ANAPHYLAXIS AND URTICARIA.

ANAPHYLAXIS

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ledge of the foundations of medicine is outstripping its clinical applications. The truth is that exact laboratory work is much simpler than ward work of anything like equal precision. The really inferior part of the volume is the organisation of its production ; the classification in the list of contents is bizarre and the index is useless. In these days of mass production good indexes are worth care. A second publication emanating from the Institute gives an account of its constitution, organisation, and equipment, and illustrates the means by which the Studies are produced. The scientific staff numbers 100. We have also received from another branch of Mr. Rockefeller’s benefactions, the Rockefeller Foundation, the seventh number of the accounts, which appear from time to time under Dr. R. M. Pearce’s direction, of the fabric and equipment of buildings used for medical education. It contains an interesting and well-illustrated account of the new school of medicine and dentistry which was opened at Rochester, New York, last autumn. The most noticeable feature is the inclusion of the departments of anatomy, physiology, and biochemistry, as well as those of pathology and bacteriology, in the same building as the hospital wards. Unity of purpose and work is without doubt best achieved in this way, and many schools have been slow to realise that a separation in space which seems trivial may mean an isolation of interest. The detailed accounts of the various departments will be very useful to those who are occupied with new buildings. A good many of the rooms pictured seem to be rather badly lit, and the workers who appear in the photographs look preternaturally earnest and strenuous. ANAPHYLAXIS AND URTICARIA. THE conception that the cutaneous reaction known as urticaria might be a manifestation of the anaphylactic state was advanced by Wolff-Eisner soon after the peculiar phenomenon of anaphylaxis was first The theory has received observed in animals. much support, and it is generally acknowledged that although there is a wide difference between the condition of an animal which has been reinjected after an interval of ten days with some foreign protein and a patient suffering from urticaria, yet there is A case jointly a relationship between the two states. reported by Pasteur Vallery-Radot, P. A. Carrie, P. Blamoutier, and M. Laudat,l seems considerably to strengthen this view. The patient was a woman, aged 28 ; after undergoing moderate exertion for a few minutes she not only suffered from a profuse urticarial rash but also showed signs of dyspnoea, vertigo, profound cardiovascular disturbances, and collapse-her condition closely resembling that of an animal suffering from true anaphylaxis. A detailed examination of the blood and cardiovascular system revealed a further similarity, for the patient was found to have leucopenia, moderate eosinophilia, fall of blood pressure, and albuminuria shortly after each attack. From the description given it does not appear that for any considerable time after an attack the patient experienced the protection which is observed in animals for at least ten days after anaphylactic shock.

AND URTICARIA.

of sodium thiosulphate. It was found that the alkaline reserve of the blood was subnormal, and in view of this deficiency sodium bicarbonate was administered by the mouth. This raised the alkali to within normal limits, but did not prevent the attacks. The same salt given intravenously did, however, partly relieve the patient. On the assumption that the relief was in reality due to the desensitising power of sodium bicarbonate, and not to its influence on the alkalinity, the neutral salt, thiosulphate of soda, which is known to havesimilar desensitising power, was given intravenously on two Each injection was followed an hour occasions. later by vomiting, headache, and tremors, a condition which reminded the authors of the nitritoid crises which sometimes follow the injection of the arsenobenzol compounds. The patient was duly rewarded, however, for although she had suffered from these distressing attacks for a year and a half they now ceased. Apparently the shock produced by the injections of this neutral salt in some manner modified the unstable or allergic state of this patient, thereby enabling her to resume her customary habits without further inconvenience.

injections

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INTERNATIONAL OPHTHALMOLOGICAL CONGRESSES. FOR two years an Anglo-American committee has been preparing the ground for a revival of the international ophthalmological congress held every four or five years before the war. The last step was to call a conference to frame the constitution, and the friendliness and unanimity which characterised last week’s meeting at Scheveningen soon made it easy to achieve the common aim. The success of the conference (which we report in another column) must largely be attributed to the unbounded hospitality shown by the Dutch hosts. None of the delegates will readily forget the kindness of Prof. van der Hoeve and others who provided delightful opportunities for the delegates to meet one another, and no one who visited Scheveningen will voluntarily miss the congress to be held at Amsterdam in September, 1929. Meanwhile, ophthalmologists in all countries may well be grateful to those who worked hard to achieve these ends, and we note with especial pleasure the election of Mr. Treacher Collins as Hon. President of the International Council and of Mr. Leslie Paton as its treasurer.

MEDICAL RESEARCH IN THE COLONIES. A PROPOSAL for the establishment of a joint committee of the Colonial Office and the Medical Research Council was endorsed by the recent Colonial Office conference. The Secretary of State for the Colonies, in consultation with the Medical Research Council, has now appointed the Colonial Medical Research Committee with the following terms of reference : " To advise the Secretary of State and the Medical Research Council upon the initiation and promotion of medical research in the interests of the Colonial Empire ; upon the recruitment and conditions of service of the necessary personnel; and upon the management and allocation of any funds available for these purposes." The Committee will also investigate proposals for the creation of a Colonial Medical Research Service and for the payment from a pool of grants to medical institutions which are considered to deservee the support of Colonial

Urticaria following muscular effort has been previously recorded on more than one occasion, and with the knowledge that an animal-and probably man-cannot (with the exception of the lens) be sensitised by its own tissues, the phenomenon is difficult to explain. The possibility that histamine released from the tissues is the exciting cause must be considered, for this substance is known to produce urticaria, and also a condition closely allied to anaphy- governments. The Committee has been constituted as follows : lactic shock, when injected into animals or man. Dr. Vallery-Radot and his collaborators regard their The Right Hon. W. Ormsby-Gore, M.P. (chairman) ; George Maxwell (deputy chairman) ; Members : patient as one of a group " atteint d’instabilite Sir The Secretary of the Medical Research Council, Sir colloidoplasmatique," in which at times physical Walter Fletcher ; and the Chief Medical Adviser to the effort may produce urticaria, asthma, migraine, or of State for the Colonies, Dr. A. T. Stanton, Secretary shock. The case is of still further interest even inasmuch as a cure was apparently achieved by two ex officio;; Prof. J. W. W. Stephens ; Sir Leonard Rogers ; Dr. Andrew Balfour ; Dr. Charles Todd;;. Dr. P. H. Manson-Bahr ; and Dr. C. M. Wenyon. Presse Médicale, June llth. I

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