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HEPATIC LESIONS IN CONGENITAL SYPHILIS
38
diabetogenic activity by
cestrin has been demon-
strated,7 but Shumacker and Lamontfailed
to find any effect of oestrin (in doses of 9 "rat units " per day) on the somatogenic, thyrotropic, adreno-
tropic, or even gonadotropic activities, as indicated by the changes in weight of the body and separate organs after a period of 67 days. Engel9 found that the effect of growth hormone on rats was not modi-
fied by the simultaneous administration of male hormone or cestrin. On the other hand, Bernhard Zondek, in a paper published in our present issue, has demonstrated that administration of massive doses of cestrin to young rats over a long period not only represses development of ovaries or testes, but has a most striking effect in inhibiting growth, reducing body-weight by as much as 43 per cent. as compared with control animals. In addition, he forecasts the publication of data showing effects on the thyrotropic and other activities of the pituitary, as well as changes in the anterior pituitary itself. Correlating these observations with the recorded result of thyroid feeding on the anterior and secondarily on the cestrous cycle of pituitary rats 10 it seems that we are on the threshold of a closer understanding of the interrelationship of the anterior pituitary and the other endocrine organs, and of the manifold effects of administering a single hormone. Such understanding should lead to a yet more rational system of hormone therapy. CARRIER LICENCES THERE would not at first sight appear to be much particular interest to medical men in a treatise 11 on " The Law Relating to Carriers’ Licenses, under the Road and Traffic Act, 1933," unless indeed they wished for some strenuous intellectual exercise. The numerous full and complicated enactments from the Railway and Canal Traffic Act of 1854 to that of 1933 offer an intricate study for anyone rash enough to attempt their understanding without a training in the law. Mr. Maxwell has set out to make their principles and precepts clear to all those concerned with transport on the roads. And it is here that the doctor will find his curiosity justified if he looks into this volume ; indeed, he may see a certain cause for alarm. Mr. Maxwell shows him that he is, according to the wording of the law, subject to penalties in which he could not expect to be involved by the ordinary use of his car. Here is one passage from the chapter on offences : ’’ the conclusion can hardly be avoided that every motor car fitted with any kind of convenience for carrying the luggage or effects of passengers or any other kind of load is a goods vehicle, and that a license is required to carry anything in any motor car in connection with a business...." This definition seems certain to include the car in which the doctor carries his case of drugs, his emergency outfit, his anaesthetic bag, and so on. Later on comes the more specific statement : "if an engineer needs a license to carry his tools a surgeon should need a license to carry his instruments," and the author goes on to show that the typist might need one to carry his typewriter, and
of
7 Barnes, B. O., Regan, J. F., and Nelson, W. O. : Jour. Amer. Med. Assoc., 1933, ci., 926 ; Nelson, W. O., and OverM. D.: Proc. Soc. Exp. Biol. Med., 1934, xxxii., 150. holzer, 8 Shumacker, H. B., Jun., and Lamont, A. : Proc. Soc. Exp. Biol. Med., 1935, xxxii., 1568. 9 Engel, P.: Klin. Woch., 1934, xiii., 1540. 10 Campbell, M., Wolfe, J. M., and Phelps, D. : Proc. Soc. Exp. Biol. Med., 1934, xxxii., 1205. 11 The Law Relating to Carriers’Licenses under the Road and Rail Traffic Act, 1933. By Eric F. M. Maxwell, of the Inner London : Temple and Northern Circuit, Barrister-at-Law. Sweet and Maxwell Ltd. 1936. Pp. 330. 15s.
perhaps the barrister to carry his briefs. It appears that much of the drafting of the bills governing traffic is faulty, making the clear meaning of The law difficult to discern and indeed, if taken strictly, not seldom reducing the law to absurdity. Mr. Maxwell, an authority on railway law, has been impressed with the necessity of clearing up the muddle if people are to have a fair chance of evading liabilities for which they are unlikely to realise their,responsibility, and his book should be of service to the many persons who become involved in litigation through incidents of road travel of one kind or another. HEPATIC
LESIONS
IN
CONGENITAL
SYPHILIS
THE morbid anatomist nowadays sees relatively little of the lesions of acquired syphilis, at any rate in a frank and easily recognisable form ; the gumma has become a rarity and even syphilitic aortitis is nothing like as common as it was. Stillmoreuncommon are the lesions of the congenital form of the disease, for antenatal and infant welfare and venereal disease clinics are making their influence felt, not to speak of the increased vigilance in this direction of the general practitioner. Nevertheless, from time to time an unhappy infant slips through the therapeutic net and may in due course present very puzzling problems to the unwary pathologist. In a scholarly article in the recently established Indian Journal of Venereal Diseases (1935, i., 183)Dr. P. Ramachandra Rao discusses in detail the manifestations of congenital syphilis as seen in the liver. This organ, as he points out, is particularly liable to be affected by the disease, for the maternal blood passes directly to it through the umbilical vein and only reaches the rest of the body after it has passed through its capillaries. The intense saturation of the liver with spirochsetes, with the accompanying fine fibrosis and the development of miliary gummata, is the form of congenital syphilitic disease of the liver which is familiar to everybody. Less well recognised are the later or more chronic manifestations, for, as Dr. Rao observes, it may be impossible to demonstrate spirochaetes in them. Often enough the syphilitic nature of the lesions can only be presumed from the clinical history or the recognition of more cha,racteristic changes elsewhere in the body. Among these more obscure hepatic lesions Dr. Rao includes chronic periportal pylephlebitis, pericholangitis, and endophlebitis of the hepatic vein, illustrating his thesis by descriptions of interesting cases occurring in the autopsy practice of the King George Hospital of Vizagapatam. A number of helpful photomicrographs are included and the value of the article is enhanced by a very complete bibliography. USE OF MENTHOL IN CHILDHOOD
IN an annotation on the treatment of the common cold in France, published a fortnight ago, we mentioned the apparent unpopularity of menthol as a remedy. In adults toxic symptoms due to the use of this drug must be extremely rare, but as long ago as 1912, it seems, R. Leroux wrote in no uncertain terms of the danger of its use in childhood, and particularly in infancy, even when given by intranasal instillation in vaseline. He thought that it was liable to produce reflex inhibition of both respiration and cardiac action, and that its action and dangers were exactly comparable to those of chloroform anaesthesia in its early stages. It happens that Dr. Champeau has just recordedsevere disturbances 1 Bull. de l’Acad. de
Méd., 1935, cxiv., 448.
diabetogenic activity by
cestrin has been demon-
strated,7 but Shumacker and Lamontfailed
to find any effect of oestrin (in doses of 9 "rat units " per day) on the somatogenic, thyrotropic, adreno-
tropic, or even gonadotropic activities, as indicated by the changes in weight of the body and separate organs after a period of 67 days. Engel9 found that the effect of growth hormone on rats was not modi-
fied by the simultaneous administration of male hormone or cestrin. On the other hand, Bernhard Zondek, in a paper published in our present issue, has demonstrated that administration of massive doses of cestrin to young rats over a long period not only represses development of ovaries or testes, but has a most striking effect in inhibiting growth, reducing body-weight by as much as 43 per cent. as compared with control animals. In addition, he forecasts the publication of data showing effects on the thyrotropic and other activities of the pituitary, as well as changes in the anterior pituitary itself. Correlating these observations with the recorded result of thyroid feeding on the anterior and secondarily on the cestrous cycle of pituitary rats 10 it seems that we are on the threshold of a closer understanding of the interrelationship of the anterior pituitary and the other endocrine organs, and of the manifold effects of administering a single hormone. Such understanding should lead to a yet more rational system of hormone therapy. CARRIER LICENCES THERE would not at first sight appear to be much particular interest to medical men in a treatise 11 on " The Law Relating to Carriers’ Licenses, under the Road and Traffic Act, 1933," unless indeed they wished for some strenuous intellectual exercise. The numerous full and complicated enactments from the Railway and Canal Traffic Act of 1854 to that of 1933 offer an intricate study for anyone rash enough to attempt their understanding without a training in the law. Mr. Maxwell has set out to make their principles and precepts clear to all those concerned with transport on the roads. And it is here that the doctor will find his curiosity justified if he looks into this volume ; indeed, he may see a certain cause for alarm. Mr. Maxwell shows him that he is, according to the wording of the law, subject to penalties in which he could not expect to be involved by the ordinary use of his car. Here is one passage from the chapter on offences : ’’ the conclusion can hardly be avoided that every motor car fitted with any kind of convenience for carrying the luggage or effects of passengers or any other kind of load is a goods vehicle, and that a license is required to carry anything in any motor car in connection with a business...." This definition seems certain to include the car in which the doctor carries his case of drugs, his emergency outfit, his anaesthetic bag, and so on. Later on comes the more specific statement : "if an engineer needs a license to carry his tools a surgeon should need a license to carry his instruments," and the author goes on to show that the typist might need one to carry his typewriter, and
of
7 Barnes, B. O., Regan, J. F., and Nelson, W. O. : Jour. Amer. Med. Assoc., 1933, ci., 926 ; Nelson, W. O., and OverM. D.: Proc. Soc. Exp. Biol. Med., 1934, xxxii., 150. holzer, 8 Shumacker, H. B., Jun., and Lamont, A. : Proc. Soc. Exp. Biol. Med., 1935, xxxii., 1568. 9 Engel, P.: Klin. Woch., 1934, xiii., 1540. 10 Campbell, M., Wolfe, J. M., and Phelps, D. : Proc. Soc. Exp. Biol. Med., 1934, xxxii., 1205. 11 The Law Relating to Carriers’Licenses under the Road and Rail Traffic Act, 1933. By Eric F. M. Maxwell, of the Inner London : Temple and Northern Circuit, Barrister-at-Law. Sweet and Maxwell Ltd. 1936. Pp. 330. 15s.
perhaps the barrister to carry his briefs. It appears that much of the drafting of the bills governing traffic is faulty, making the clear meaning of The law difficult to discern and indeed, if taken strictly, not seldom reducing the law to absurdity. Mr. Maxwell, an authority on railway law, has been impressed with the necessity of clearing up the muddle if people are to have a fair chance of evading liabilities for which they are unlikely to realise their,responsibility, and his book should be of service to the many persons who become involved in litigation through incidents of road travel of one kind or another. HEPATIC
LESIONS
IN
CONGENITAL
SYPHILIS
THE morbid anatomist nowadays sees relatively little of the lesions of acquired syphilis, at any rate in a frank and easily recognisable form ; the gumma has become a rarity and even syphilitic aortitis is nothing like as common as it was. Stillmoreuncommon are the lesions of the congenital form of the disease, for antenatal and infant welfare and venereal disease clinics are making their influence felt, not to speak of the increased vigilance in this direction of the general practitioner. Nevertheless, from time to time an unhappy infant slips through the therapeutic net and may in due course present very puzzling problems to the unwary pathologist. In a scholarly article in the recently established Indian Journal of Venereal Diseases (1935, i., 183)Dr. P. Ramachandra Rao discusses in detail the manifestations of congenital syphilis as seen in the liver. This organ, as he points out, is particularly liable to be affected by the disease, for the maternal blood passes directly to it through the umbilical vein and only reaches the rest of the body after it has passed through its capillaries. The intense saturation of the liver with spirochsetes, with the accompanying fine fibrosis and the development of miliary gummata, is the form of congenital syphilitic disease of the liver which is familiar to everybody. Less well recognised are the later or more chronic manifestations, for, as Dr. Rao observes, it may be impossible to demonstrate spirochaetes in them. Often enough the syphilitic nature of the lesions can only be presumed from the clinical history or the recognition of more cha,racteristic changes elsewhere in the body. Among these more obscure hepatic lesions Dr. Rao includes chronic periportal pylephlebitis, pericholangitis, and endophlebitis of the hepatic vein, illustrating his thesis by descriptions of interesting cases occurring in the autopsy practice of the King George Hospital of Vizagapatam. A number of helpful photomicrographs are included and the value of the article is enhanced by a very complete bibliography. USE OF MENTHOL IN CHILDHOOD
IN an annotation on the treatment of the common cold in France, published a fortnight ago, we mentioned the apparent unpopularity of menthol as a remedy. In adults toxic symptoms due to the use of this drug must be extremely rare, but as long ago as 1912, it seems, R. Leroux wrote in no uncertain terms of the danger of its use in childhood, and particularly in infancy, even when given by intranasal instillation in vaseline. He thought that it was liable to produce reflex inhibition of both respiration and cardiac action, and that its action and dangers were exactly comparable to those of chloroform anaesthesia in its early stages. It happens that Dr. Champeau has just recordedsevere disturbances 1 Bull. de l’Acad. de
Méd., 1935, cxiv., 448.