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ACTIVE IMMUNISATION AGAINST DIPHTHERIA IN ADULTS.
84 of the blood or the serum of convalescents, a method which is obviously of limited application. In scarlet fever further researches have been carried on with the Schultz-Charlton so-called extinction test, experifollows inoculation. Work on bac’llary dysentery has ments also having been conducted by Saloz and Schiff also mainly taken the form of studies on prophylactic with a view to obtaining a diagnostic complementH. Vincent inoculated 2175 subjects fixation test, in which experiments they claim to have vaccination. with a polyvalent ethero-vaccine, the doses given been successful, the antibodies disappearing on the (500 to 700 million bacilli) resulting in a decline in thirty-fifth day. The review bears out Dr. Dopter’s opening remark susceptibility to invasion by Shiga’s bacillus, as shown while no outstanding discovery regarding infecthe an 16 1000 in vaccinated rate of incidence that, by per persons compared with 228 per 1000 in the non- tious diseases was made in France during 1921, vaccinated. An interesting development has been the much interesting and suggestive work was done. work of Nicolle and Conseil, who demonstrated the possibility of protective inoculation via the digestive tract. The two subjects who voluntarily underwent ORIGIN OF COLLOID IN THE THYROID. the experiment were given by mouth for three consecutive days cultures of Shiga’s bacillus, sterilised Dr. H. M. Woodcock tells further of his work on at 75° C., and on the fifth day 100,000 million hsematophagy and haematoboly in the Journal of the bacilli, preceded and followed by six hours of a special R.A.1J;J.C. for June. He admits his conclusions are diet. Fifteen and eighteen days later the subjects were novel and not yet accepted, but he suggests that when injected with 10,000 million bacilli from virulent so much work is being done on cells, and particularly cultures of Shiga’s bacillus, no evil effects following. in the investigation of cancer, a protozoologist, such Dysentery contracted by control subjects who had as himself, accustomed to investigate life-histories not been vaccinated was immediately arrested by anti- by a static method, is particularly suited to report dysenteric serotherapy. on the precise behaviour of cells of the more Epidemic Encephalitis.-While no important clinical complicated human organism. In this contribution data have been recorded in France new biological he discusses colloid formation in the normal facts have come to light, these including the discovery thyroid and in an adenoma of the thyroid. Metchby Levaditi, Harvier, and Nicolau of the presence of nikoff, himself a protozoologist, noted that a red the specific virus in the buccal cavity and the saliva corpuscle ingested by a cell might appear as a colourof healthy subjects ; and, by the same observers, of less vacuole, but he did not know that, having first the identity of Griiter’s virus of corneal herpes, and lost in this way its staining reactions, it might of Loewenstein’s and Doerr’s virus of herpes labialis undergo further change and again acquire an affinity with that of epidemic encephalitis, the only difference for stains. Metchnikoff also noted that red corpuscles between them being that of degree of virulence. in contact with one another are apt to run together These and kindred facts, the importance of which during metabolism. And these things happen in the from an epidemiological point of view is incontestable, thyroid where the colloid appears to be formed from suggest that, properly speaking, there is no such red cells that have escaped into the acini, and have thing as an epidemic of encephalitis lethargica, but been metabolised by a ferment secreted by the nuclei that epidemics of rhino-pharyngitis, clinical or of the epithelial cells. They stain well at first, then bacteriological, may occur, caused by a specific virus losing their colour and staining reaction, and later and complicated at times by an encephalitis.-Diph- gradually reacquire this as they are being turned into iheria is discussed mainly under the three heads of colloid. The iron of the corpuscles becomes iron in Schick’s reaction, the reliability of which Dopter the colloid material, and the stages through which looks upon as doubtful and needing further confirma- this blood change is developed are beautifully shown tion ; prophylactic anti-diphtheritic vaccination, the n the photomicrographs for which Dr. D. J. Reid is value of which is heavily discounted by the difficulty responsible. In the thyroid this change occurs only of determining the optimum dose owing to the widely in the acini, but in the benign adenoma it also occurs differing individual sensitivity; and anti-diphtheritic in the inter-follicular tissue, in the capillaries, whereby - serotherapy. The oral route has been found to be new acini are constantly being thus produced. useless ; intravenous injection is useful in severe cases in which immediate action is called for ; intramuscular injection has its place in the same class of case, but with both methods the antitoxin is eliminated too ACTIVE IMMUNISATION AGAINST DIPHTHERIA rapidly to avert late complications. Subcutaneous IN ADULTS. injection remains the route for choice in the large WHILE many reports have lately been published majority of cases. On the question of diphtheritic palatal paralysis, de Lavergne has recently shown on the successful immunisation of children against that (a) anginal paralysis following an inflammation diphtheria by the toxin-antitoxin method-a success of the underlying mucosa may be averted by the use which has repeatedly been confirmed by subsequent of early and large injections of antitoxin ; (b) early Schick tests-no such studies on groups of adults have paralyses should also be treated by means of large been reported. This lacuna has now been filled by doses ; (c) in late paralyses a Schick test should be Dr. J. V. Cooke, of St. Louis,who has recently given done, and serum given in all cases in which the the results of a systematic immunisation over a period of four years of the susceptible individuals in a nurses’ reaction is positive. Under the heading of menvngococcal infection training school, all of whom were on duty for one or reference is made both to the new technique devised two months in the infectious wards of a children’s by Dopter and Dujarrie de la Riviere for the rapid hospital as part of their training. Of 147 nurses on bacteriological diagnosis of this condition, and to whom a preliminary Schick test was done, 86, or 58-5 various interesting cases that have been reported per cent., gave positive reactions, Dr. Cooke suggesting during the year, including a rare case of abscess of the that this high proportion of non-immune individuals temporal lobe following on a mastoiditis of meningo- was due to the fact that most of them had been reared coccal origin. Whooping-cough. Dopter recalls in small communities where diphtheria is much less Meyer’s experiments on the length of time during prevalent than in cities, contact with the disease which the specific organism is eliminated by the probably playing an important part in the developpatient, these researches demonstrating that by the ment of immunity. Sixty-two of the nurses showing fourth week only 10 per cent. of positive results could a positive reaction were given three subcutaneous be obtained, and after the fifth none but negative injections of toxin-antitoxin mixture with a week’s results.—Afeetses. The only point discussed by Dopter interval between each, and the Schick test repeated under this heading is the work done by Nicolle and 1 American Journal of Diseases of Children, June, 1922. Conseil on the prophylaxis of measles by the injection
typhoid patients. For the general population a campaign of education and persuasion is indicated, largely in order to counteract the dread-amounting to a phobia--of the severe reaction which occasionally of
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This arrangement, according to Mr. Jefferson, was to be expected, since the best evidence showed that the peristaltic wave was myogenic in its origin and nature. The connexions of the oblique muscle were next figured, and this coat was shown to be a, derivative of the circular muscle. The laying down of a, third coat over the cardiac portion of the viscus required some explanation, for in general in the alimentary tract the processes of digestion are satisfactorily carried out by two coats only-an inner circular and an outer longitudinal. Why should the stomach have three, and why should this third coat be applied to a part of the stomach which is relatively muscularly inactive ? Mr. Jefferson believed the answer to be that this coat is in large degree suspensory, that the activity of the gastric musculature is partly static or postural and partly phasic or peristaltic. These activities are interchangeable between the various coats in different bodily postures, the oblique coat taking on peristaltic powers for instance in recumbency. Mr. Jefferson does not think ECONOMICS OF RURAL PRACTICE. that the existence of a functional" gastric canal " can IN the issue of Health dated July 1st appears an be said to be although the longitudinal article entitled " Taxation and the Country Doctor,’’ bands and theestablished, inner views of the organ which he pointing out that whilst the rural practitioner is in displayed in his photographs were very suggestive of most ways no more taxed than his colleagues in the and presumably of its functioning-at any its towns, his transport problem is a serious one entailing ratepresence life. partially-during considerable expense. The lightest and oldest car is heavily taxed ; frequently a motor-bicycle is the only means of conveyance for a man who finds his life PLANT PATHOLOGY. already strenuous enough without such an additional THE historical evolution of pathology in this strain. Holidays and illness are complicated by the has led to its development along a rather country of a locum-tenent who difficulty rapidly obtaining narrow track starting in the post-mortem room, and combines experience and steadiness in his profession with the ability to ride a motor-bicycle. The locum- only now branching out into some of the many lines of obvious expansion. This restricted outlook is tenent of middle age, indeed, can be seriously hamplain in bacteriology and parasitology in lack in this of mechanical knowledge respect, especially pered by with us means hardly more general. Bacteriology whatever may be his professional skill. Another conof the relatively insignificant number than the study dition of the times which aggravates the economic of organisms of immediate medical and hygienic position of the country practitioner is the difficulty import. General laws can never be discovered from of the vegetable garden :such a limited outlook. The wonderful interest of "That feature of the countryside,’the doctor’s man,’ who drove the car, cultivated the potatoes, mothered the comparative pathology-and by this we mean somelocum-tenent, and knew all about the income and private thing more than the veterinary technology which life of every person in the district is, alas ! becoming almost sometimes masquerades under the title-has yet to be The wealth of material at the Zoo still extinct. A jobbing gardener and a boy from the garage appreciated. twice a week are poor substitutes for a professor in an remains almost unused, and Sir James Paget’s plea honoured and unique position, who often served three or made many years ago seems to have had as little four successive masters in the same practice and earned the response as Sir John Bland-Sutton’s more recent gratitude of them all." demonstrations of what may be found in other An appreciable amount of rural unemployment, it animals to elucidate the processes of human disease. appears, results from the frequent inability of doctor In plant pathology there are welcome signs of more and parson to employ a whole-time man at the present active interest. Readers of THE LANCET will recall day, and the reasonable suggestion is made that it the interesting lecture by Prof. V. H. Blackman on might be wise to allow a rebate on the income-tax of the processes of immunity and resistance in plants any person employing a servant who can be shown to as compared with animals, and at the forthcoming devote a reasonable portion of his time to the care of annual meeting of the British Medical Association at fruit, vegetables, pigs, and poultry. Glasgow a special Section of Microbiology apart from medical bacteriology will discuss kindred problems with a lead from Prof. Blackman and Dr. W. B. THE ANATOMICAL STRUCTURE OF THE Brierley, head of the Department of Mycology at the Rothamsted Agricultural Experiment Station at STOMACH. Harpenden. The origin of this new section of the AT the summer meeting of the Anatomical Society, Association may perhaps have some connexion with held in Edinburgh on July 23rd, Mr. Geoffrey Jefferson the fascinating work done by its president on the read a suggestive paper entitled " Some Remarks on growth and shedding of the deer’s antlers. the Anatomical Structure of the Stomach with The plant pathologist can doubtless get a good deal special reference to Gastric Function." After a brief from the highly developed specialised technique of description of the gastric mucosa, the speaker passed the medical pathologist, who in his turn can probably on to the musculature, and demonstrated by means: get more from the far wider and more varied field with of photographs of dissections that the external coat which his botanical colleagues deal-"colleagues " appeared to be derived from three sources ; (1) the- unfortunately in theory rather than practice. The coarse fibres from the oesophagus deploying on to thefacility with which a worm-hole in a potato is stomach ; (2) much finer fibres which appear to arisei lined with skin recalls the behaviour of the epidermis in the course of the organ ; and (3) fibres continuousi in a sinus, and raises the whole question of woundwith those of the duodenum. The strong bandsi healing, Prof. S. G. Shattock’s paper on which is a rare on front and back of the pars pylorica, the ligamenta example of one of our animal pathologists making pylori, were illustrated, together with their adhesionL an excursion into the vegetable world. The galls to the circular muscle fibres beneath. These form produced by hymenopterous and other parasites on important intrinsic supports to this region, and arei plants are the most exquisite examples of specific plentifully interspersed with elastic tissue. Thei anatomical responses to specific stimuli : animals circular musculature was seen to consist of inter1 THE LANCET, 1921, ii., 935. woven fibres and not of rings applied in contiguity.
four months later, when 47, or 75-8 per cent., were immune. Two more cases gave a negative reaction nine and fifteen months after the injections, 8 of the remaining 13 receiving a second series of three 5 still toxin-antitoxin injections, after which remained persistently positive. The result of the immunisation was to effect a decrease in the incidence of clinical diphtheria among these nurses of at least 90 per cent. as compared with a previous three years’ period. The local reactions following the injections are said to have been similar to those following prophylactic typhoid vaccination, and in only two cases were the constitutional effects at all severe, although several complained of listlessness and headache. Dr. Cooke concludes by emphasising the fact that it is relatively easy to protect an entire nursing staff from contracting diphtheria by the use of the Schick test and toxin-antitoxin injections.
,
,
,
typhoid patients. For the general population a campaign of education and persuasion is indicated, largely in order to counteract the dread-amounting to a phobia--of the severe reaction which occasionally of
-
85
I
This arrangement, according to Mr. Jefferson, was to be expected, since the best evidence showed that the peristaltic wave was myogenic in its origin and nature. The connexions of the oblique muscle were next figured, and this coat was shown to be a, derivative of the circular muscle. The laying down of a, third coat over the cardiac portion of the viscus required some explanation, for in general in the alimentary tract the processes of digestion are satisfactorily carried out by two coats only-an inner circular and an outer longitudinal. Why should the stomach have three, and why should this third coat be applied to a part of the stomach which is relatively muscularly inactive ? Mr. Jefferson believed the answer to be that this coat is in large degree suspensory, that the activity of the gastric musculature is partly static or postural and partly phasic or peristaltic. These activities are interchangeable between the various coats in different bodily postures, the oblique coat taking on peristaltic powers for instance in recumbency. Mr. Jefferson does not think ECONOMICS OF RURAL PRACTICE. that the existence of a functional" gastric canal " can IN the issue of Health dated July 1st appears an be said to be although the longitudinal article entitled " Taxation and the Country Doctor,’’ bands and theestablished, inner views of the organ which he pointing out that whilst the rural practitioner is in displayed in his photographs were very suggestive of most ways no more taxed than his colleagues in the and presumably of its functioning-at any its towns, his transport problem is a serious one entailing ratepresence life. partially-during considerable expense. The lightest and oldest car is heavily taxed ; frequently a motor-bicycle is the only means of conveyance for a man who finds his life PLANT PATHOLOGY. already strenuous enough without such an additional THE historical evolution of pathology in this strain. Holidays and illness are complicated by the has led to its development along a rather country of a locum-tenent who difficulty rapidly obtaining narrow track starting in the post-mortem room, and combines experience and steadiness in his profession with the ability to ride a motor-bicycle. The locum- only now branching out into some of the many lines of obvious expansion. This restricted outlook is tenent of middle age, indeed, can be seriously hamplain in bacteriology and parasitology in lack in this of mechanical knowledge respect, especially pered by with us means hardly more general. Bacteriology whatever may be his professional skill. Another conof the relatively insignificant number than the study dition of the times which aggravates the economic of organisms of immediate medical and hygienic position of the country practitioner is the difficulty import. General laws can never be discovered from of the vegetable garden :such a limited outlook. The wonderful interest of "That feature of the countryside,’the doctor’s man,’ who drove the car, cultivated the potatoes, mothered the comparative pathology-and by this we mean somelocum-tenent, and knew all about the income and private thing more than the veterinary technology which life of every person in the district is, alas ! becoming almost sometimes masquerades under the title-has yet to be The wealth of material at the Zoo still extinct. A jobbing gardener and a boy from the garage appreciated. twice a week are poor substitutes for a professor in an remains almost unused, and Sir James Paget’s plea honoured and unique position, who often served three or made many years ago seems to have had as little four successive masters in the same practice and earned the response as Sir John Bland-Sutton’s more recent gratitude of them all." demonstrations of what may be found in other An appreciable amount of rural unemployment, it animals to elucidate the processes of human disease. appears, results from the frequent inability of doctor In plant pathology there are welcome signs of more and parson to employ a whole-time man at the present active interest. Readers of THE LANCET will recall day, and the reasonable suggestion is made that it the interesting lecture by Prof. V. H. Blackman on might be wise to allow a rebate on the income-tax of the processes of immunity and resistance in plants any person employing a servant who can be shown to as compared with animals, and at the forthcoming devote a reasonable portion of his time to the care of annual meeting of the British Medical Association at fruit, vegetables, pigs, and poultry. Glasgow a special Section of Microbiology apart from medical bacteriology will discuss kindred problems with a lead from Prof. Blackman and Dr. W. B. THE ANATOMICAL STRUCTURE OF THE Brierley, head of the Department of Mycology at the Rothamsted Agricultural Experiment Station at STOMACH. Harpenden. The origin of this new section of the AT the summer meeting of the Anatomical Society, Association may perhaps have some connexion with held in Edinburgh on July 23rd, Mr. Geoffrey Jefferson the fascinating work done by its president on the read a suggestive paper entitled " Some Remarks on growth and shedding of the deer’s antlers. the Anatomical Structure of the Stomach with The plant pathologist can doubtless get a good deal special reference to Gastric Function." After a brief from the highly developed specialised technique of description of the gastric mucosa, the speaker passed the medical pathologist, who in his turn can probably on to the musculature, and demonstrated by means: get more from the far wider and more varied field with of photographs of dissections that the external coat which his botanical colleagues deal-"colleagues " appeared to be derived from three sources ; (1) the- unfortunately in theory rather than practice. The coarse fibres from the oesophagus deploying on to thefacility with which a worm-hole in a potato is stomach ; (2) much finer fibres which appear to arisei lined with skin recalls the behaviour of the epidermis in the course of the organ ; and (3) fibres continuousi in a sinus, and raises the whole question of woundwith those of the duodenum. The strong bandsi healing, Prof. S. G. Shattock’s paper on which is a rare on front and back of the pars pylorica, the ligamenta example of one of our animal pathologists making pylori, were illustrated, together with their adhesionL an excursion into the vegetable world. The galls to the circular muscle fibres beneath. These form produced by hymenopterous and other parasites on important intrinsic supports to this region, and arei plants are the most exquisite examples of specific plentifully interspersed with elastic tissue. Thei anatomical responses to specific stimuli : animals circular musculature was seen to consist of inter1 THE LANCET, 1921, ii., 935. woven fibres and not of rings applied in contiguity.
four months later, when 47, or 75-8 per cent., were immune. Two more cases gave a negative reaction nine and fifteen months after the injections, 8 of the remaining 13 receiving a second series of three 5 still toxin-antitoxin injections, after which remained persistently positive. The result of the immunisation was to effect a decrease in the incidence of clinical diphtheria among these nurses of at least 90 per cent. as compared with a previous three years’ period. The local reactions following the injections are said to have been similar to those following prophylactic typhoid vaccination, and in only two cases were the constitutional effects at all severe, although several complained of listlessness and headache. Dr. Cooke concludes by emphasising the fact that it is relatively easy to protect an entire nursing staff from contracting diphtheria by the use of the Schick test and toxin-antitoxin injections.
,
,
,