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HEREDITARY TRANSMISSION OF SYPHILIS.
310 control experiments Mr. Gilruth draws the following conclusions :— 1. Guinea-pigs, rabbits, and sheep can completely resist the inoculation of large doses of virulent anthrax bacilli, provided these organisms are mixed with a larger quantity of some other organisms which are non-pathogenic to these animals. 2. Death is frequently delayed very considerably when the organism mixed with the anthrax bacillus is possessed of small pathogenic properties. ’
’
3. The anthrax bacillus must be mixed " with the other organism, for if they be injected under different parts of the skin no resistance results. 4. An animal which has suffered without absolute impunity the injection of a large dose of anthrax bacillus when mixed with a foreign organism may succumb later to a much smaller dose of anthrax bacillus of pure culture although generally some resistance is evidenced. 5. It was observed with rabbits and sheep which received repeated doses of both anthrax and Gaertner bacillus mixed together in increasing quantities that a certain amount of immunity to comparatively large doses of pure anthrax could.be conferred. 6. If the subject is further investigated it may possibly aftord a surer and more satisfactory manner of conferring immunity against anthrax, and possibly other diseases, than those now in vogue.
learned magistrate would seem to be a certificate that 60 tons possibly saturated in varying degrees will make a safe and wholesome drink for those who will partake of it. According to the Standard it now appears that Mr. Rose, at Southwark police court, refused to revoke his order for the destruction of the coffee in spite of Mr. Chapman holding with regard to a portion of it that If this be so we it was fit for human consumption. his Mr. Rose on attitude. congratulate
HEREDITARY
TRANSMISSION
OF SYPHILIS.
’
THE ROYAL COLLEGE OF PHYSICIANS OF LONDON. THE lectures of the present year to be delivered before the Royal College of Physicians of London are as follows. The Milroy lectures will be given by Dr. T. M. Legge on March 7th, 9th, and 14th, the subject being Industrial Anthrax ; the Goulstonian lectures will be given by Dr. W. C. Bosanquet on March 16th, 21st, and 23rd. the subject being Some Considerations on the Nature of Diabetes Mellitus ; the Lumleian lectures will be given by Dr.’W. H. Allchin on March 28th and 30th and April 4th, the subject being Some Aspects of Malnutrition ; and the OliverSharpey lecture will be given by Dr. Leonard E. Hill on April 6th, the subject being the Influence of Atmospheric Pressure on Man. The days of the week for the delivery of the lectures are Tuesdays and Thursdays. The hour of delivery is 5 P.M. at the Royal College of Physicians, Pall Mall East, S.W. -
COFFEE AND SEWAGE.
strange decision seems to have been arrived which was concluded at the Southwark police on Jan. 24th after an adjournment from the preceding week. The application made by the chief sanitary inspector of the borough of Bermondsey was for the destruction of 60 tons of coffee salvaged from a ship which had been sunk in the Thames and the summons was taken out in order to prevent the berries from being dried and sold for human consumption. The evidence of Dr. R. K. Brown, medical officer .of health of Bermondsey, of Dr. J. W. H. Eyre, and of Mr. Bodmer was to the effect that the coffee was moist, sodden, permeated with sewage, and unfit for food purposes. Although they admitted that the necessary roasting might modify - the dangerous conditions they declined to say that the subsequent decoction would thereby be rendered a wholesome beverage. On the other side, Mr. Friswell of Great Tower-street said that he had drunk coffee made from Dr. the sewage-laden berries without untoward results. F. J. Smith also gave evidence that he was prepared to do the same but that he "would not do so for choice." ’The magistrate, Mr. C. Chapman, appears to have been satisfied that the usual roasting process was sufficient to Tender the coffee fit for the food of man and dismissed the application. If he could have ordered that the -stuff when sold retail should be labelled "coffee and sewage," so that the purchaser would have the same choice in ,purchasing that the law gives him in the. case of admixture with chicory, the matter might have passed without .comment. Few, even when tempted by a cheaper price, would be likely to buy coffee if they knew that it had ’undergone soaking in the diluted products of the metropolitan drainage system, although the decision of the A
at in court
RATHER a case
ABOUT two years ago Professor Matzenauer, in a paper read before a medical society at Vienna and published in the Wiener Elinisehe TVockensckrift,1903, Nos. 7-13, stated that in his opinion a direct paternal transmission of syphilis to.the offspring has not been proved. His principal conclusions may be summed up in three general propositions : first, "that the mother of a congenitally syphilitic infant is invariably herself the subject of syphilis, even when to all appearances healthy." The second is "that an inheritance.of the disease through an infected ovum or spermatozoon-that is, hereditary transmission in the true sense of the word-has not been proved." The third proposition is the natural consequence of these-viz., that the infection of the offspring is in every case secondary and brought about by an infection from the mother by the channel of the placental circulation. If these be accepted it follows that what has been called e7toe en retour, that is, the infection of a. healthy mother through the placental circulation by a syphilitic foetus, the result of paternal infection, does not exist. From the outset these conclusions of Professor Matzenauer were vigorously attacked and a somewhat polemical discussion raged in certain German and Austrian papers for some time. A paper has been published in the -Jftinchener -4-redicinische lY’oc3aenschrift, Nos. 49 and 50, 1904, by Dr. Jesionek of Munich, in which two cases of considerable interest are recorded and Professor Matzenauer’s views are vigorously criticised. The first case was that of a girl, aged 18 years, admitted into hospital for an attack of gonorrhoea, the gonococci being repeatedly demonstrated in the discharge. Since the case was one brought in by the police and was being dealt with judicially very careful examination was repeatedly made by several observers for evidence of syphilitic affection but always with negative result. It soon became apparent that the patient was pregnant and about four months after the date of impregnation her general condition, which had previously been good, markedly deteriorated and about a month later she developed a typical severe syphilitic roseolous eruption. The patient had been in hospital during the whole of this time and no evidence could be found of any primary chancre or anything to point to infection while in hospital. Shortly afterwards general enlargement of lymphatic glands became manifest and the case progressed as an ordinary case of secondary syphilis. About two and a half months later-that is, about the middle of the eighth month of pregnancy-a dead foetus 35 centimetres in length was born which showed appearances of typical congenital syphilis-viz., maceration, enlarged spleen, swelling and parenchymatous degeneration of the liver, general icterus, syphilitic osteochondritis, multiple hæmorrhages, and complete atelectasis. Dr. Jesionek considers it highly improbable that such advanced changes as were found in almost all the organs of the foetus could have developed in the short space of two and a half months, and taking into consideration the history of the case comes to the conclusion that the case is one of choo en reto-aor and that infection of the foetus through the spermatozoon without direct infection of the mother is thus a possibility. , He also brings forward another case in support of his contention that the spermatozoa may serve as
311 the infective agent in direct contradiction of Professor Matzenauer’a dictum that the spermatozoa of a syphilitic man are not infective. The patient was a medical practitioner, aged 45 years, wh’o acquired a primary chancre on one of his right nngers from attending a syphilitic woman,in her confinement ; this was followed by a typical rash and sore-throat. Treatment by mercurial inunction was adopted vigorously for four months, after which period no signs of syphilis were discoverable. Shortly afterwards the patient resumed conjugal relations with his wife who subsequently developed a chancre of the vagina followed by roseola and glandular enlargements. In this case Dr. Jesionek attributes the infection to the spermatozoa since no syphilitic lesions such as mucous patches or a rash could be found about the man. Although no generalisations can be made from two cases yet the very careful manner in which they have been observed and recorded demands that due attention -shall be given to the conclusions to which they apparently point, and while we cannot on this evidence alone accept Dr. Jesionek’s conclusions that the spermatozoa of a syphilitic man are directly infective and that paternal inheritance and choe en retour are both proved, yet the striking nature of the cases should lead to careful observation of others in the same manner by other observers and the paper forms a valuable addition to our knowledge ofa a controversial matter. ____
DINNER AND DISEASE.
IN an evening contemporary there recently appeared an admirable article by Mrs. Hugh Bell entitled "The Dietetics of Conversation." In it she protests against the perpetual references to health, diseae, and the state of the "inside"which now form such a prominent topic of conversation. In her own words : " To have people bitting in one’s drawing-room talking about their secretions seems to me repellent, not to say disgusting. It is bad enough to have each of their most trifling actions explained and justified by a symptom ; but it is quite intolerable that each
records of a recent trial have shown that there an occasional entertainment is a biograph representation of the" hostess or one of her friends undergoing an abdominal’ section. But it is too true that refinement and that oldfashioned virtue known as reserve have markedly decreased of late years. The arcana of feminine dress are exposed toall and sundry in every shop window, to say nothing of the advertisements in fashion papers, and although there is, nothing immoral in underclothing or.in conversation about appendicitis or curetting we cordially agree with Mrs. Hugh Bell that such matters are not fitting for ordinary social
conversation. ____
CEREBRAL HÆMORRHAGE IN CHILDREN. IN another column we publish an interesting case of non traumatic cerebral hemorrhage in a child, aged ten years, recorded by Dr. Hugh Taylor. Cerebral haemorrhage in children is certainly a rare disease but nevertheless it has to be borne in mind in ascertaining the It cause of sudden or unforeseen death in young subjects. may be meningeal or intra-arachnoid or into the substanceof the brain, the first-named being the more corpmon,. Meningeal hæmorrhage is generally met with in children. At this time congestiveat the period of dentition. attacks may occur, including lesions of the parietal arachnoid which becomes vascular; the small vessels newly formed in the membranes may burst and sudden death follows. Whooping-cough may also be the cause of the hmmorrhage or severe purpura may bring it about. Thrombosisof the sinuses and the various abnormal conditions of the blood met with in the exanthemata are also occasional causes. Haemorrhage into the substance of the brain seldom occurs in children ; when it is found it has in most cases been secondary to ulcerative endocarditis and has been due to embolism. Very exceptionally the vessels in childhood present a condition of atheroma and cerebral haemorrhagehas resulted from the rupture of a vessel thus diseased.
Congenital syphilis may also produce vascular lesions in theand a name given brain and elsewhere. Dr. Taylor states that in his case all or of inflammation to which to the particular other organs were macroscopically quite healthy.it is due." Further on she says: "It is like poor people, Probably some disease of the blood-vessels of the brain waswhose favourite form of conversation is to offer to show you present which would only have been detected on microtheir bad leg’-a mysterious disease which will no scopic examination. doubt in due time work its way up into the drawing-rooms and the conversation of Belgravia." We quite agree with INFLUENZA AND ENDOCARDITIS. Mrs. Hugh Bell but we do not think that the style of SINCE influenza has established itself as a permanent. conversation to which she objects is altogether a novelty. in this country we have had only too frequent scourge In chapter 41 of that storehouse of human psychology, of observing the disturbing effects of its opportunities "Vanity Fair," Thackeray refers to Lady Jane Crawley and toxins the The most common manifestations upon Becky Sharp having one of those confidential medical con- of this action areheart. seen in the irregularities characteristic versations about the children which all mothers delight in. He continues, with a fine disregard of dates,"Fifty years of the pulse in influenza ; this may be frequent, inor irregular, or may exhibit the special inago, and when the present writer, being an interesting little frequent described These disturbances must Huchard. by stability" boy, was ordered out of the room with the ladies after in all the action of the of be ascribed to poison probability I remember talk was chiefly dinner, quite well that their about their ailments." Again, in chapter 60, after an account influenza upon the nervous apparatus of the heart. But of one of Joseph Sedley’s dinner parties, we learn " Politics actual inflammatory affections of the organ may alsa. occur and both pericarditis and endocarditis are somestepped in a short time after dessert when the ladies times met with, though they are comparatively rare. A. retired upstairs and talked about their complaints and case of the latter affection has recently been recorded their children." Nowadays, however, the talk about comcommunication made to the plaints is openly indulged in at the dinner-table by by Dr. Pedro Eseudero in 1 a The Medical Society. patient was a boy, aged members of opposite sexes and in our opinion it is due Argentine attack of influenza complicated. 13 who went an years, through in great part to that emancipation for which women have in both lungs succession. The pneubeen crying out for so long and which now they have by pneumonia affecting monia resolved satisfactorily but a relapse of fever occurred, undoubtedly gained. Not only have we heard appendicitis time by the appearance of a systolic this accompanied discussed at the dinner-table but even intimate gynæmurmur at the apex of the heart, conducted into the axilla. cological complaints. It is true that London society is not and apparently pointed to. yet so advanced as is fashionable society in Paris, for the This persisted after convalescence an organic valvular lesion. There is some doubt as to. 1 "Vanity Fair" was written in 1847-48 and Thackeray was born 1 in 1811. "Endocardite Grippale," Argentina Medica, Nov. 19th, 1904. symptom should in
its turn be form of acid
explained
the
-
’
3. The anthrax bacillus must be mixed " with the other organism, for if they be injected under different parts of the skin no resistance results. 4. An animal which has suffered without absolute impunity the injection of a large dose of anthrax bacillus when mixed with a foreign organism may succumb later to a much smaller dose of anthrax bacillus of pure culture although generally some resistance is evidenced. 5. It was observed with rabbits and sheep which received repeated doses of both anthrax and Gaertner bacillus mixed together in increasing quantities that a certain amount of immunity to comparatively large doses of pure anthrax could.be conferred. 6. If the subject is further investigated it may possibly aftord a surer and more satisfactory manner of conferring immunity against anthrax, and possibly other diseases, than those now in vogue.
learned magistrate would seem to be a certificate that 60 tons possibly saturated in varying degrees will make a safe and wholesome drink for those who will partake of it. According to the Standard it now appears that Mr. Rose, at Southwark police court, refused to revoke his order for the destruction of the coffee in spite of Mr. Chapman holding with regard to a portion of it that If this be so we it was fit for human consumption. his Mr. Rose on attitude. congratulate
HEREDITARY
TRANSMISSION
OF SYPHILIS.
’
THE ROYAL COLLEGE OF PHYSICIANS OF LONDON. THE lectures of the present year to be delivered before the Royal College of Physicians of London are as follows. The Milroy lectures will be given by Dr. T. M. Legge on March 7th, 9th, and 14th, the subject being Industrial Anthrax ; the Goulstonian lectures will be given by Dr. W. C. Bosanquet on March 16th, 21st, and 23rd. the subject being Some Considerations on the Nature of Diabetes Mellitus ; the Lumleian lectures will be given by Dr.’W. H. Allchin on March 28th and 30th and April 4th, the subject being Some Aspects of Malnutrition ; and the OliverSharpey lecture will be given by Dr. Leonard E. Hill on April 6th, the subject being the Influence of Atmospheric Pressure on Man. The days of the week for the delivery of the lectures are Tuesdays and Thursdays. The hour of delivery is 5 P.M. at the Royal College of Physicians, Pall Mall East, S.W. -
COFFEE AND SEWAGE.
strange decision seems to have been arrived which was concluded at the Southwark police on Jan. 24th after an adjournment from the preceding week. The application made by the chief sanitary inspector of the borough of Bermondsey was for the destruction of 60 tons of coffee salvaged from a ship which had been sunk in the Thames and the summons was taken out in order to prevent the berries from being dried and sold for human consumption. The evidence of Dr. R. K. Brown, medical officer .of health of Bermondsey, of Dr. J. W. H. Eyre, and of Mr. Bodmer was to the effect that the coffee was moist, sodden, permeated with sewage, and unfit for food purposes. Although they admitted that the necessary roasting might modify - the dangerous conditions they declined to say that the subsequent decoction would thereby be rendered a wholesome beverage. On the other side, Mr. Friswell of Great Tower-street said that he had drunk coffee made from Dr. the sewage-laden berries without untoward results. F. J. Smith also gave evidence that he was prepared to do the same but that he "would not do so for choice." ’The magistrate, Mr. C. Chapman, appears to have been satisfied that the usual roasting process was sufficient to Tender the coffee fit for the food of man and dismissed the application. If he could have ordered that the -stuff when sold retail should be labelled "coffee and sewage," so that the purchaser would have the same choice in ,purchasing that the law gives him in the. case of admixture with chicory, the matter might have passed without .comment. Few, even when tempted by a cheaper price, would be likely to buy coffee if they knew that it had ’undergone soaking in the diluted products of the metropolitan drainage system, although the decision of the A
at in court
RATHER a case
ABOUT two years ago Professor Matzenauer, in a paper read before a medical society at Vienna and published in the Wiener Elinisehe TVockensckrift,1903, Nos. 7-13, stated that in his opinion a direct paternal transmission of syphilis to.the offspring has not been proved. His principal conclusions may be summed up in three general propositions : first, "that the mother of a congenitally syphilitic infant is invariably herself the subject of syphilis, even when to all appearances healthy." The second is "that an inheritance.of the disease through an infected ovum or spermatozoon-that is, hereditary transmission in the true sense of the word-has not been proved." The third proposition is the natural consequence of these-viz., that the infection of the offspring is in every case secondary and brought about by an infection from the mother by the channel of the placental circulation. If these be accepted it follows that what has been called e7toe en retour, that is, the infection of a. healthy mother through the placental circulation by a syphilitic foetus, the result of paternal infection, does not exist. From the outset these conclusions of Professor Matzenauer were vigorously attacked and a somewhat polemical discussion raged in certain German and Austrian papers for some time. A paper has been published in the -Jftinchener -4-redicinische lY’oc3aenschrift, Nos. 49 and 50, 1904, by Dr. Jesionek of Munich, in which two cases of considerable interest are recorded and Professor Matzenauer’s views are vigorously criticised. The first case was that of a girl, aged 18 years, admitted into hospital for an attack of gonorrhoea, the gonococci being repeatedly demonstrated in the discharge. Since the case was one brought in by the police and was being dealt with judicially very careful examination was repeatedly made by several observers for evidence of syphilitic affection but always with negative result. It soon became apparent that the patient was pregnant and about four months after the date of impregnation her general condition, which had previously been good, markedly deteriorated and about a month later she developed a typical severe syphilitic roseolous eruption. The patient had been in hospital during the whole of this time and no evidence could be found of any primary chancre or anything to point to infection while in hospital. Shortly afterwards general enlargement of lymphatic glands became manifest and the case progressed as an ordinary case of secondary syphilis. About two and a half months later-that is, about the middle of the eighth month of pregnancy-a dead foetus 35 centimetres in length was born which showed appearances of typical congenital syphilis-viz., maceration, enlarged spleen, swelling and parenchymatous degeneration of the liver, general icterus, syphilitic osteochondritis, multiple hæmorrhages, and complete atelectasis. Dr. Jesionek considers it highly improbable that such advanced changes as were found in almost all the organs of the foetus could have developed in the short space of two and a half months, and taking into consideration the history of the case comes to the conclusion that the case is one of choo en reto-aor and that infection of the foetus through the spermatozoon without direct infection of the mother is thus a possibility. , He also brings forward another case in support of his contention that the spermatozoa may serve as
311 the infective agent in direct contradiction of Professor Matzenauer’a dictum that the spermatozoa of a syphilitic man are not infective. The patient was a medical practitioner, aged 45 years, wh’o acquired a primary chancre on one of his right nngers from attending a syphilitic woman,in her confinement ; this was followed by a typical rash and sore-throat. Treatment by mercurial inunction was adopted vigorously for four months, after which period no signs of syphilis were discoverable. Shortly afterwards the patient resumed conjugal relations with his wife who subsequently developed a chancre of the vagina followed by roseola and glandular enlargements. In this case Dr. Jesionek attributes the infection to the spermatozoa since no syphilitic lesions such as mucous patches or a rash could be found about the man. Although no generalisations can be made from two cases yet the very careful manner in which they have been observed and recorded demands that due attention -shall be given to the conclusions to which they apparently point, and while we cannot on this evidence alone accept Dr. Jesionek’s conclusions that the spermatozoa of a syphilitic man are directly infective and that paternal inheritance and choe en retour are both proved, yet the striking nature of the cases should lead to careful observation of others in the same manner by other observers and the paper forms a valuable addition to our knowledge ofa a controversial matter. ____
DINNER AND DISEASE.
IN an evening contemporary there recently appeared an admirable article by Mrs. Hugh Bell entitled "The Dietetics of Conversation." In it she protests against the perpetual references to health, diseae, and the state of the "inside"which now form such a prominent topic of conversation. In her own words : " To have people bitting in one’s drawing-room talking about their secretions seems to me repellent, not to say disgusting. It is bad enough to have each of their most trifling actions explained and justified by a symptom ; but it is quite intolerable that each
records of a recent trial have shown that there an occasional entertainment is a biograph representation of the" hostess or one of her friends undergoing an abdominal’ section. But it is too true that refinement and that oldfashioned virtue known as reserve have markedly decreased of late years. The arcana of feminine dress are exposed toall and sundry in every shop window, to say nothing of the advertisements in fashion papers, and although there is, nothing immoral in underclothing or.in conversation about appendicitis or curetting we cordially agree with Mrs. Hugh Bell that such matters are not fitting for ordinary social
conversation. ____
CEREBRAL HÆMORRHAGE IN CHILDREN. IN another column we publish an interesting case of non traumatic cerebral hemorrhage in a child, aged ten years, recorded by Dr. Hugh Taylor. Cerebral haemorrhage in children is certainly a rare disease but nevertheless it has to be borne in mind in ascertaining the It cause of sudden or unforeseen death in young subjects. may be meningeal or intra-arachnoid or into the substanceof the brain, the first-named being the more corpmon,. Meningeal hæmorrhage is generally met with in children. At this time congestiveat the period of dentition. attacks may occur, including lesions of the parietal arachnoid which becomes vascular; the small vessels newly formed in the membranes may burst and sudden death follows. Whooping-cough may also be the cause of the hmmorrhage or severe purpura may bring it about. Thrombosisof the sinuses and the various abnormal conditions of the blood met with in the exanthemata are also occasional causes. Haemorrhage into the substance of the brain seldom occurs in children ; when it is found it has in most cases been secondary to ulcerative endocarditis and has been due to embolism. Very exceptionally the vessels in childhood present a condition of atheroma and cerebral haemorrhagehas resulted from the rupture of a vessel thus diseased.
Congenital syphilis may also produce vascular lesions in theand a name given brain and elsewhere. Dr. Taylor states that in his case all or of inflammation to which to the particular other organs were macroscopically quite healthy.it is due." Further on she says: "It is like poor people, Probably some disease of the blood-vessels of the brain waswhose favourite form of conversation is to offer to show you present which would only have been detected on microtheir bad leg’-a mysterious disease which will no scopic examination. doubt in due time work its way up into the drawing-rooms and the conversation of Belgravia." We quite agree with INFLUENZA AND ENDOCARDITIS. Mrs. Hugh Bell but we do not think that the style of SINCE influenza has established itself as a permanent. conversation to which she objects is altogether a novelty. in this country we have had only too frequent scourge In chapter 41 of that storehouse of human psychology, of observing the disturbing effects of its opportunities "Vanity Fair," Thackeray refers to Lady Jane Crawley and toxins the The most common manifestations upon Becky Sharp having one of those confidential medical con- of this action areheart. seen in the irregularities characteristic versations about the children which all mothers delight in. He continues, with a fine disregard of dates,"Fifty years of the pulse in influenza ; this may be frequent, inor irregular, or may exhibit the special inago, and when the present writer, being an interesting little frequent described These disturbances must Huchard. by stability" boy, was ordered out of the room with the ladies after in all the action of the of be ascribed to poison probability I remember talk was chiefly dinner, quite well that their about their ailments." Again, in chapter 60, after an account influenza upon the nervous apparatus of the heart. But of one of Joseph Sedley’s dinner parties, we learn " Politics actual inflammatory affections of the organ may alsa. occur and both pericarditis and endocarditis are somestepped in a short time after dessert when the ladies times met with, though they are comparatively rare. A. retired upstairs and talked about their complaints and case of the latter affection has recently been recorded their children." Nowadays, however, the talk about comcommunication made to the plaints is openly indulged in at the dinner-table by by Dr. Pedro Eseudero in 1 a The Medical Society. patient was a boy, aged members of opposite sexes and in our opinion it is due Argentine attack of influenza complicated. 13 who went an years, through in great part to that emancipation for which women have in both lungs succession. The pneubeen crying out for so long and which now they have by pneumonia affecting monia resolved satisfactorily but a relapse of fever occurred, undoubtedly gained. Not only have we heard appendicitis time by the appearance of a systolic this accompanied discussed at the dinner-table but even intimate gynæmurmur at the apex of the heart, conducted into the axilla. cological complaints. It is true that London society is not and apparently pointed to. yet so advanced as is fashionable society in Paris, for the This persisted after convalescence an organic valvular lesion. There is some doubt as to. 1 "Vanity Fair" was written in 1847-48 and Thackeray was born 1 in 1811. "Endocardite Grippale," Argentina Medica, Nov. 19th, 1904. symptom should in
its turn be form of acid
explained
the
-