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DIFFERENT FORMS OF PROTEIN SENSITISATION.
290 that the failure to recognise dissecting aneurysm of the aorta during life is partly at least due to inability to appreciate the fact that symptoms of the condition may be produced by interference with the bloodsupply in these branches. Rupture of the pericardial sac which occurred in 45 per cent. of the cases is manifested by sudden and severe pain in the chest and collapse. If death does not take place in a few moments, partial recovery occurs, but is followed within a few hours or days by a similar pain with almost immediate cardiac and respiratory failure. Reference is made to cases in which paralysis ensues, being probably due to interference with the bloodsupply of the spinal cord or brain. In one of Dr. Crowell’s cases there was flaccid paralysis of the legs and right arm and spastic paralysis of the left arm, and in another left hemiplegia. In other instances interference with the intestinal blood-supply may lead to the performance of laparotomy because of the " diagnosis of surgical abdomen."
SIR THOMAS
BROWNE’S SKULL.
A SOMEWHAT peculiar controversy which has lasted for many years between the board of the Norfolk and Norwich Hospital, and the vicar and churchwardens of St. Peter Mancroft Church, Norwich, has at last reached a satisfactory conclusion. The controversy concerns the skull of no less a person than Sir Thomas Browne, the author of Religio Medici and other works, who died in 1682. This famous Norwich citizen was buried in the precincts of the splendid church of St. Peter Mancroft, where a monument has been erected to him. His skull was by some means or other stolen from the grave in 1840, and a few years later it found its way to the Norfolk and Norwich Hospital, and was placed in the museum, where it has been ever since. The vicar and churchwardens of St. Peter Mancroft have, for a considerable time, been anxious to have the skull restored to its original resting-place, but the hospital authorities were unwilling to part with such an interesting relic of an ornament of the medical profession. However, the matter has at last been amicably settled by a resolution of the board of governors of the hospital at their last quarterly meeting : ’’ That the skull shall be handed over to the church, on condition that it shall be reverently re-interred as soon as possible in the church near the supposed site of Sir Thomas Browne’s grave, with the burying place suitably marked, and that before the skull is handed over a plaster cast of it shall be presented to the hospital authorities, and that it shall not be exposed in any way to the public as a relic of Sir Thomas Browne." These conditions were accepted by the vicar of St. Peter Mancroft, Canon F. J. Meyrick, so that it may now be hoped that Sir Thomas Browne’s bones will at last rest in peace.
FORMS OF PROTEIN SENSITISATION.
DIFFERENT
i
skin affections in relation to focal sepsis and sensitisation. Urticaria and erythema have, of course, long been recognised as frequent manifestations of protein hypersensitiveness, but Dr. Barber enlarges this list
by including herpes zoster, lupus erythematosus, psoriasis, and several forms of eczema and dermatitis ; and he points out by illustrative cases the relationship
which he believes to exist between protein sensitisation and focal sepsis in the form of dental caries, pyorrhoea, and unhealthy tonsils. Judged from this standpoint, which we believe to be a right one, these skin affections can no longer be regarded as clinical entities, but must rather be looked upon as prominent symptoms of a protein hypersensitiveness due to a number of causes, bacterial and dietetic. Other examples of this " acquired local susceptibility of the skin " are also
given.
Furthermore, Dr. Barber raises two interesting points which will doubtless become more familiar as The one is the we study the question more closely. frequency of cross-sensitisation-a patient hypersensitive to one protein may give a positive reaction to another kind-a fact which has been made use of by Widal, Auld, and others in the treatment of asthma; and the second is the possibility of an hereditary factor underlying certain types of protein sensitisation. It is easy, of course, to blame heredity for troubles we do not understand, but in this particular instance we think a certain amount of proof could be adduced in support of the view. Be that as it may, it is clear that the whole question of anaphylaxis is one which cuts across the old-established boundaries of clinical medicine, bacteriology, and biochemistry. We must all of us be personally interested in a matter which plays such an intimate part in our daily lives as protein sensitisation appears to do. Dr. Barber’s article opens up many by-paths. The question of the mode of action, if any, of non-virulent or feebly virulent bacteria found in so many of these chronic septic conditions needs much elucidation; whilst the relation of bacterial anaphylaxis to the rashes of some of the acute exanthemata, a subject discussed by McIntosh2 some years ago, is another The trouble is that debatable point. anaphylaxis appears to be protean in its manifestations, and we do not know where and how to limit our correlation of the observed facts. Prof. Henri Hartmann, an honorary Fellow of the Royal College of Surgeons of England, will givean address on Inflammatorv Strictures of the Rectum before the Medical Society of London, on Monday, Feb. 13th, at 8.30 P.M. As professor of clinical surgery at the University of Paris Dr. Hartmann has paid special attention to abdominal and rectal surgery, and his address will be based mainly on his own large experience. The address will be given in English, with epidiascope illustrations. There will also be an exhibition of specimens of infiammatory stricture of the rectum from various London museums, before the lecture and on Tuesday
on
view
morning.
MucH interest is being evinced in the group of affections of which hay fever and urticaria are the best known examples. Dr. Arthur Latham, in an address which we print in our present issue, refers to the instability of body-chemistry which is the feature common to the whole group. He deals principally with the case of bronchial asthma on which we recently commented1 in the light of current American work. Dr. Latham, while he admits that we do not know in the least what hypersensitiveness means, finds that our knowledge of it has already definitely improved the outlook for the asthmatic person. Several important implications of protein I sensitisation were dealt with in the October number of the Guy’s Hospital Reports for 1921 by Dr. H. W. Barber in a thoughtful paper on the aetiology of certain
of the General Nursing Council for and Wales was held on Feb. 3rd, at which Sir Wilmot I3erringham presided for the first time since his appointment to succeed Mr. Priestley. All the members who resigned with the late chairman have now withdrawn their resignations, and the Council has resumed its normal activities. In view of various unauthorised and unfounded statements which have been made, Sir Alfred Mond thinks it desirable to state that these resignations had nothing to do either with the question of the syllabus of training or the question of the entry of certificates in the register. There is, further, no foundation for the suggestion that there has been any controversy between the Council and the Minister ; the relations between the two have been uniformly cordial.
1 THE LANCET, 1921, ii., 1174.
2 Quarterly Journal of Medicine, 1913-14, vii., 272.
anaphylactic
A
MEETING
England
SIR THOMAS
BROWNE’S SKULL.
A SOMEWHAT peculiar controversy which has lasted for many years between the board of the Norfolk and Norwich Hospital, and the vicar and churchwardens of St. Peter Mancroft Church, Norwich, has at last reached a satisfactory conclusion. The controversy concerns the skull of no less a person than Sir Thomas Browne, the author of Religio Medici and other works, who died in 1682. This famous Norwich citizen was buried in the precincts of the splendid church of St. Peter Mancroft, where a monument has been erected to him. His skull was by some means or other stolen from the grave in 1840, and a few years later it found its way to the Norfolk and Norwich Hospital, and was placed in the museum, where it has been ever since. The vicar and churchwardens of St. Peter Mancroft have, for a considerable time, been anxious to have the skull restored to its original resting-place, but the hospital authorities were unwilling to part with such an interesting relic of an ornament of the medical profession. However, the matter has at last been amicably settled by a resolution of the board of governors of the hospital at their last quarterly meeting : ’’ That the skull shall be handed over to the church, on condition that it shall be reverently re-interred as soon as possible in the church near the supposed site of Sir Thomas Browne’s grave, with the burying place suitably marked, and that before the skull is handed over a plaster cast of it shall be presented to the hospital authorities, and that it shall not be exposed in any way to the public as a relic of Sir Thomas Browne." These conditions were accepted by the vicar of St. Peter Mancroft, Canon F. J. Meyrick, so that it may now be hoped that Sir Thomas Browne’s bones will at last rest in peace.
FORMS OF PROTEIN SENSITISATION.
DIFFERENT
i
skin affections in relation to focal sepsis and sensitisation. Urticaria and erythema have, of course, long been recognised as frequent manifestations of protein hypersensitiveness, but Dr. Barber enlarges this list
by including herpes zoster, lupus erythematosus, psoriasis, and several forms of eczema and dermatitis ; and he points out by illustrative cases the relationship
which he believes to exist between protein sensitisation and focal sepsis in the form of dental caries, pyorrhoea, and unhealthy tonsils. Judged from this standpoint, which we believe to be a right one, these skin affections can no longer be regarded as clinical entities, but must rather be looked upon as prominent symptoms of a protein hypersensitiveness due to a number of causes, bacterial and dietetic. Other examples of this " acquired local susceptibility of the skin " are also
given.
Furthermore, Dr. Barber raises two interesting points which will doubtless become more familiar as The one is the we study the question more closely. frequency of cross-sensitisation-a patient hypersensitive to one protein may give a positive reaction to another kind-a fact which has been made use of by Widal, Auld, and others in the treatment of asthma; and the second is the possibility of an hereditary factor underlying certain types of protein sensitisation. It is easy, of course, to blame heredity for troubles we do not understand, but in this particular instance we think a certain amount of proof could be adduced in support of the view. Be that as it may, it is clear that the whole question of anaphylaxis is one which cuts across the old-established boundaries of clinical medicine, bacteriology, and biochemistry. We must all of us be personally interested in a matter which plays such an intimate part in our daily lives as protein sensitisation appears to do. Dr. Barber’s article opens up many by-paths. The question of the mode of action, if any, of non-virulent or feebly virulent bacteria found in so many of these chronic septic conditions needs much elucidation; whilst the relation of bacterial anaphylaxis to the rashes of some of the acute exanthemata, a subject discussed by McIntosh2 some years ago, is another The trouble is that debatable point. anaphylaxis appears to be protean in its manifestations, and we do not know where and how to limit our correlation of the observed facts. Prof. Henri Hartmann, an honorary Fellow of the Royal College of Surgeons of England, will givean address on Inflammatorv Strictures of the Rectum before the Medical Society of London, on Monday, Feb. 13th, at 8.30 P.M. As professor of clinical surgery at the University of Paris Dr. Hartmann has paid special attention to abdominal and rectal surgery, and his address will be based mainly on his own large experience. The address will be given in English, with epidiascope illustrations. There will also be an exhibition of specimens of infiammatory stricture of the rectum from various London museums, before the lecture and on Tuesday
on
view
morning.
MucH interest is being evinced in the group of affections of which hay fever and urticaria are the best known examples. Dr. Arthur Latham, in an address which we print in our present issue, refers to the instability of body-chemistry which is the feature common to the whole group. He deals principally with the case of bronchial asthma on which we recently commented1 in the light of current American work. Dr. Latham, while he admits that we do not know in the least what hypersensitiveness means, finds that our knowledge of it has already definitely improved the outlook for the asthmatic person. Several important implications of protein I sensitisation were dealt with in the October number of the Guy’s Hospital Reports for 1921 by Dr. H. W. Barber in a thoughtful paper on the aetiology of certain
of the General Nursing Council for and Wales was held on Feb. 3rd, at which Sir Wilmot I3erringham presided for the first time since his appointment to succeed Mr. Priestley. All the members who resigned with the late chairman have now withdrawn their resignations, and the Council has resumed its normal activities. In view of various unauthorised and unfounded statements which have been made, Sir Alfred Mond thinks it desirable to state that these resignations had nothing to do either with the question of the syllabus of training or the question of the entry of certificates in the register. There is, further, no foundation for the suggestion that there has been any controversy between the Council and the Minister ; the relations between the two have been uniformly cordial.
1 THE LANCET, 1921, ii., 1174.
2 Quarterly Journal of Medicine, 1913-14, vii., 272.
anaphylactic
A
MEETING
England