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A DUAL ORIGIN FOR RICKETS.
704 and after-care.
The section contains a stimulating forth the ideals of public service which should actuate all those who work for the common weal, and the report ends with a section on practical steps towards the ideal-the first step towards this being the acquisition of the Poor-law infirmaries from the guardians and the transference of them to the local health authorities. We welcome this report as a contribution towards the discussion of national health, aroused by the state of things revealed by the medical boards during the war. Every reader of the Labour Party’s pamphlet may not agree with the proposals set forth, but the suggestions made and the principles enunciated are free from bitterness and party rancour : " It will make no difference to the recording angel whether or not the hospital is controlled by the local health authorities .... To the truly charitable, opportunities of service are of even greater value than gifts in kind, and to these there can hardly be a limit even under a public medical service." The report purports to be, and is, an honest and frank statement of what Labour stands for in public health administration.
paragraph setting
A
DUAL ORIGIN
FOR RICKETS.
Two widely different explanations have been given o: the common origin of rickets, different but not mutuall3 exclusive. Some observations by E. V. McColluix and his co-workers recently communicated1 to thE Society for Experimental Biology, point to the existencE of more than one kind of the disease. Amongst thE clinical observations which led these observers tc the possibility of this duality are certain peculiai manifestations of the disease and associations with other diseases. Rickets occurs with great frequency in premature children, even when breast-fed, and it seems to affect the head more than the extremities or ribs. Indeed, the rachitic involvement of the head in these children appears to be out of all proportion to the involvement of the extremities. In another group of cases of rickets the disease shows an especial tendency to involve the shafts of the long bones, with the of multiple fractures from trivial causes. occurrence There is a curious association between rickets and certain forms of secondary anaemia (so-called alimentary anaemias). Rickets is also associated with the most severe forms of chronic interstitial nephritis or developmental defects of the kidney. Tetany sometimes occurs with rickets, sometimes not. Experiment, however, seems to yield results which indicate that there may be two distinct forms of the disease. It is already known that certain defective diets when fed to the young rat produce marked disturbances in growth and calcification of the skeleton-such diets were all insufficiently supplied with a factor or factors present in cod-liver oil, but differed considerably in their mineral fraction, chiefly as regards their calcium and phosphorus. In one group the phosphorus was at a low level, but the calcium at or above the optimal level ; in the other group the calcium was at an extremely low level but the phosphorus was not far from the optimal. Young rats fed under laboratory conditions (room light) with the former diet developed a diseased condition of the skeleton which was identical in all essential particulars with that seen in the rickets of human beingsthe costo-chondral junctions were greatly enlarged, the long bones of extremities enlarged at the ends, they could be cut and broken easily ; the rachitic metaphysis was well marked, calcium deposition was entirely lacking or extremely defective. Young rats fed on the second diet developed a diseased condition of the skeleton which also bore resemblance to the lesions found in the rickets of human beings ; the gross deformities were as great or even greater than in the first group, but the pathological condition induced in the bones by the diets of the second group did not correspond at all points to that usually found in the human subjects of the disease. The authors, in discussing their results, come to the conclusion that
Proceedings, January, 1922.
in the rat, when deprived of certain light rays and an unidentified factor contained in cod-liver oil, a pathological condition corresponding in all fundamental respects to the rickets of human beings can be produced through the diet in two ways : (1) by diminishing the phosphorus in the diet and supplying calcium in excess ; or (2) by reducing the calcium but maintaining the phosphorus at a concentration somewhere near the optimal. They are led to believe that there are two main forms of rickets, one characterised by a normal or nearly normal blood calcium and a low phosphorus, the calcium-phosphate ratio being high, the other by a normal or nearly normal phosphorus, but low calcium, the calcium-phosphorus ratio being low. Between the two there are probably innumerable forms. On theoretical grounds, the observers think it possible that the rickets which develops in the youthful subjects of the severe functional derangements of the kidney may belong to the low calcium form of the disease; in other words, that the rickets in these patients may be truly endogenous in origin, depending primarily on the inability of the kidney to excreta phosphorus. The authors remark that if this view proves to be correct " renal dwarfism " is in reality renal rickets and ought so to be called and regarded.
SARCOMA OF THE PENIS. SARCOMA of the penis is a somewhat rare tumour,, only a score or so of cases having been reported up to the present time. In a recent number of Le Scalpel. (March llth) Dr. F. Van den Branden, of Brussels, reports a case occurring in a mechanic aged 31. It was only seen by him after five months of evolution during which it had been more than once mistaken for a chancre. Since the third month there had been pain sufficiently severe to interfere with sleep. During the five months the patient had lost over 2 st. in weight. There were enlarged painless glands in both groins. The penis was amputated 2 cm. above the pubis. Sections of the growth showed a large-celled sarcoma. Radiotherapy was administered and the patient left the hospital after a month. Four months later, however, he returned with greatly enlarged inguinal glands. An attempt was made to extirpate the growth by dissection and electro-coagulation but without success. At autopsy metastases were found in the right kidney and suprarenal body. The moral of this case, as the author points out, is twofold-the importance of early diagnosis and the necessity, in spite of the views of several writers, of immediate dissection of the inguinal glands. BOVINE TUBERCLE AND MAN. THE case for the present campaign in favour of purer milk is so unanswerably strong that it would be a great pity if it were overstated. In a recent letter to the Times a medical correspondent suggested that if Sir Alfred Mond would devote half a million of money to the supply of tubercle-free milk to the children of the country, he would soon eliminate surgical tuberculosis. Speaking in Parliament a few days later, Sir Watson Cheyne was credited with the statement that "... about 60 per cent. of the various forms of disease in children were due to infection from tuberculous cattle by means of milk ... " Do the facts as ascertained support such statements as theseScandinavian experience points definitely in another direction. In a monograph published by Dr. F. Harbitz,1professor of pathology at the University of Christiania, and president of the Norwegian National Association for Combating Tuberculosis, present knowledge of tuberculosis, is reviewed in the detached and objective light. of the bacteriological laboratory and post-mortem room. Prof. Harbitz publishes maps of Norway showing the distribution of tuberculosis in man and cattle, and it is obvious at a glance thatthe
1
Om Oprindelsen til og utviklingen Sygdommer, Christiania, 1922, pp. 96.
av
de Tuberkulöse
The section contains a stimulating forth the ideals of public service which should actuate all those who work for the common weal, and the report ends with a section on practical steps towards the ideal-the first step towards this being the acquisition of the Poor-law infirmaries from the guardians and the transference of them to the local health authorities. We welcome this report as a contribution towards the discussion of national health, aroused by the state of things revealed by the medical boards during the war. Every reader of the Labour Party’s pamphlet may not agree with the proposals set forth, but the suggestions made and the principles enunciated are free from bitterness and party rancour : " It will make no difference to the recording angel whether or not the hospital is controlled by the local health authorities .... To the truly charitable, opportunities of service are of even greater value than gifts in kind, and to these there can hardly be a limit even under a public medical service." The report purports to be, and is, an honest and frank statement of what Labour stands for in public health administration.
paragraph setting
A
DUAL ORIGIN
FOR RICKETS.
Two widely different explanations have been given o: the common origin of rickets, different but not mutuall3 exclusive. Some observations by E. V. McColluix and his co-workers recently communicated1 to thE Society for Experimental Biology, point to the existencE of more than one kind of the disease. Amongst thE clinical observations which led these observers tc the possibility of this duality are certain peculiai manifestations of the disease and associations with other diseases. Rickets occurs with great frequency in premature children, even when breast-fed, and it seems to affect the head more than the extremities or ribs. Indeed, the rachitic involvement of the head in these children appears to be out of all proportion to the involvement of the extremities. In another group of cases of rickets the disease shows an especial tendency to involve the shafts of the long bones, with the of multiple fractures from trivial causes. occurrence There is a curious association between rickets and certain forms of secondary anaemia (so-called alimentary anaemias). Rickets is also associated with the most severe forms of chronic interstitial nephritis or developmental defects of the kidney. Tetany sometimes occurs with rickets, sometimes not. Experiment, however, seems to yield results which indicate that there may be two distinct forms of the disease. It is already known that certain defective diets when fed to the young rat produce marked disturbances in growth and calcification of the skeleton-such diets were all insufficiently supplied with a factor or factors present in cod-liver oil, but differed considerably in their mineral fraction, chiefly as regards their calcium and phosphorus. In one group the phosphorus was at a low level, but the calcium at or above the optimal level ; in the other group the calcium was at an extremely low level but the phosphorus was not far from the optimal. Young rats fed under laboratory conditions (room light) with the former diet developed a diseased condition of the skeleton which was identical in all essential particulars with that seen in the rickets of human beingsthe costo-chondral junctions were greatly enlarged, the long bones of extremities enlarged at the ends, they could be cut and broken easily ; the rachitic metaphysis was well marked, calcium deposition was entirely lacking or extremely defective. Young rats fed on the second diet developed a diseased condition of the skeleton which also bore resemblance to the lesions found in the rickets of human beings ; the gross deformities were as great or even greater than in the first group, but the pathological condition induced in the bones by the diets of the second group did not correspond at all points to that usually found in the human subjects of the disease. The authors, in discussing their results, come to the conclusion that
Proceedings, January, 1922.
in the rat, when deprived of certain light rays and an unidentified factor contained in cod-liver oil, a pathological condition corresponding in all fundamental respects to the rickets of human beings can be produced through the diet in two ways : (1) by diminishing the phosphorus in the diet and supplying calcium in excess ; or (2) by reducing the calcium but maintaining the phosphorus at a concentration somewhere near the optimal. They are led to believe that there are two main forms of rickets, one characterised by a normal or nearly normal blood calcium and a low phosphorus, the calcium-phosphate ratio being high, the other by a normal or nearly normal phosphorus, but low calcium, the calcium-phosphorus ratio being low. Between the two there are probably innumerable forms. On theoretical grounds, the observers think it possible that the rickets which develops in the youthful subjects of the severe functional derangements of the kidney may belong to the low calcium form of the disease; in other words, that the rickets in these patients may be truly endogenous in origin, depending primarily on the inability of the kidney to excreta phosphorus. The authors remark that if this view proves to be correct " renal dwarfism " is in reality renal rickets and ought so to be called and regarded.
SARCOMA OF THE PENIS. SARCOMA of the penis is a somewhat rare tumour,, only a score or so of cases having been reported up to the present time. In a recent number of Le Scalpel. (March llth) Dr. F. Van den Branden, of Brussels, reports a case occurring in a mechanic aged 31. It was only seen by him after five months of evolution during which it had been more than once mistaken for a chancre. Since the third month there had been pain sufficiently severe to interfere with sleep. During the five months the patient had lost over 2 st. in weight. There were enlarged painless glands in both groins. The penis was amputated 2 cm. above the pubis. Sections of the growth showed a large-celled sarcoma. Radiotherapy was administered and the patient left the hospital after a month. Four months later, however, he returned with greatly enlarged inguinal glands. An attempt was made to extirpate the growth by dissection and electro-coagulation but without success. At autopsy metastases were found in the right kidney and suprarenal body. The moral of this case, as the author points out, is twofold-the importance of early diagnosis and the necessity, in spite of the views of several writers, of immediate dissection of the inguinal glands. BOVINE TUBERCLE AND MAN. THE case for the present campaign in favour of purer milk is so unanswerably strong that it would be a great pity if it were overstated. In a recent letter to the Times a medical correspondent suggested that if Sir Alfred Mond would devote half a million of money to the supply of tubercle-free milk to the children of the country, he would soon eliminate surgical tuberculosis. Speaking in Parliament a few days later, Sir Watson Cheyne was credited with the statement that "... about 60 per cent. of the various forms of disease in children were due to infection from tuberculous cattle by means of milk ... " Do the facts as ascertained support such statements as theseScandinavian experience points definitely in another direction. In a monograph published by Dr. F. Harbitz,1professor of pathology at the University of Christiania, and president of the Norwegian National Association for Combating Tuberculosis, present knowledge of tuberculosis, is reviewed in the detached and objective light. of the bacteriological laboratory and post-mortem room. Prof. Harbitz publishes maps of Norway showing the distribution of tuberculosis in man and cattle, and it is obvious at a glance thatthe
1
Om Oprindelsen til og utviklingen Sygdommer, Christiania, 1922, pp. 96.
av
de Tuberkulöse