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CALCIUM CONTENT OF BLOOD IN SYPHILIS.
767 be in accordance with the laws of physics. As College Hospital in the autumn of 1849 I was able regards dictum (2): If a small volume of gas be to test and to appreciate the value of emetics introduced into the pleural cavity and the needle administered in the earlier stages of the disease. be immediately withdrawn, the gas will be subject Not having many drugs at hand in the island I fell to the following forces, (a) capillary attraction back upon hot salt and water, and found that between the layers of the pleura, tending to keep if by half-pint doses of this mixture I could it in position, and (b) during respiration to alternate ensure copious vomiting for three or four hours It is a the malady might be checked and life preserved. increase and diminution of pressure. Reference to your journal during the autumn of justifiable assumption that the increase of pressure is than the 1849 would, I believe, show that this treatment greater during expiration pleural capillarity, consequently the gas will be driven to was originally suggested by Dr. Beaman, a general any part of the pleural cavity, where it will be practitioner then living, I think, not far from I am, Sir, yours faithfully, least subject to compression, and, as Dr. Parry Covent Garden. will take has a I. D. CHEPMELL. shown, up position Morgan opposite Mr. of any consolidated portion of lung. But if the needle George Beaman, King-street, Covent Garden, "’ connected wiuh the manometer has not been W.C., described in THE LANCET of August 23rd, 1834, the suc-
withdrawn the conditions are altered. Capillary attraction still exerts its limiting action, but alterations in pressure are met by the movement of a corresponding portion of gas to or from the manometer. Therefore, the gas does not move away from the needle, as its position is already one in which increase in pressure cannot affect it. It will be accommodated by a conical delling of the lung, the base of the cone being roughly circular with its centre at the point of the needle (a mathematical person might calculate the area of this circle for any volume of gas), and this, provided the needle has not been pushed in to an unjustifiable extent, disposes of dictum number (3). Therefore, provided the lung has not been punctured, the manometer will accurately register intrapleural pressures, and respiration will be accompanied by corresponding free oscillations. I am,
Sir, yours faithfully, W. MILLER.
ANTITYPHOID INOCULATION IN WAR TIME. To the Editor of THE LANCET.
SIR,-On behalf of the Research Defence Society, which represents the general opinion of all who have studied the facts of antityphoid inoculation, we desire to say that the society very strongly approves of this treatment for all men and women who are likely in the near future to come in contact with typhoid fever. We have accordingly offered the services of this society to the Royal Army Medical Corps. We are, Sir, yours faithfully, LAMINGTON,
cessful treatment of 11 successive cases of cholera by saline emetics, disclaiming merit for originality of system." In THE LANCET of August llth, 1849, there will be found a synopsis of the treatment adopted by ten ofthe metropolitan general hospitals during an epidemic of cholera. " Mr. Beaman’s treatment " is referred to as being employed at King’s College Hospital. We thank our old Paris Correspondent for his interesting note.-ED. L.
CALCIUM
CONTENT
OF
BLOOD
IN
SYPHILIS. To the Editor of THE LANCET.
SIR,-Professor F. W. Andrewes recently suggested me that it would be useful to estimate the calcium content of the blood in patients suffering from primary, secondary, ’and tertiary syphilis. The following results show fairly well certain apparent differences between the normal individual and the My reason for publishing them is to learn if others who may have done similar work have had like results. Wright’s method with throttled glass tube and a solution of ammonium oxalate of known strength was used; all dilutions The were made with normal saline solution. determining factor was the strongest solution of ammonium oxalate in which a clot appeared.
to
syphilitics.
President.
F. M. SANDWITH, M.D.Durh., F.R.C.P.Lond., Honorary Treasurer. STEPHEN PAGET, F.R.C.S. Eng., Honorary Secretary.
EMETINE IN THE TREATMENT OF CHOLERA. To the Editor of THE LANCET. your issue of Sept. 12th annotation dealing with the successful treatment of Asiatic cholera by emetine. This reminds me of an experience of my own during the epidemic in the island of Ischia, near Naples, when I was resident physician to the late Lord Holland. Cholera was decimating the population of the In a series of investigations with healthy and island when we arrived there in June, 1854. Having non-syphilitic persons I found the calcium content had a three months’ apprenticeship while dis- by Wright’s method to be equivalent to a 1 in 1300 oxalate. With the present charging the duties of house physician at King’ssolution
SIR,—I have just read in
an
of ammonium
768 series it was convenient to
use solutions of 1 in 600, 1 in 800, 1 in 1000, 1 in 1200, 1 in 1400, and 1 in 1600. The method shows the amount of ionic calcium salt which can be neutralised by the oxalate solution in order to prevent coagulation. The above results demonstrate the fact that whereas the non-syphilitic individual showed a clot with a 1 in 1400 solution the primarv syphilitics suggested a tendency to clot with stronger solutions, and therefore pointing to a slight increase of the calcium content of their blood. During the secondary stage the tendency to clot in still stronger solutions is noticed. The average here was a clot with a 1 in 1000 solution, but in two instances clotting was obtained with a strength of 1 in 800. With the tertiary syphilitics some clotting was obtained with a 1 in 1200 solution, but the number of cases investigated was insufficient to draw deductions from. Briefly, these that there is a experiments suggest tendency for slight increase of the calcium content with the primaries, a greater increase with the secondaries, and a decrease again with the tertiaries, so that their bloods contain only slightly more calcium than the non-syphilitic and healthy. If these facts should turn out, after further investigation, to be the truth, how can we interpret them ? Possibly the increase of calcium may act as a protective power in that the blood clotting more easily might allow less of the syphilitic toxins to pass out from the capillaries into the lymph which bathes the cells in the various tissues of the body. This is merely speculative argument and may or may not be true. I might mention that in obtaining the few drops of blood from the thumb necessary for the experiment one had to be very quick in most of the secondaries lest the blood In some this was not clotted on the thumb itself. seen, and perhaps previous treatment by " 606 may make a difference. These experiments were performed at the Male Lock Hospital, Dean-street, London, W., by kind permission of Mr. J. Ernest Lane and Mr. J. E. R. McDonagh.-I am, Sir, yours BERNARD MYERS, M.D. Edin., "
faithfully,
Physician
to
Out-patients
at the
Royal Waterloo Hospital, S.E.
ORAL SEPSIS AND THE EXTRACTION OF TEETH. To the Editor of THE LANCET.
SIR,-In any given case may or may not be the best
"wholesale" extraction treatment, but the man
who advises should have a thorough understanding of dental sepsis. Sir James F. Goodhart, on his own showing, does not possess such an understanding. I exposed the weakness of his first letter; may I In his "poor nonanswer that of August 22nd? James Sir Goodhart examines for expert way" pockets by finger pressure. If he expresses visible pus there is "pyorrhoea alveolaris"; if not, all is well. This is indeed a "poor non-expert" criterion. It can be applied only to the front surfaces of the more anterior teeth, leaving their interstitial and lingual surfaces and all the back teeth unexamined. Moreover, it is not trustworthy for what it does reach; the pockets may have been but recently evacuated and their bases may be formed by a gutter of unyielding bone from which no finger pressure can express the contents. Unless the examiner uses both a fine probe and cotton-wool wisps and explores carefully the whole
circumference
judgment of visible pus:
of every tooth he can form the absence either of pockets’
no,
or-
Next I may ask why putrid decomposition is so. summarily dismissed. It is, indeed, not pleasant to. have to use the sense of smell for its detection, but this will not diminish its danger, and I can offer no, more delicate way of detecting it. Why is a stinking cowyard or drain or putrid meat condemned ? I can see no less danger in swallowing putridity from between your teeth than from off your plate, and if a thorough examination be made of every mouth the amount of putrid stagnation that is to be found among the teeth will astonish the non-expert. We are asked, "have the changes said to occur in the bone in these cases [I presume of "pyorrhœa"] been clearly distinguished from those which must exist in company with retrocession of the gum-?" Why should we distinguish? In some cases of slow "pyorrhcea" the recession of the gum progresses at, an equal rate with the destruction of bone, and the disease is so much the less dangerous, but the carious process is fundamentally the same. Can Sir James Goodhart give us a reason for separating recession of gums from "pyorrhoea alveolaris?" We are asked for proof that dental (or oral) sepsis is a dangerous condition. Proof is found both in the results of treatment-often by "wholesale" extraction-and in the condition of the local tissues. Has Sir James Goodhart never effected a cure of some one of the manifold diseases of the human body by total extraction of teeth?’at least others have, and in no small numbers. This, I take it, is proof of the danger, though not of how much or how little dental sepsis is a danger. This is measured by the patient’s resistance-an unknown quantity till tried. Looking at the mouth we find the tissues in varying states of persistent inflammation and ulceration, while the teeth themselves are being absorbed and extruded, treated as dangerous foreign bodies. The fact of inflammation shows that the local tissues resent the presence of dental sepsis, while every inflamed focus, and more so every ulcer, is a centre for absorption of toxins and germs. Sir James This is fundamental pathology. Goodhart, I presume, does not doubt the ulceration of the toothward surface of the gum-flaps forming the pockets, but there are other areas of ulceration. Wherever the gum is in contact with tartar it is in a state of chronic catarrh or actual ulceration. These two sources of ulceration yield a superficial area of no small extent draining into the mouth or causing absorption into the general system. Is there any doubt of danger? Sir James Goodhart’s criterion of danger is pockets and pus. Why is not persistent gingivitis a sign of danger? It indicates dental sepsis, absorption of germs and toxins, and swallowing of putrid debris. As another not negligible danger I may point to the possibility that a septic mouth is a carrier to the detriment of the community. Sir James Goodhart makes his "position clear" by saying I (the writer) "seem to hold that pyorrhoea. is a common disease, an insidious one, easily overlooked, yet associated with definite changes in the bones, and that it leads to septic intoxication. If what I (Sir J. Goodhart) in my ignorance call gingivitis he calls pyorrhcea alveolaris, so be it. My essential point is, however, is it the cause of septic absorption, and is it worthy of the extraction of the teeth in bulk?" Yes, "pyorrhoea.’
withdrawn the conditions are altered. Capillary attraction still exerts its limiting action, but alterations in pressure are met by the movement of a corresponding portion of gas to or from the manometer. Therefore, the gas does not move away from the needle, as its position is already one in which increase in pressure cannot affect it. It will be accommodated by a conical delling of the lung, the base of the cone being roughly circular with its centre at the point of the needle (a mathematical person might calculate the area of this circle for any volume of gas), and this, provided the needle has not been pushed in to an unjustifiable extent, disposes of dictum number (3). Therefore, provided the lung has not been punctured, the manometer will accurately register intrapleural pressures, and respiration will be accompanied by corresponding free oscillations. I am,
Sir, yours faithfully, W. MILLER.
ANTITYPHOID INOCULATION IN WAR TIME. To the Editor of THE LANCET.
SIR,-On behalf of the Research Defence Society, which represents the general opinion of all who have studied the facts of antityphoid inoculation, we desire to say that the society very strongly approves of this treatment for all men and women who are likely in the near future to come in contact with typhoid fever. We have accordingly offered the services of this society to the Royal Army Medical Corps. We are, Sir, yours faithfully, LAMINGTON,
cessful treatment of 11 successive cases of cholera by saline emetics, disclaiming merit for originality of system." In THE LANCET of August llth, 1849, there will be found a synopsis of the treatment adopted by ten ofthe metropolitan general hospitals during an epidemic of cholera. " Mr. Beaman’s treatment " is referred to as being employed at King’s College Hospital. We thank our old Paris Correspondent for his interesting note.-ED. L.
CALCIUM
CONTENT
OF
BLOOD
IN
SYPHILIS. To the Editor of THE LANCET.
SIR,-Professor F. W. Andrewes recently suggested me that it would be useful to estimate the calcium content of the blood in patients suffering from primary, secondary, ’and tertiary syphilis. The following results show fairly well certain apparent differences between the normal individual and the My reason for publishing them is to learn if others who may have done similar work have had like results. Wright’s method with throttled glass tube and a solution of ammonium oxalate of known strength was used; all dilutions The were made with normal saline solution. determining factor was the strongest solution of ammonium oxalate in which a clot appeared.
to
syphilitics.
President.
F. M. SANDWITH, M.D.Durh., F.R.C.P.Lond., Honorary Treasurer. STEPHEN PAGET, F.R.C.S. Eng., Honorary Secretary.
EMETINE IN THE TREATMENT OF CHOLERA. To the Editor of THE LANCET. your issue of Sept. 12th annotation dealing with the successful treatment of Asiatic cholera by emetine. This reminds me of an experience of my own during the epidemic in the island of Ischia, near Naples, when I was resident physician to the late Lord Holland. Cholera was decimating the population of the In a series of investigations with healthy and island when we arrived there in June, 1854. Having non-syphilitic persons I found the calcium content had a three months’ apprenticeship while dis- by Wright’s method to be equivalent to a 1 in 1300 oxalate. With the present charging the duties of house physician at King’ssolution
SIR,—I have just read in
an
of ammonium
768 series it was convenient to
use solutions of 1 in 600, 1 in 800, 1 in 1000, 1 in 1200, 1 in 1400, and 1 in 1600. The method shows the amount of ionic calcium salt which can be neutralised by the oxalate solution in order to prevent coagulation. The above results demonstrate the fact that whereas the non-syphilitic individual showed a clot with a 1 in 1400 solution the primarv syphilitics suggested a tendency to clot with stronger solutions, and therefore pointing to a slight increase of the calcium content of their blood. During the secondary stage the tendency to clot in still stronger solutions is noticed. The average here was a clot with a 1 in 1000 solution, but in two instances clotting was obtained with a strength of 1 in 800. With the tertiary syphilitics some clotting was obtained with a 1 in 1200 solution, but the number of cases investigated was insufficient to draw deductions from. Briefly, these that there is a experiments suggest tendency for slight increase of the calcium content with the primaries, a greater increase with the secondaries, and a decrease again with the tertiaries, so that their bloods contain only slightly more calcium than the non-syphilitic and healthy. If these facts should turn out, after further investigation, to be the truth, how can we interpret them ? Possibly the increase of calcium may act as a protective power in that the blood clotting more easily might allow less of the syphilitic toxins to pass out from the capillaries into the lymph which bathes the cells in the various tissues of the body. This is merely speculative argument and may or may not be true. I might mention that in obtaining the few drops of blood from the thumb necessary for the experiment one had to be very quick in most of the secondaries lest the blood In some this was not clotted on the thumb itself. seen, and perhaps previous treatment by " 606 may make a difference. These experiments were performed at the Male Lock Hospital, Dean-street, London, W., by kind permission of Mr. J. Ernest Lane and Mr. J. E. R. McDonagh.-I am, Sir, yours BERNARD MYERS, M.D. Edin., "
faithfully,
Physician
to
Out-patients
at the
Royal Waterloo Hospital, S.E.
ORAL SEPSIS AND THE EXTRACTION OF TEETH. To the Editor of THE LANCET.
SIR,-In any given case may or may not be the best
"wholesale" extraction treatment, but the man
who advises should have a thorough understanding of dental sepsis. Sir James F. Goodhart, on his own showing, does not possess such an understanding. I exposed the weakness of his first letter; may I In his "poor nonanswer that of August 22nd? James Sir Goodhart examines for expert way" pockets by finger pressure. If he expresses visible pus there is "pyorrhoea alveolaris"; if not, all is well. This is indeed a "poor non-expert" criterion. It can be applied only to the front surfaces of the more anterior teeth, leaving their interstitial and lingual surfaces and all the back teeth unexamined. Moreover, it is not trustworthy for what it does reach; the pockets may have been but recently evacuated and their bases may be formed by a gutter of unyielding bone from which no finger pressure can express the contents. Unless the examiner uses both a fine probe and cotton-wool wisps and explores carefully the whole
circumference
judgment of visible pus:
of every tooth he can form the absence either of pockets’
no,
or-
Next I may ask why putrid decomposition is so. summarily dismissed. It is, indeed, not pleasant to. have to use the sense of smell for its detection, but this will not diminish its danger, and I can offer no, more delicate way of detecting it. Why is a stinking cowyard or drain or putrid meat condemned ? I can see no less danger in swallowing putridity from between your teeth than from off your plate, and if a thorough examination be made of every mouth the amount of putrid stagnation that is to be found among the teeth will astonish the non-expert. We are asked, "have the changes said to occur in the bone in these cases [I presume of "pyorrhœa"] been clearly distinguished from those which must exist in company with retrocession of the gum-?" Why should we distinguish? In some cases of slow "pyorrhcea" the recession of the gum progresses at, an equal rate with the destruction of bone, and the disease is so much the less dangerous, but the carious process is fundamentally the same. Can Sir James Goodhart give us a reason for separating recession of gums from "pyorrhoea alveolaris?" We are asked for proof that dental (or oral) sepsis is a dangerous condition. Proof is found both in the results of treatment-often by "wholesale" extraction-and in the condition of the local tissues. Has Sir James Goodhart never effected a cure of some one of the manifold diseases of the human body by total extraction of teeth?’at least others have, and in no small numbers. This, I take it, is proof of the danger, though not of how much or how little dental sepsis is a danger. This is measured by the patient’s resistance-an unknown quantity till tried. Looking at the mouth we find the tissues in varying states of persistent inflammation and ulceration, while the teeth themselves are being absorbed and extruded, treated as dangerous foreign bodies. The fact of inflammation shows that the local tissues resent the presence of dental sepsis, while every inflamed focus, and more so every ulcer, is a centre for absorption of toxins and germs. Sir James This is fundamental pathology. Goodhart, I presume, does not doubt the ulceration of the toothward surface of the gum-flaps forming the pockets, but there are other areas of ulceration. Wherever the gum is in contact with tartar it is in a state of chronic catarrh or actual ulceration. These two sources of ulceration yield a superficial area of no small extent draining into the mouth or causing absorption into the general system. Is there any doubt of danger? Sir James Goodhart’s criterion of danger is pockets and pus. Why is not persistent gingivitis a sign of danger? It indicates dental sepsis, absorption of germs and toxins, and swallowing of putrid debris. As another not negligible danger I may point to the possibility that a septic mouth is a carrier to the detriment of the community. Sir James Goodhart makes his "position clear" by saying I (the writer) "seem to hold that pyorrhoea. is a common disease, an insidious one, easily overlooked, yet associated with definite changes in the bones, and that it leads to septic intoxication. If what I (Sir J. Goodhart) in my ignorance call gingivitis he calls pyorrhcea alveolaris, so be it. My essential point is, however, is it the cause of septic absorption, and is it worthy of the extraction of the teeth in bulk?" Yes, "pyorrhoea.’