresh ox bile was used as a the results of the x ray method of treatment of cases of ringmedium in 90 cases and inspissated bile in the other 30,with worm in the Downs Ringworm School provided by that Board. equally good results. Five cubic centimetres of the fresh It is stated that the duration of residence of these cases in bile were placed in tubes and sterilised in an autoclave for 30 the above-mentioned school before this new method of treatminutes at 15 pounds pressure. The blood was obtained from ment was introduced averaged about 18 months, whereas the the lobe of the ear. The skin was cleansed with soap and water of detention of 100 cases so treated in 1906 and then with 70 per cent. of alcohol. This was allowed to average period did not exceed 573 months, or, if calculated from the time evaporate and then a deep puncture was made with the this treatment actually began, was only 4’ 49 months. During point of a small scalpel. The blood was collected in sterile 1907 the average period of detention of the last 100 cases pipettes. It was at once transferred to the ox bile before treated by x rays and discharged prior to Dec. 31st last clotting could take place. After incubation at 370 C. was 6’21 months. The report states that owing to the for six hours platinum loops of the culture were transdemand made in this ringworm school on the apparatus, ferred to plain bouillon (as the dark colour of the bile which has since been enlarged, many cases had to wait some rendered detection of a few microbes difficult). In most time before being so treated, and if the period of detention in of the cases in which the bacillus was present it was found these 100 cases is calculated from the date of the comin the first transfer to the bouillon ; if not, other transfers mencement of the treatment it averaged only 5’ 33 months. were made from the bile culture after longer periods of incubation. If the fourth transfer showed no bacilli the case was It is pointed out that the slight increase of average detention in 1907, compared with that in 1906, was largely regarded as negative. Of the 120 patients 98 developed of cases due to delay in discharging cases last year caused by small typical symptoms of enteric fever. The percentage of positive results in the first week was 95, in the second outbreaks of whooping-cough and chicken-pox in these 17-7, and in the third 14-2. Comparing these results with schools. It is satisfactory to note that the number of cases the Widal reaction in the same cases the percentage of positive under treatment in the Downs school, which averaged 554 results in the first week was five, and in the second and third during the three years 1903-04-05, had declined to 339 on weeks 100. The percentage of positive results from cultures Dec. 31st, 1906, and on Dec. 31st last had further fallen to 329. This decrease was in great measure due to the in the first week corresponds with that of other observers, but in the second and third week is much lower than that of 1 An apparatus of this kind was described in THE LANCET of .some observers who took a much larger quantity of blood (at Jan. 27th, 1900, p. 252.
nearly forty
years,
was
Wales, and Scotland.
broken in several parts of England, As has been already remarked, the
centimetre
.