- Email: [email protected]
AN ALMONER'S DEPARTMENT.
1253
THE POISON OF TICK PARALYSIS.
microscopical examination of the cesophageal tissue. With the exception of a patient in whom the stenosis was complete all the 40 cases were treated by dilatation with excellent functional results and without .death.
a
____
UNIVERSITIES YEAR
BOOK, 1931.
July 7th-10th next the fourth quinquennial of British universities will be held at Edinburgh. We have received from Messrs. G. Bell and Sons a copy of the Year Book of the Universities of the Empire for 1931, published for the Universities Bureau and edited by Sir H. Frank Heath. From its appearance in 1914, this year book has aimed at presenting in handy form such information about British universities, of which there are now 70 or more, as is likely to interest members of other universities and colleges, government departments, clubs, schoolmasters, and the public generally. With what success this has been achieved under a - series of able editors can best be visualised by those who have been obliged to seek such information in the calendars of the several universities without its help. Each section of the year book contains a directory of the officers and members of the staff of the university, a general account of the facilities .offered and of the equipment provided, and a report of the last academic year. In 1930 there was added to the year book a survey of facilities available for .scientific research, and now there is a further comprehensive review of the aids available in every country for post-graduate students and research workers. The register of names at the end of the volume has long been a bright spot in every reference library, and the general information has now been adequately indexed. The price of the year book is 15s. FROM .congress
THE POISON OF TICK PARALYSIS. Ix several parts of the world, notably British ’Columbia, South Africa, and Queensland, sheep which havebeen bitten by certain species of ticks develop an incoordination of the hind legs which gradually works up the spine until death results from respiratory paralysis, the effect being due to a toxic degeneration of the spinal cord. Other animals and occasionally man are affected in the same way. P. Regendanz and E. Reichenow have been investigating’at Hamburg the action of the poison of an ixodid tick, Rhipicephalus sanguineus, which produces a clinical syndrome of this kind. They find that the poison is not in the tick before it feeds, nor after it has laid its eggs ; it is in the ova, but not in the developed larvse. The poison is formed in the ovary, which enlarges in proportion as blood ingested increases, but it is concentrated in the ova (not in the shells), and tcirculates through the body of the tick, thus reaching the salivary gland, which increases in size, and in output of saliva, during the days of feeding. The gland does not itself form the poison, but passes it through to the saliva. Thus the poison reaches the host if suction is interfered with, or if the tick remains attached to the host after its meal. The poison is destroyed in the digestive system of the host, but injected subcutaneously into dogs, rabbits, guineapigs, rats, mice, or canaries, causes immediate vomiting and weakness, death occurring in a couple of days. The authors regard the poison as similar to that of spiders such as Lathi-odectus erebus, but they have discovered no means of immunisation - against it. 1
Arch. f. Schiffs-
u.
Tropen-Hygiene, May, 1931, p. 255.
AN ALMONER’S DEPARTMENT.
No hospital is complete nowadays without its social service department, and the first of all these departments-that at St. Thomas’s Hospital-now publishes an annual report covering 40 pages. The changed conditions of hospital practice have by no means made the almoner’s department less necessary, though they may perhaps have changed the work in some ways. More and more the almoner has to take the position of interpreter between the language of treatment and cure as applied to a case " and the language of the patient as an individual with personal and family difficulties. " The function of the almoner," says this report, " is not to superimpose material benefits regardless of the reaction of the patient, not even to attempt to tidy up an untidy world, but to help the patient whenever possible to help himself, to wake up his innate desire for progress and better things, to try to prevent the disaster of illness from crushing character and from killing hope, and to help patients to readjust themselves, as soon as possible and as far as possible, to normal life." The two outstanding problems of the present time are housing and unemployment, the evil effects of which cause ill-health, while ill-health in its turn unfits people for taking work when it is available and, worse still, causes them to lose the hope or desire of anything better. The patients’ payments in 1930 were more than JE700 less than in 1929, and the almoner has a hard time in striking a fair balance for the basis of payment. The hospital is being increasingly used as a consultative centre by private doctors, and the numbers with which the almoner has to deal, at high speed yet without apparent hurry, are almost overwhelming. Each of the special departments of the out-patient hall has its own special problems for the almoner. The orthopaedic patient presents the difficulty of finding suitable accommodation for adult or child who has to be in plaster for many weeks, as well as the provision of appliances. The ophthalmic department offers all the problems connected with the sightless, particularly the training of mothers of blind children so that the child is taught to make the full use of the faculties it has and is not endowed with that cruellest of all gifts-self-pity. In the ear, nose, and throat department the almoner has to deal with the equally great tragedy of the deaf. The children’s department is a busy but often happy and hopeful one ; its work includes provision for rheumatism, heart trouble, asthma, maladjustment, and mental deficiency, and the complete re-establishment of health by long periods in convalescent homes. There is still a lack of convalescent accommodation While recognising the for children under three. tremendous advance in the treatment of tuberculosis during the last 20 years, the report draws attention to the drawbacks of having two authorities for tuberculous patients in London : the tuberculosis scheme and the public assistance department. Much can be done, however, to overcome these difficulties by close cooperation. The Lydia out-patient department for venereal disease has many special problems ; many of the patients need psychological treatment as much as physical, and for many work has to be found if they are to be helped at all. The maternity department has seen two important changes during the last year : the arrangement that every patient should have a trained nurse as well as a doctor, and the abolition of payment by women attended on the district. The almoner has not only to arrange the provision of home help during the confinement and for the care of the unmarried mother, but also to "
1254
A TREATMENT FOR CARBUNCLE.
follow up the babies who attend the welfare centre
can be controlled to some extent by pressure with the the first year of their life. finger. No further injection is given for 24 hours, by The speech clinic has now been working for 18 which time, as a rule, the artificial hypersemia, has years, and the number of admissions is increasing. disappeared. The treatment is then repeated as The fathers’ and mothers’ centre has moved into an often as may be necessary. The number of injections enlarged building where there is scope for new required depends on the stage at which they are ventures, bigger nurseries, and an open-air roof begun, and it occasionally happens that six or eight garden, while the old informal atmosphere is are needed before suppuration occurs. Meanwhile, maintained. it is said, the symptoms are obviously controlled. Pain and fixation disappear almost at once, and the TO BOOK LOVERS. patient feels better. The symptoms soon return Messrs. Sotheby are announced to sell shortly, however; the temperature rises, and in 24 hours the in the New Bond-street auction rooms, London, two bluish periphery of the carbuncle assumes a ruddier rare books which have direct interest for the medical tint, which is regarded as evidence of acceleration of profession as well as the bibliophile. The first is the more acute stage. The same phenomena are a translation of Ulric von Hutten’s "De Morbi provoked by the second and third injections, if Gallici Quaestione, &c.," published in 1539, the required, but no case appears to have needed more translation being entitled " Of the Wood called than eight injections in all. An increased tendency Guaiacum that Healeth the French Pockes." to small local haemorrhages at each change of dressing Guaiacum had been introduced into Europe by the will usually be noted and need not be feared ; it Spaniards some 20 years before, although the action springs from an activated blood-supply and is of the resin was not known till later. Von Hutten’s easily controlled by pressure. A further local treatise was written shortly after his famous epistolary manifestation of the protective response is the developsatires on theologians and was translated by Thomas ment of superficial pustules near the carbuncle, Paynel and published in London by one, Thomas while marked general sweating is a common sign of Berthelot. The disease referred to is, of course, recovery. Healing of the lesion is sometimes associated with a local itching which is in striking syphilis, which we called after the people from whom contrast with the pain caused by the slightest pressure it was introduced into Britain, just as they named it after the Italians who, in turn, blamed it on to the on an untreated carbuncle. Gerlach claims that Spaniards. The other book is rarer, probably, if the case is treated in its early stages, before necrosis for it is thought that but two other copies exist, has begun, the whole process remains localised and It is a small subcutaneous, and the pus is evacuated through a one in England and one in America. John octavo volume Dr. Caius, and was pea-sized opening, so that the scar is subsequently by paged R. in 1552 London Grafton. The invisible. The best local dressing is a moist compress in published by of diluted arnica in normal saline. Furthermore he name of it is " A Boke, or Counsell against the Disease commonly called the Sweate, or Sweatying says that large boils mostly involute after one or two Sicknesse." This is Caius’s famous treatise on a injections, and cases of lymphadenitis, bursitis, and remarkable epidemic, which exists in the form of superficial cellulitis can be similarly aborted. It will be noted that the treatment here described an English translation only, save for these rare examples. It may be added that the lot preceding bears a resemblance to the use of setons, formerly Dr. Caius’s book is a copy of the first edition of much in favour.
during
____
____
Sir Thomas Browne’s Pseudoxia Epidemica, 1646, which is much less rare than the other two books, though fully as interesting from the medical aspect. A TREATMENT FOR CARBUNCLE.
THE
carbuncle is
the
prototype
of
indolently
’
Mr. D. P. D. Wilkie, professor of surgery in the University of Edinburgh, is acting as director of the surgical professorial unit at St. Bartholomew’s Hospital, during the first fortnight in June. He takes over the duties of Prof. Gask and also lectures to the students. Each year an exchange of this kind is made, and the experiment has been notably successful.
and is seldom seen at its worst in young persons, since their defensive mechanisms are active enough to lead to early and To celebrate the centenary of the Harveian Society brisk suppuration. Treatment may reasonably aim, of London a meeting will be held at St. Bartholomew’s therefore, at increasing general and local resistance, at 3 P.M. next Thursday. At 3.15 P.lB!. Hospital and for the past four years a method has been tried in Prof. Bier’s clinic in Berlin which is intended Dr. Raymond Crawfurd will deliver an oration on Place of Medical Societies in the Progress of simply to amplify the local reaction to infection, the Exhibits of interest in connexion with Medicine. which is assumed to be deficient in such cases. The will be on view in the library from 4.30 P.M. immediate object is to produce an active capillary Harvey
progressive inflammation,
hypersemia, of arnica is
and for this purpose
a
pure solution
used, prepared in ampoules and sold under
W. Gerlach,l who reports on the results, points out that the injections must be made into healthy tissue in the vicinity of the infected area, and not into the carbuncle itself, which is already so poisoned that it cannot respond normally. For the same reason it is unnecessary to surround the lesion with a ring of injections, and this moreover would employ too large a bulk of a drug poison. Very minute doses prove sufficient, and they are given subcutaneously at least a hands-breadth away from the zone of inflammation. A burning pain follows but the
name
1
Arnusit.
Münch. med. Woch., May 8th, p. 78 3.
AT the annual general meeting of the Research Defence Society, to be held at 11, Chandos-street, W., at 3.30 P.M., on Wednesday next, Dr. H. H. Dale, F.R.S., will deliver the fifth Stephen Paget memorial lecture. His subject will be the Effect of Research on
Curative Medicine.
EAST END MATERNITY HOSPITAL.-Dr. W. H.
Oxley,
hon. medical officer, reports that " booked cases" have numbered 10,366 during the last five years. Of these only one healthy mother died as the result of childbirth. Six others who died " were seriously ill before labour commenced with some disease quite apart from pregnancy, which either entirely caused or contributed to the fatal result."
THE POISON OF TICK PARALYSIS.
microscopical examination of the cesophageal tissue. With the exception of a patient in whom the stenosis was complete all the 40 cases were treated by dilatation with excellent functional results and without .death.
a
____
UNIVERSITIES YEAR
BOOK, 1931.
July 7th-10th next the fourth quinquennial of British universities will be held at Edinburgh. We have received from Messrs. G. Bell and Sons a copy of the Year Book of the Universities of the Empire for 1931, published for the Universities Bureau and edited by Sir H. Frank Heath. From its appearance in 1914, this year book has aimed at presenting in handy form such information about British universities, of which there are now 70 or more, as is likely to interest members of other universities and colleges, government departments, clubs, schoolmasters, and the public generally. With what success this has been achieved under a - series of able editors can best be visualised by those who have been obliged to seek such information in the calendars of the several universities without its help. Each section of the year book contains a directory of the officers and members of the staff of the university, a general account of the facilities .offered and of the equipment provided, and a report of the last academic year. In 1930 there was added to the year book a survey of facilities available for .scientific research, and now there is a further comprehensive review of the aids available in every country for post-graduate students and research workers. The register of names at the end of the volume has long been a bright spot in every reference library, and the general information has now been adequately indexed. The price of the year book is 15s. FROM .congress
THE POISON OF TICK PARALYSIS. Ix several parts of the world, notably British ’Columbia, South Africa, and Queensland, sheep which havebeen bitten by certain species of ticks develop an incoordination of the hind legs which gradually works up the spine until death results from respiratory paralysis, the effect being due to a toxic degeneration of the spinal cord. Other animals and occasionally man are affected in the same way. P. Regendanz and E. Reichenow have been investigating’at Hamburg the action of the poison of an ixodid tick, Rhipicephalus sanguineus, which produces a clinical syndrome of this kind. They find that the poison is not in the tick before it feeds, nor after it has laid its eggs ; it is in the ova, but not in the developed larvse. The poison is formed in the ovary, which enlarges in proportion as blood ingested increases, but it is concentrated in the ova (not in the shells), and tcirculates through the body of the tick, thus reaching the salivary gland, which increases in size, and in output of saliva, during the days of feeding. The gland does not itself form the poison, but passes it through to the saliva. Thus the poison reaches the host if suction is interfered with, or if the tick remains attached to the host after its meal. The poison is destroyed in the digestive system of the host, but injected subcutaneously into dogs, rabbits, guineapigs, rats, mice, or canaries, causes immediate vomiting and weakness, death occurring in a couple of days. The authors regard the poison as similar to that of spiders such as Lathi-odectus erebus, but they have discovered no means of immunisation - against it. 1
Arch. f. Schiffs-
u.
Tropen-Hygiene, May, 1931, p. 255.
AN ALMONER’S DEPARTMENT.
No hospital is complete nowadays without its social service department, and the first of all these departments-that at St. Thomas’s Hospital-now publishes an annual report covering 40 pages. The changed conditions of hospital practice have by no means made the almoner’s department less necessary, though they may perhaps have changed the work in some ways. More and more the almoner has to take the position of interpreter between the language of treatment and cure as applied to a case " and the language of the patient as an individual with personal and family difficulties. " The function of the almoner," says this report, " is not to superimpose material benefits regardless of the reaction of the patient, not even to attempt to tidy up an untidy world, but to help the patient whenever possible to help himself, to wake up his innate desire for progress and better things, to try to prevent the disaster of illness from crushing character and from killing hope, and to help patients to readjust themselves, as soon as possible and as far as possible, to normal life." The two outstanding problems of the present time are housing and unemployment, the evil effects of which cause ill-health, while ill-health in its turn unfits people for taking work when it is available and, worse still, causes them to lose the hope or desire of anything better. The patients’ payments in 1930 were more than JE700 less than in 1929, and the almoner has a hard time in striking a fair balance for the basis of payment. The hospital is being increasingly used as a consultative centre by private doctors, and the numbers with which the almoner has to deal, at high speed yet without apparent hurry, are almost overwhelming. Each of the special departments of the out-patient hall has its own special problems for the almoner. The orthopaedic patient presents the difficulty of finding suitable accommodation for adult or child who has to be in plaster for many weeks, as well as the provision of appliances. The ophthalmic department offers all the problems connected with the sightless, particularly the training of mothers of blind children so that the child is taught to make the full use of the faculties it has and is not endowed with that cruellest of all gifts-self-pity. In the ear, nose, and throat department the almoner has to deal with the equally great tragedy of the deaf. The children’s department is a busy but often happy and hopeful one ; its work includes provision for rheumatism, heart trouble, asthma, maladjustment, and mental deficiency, and the complete re-establishment of health by long periods in convalescent homes. There is still a lack of convalescent accommodation While recognising the for children under three. tremendous advance in the treatment of tuberculosis during the last 20 years, the report draws attention to the drawbacks of having two authorities for tuberculous patients in London : the tuberculosis scheme and the public assistance department. Much can be done, however, to overcome these difficulties by close cooperation. The Lydia out-patient department for venereal disease has many special problems ; many of the patients need psychological treatment as much as physical, and for many work has to be found if they are to be helped at all. The maternity department has seen two important changes during the last year : the arrangement that every patient should have a trained nurse as well as a doctor, and the abolition of payment by women attended on the district. The almoner has not only to arrange the provision of home help during the confinement and for the care of the unmarried mother, but also to "
1254
A TREATMENT FOR CARBUNCLE.
follow up the babies who attend the welfare centre
can be controlled to some extent by pressure with the the first year of their life. finger. No further injection is given for 24 hours, by The speech clinic has now been working for 18 which time, as a rule, the artificial hypersemia, has years, and the number of admissions is increasing. disappeared. The treatment is then repeated as The fathers’ and mothers’ centre has moved into an often as may be necessary. The number of injections enlarged building where there is scope for new required depends on the stage at which they are ventures, bigger nurseries, and an open-air roof begun, and it occasionally happens that six or eight garden, while the old informal atmosphere is are needed before suppuration occurs. Meanwhile, maintained. it is said, the symptoms are obviously controlled. Pain and fixation disappear almost at once, and the TO BOOK LOVERS. patient feels better. The symptoms soon return Messrs. Sotheby are announced to sell shortly, however; the temperature rises, and in 24 hours the in the New Bond-street auction rooms, London, two bluish periphery of the carbuncle assumes a ruddier rare books which have direct interest for the medical tint, which is regarded as evidence of acceleration of profession as well as the bibliophile. The first is the more acute stage. The same phenomena are a translation of Ulric von Hutten’s "De Morbi provoked by the second and third injections, if Gallici Quaestione, &c.," published in 1539, the required, but no case appears to have needed more translation being entitled " Of the Wood called than eight injections in all. An increased tendency Guaiacum that Healeth the French Pockes." to small local haemorrhages at each change of dressing Guaiacum had been introduced into Europe by the will usually be noted and need not be feared ; it Spaniards some 20 years before, although the action springs from an activated blood-supply and is of the resin was not known till later. Von Hutten’s easily controlled by pressure. A further local treatise was written shortly after his famous epistolary manifestation of the protective response is the developsatires on theologians and was translated by Thomas ment of superficial pustules near the carbuncle, Paynel and published in London by one, Thomas while marked general sweating is a common sign of Berthelot. The disease referred to is, of course, recovery. Healing of the lesion is sometimes associated with a local itching which is in striking syphilis, which we called after the people from whom contrast with the pain caused by the slightest pressure it was introduced into Britain, just as they named it after the Italians who, in turn, blamed it on to the on an untreated carbuncle. Gerlach claims that Spaniards. The other book is rarer, probably, if the case is treated in its early stages, before necrosis for it is thought that but two other copies exist, has begun, the whole process remains localised and It is a small subcutaneous, and the pus is evacuated through a one in England and one in America. John octavo volume Dr. Caius, and was pea-sized opening, so that the scar is subsequently by paged R. in 1552 London Grafton. The invisible. The best local dressing is a moist compress in published by of diluted arnica in normal saline. Furthermore he name of it is " A Boke, or Counsell against the Disease commonly called the Sweate, or Sweatying says that large boils mostly involute after one or two Sicknesse." This is Caius’s famous treatise on a injections, and cases of lymphadenitis, bursitis, and remarkable epidemic, which exists in the form of superficial cellulitis can be similarly aborted. It will be noted that the treatment here described an English translation only, save for these rare examples. It may be added that the lot preceding bears a resemblance to the use of setons, formerly Dr. Caius’s book is a copy of the first edition of much in favour.
during
____
____
Sir Thomas Browne’s Pseudoxia Epidemica, 1646, which is much less rare than the other two books, though fully as interesting from the medical aspect. A TREATMENT FOR CARBUNCLE.
THE
carbuncle is
the
prototype
of
indolently
’
Mr. D. P. D. Wilkie, professor of surgery in the University of Edinburgh, is acting as director of the surgical professorial unit at St. Bartholomew’s Hospital, during the first fortnight in June. He takes over the duties of Prof. Gask and also lectures to the students. Each year an exchange of this kind is made, and the experiment has been notably successful.
and is seldom seen at its worst in young persons, since their defensive mechanisms are active enough to lead to early and To celebrate the centenary of the Harveian Society brisk suppuration. Treatment may reasonably aim, of London a meeting will be held at St. Bartholomew’s therefore, at increasing general and local resistance, at 3 P.M. next Thursday. At 3.15 P.lB!. Hospital and for the past four years a method has been tried in Prof. Bier’s clinic in Berlin which is intended Dr. Raymond Crawfurd will deliver an oration on Place of Medical Societies in the Progress of simply to amplify the local reaction to infection, the Exhibits of interest in connexion with Medicine. which is assumed to be deficient in such cases. The will be on view in the library from 4.30 P.M. immediate object is to produce an active capillary Harvey
progressive inflammation,
hypersemia, of arnica is
and for this purpose
a
pure solution
used, prepared in ampoules and sold under
W. Gerlach,l who reports on the results, points out that the injections must be made into healthy tissue in the vicinity of the infected area, and not into the carbuncle itself, which is already so poisoned that it cannot respond normally. For the same reason it is unnecessary to surround the lesion with a ring of injections, and this moreover would employ too large a bulk of a drug poison. Very minute doses prove sufficient, and they are given subcutaneously at least a hands-breadth away from the zone of inflammation. A burning pain follows but the
name
1
Arnusit.
Münch. med. Woch., May 8th, p. 78 3.
AT the annual general meeting of the Research Defence Society, to be held at 11, Chandos-street, W., at 3.30 P.M., on Wednesday next, Dr. H. H. Dale, F.R.S., will deliver the fifth Stephen Paget memorial lecture. His subject will be the Effect of Research on
Curative Medicine.
EAST END MATERNITY HOSPITAL.-Dr. W. H.
Oxley,
hon. medical officer, reports that " booked cases" have numbered 10,366 during the last five years. Of these only one healthy mother died as the result of childbirth. Six others who died " were seriously ill before labour commenced with some disease quite apart from pregnancy, which either entirely caused or contributed to the fatal result."