EPIDEMIOLOGY OF ST. LOUIS ENCEPHALITIS

EPIDEMIOLOGY OF ST. LOUIS ENCEPHALITIS

1310 of synthetic ephedrine, which is identical with that obtained from the herb. Synthetic ephedrines are now on the market, and if their cost can be...

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1310 of synthetic ephedrine, which is identical with that obtained from the herb. Synthetic ephedrines are now on the market, and if their cost can be reduced they may come to compete seriously with the natural

product. RADIOTHERAPY OF CANCER

IN their annual report1 issued this week the National Radium Commission deplore the lack of progress made towards the organisation of a national cancer service. The Bill that Mr. Walter Elliot hopes to introduce before Christmas will presumably set such an organisation on its feet, and it is important to note the Commission’s firm belief that cancer treatment " should be undertaken only at, or in cooperation with, the large hospitals forming the existing National Radium Centres, or at new centres of equal status." In the absence of a national scheme including support for hospitals participating in such work the Commission have found it hard to promote the wider development of radiation treatment, but they have been negotiating with some success for the extension of radiotherapeutic services in Northumberland and Durham, Lincolnshire, East Anglia, South Lancashire, the West Riding, Kent, Wessex, South Wales, Devon, and Cornwall. Thus a radiological wing has been opened at the General (municipal) Hospital at N ewcastle- upon- Tyne ; the county medical officer of the West Riding has been authorised to send cases to Bradford Royal Infirmary, Leeds General Infirmary, or Sheffield Royal Infirmary ; and in South Wales a scheme is being considered for a Welsh National Institute of Radiotherapy in which local authorities will be interested. In Kent and Lincolnshire, too, their plans of extension are well advanced ; but in East Anglia, Oxford, Cambridge, Devon, and Cornwall no solution has been reached. What is needed is not only the extension of existing services but the establishment of new ones, and it is strongly felt that radium and X ray therapy must always be deemed inseparable parts of any scheme. The possible advantages of exposing malignant growths to large quantities of radium are still being explored, and thanks to the loan of a second 10 grammes obtained by the National Radium Trust from the Eldorado Gold Mines, Ltd., of Canada, radium-beam apparatus is now installed and working at Aberdeen Royal Infirmary (1g.), Birmingham General Hospital (3 g.), Bradford Royal Infirmary

(2 g.), Edinburgh Royal Infirmary (3 g.), Glasgow Infirmary (3 g.), Leeds General Infirmary (2 g.), and Sheffield Royal Infirmary (2 g.). Besides reporting progress at their 13 national and 9 regional centres, the Commission provide an instructive analysis of 2534 cases of rodent ulcer, 464 of recurrent rodent ulcer, and 952 of epithelioma of the skin, all of Western

which were treated with radium in 1930-34. Rodent ulcer shows a three-year net disease-free rate of 91 per cent. and a three-year net symptom-free rate of 73 per cent. for all stages, while the corresponding percentages for recurrent rodent ulcer are 75 and 48. Among the patients treated for epithelioma of the skin the three-year and five-year net survival rates for all stages are respectively 73 and 60 per cent., the corresponding symptom-free rates being 56 and 45- per cent. The Commission continue to pay close attention not only to the keeping of full records of the treatment of all patients but also to their afterhistory. Arrangements, moreover, have lately been 1 Ninth Annual Reports of the National Radium Trust and Cmd. 5883. of the Radium Commission, 1937-38. H.M. Stationery Office. 1938. Pp. 63. 1s.

made by which the national centres at Birmingham, Cardiff, Edinburgh, and Sheffield, with the help of the local authorities, will supply the Commission with records of all cancer patients seen at these centres and the cooperating hospitals, whether they It is thought that these records are treated or not. will provide useful information-for example, about the proportion of applicants who receive no treatment and the reasons why none is undertaken. EPIDEMIOLOGY OF ST. LOUIS ENCEPHALITIS

generally accepted that the epidemics of encephalitis in St. Louis city and county in 1933 and 1937 were something distinct from the von Economo type of encephalitis with which Europe became unhappily familiar during, and for a few years after, the late war. One of the many points of difference is the season of onset. In Europe the disease appeared year after year in cold weather (February to April), whereas both the St. Louis epidemics began in the hot season (July to September) and ended with the colder days of October. Attempts have lately been made by workers in the department of pathology and medicine of St. Louis University to ascertain by statistical methods whether foci of encephalitis can be detected in particular areas of the city and county. Some of the results, as reported by Dr. Casey and Prof. Brounseem important, for it was found that in both epidemics the disease appeared first and simultaneously in certain widely separated areas and continued to be most prevalent there. All these areas or foci of were situated within a mile, and all encephalitis except one, within half a mile, of the small streams in St. Louis and St. Louis County," nearly all of which carry sewage. In fact there seemed to be a fairly IT is

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close correlation between these foci and the existence of outdoor sanitary defects of various kinds, such as " the presence of weeds, open sewage, ponds, streams, and tin-can dumps." On the other hand, every district which was free from such outdoor sanitary defects, or situated a mile or more from them, not only was without epidemic foci but had a statistically significant scarcity of cases. The survey further showed that in these foci of encephalitis the factors of age, poverty, bad indoor sanitation, and overcrowding could be excluded; indeed some of the foci were in districts inhabited by persons with means above the average. Previous investigations had revealed no obvious connexion of the epidemics with the supply of water, food, or milk. The present survey increases the resemblance of the St. Louis disease, both in season and " locale," to such mosquito-borne infections as yellow fever, malaria, and equine encephalomyelitis.

at 5 P.M., Prof. R. E. Kelly will Bradshaw lecture to the Royal College of Surgeons of England. Hewillspeak on recurrent peptic ulceration. On Thursday, Dec. 8th, Mr. H. A. T. Fairbank will give the first Robert Jones lecture, on increased and decreased density of bone with special reference to fibrosis of the marrow, and on Thursday, Dec. 15th, Sir Humphry Rolleston will give the Thomas Vicary lecture, on the early history of morbid anatomy in England. All the lectures will take place at the college at 5 P.M.

TO-DAY, Friday,

deliver the

1 Casey, A. E., and Broun, G. O., Science, Nov. 11th, 1938, p. 450.