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CONGENITAL PYLORIC STENOSIS.
THE BIOLOGICAL METHOD IN PSYCHIATRY.
601
important factor in the xtiology of the pernicious involved in Barbour’s test is not serious, and further ansemia syndrome, especially those cases associated investigation might be made along this novel line. with chronic disturbances of the lower intestines and Opportunity to do so is likely to arise, as the malady seems to be on the increase in this country. an apparently normal gastric function. CONGENITAL PYLORIC STENOSIS. A NEW DISEASE. THE treatment of this condition in this country is UNDER the name of " Rift Valley fever " Drs. R In his analysis last now predominantly surgical. J. R. Hudson, and P. C. Garnham describe1 week (p. 526) of 18 cases at the Middlesex Hospital Daublley, a fresh human disease which they have identified from 1919-30 Mr. C. MacLeod stated that only the in Kenya. Like many other profitable things which ,first five were treated medically, the remaining 13 have lately come to the student of infection, this new (all the cases since 1924) by Rammstedt’s operation. information arose from the investigation of veterinary And in introducing the discussion at the Eastbourne when the authors were asked to look into meeting of the British Medical Association, Mr. Max subjects an excessive mortality among new-born lambs. Page pointed out (p. 533) that this operation was This, they found, was due to some agent which accepted in this country as the treatment giving the would pass through a fine Chamberland filter. The best results. Other views were laid before the section condition is not contagious and there are fairly good on diseases of children at the recent annual gathering reasons for suspecting a mosquito as the insect vector, of the American Medical Association at Philadelphia.l this point is not yet settled. The characterDr. Orville Barbour, who opened the discussion, held though istic lesion of the disease in lambs is a focal necrosis that spasm plays a part in almost every case of pyloric of the liver, not unlike the condition found in yellow stenosis, and that this spasm can be relieved by with nuclear fragmentation and cytoplasmic irradiation. He applies what he calls a roentgeno- fever, " bodies." In adult sheep the disease is much less therapeutic test to any case which does not respond severe. It causes abortion and a moderate mortality to medical treatment within 48 hours. X rays are in ewes and much the same in ; other domestic applied for three to five minutes to the upper part animals appear to be immune.cowsDuring the course of the chest, when, if the obstruction at the pylorus ’, of the the of the all four sheep, Europeans investigation is due mainly to spasm, the symptoms abate within involved developed a dengue-like fever, with rigors 24 hours. If the obstruction caused by the tumour .is extreme, little or no abatement occurs, but the and severe pains about the joints, the whole attack about four days. It was then found that most patient is in a better condition to withstand operation lasting of the natives who had been in close contact with the than after a prolonged period of expectant treatment. in the sheep had had similar attacks. ’While some other speakers at the American meeting original epidemic a man was deliberately inoculated with the - were in favour of the irradiation treatment, which Finally, from an infected lamb which caused ,filtered plasma appears to produce its effects by a non-specific protein reactions in two sheep injected at the same reaction stimulating the sympathetic nervous system, typical time. He took ill in the characteristic way on the others supported the view that in all cases of true third and his blood proved infective to sheep hypertrophic stenosis a tumour can be felt, and in for sixday, after his temperature rose but for no days most of them early operation is advisable. If after understand too that several persons We longer. several attempts by trained observers a tumour cannot been while working at the disease in infected have be found when other criteria are present, the case is in this country, and there can be little doubt animals probably one of pyloric spasm. It was admitted that we have an addition to make to the list’of both at Eastbourne and Philadelphia that radioIt is perhaps infections to which man is graphy is disappointing in the help it gives towards of relatively little practicalsubject. but trivial moment, diagnosing between spasm and true stenosis. In diseases of limited geographical distribution such as America it is an axiom, generally attributed to Sauer, are followed by a substantial resistance that the skill of the physician is the outstanding feature this which afford excellent material for the investigation would in the prognosis of pyloric stenosis. From what was of immunological problems in man. said at Eastbourne, it would appear that once the diagnosis is made the outstanding feature in the prognosis is rather the skill of the nurse. Dr. Donald THE BIOLOGICAL METHOD IN PSYCHIATRY. Paterson produced striking evidence of the great ALTHOUGH psychological medicine . lends itself difference in post-operative mortality between private and hospital cases, due presumably to the fact that to philosophic treatment, general biological method in a nursing-home a baby has the individual attention is not always adequately used by psychiatrists who, of special nurses day and night. Reviewing the two in their zeal for either purely mental or purely discussions, it is evident that the old controversy physical categories of explanation, slip into a onebetween advocates of medical and of surgical treatment sided point of view, which leaves essentials of organic is no longer acute. It is now agreed that when a life, philosophically viewed, out of account. As definite tumour exists operation is advisable, unless a healthy corrective to this weakness, Prof. W. A. the child had already passed the third month before White opens his work on Medical Psychology2 with the symptoms became acute. Medical treatment a discussion of the meaning of " organism," and must be in accord with recent biochemical work. approaches this topic from the angle made familiar As Dr. Noah Morris pointed out at Eastbourne, babies to us by Prof. Child in his conception of physiological with pyloric stenosis pass easily into a state of alka- and dynamic gradients. Having established biolosis ; washing out the stomach with sodium bicar- logical premisses for argument, the author illustrates bonate solution and the administration of citrated from biology the value of the concepts of Ambivalence milk are therefore unsafe. We hardly know whether and Conflict in all vital phenomena, so that the familiar irradiation is to be advised when a well-marked 1 Jour. of Path. and Bact., July, 1931, p. 545. pyloric tumour is present, but the delay of 24 hours .
1 Jour. Amer. Med. Assoc., August 15th, p. 455.
2 Medical Psychology. By Prof. William A. White. Nervous and Mental Diseases Monographs, No. 54. New York : Nervous and Mental Diseases Publishing Co. 1931. Pp. 141. $3.
601
important factor in the xtiology of the pernicious involved in Barbour’s test is not serious, and further ansemia syndrome, especially those cases associated investigation might be made along this novel line. with chronic disturbances of the lower intestines and Opportunity to do so is likely to arise, as the malady seems to be on the increase in this country. an apparently normal gastric function. CONGENITAL PYLORIC STENOSIS. A NEW DISEASE. THE treatment of this condition in this country is UNDER the name of " Rift Valley fever " Drs. R In his analysis last now predominantly surgical. J. R. Hudson, and P. C. Garnham describe1 week (p. 526) of 18 cases at the Middlesex Hospital Daublley, a fresh human disease which they have identified from 1919-30 Mr. C. MacLeod stated that only the in Kenya. Like many other profitable things which ,first five were treated medically, the remaining 13 have lately come to the student of infection, this new (all the cases since 1924) by Rammstedt’s operation. information arose from the investigation of veterinary And in introducing the discussion at the Eastbourne when the authors were asked to look into meeting of the British Medical Association, Mr. Max subjects an excessive mortality among new-born lambs. Page pointed out (p. 533) that this operation was This, they found, was due to some agent which accepted in this country as the treatment giving the would pass through a fine Chamberland filter. The best results. Other views were laid before the section condition is not contagious and there are fairly good on diseases of children at the recent annual gathering reasons for suspecting a mosquito as the insect vector, of the American Medical Association at Philadelphia.l this point is not yet settled. The characterDr. Orville Barbour, who opened the discussion, held though istic lesion of the disease in lambs is a focal necrosis that spasm plays a part in almost every case of pyloric of the liver, not unlike the condition found in yellow stenosis, and that this spasm can be relieved by with nuclear fragmentation and cytoplasmic irradiation. He applies what he calls a roentgeno- fever, " bodies." In adult sheep the disease is much less therapeutic test to any case which does not respond severe. It causes abortion and a moderate mortality to medical treatment within 48 hours. X rays are in ewes and much the same in ; other domestic applied for three to five minutes to the upper part animals appear to be immune.cowsDuring the course of the chest, when, if the obstruction at the pylorus ’, of the the of the all four sheep, Europeans investigation is due mainly to spasm, the symptoms abate within involved developed a dengue-like fever, with rigors 24 hours. If the obstruction caused by the tumour .is extreme, little or no abatement occurs, but the and severe pains about the joints, the whole attack about four days. It was then found that most patient is in a better condition to withstand operation lasting of the natives who had been in close contact with the than after a prolonged period of expectant treatment. in the sheep had had similar attacks. ’While some other speakers at the American meeting original epidemic a man was deliberately inoculated with the - were in favour of the irradiation treatment, which Finally, from an infected lamb which caused ,filtered plasma appears to produce its effects by a non-specific protein reactions in two sheep injected at the same reaction stimulating the sympathetic nervous system, typical time. He took ill in the characteristic way on the others supported the view that in all cases of true third and his blood proved infective to sheep hypertrophic stenosis a tumour can be felt, and in for sixday, after his temperature rose but for no days most of them early operation is advisable. If after understand too that several persons We longer. several attempts by trained observers a tumour cannot been while working at the disease in infected have be found when other criteria are present, the case is in this country, and there can be little doubt animals probably one of pyloric spasm. It was admitted that we have an addition to make to the list’of both at Eastbourne and Philadelphia that radioIt is perhaps infections to which man is graphy is disappointing in the help it gives towards of relatively little practicalsubject. but trivial moment, diagnosing between spasm and true stenosis. In diseases of limited geographical distribution such as America it is an axiom, generally attributed to Sauer, are followed by a substantial resistance that the skill of the physician is the outstanding feature this which afford excellent material for the investigation would in the prognosis of pyloric stenosis. From what was of immunological problems in man. said at Eastbourne, it would appear that once the diagnosis is made the outstanding feature in the prognosis is rather the skill of the nurse. Dr. Donald THE BIOLOGICAL METHOD IN PSYCHIATRY. Paterson produced striking evidence of the great ALTHOUGH psychological medicine . lends itself difference in post-operative mortality between private and hospital cases, due presumably to the fact that to philosophic treatment, general biological method in a nursing-home a baby has the individual attention is not always adequately used by psychiatrists who, of special nurses day and night. Reviewing the two in their zeal for either purely mental or purely discussions, it is evident that the old controversy physical categories of explanation, slip into a onebetween advocates of medical and of surgical treatment sided point of view, which leaves essentials of organic is no longer acute. It is now agreed that when a life, philosophically viewed, out of account. As definite tumour exists operation is advisable, unless a healthy corrective to this weakness, Prof. W. A. the child had already passed the third month before White opens his work on Medical Psychology2 with the symptoms became acute. Medical treatment a discussion of the meaning of " organism," and must be in accord with recent biochemical work. approaches this topic from the angle made familiar As Dr. Noah Morris pointed out at Eastbourne, babies to us by Prof. Child in his conception of physiological with pyloric stenosis pass easily into a state of alka- and dynamic gradients. Having established biolosis ; washing out the stomach with sodium bicar- logical premisses for argument, the author illustrates bonate solution and the administration of citrated from biology the value of the concepts of Ambivalence milk are therefore unsafe. We hardly know whether and Conflict in all vital phenomena, so that the familiar irradiation is to be advised when a well-marked 1 Jour. of Path. and Bact., July, 1931, p. 545. pyloric tumour is present, but the delay of 24 hours .
1 Jour. Amer. Med. Assoc., August 15th, p. 455.
2 Medical Psychology. By Prof. William A. White. Nervous and Mental Diseases Monographs, No. 54. New York : Nervous and Mental Diseases Publishing Co. 1931. Pp. 141. $3.