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ACUTE NITROBENZOL POISONING.
1092 series with the coil indicates the variations! Mr. L. T. current and so the cooling power. Hogben, from the Zoological Laboratory of the Imperial College of Science, illustrated the effectj of pineal gland administration on the pigment cells of tadpoles. Within half an hour the melanophoresi retract to such an extent as to turn the brown opaquei tad into a grey translucent one. No other organic! Of extract has been found to produce this result. more practical importance was a demonstration by Mr. Franklin Kidd on the application of cold-storage and gas-storage to English apples. The Food Investigation Board recognises that improved methods of apple storage are required in order to bring the home grown apple into successful competition with imported apples throughout the winter season. In cold-storage The the apples are kept just above freezing point. method is costly. In gas-storage the apples.are held in a gas mixture, created and maintained by their own respiratory activity, no machinery being required. The optimum CO., pressure has been determined and by its means the life of the apple is prolonged at a lower level of metabolism to twice its normal span. The specimens shown fully bore out this contention. in of
,
’
’
INTERNATIONAL TEAM-WORK.
than between birth and the age of 3. The argument is that infection is most rife at the age when children play amongst the dust both of the house and of the street. The hands of the normal child "are dirty most of the time " and " few children have developed a consciousness about putting their hands in their mouths." Here is a practical moral drawn from the work of two generations of the members of the tuberIt is a culosis team scattered across the world. moral that deserves attention.
ACUTE NITROBENZOL POISONING. ACCORDING to Dr. Robert F. Loeb, Dr. Arlie V. Bock and Dr. Reginald Fitz,l of the Medical Clinic of the Massachusetts General Hospital, Boston, who are engaged in a series of studies on the physiology and pathology of the blood, nitrobenzol or oil of mirbane, a coal-tar derivative resulting from the action of strong nitric acid on benzol, was first discovered by Mitscherlich in 1834, but it was not until 1859 that Caspar described it as a new poison with toxic properties. It is employed in the manufacture of high explosives, and is used to a limited extent in perfumery. soap, confectionery, cookery, in making dyes, and in pharmaceutical laboratories. Grandhomme, in 1883, collected 43 cases of nitrobenzol poisoning, the majority of which had occurred a comparatively short time after nitrobenzol had been used commercially. After the appearance of Grandhomme’s work only a few new cases were published until two years ago, when Stifel reported 17 cases which were poisoned by nitrobenzol in shoe polish. Subsequently Scott and Hanzlik, Donovan, and Dr. Loeb and his colleagues met with cases in which intoxication was due to nitrobenzol being consumed as a substitute for alcohol. The toxic action of nitrobenzol, as shown by Filehne’s experiments in 1878, is due to the fact that it renders the blood unable to transport oxygen. Experiments on dogs
COOPERATIVE effort in medical research has of recent years been productive of so much good and its value is now so widely recognised that no one can doubt that team-work will continue to contribute to the advance of medical science. Yet when all due respect has been paid to the advantages of such cooperation one is forced to admit its limitations. Brilliant as are the results published from that most admirably equipped of all local teams captained by the Mayo brothers in America, it is doubtful whether anything they have produced can rank in practical importance beside the discoveries of such individuals as Koch, Pasteur, or Noguchi. The truth is that local team-work must be compared, not always to its advantage, with individual exploits. For this reason it is well to remember that for many years there have been widely scattered international teams working together with magnificent harmony in the various fields of physical disease. This would not have been possible but for the fine medical tradition that has always prevailed among physicians of every race and ’creed. It would be inaccurate to speak of the captain of an international team. The inspiration of genius is its sole directing force. But such a team is handicapped unless it possesses at least one member endowed with such critical insight and deductive imagination that he is able to sift the work of his colleagues and rearrange their variously coloured contributions into a comprehensive and cohesive pattern-in short, the value of a captain is as obvious in an international as in a local team. A brilliant example of this will be found in a recent paper on the course of the tubercle bacillus from sputum to the child by Dr. Allen K. Krause, of Baltimore. Dr. Krause first restates the three main theories of the aetiology of pulmonary tuberculosis which may shortly be described as " the dust," the " droplet," and " the ingestion" theories. He argues that from the absence of direct evidence to confirm any one of these theories it is necessary to seek for correlative evidence. Here another group of observers, statisticians rather than pathologists, furnish their contribution. A composite infection chart is built from the charts of Moro (Munich), Mantoux (Paris), Petruschky (Danzig), Gaughofner (Prague), Pirquet and Hamburger (Vienna), Nottiman (Diisseldorf), Veeder (St. Louis), and Armstrong (Framingham). The evidence so collected shows that 10 per cent. of children are infected by the end of their second year of life, by 3 years 15 to 20 per cent., by 6 years 50 to 60 per cent., by 15 about 75 per cent.-i.e., only about one-seventh of all infected receive their first infection during the first two years. If the " droplet " method of infection accounts for all infections, then children must be confined indoors more between the ages of 4 and 7
laboratory worker who has to collect from patients each week large numbers of blood specimens for fixation of complement tests is acquainted with those curious phenomena which occasionally occur during clotting. Sometimes a blood sample will clot almost as soon as it is withdrawn from the syringe, occasionally it will remain fluid for several hours, occasionally also it shows haemolysis, and every now and then a specimen is found which produces an almost opalescent serum. Some of these phenomena are doubtless due to mechanical factors of manipulation; but apart from these it seems clear that we are presented with inexplicable stages in that colloidal reaction, coagulation of protein, which is probably due in a large measure to the reduction in the surface energy at the interface of the colloid, and is known biochemically as These colloid changes the adsorption phenomenon.
1 New York State Journal of Medicine, March, 1921, p. 83.
1 The American Journal of the Medical Sciences, April, 1921.
"
showed that haemoglobin was changed into another form with a characteristic spectroscopic absorption line which did not correspond to any of the ordinary haemoglobin products. Whether nitrobenzol haemoglobin, meth-heemoglobin, or both are produced is uncertain. The clinical picture consists in a gradual onset of nervous and digestive symptoms going on to coma and death, the skin assuming a characteristic blue-black colour. The urine is almost black and contains para-amido-phenol. In cases which recover, the changed haemoglobin returns to normal haemoglobin quickly, so that oxygen can again be carried to the body cells in a short time. Although the majority of the recent cases in America have been mild, nitrobenzol may often be a fatal poison, as is shown by the fact that the mortality among Grandhomme’s cases was 32 per cent. There is no specific antidote, but treatment consists in as complete and rapid removal as possible from the body of any nitrobenzol which has not been absorbed. Bleeding and transfusion are indicated in the severest cases. THE "STABILITARY"
REACTION OF THE BLOOD.
EVERY
,
’
’
INTERNATIONAL TEAM-WORK.
than between birth and the age of 3. The argument is that infection is most rife at the age when children play amongst the dust both of the house and of the street. The hands of the normal child "are dirty most of the time " and " few children have developed a consciousness about putting their hands in their mouths." Here is a practical moral drawn from the work of two generations of the members of the tuberIt is a culosis team scattered across the world. moral that deserves attention.
ACUTE NITROBENZOL POISONING. ACCORDING to Dr. Robert F. Loeb, Dr. Arlie V. Bock and Dr. Reginald Fitz,l of the Medical Clinic of the Massachusetts General Hospital, Boston, who are engaged in a series of studies on the physiology and pathology of the blood, nitrobenzol or oil of mirbane, a coal-tar derivative resulting from the action of strong nitric acid on benzol, was first discovered by Mitscherlich in 1834, but it was not until 1859 that Caspar described it as a new poison with toxic properties. It is employed in the manufacture of high explosives, and is used to a limited extent in perfumery. soap, confectionery, cookery, in making dyes, and in pharmaceutical laboratories. Grandhomme, in 1883, collected 43 cases of nitrobenzol poisoning, the majority of which had occurred a comparatively short time after nitrobenzol had been used commercially. After the appearance of Grandhomme’s work only a few new cases were published until two years ago, when Stifel reported 17 cases which were poisoned by nitrobenzol in shoe polish. Subsequently Scott and Hanzlik, Donovan, and Dr. Loeb and his colleagues met with cases in which intoxication was due to nitrobenzol being consumed as a substitute for alcohol. The toxic action of nitrobenzol, as shown by Filehne’s experiments in 1878, is due to the fact that it renders the blood unable to transport oxygen. Experiments on dogs
COOPERATIVE effort in medical research has of recent years been productive of so much good and its value is now so widely recognised that no one can doubt that team-work will continue to contribute to the advance of medical science. Yet when all due respect has been paid to the advantages of such cooperation one is forced to admit its limitations. Brilliant as are the results published from that most admirably equipped of all local teams captained by the Mayo brothers in America, it is doubtful whether anything they have produced can rank in practical importance beside the discoveries of such individuals as Koch, Pasteur, or Noguchi. The truth is that local team-work must be compared, not always to its advantage, with individual exploits. For this reason it is well to remember that for many years there have been widely scattered international teams working together with magnificent harmony in the various fields of physical disease. This would not have been possible but for the fine medical tradition that has always prevailed among physicians of every race and ’creed. It would be inaccurate to speak of the captain of an international team. The inspiration of genius is its sole directing force. But such a team is handicapped unless it possesses at least one member endowed with such critical insight and deductive imagination that he is able to sift the work of his colleagues and rearrange their variously coloured contributions into a comprehensive and cohesive pattern-in short, the value of a captain is as obvious in an international as in a local team. A brilliant example of this will be found in a recent paper on the course of the tubercle bacillus from sputum to the child by Dr. Allen K. Krause, of Baltimore. Dr. Krause first restates the three main theories of the aetiology of pulmonary tuberculosis which may shortly be described as " the dust," the " droplet," and " the ingestion" theories. He argues that from the absence of direct evidence to confirm any one of these theories it is necessary to seek for correlative evidence. Here another group of observers, statisticians rather than pathologists, furnish their contribution. A composite infection chart is built from the charts of Moro (Munich), Mantoux (Paris), Petruschky (Danzig), Gaughofner (Prague), Pirquet and Hamburger (Vienna), Nottiman (Diisseldorf), Veeder (St. Louis), and Armstrong (Framingham). The evidence so collected shows that 10 per cent. of children are infected by the end of their second year of life, by 3 years 15 to 20 per cent., by 6 years 50 to 60 per cent., by 15 about 75 per cent.-i.e., only about one-seventh of all infected receive their first infection during the first two years. If the " droplet " method of infection accounts for all infections, then children must be confined indoors more between the ages of 4 and 7
laboratory worker who has to collect from patients each week large numbers of blood specimens for fixation of complement tests is acquainted with those curious phenomena which occasionally occur during clotting. Sometimes a blood sample will clot almost as soon as it is withdrawn from the syringe, occasionally it will remain fluid for several hours, occasionally also it shows haemolysis, and every now and then a specimen is found which produces an almost opalescent serum. Some of these phenomena are doubtless due to mechanical factors of manipulation; but apart from these it seems clear that we are presented with inexplicable stages in that colloidal reaction, coagulation of protein, which is probably due in a large measure to the reduction in the surface energy at the interface of the colloid, and is known biochemically as These colloid changes the adsorption phenomenon.
1 New York State Journal of Medicine, March, 1921, p. 83.
1 The American Journal of the Medical Sciences, April, 1921.
"
showed that haemoglobin was changed into another form with a characteristic spectroscopic absorption line which did not correspond to any of the ordinary haemoglobin products. Whether nitrobenzol haemoglobin, meth-heemoglobin, or both are produced is uncertain. The clinical picture consists in a gradual onset of nervous and digestive symptoms going on to coma and death, the skin assuming a characteristic blue-black colour. The urine is almost black and contains para-amido-phenol. In cases which recover, the changed haemoglobin returns to normal haemoglobin quickly, so that oxygen can again be carried to the body cells in a short time. Although the majority of the recent cases in America have been mild, nitrobenzol may often be a fatal poison, as is shown by the fact that the mortality among Grandhomme’s cases was 32 per cent. There is no specific antidote, but treatment consists in as complete and rapid removal as possible from the body of any nitrobenzol which has not been absorbed. Bleeding and transfusion are indicated in the severest cases. THE "STABILITARY"
REACTION OF THE BLOOD.
EVERY