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HERPES ZOSTER SIMULATING DISEASE WITHIN THE ABDOMEN.
409
only for sanitary but also for economic Unfortunately, the extermination of the rat is a far more difficult problem than that of the domestic fly. Though each householder, shopkeeper, and shipowner can perform his own share of the necessary work, united action by local and central authorities is also essential if the numbers of the malignant rat are to be perceptibly reduced, total extermination being apparently impossible under present conditions. The rendering of dwellings, stores, and wharves reasonably rat-proof is likewise indispensable. If, therefore, the public authorities are not impelled to move in this direction on medical grounds alone, there is a very strong incentive to immediate action strictly upon economic considerations, which, perhaps, are more likely to appeal to the sympathies of the public all the world over. to be desired not
reasons.
born, for from the conflict of the views of the extremists the mean, which probably lies nearest to the truth, is apt to
be chosen and accepted as currency in the end. So many debates, have been won and lost that it will probably strike the attentive reader of more recent work that there may, in the near future, be danger of a lack of healthy opposition to the acceptance of new finds. From the controversies of the past Neandertal man and Pithecanthropus have emerged as orthodox and accepted axioms, and now is added Eoanthropus dawsoni. Eoanthropus dawsoni has not had his baptism of fire. It must be remembered that while Huxley was attacking Mayer, of Bonn, he was equally engaged in refuting the views of Professor King, for if the Cossack idea of the one struck Huxley as being too homely, the assertion of the other that the skull was not only specifically but generically distinct from manwas far too revolutionary for him. May not history repeat MAN AND HIS FORERUNNERS. itself ?1 Professor Buttel-Reepen says of the Piltdown skull IT was one of the most heartfelt pleadings uttered by the that it I has been placed by Woodward not only in a new late Professor Dwight, of Harvard, that we should stop from species, but-an extreme step-in a new genus, and has been time to time in the march of science; pause for however given the name Eoanthropus dawsoni." The Piltdown brief a spell, just to look back to see where our ideas had individual has had a peculiarly fortunate genesis, for he has come from, and to look ahead to see where they were leading been ushered into the world under a geological segis so disHe made this charge against the men who were labour- tinguished that he takes rank at once as a representative us. at the problems of evolution, that once the idea had of late Pliocene or early Pleistocene times. But it seems. ing started making progress not one of them paused to make a not impossible that the geological distinction of his rebirth reasoned survey of the premises, or considered the logical may be in danger of permitting him to pass to his place outcome of pushing those ideas to a conclusion and present- without running the gauntlet of battle waged around the ing the final product to the world. There is no study in earlier finds. He has come to his place in the lay mind, he which this stock-taking process is more necessary than that has found his way into printed books and into tables and which concerns itself with the geological story of man. Every schemes; his relationship with other early types is guessed fresh find, whether of actual bones or objects of culture, at, presumed, or asserted ; and yet, anthropologically dictates a pause ; it is not enough to attempt to fit the new speaking, his battle is unfought. As a geological relic he material into some gap in a preconceived scheme ; for the has taken permanent and proper place, but as an anthromaterial must be judged on its own merits and the scheme, if pological type he remains unchastened by criticism. He is necessary, be recast for its reception. Within the last two late Pliocene or early Pleistocene, but is he Eoanthropusyears our knowledge of the early remains of man has been a genus distinct from Homo ?1 It is for questions such as. admirably summarised in three separate publications, each these that the pause and the stock-taking are required. marked with its own distinctive individuality, by Keith, Sollas, and Duckworth. These excellent réS1tmés of the HERPES ZOSTER SIMULATING DISEASE WITHIN THE ABDOMEN. story of ancient man were all issued before the discovery of the remains of the individual, now famous as ’’ the Piltdown THE eruption of herpes zoster may be preceded for some skull,"was made known to the public ; but recently there has days by pain, and then a wrong diagnosis may easily appeared an English translation of the work of Professor be made. In the Journal of the American Medical Association H. v. Buttel-Reepen, which incorporates this Sussex find of May 31st Dr. L. Litchfield has reported two cases in among the forerunners of modern man.x We have therefore which intra-abdominal disease was suggested. In the first, an entirely up-to-date review of the position to which the a widow, aged 45 years, suffered from severe pains over the study of the early human forms has attained-a position from course of the left ureter, with exacerbations at night which which it is possible to take some survey of the past and of the kept her awake. The pain was not influenced by meals, future. It is curious to look back only 50 years in the story of defalcation, or micturition. On deep pressure tenderness the study of the history of man. It is less than 50 years was elicited over the left ureter and nowhere else. Owing ago that Huxley was seriously concerned in a vigorous and to the apparent urgency of the case radiograms were at weighty reply to Professor Mayer, of Bonn, and it is almost once taken. On the next day the eruption of herpes zoster startling to-day to think that this fighting effort was made in appeared in the site of the pain. In the second case Dr. order to refute Professor Mayer’s assertion that the celebrated Litchfield’s opinion as to the advisability of immediate Neandertal skull had belonged to no one more interesting operation was sought by colleagues. On Oct. 2nd, 1912, he than I Ia rickety Mongolian Cossack belonging to one of the saw a woman aged 70 years. She was taken ill on hordes driven by Russia, through Germany, into France in 25th with severe pain across the upper abdomen which Sept. 1814."" The exactly similar debate that was waged around kept her awake most of the night. On the following day the Trinil find of Dubois is a more familiar subject, and in the pain was less, but at night it again became severe. England Cunningham and Keith took up the cudgels in On Sept. 26th and 27th the pain was accompanied by abdodefence of the antiquity and primitive characters of minal distension and she vomited. On the 29th she was the Java man. Each fresh discovery has had pitched somnolent; she could be aroused, but immediately went to battle waged around it ; and from some the smoke sleep again. The bowels were kept open from the beginning of battle has not yet cleared away. It is healthy by calomel and other means. On Oct. lst gall-stones were and proper that this atmosphere of doubt and debate diagnosed and immediate operation was recommended by a should be the one into which such ancient relics are surgeon. On the 2nd the abdomen was much distended. The 1 Man and His Forerunners. pain had not been severe since Sept. 28th. There was By H. v. Buttel-Reepen. Authorised Translation by A. G. Thacker, A.R.C.S Lond. With a frontispiece, a well-marked eruption of herpes zoster in the right hypo70 figures in the text, and three tables. London: Longmans, Green, chondriac and subscapular regions. At first the rash was and Co. 1913. Price 2s. 6d. net.
Pp.96.
410 :attributed to mustard plasters and turpentine stupes which had been used. Only when characteristic vesicles were discovered in the same segment posteriorly was the nature of ’, Close inspection of the anteriorI the case recognised. ,patches showed the characteristic grouped vesicles of herpes zoster. Marinacci has reported a case of herpes zoster in which intense pain across the lower abdomen with marked tenderness in the hypogastrium and both iliac fossae, fever, small frequent pulse, persistent vomiting, hiccough, and Dr. Henry Head has drawn face suggested peritonitis. mentioned the fact that cases of herpes zoster in the preeruptive stage have been admitted to London hospitals as examples of pleurisy and pneumonia.
by an ascending invasion from the bladder or by lymphatic infection from the intestinal tract or from the lower urinary organs, the common origin is by hmmatogenous infection. They believe that most cases of pyelonephritis are probably unilateral in the beginning. They also state that the great majority of cases of unilateral nephritis have occurred in women, and the explanation they offer is that it is due to the frequency of displacement of the right kidney and the greater tendency to intestinal stasis in that sex. Following Brewer, they describe three types of unilateral nephritis, a severe one in which the local symptoms are obscured by an occur
intense toxaemia, and an intermediate type with severe initial symptoms but without grave toxasmia, going on, however, to renal abscess, perinephritic abscess, pyelonephritis ACUTE UNILATERAL NEPHRITIS. or pyonephrosis unless recognised and treated ; the third AN interesting account of the condition of acute unilateral form is of mild character, with tenderness over the costonephritis with the report of a case is published in the vertebral angle as the only symptom, frequently mistaken for Archives of Internal Medioine of June 15th, by Dr. David subacute appendicitis or cholecystitis. To this they add a Riesman and Dr. George P. Muller, of Philadelphia. The fourth type in which the chief and perhaps the only symptom patient was a woman, aged 22 years, who was seized in the is hasmaturia. The treatment recommended is that the early morning with sudden pain in the left loin after vomit. acute form should be operated upon as soon as the diagnosis ing. The temperature rose to 1020 F. and the pulse to 120. can be made, nephrectomy or nephrotomy being performed. There was rigidity of the lumbar muscles, with tenderness In mild cases rest in bed, milk diet, urinary antiseptics, in the costo-vertebral angle. The leucocytes were 7000 purgatives, and abundance of water usually suffice to bring ,per cubic millimetre on the first day, but two days later had about recovery. risen to 13,000. The urine was highly coloured, contained THE ENDOWMENT OF MEDICAL RESEARCH. .albumin, and on microscopical examination showed hyaline WE are not without examples in this country of and granular casts, but no pus cells. The pain and fever but the About subsided, magnificent generosity for philanthropic purposes, though rigidity persisted. gradually so far they have mainly been of one pattern. The benefits a week after the onset of the attack the patient insisted derived from increasing knowledge of pathology are conon getting out of bed, after which her symptoms recurred, and pus appeared in the urine. The pain was stantly placed at the disposal of our sick poor by charitable in the left loin and left hypochondrium, radiating at times rich. This is the side of philanthropic endeavour that most There was insistently thrusts itself upon the practical man. We may down to the groin, at others to the back. tenderness to pressure at the costo-vertebral angle extending refer, for example, to the munificence of the late Mr. George forwards to the crest of the ilium. There was rigidity of the Herring, who, besides large donations during life to hospitals muscles in the loin, with some fulness on palpation, but no and the Hospital Sunday Fund, to the Salvation Army’s At this time examination of the philanthropic work, and to the establishment and endowtumour could be felt. urine showed erythrocytes and pus cells in addition to the ment of various charitable institutions, bequeathed at albumin and casts. Unilateral infection of the kidney was his death in 1906 the residue of his vast estate to the Metrodiagnosed. Hot fomentations were applied to the kidney politan Hospital Sunday Fund. But before philanthropic region, and urotropine, abundant water to drink, liquid diet, endeavour can effectively be applied to the relief of suffering and purgation were prescribed. For about ten days the knowledge must first be gained, and the work of those who patient varied, sometimes improving, but eventually relapsing. devote themselves to seeking that knowledge and estabHer temperature continued at about 102°, and her general lishing therefrom the principles of action whereby such appearance indicated increasing sepsis, so that an operation knowledge can effectively be applied must be adequately was deemed advisable. The symptoms were throughout supported. The endowment of research, therefore, serves unilateral and localised in the region of the left kidney. At humanity, as it were, in geometrical progression, for as the operation the perinephric fat was found to be infiltrated achievement is added to achievement in knowledge methods -and inflamed, and on further exploration an abscess was of application become multiplied many fold. Suppose that opened containing 3 or 4 ounces of thick pus. On exposing an absolute preventive of and cure for cancer were discovered the kidney it was found to be the seat of a diffuse suppurative to-morrow, can we doubt that money in abundance would be process. Nephrectomy was performed and the patient slowly forthcoming to help to distribute its benefits as widely as recovered. She was discharged 44 days after admission to the possible‘! Everyone could see the practical utility of that. .hospital with a small sinus which closed shortly afterwards. But it is a far harder matter to get money to search for such About six weeks later a swelling of the right submaxillary a cure. The reason, doubtless, is because the cure once found, salivary gland developed and pus was found to exude from its application is speedily fruitful of obvious results-there Wharton’s duct. Examination by X rays showed the is a sure return for the money expended-while money The gland was removed under laid out in research offers merely a possibility of definite presence of a calculus. - ether ansesthesia. Subsequently the patient became results being derived therefrom in the uncertain future. and miscarriage occurred. About 10 months Public spirited men in America are more alive to the pregnant after the original attack she was passing an average off pregnant possibilities of research from the practical point 40 ounces of urine in 24 hours, the urine being normal in of view, and are more ready to devote money to its prosecucharacter. Examination of the pus in the kidney at the tion, secure in the conviction that sooner or later it will time of operation and later of the discharge from the fructify to the good of suffering humanity. Recently ’wound showed the presence of micrococcus pyogenes aureus. the American Ambassador, Dr. Hines Page, startled his Dr. Riesman and Dr. Muller, in discussing the origin ofEnglish hearers at the dinner of the Anglo-Saxon Club ’unilateral nephritis, maintain that although infection mayby the announcement that the sum of 100 million dollars ------
only for sanitary but also for economic Unfortunately, the extermination of the rat is a far more difficult problem than that of the domestic fly. Though each householder, shopkeeper, and shipowner can perform his own share of the necessary work, united action by local and central authorities is also essential if the numbers of the malignant rat are to be perceptibly reduced, total extermination being apparently impossible under present conditions. The rendering of dwellings, stores, and wharves reasonably rat-proof is likewise indispensable. If, therefore, the public authorities are not impelled to move in this direction on medical grounds alone, there is a very strong incentive to immediate action strictly upon economic considerations, which, perhaps, are more likely to appeal to the sympathies of the public all the world over. to be desired not
reasons.
born, for from the conflict of the views of the extremists the mean, which probably lies nearest to the truth, is apt to
be chosen and accepted as currency in the end. So many debates, have been won and lost that it will probably strike the attentive reader of more recent work that there may, in the near future, be danger of a lack of healthy opposition to the acceptance of new finds. From the controversies of the past Neandertal man and Pithecanthropus have emerged as orthodox and accepted axioms, and now is added Eoanthropus dawsoni. Eoanthropus dawsoni has not had his baptism of fire. It must be remembered that while Huxley was attacking Mayer, of Bonn, he was equally engaged in refuting the views of Professor King, for if the Cossack idea of the one struck Huxley as being too homely, the assertion of the other that the skull was not only specifically but generically distinct from manwas far too revolutionary for him. May not history repeat MAN AND HIS FORERUNNERS. itself ?1 Professor Buttel-Reepen says of the Piltdown skull IT was one of the most heartfelt pleadings uttered by the that it I has been placed by Woodward not only in a new late Professor Dwight, of Harvard, that we should stop from species, but-an extreme step-in a new genus, and has been time to time in the march of science; pause for however given the name Eoanthropus dawsoni." The Piltdown brief a spell, just to look back to see where our ideas had individual has had a peculiarly fortunate genesis, for he has come from, and to look ahead to see where they were leading been ushered into the world under a geological segis so disHe made this charge against the men who were labour- tinguished that he takes rank at once as a representative us. at the problems of evolution, that once the idea had of late Pliocene or early Pleistocene times. But it seems. ing started making progress not one of them paused to make a not impossible that the geological distinction of his rebirth reasoned survey of the premises, or considered the logical may be in danger of permitting him to pass to his place outcome of pushing those ideas to a conclusion and present- without running the gauntlet of battle waged around the ing the final product to the world. There is no study in earlier finds. He has come to his place in the lay mind, he which this stock-taking process is more necessary than that has found his way into printed books and into tables and which concerns itself with the geological story of man. Every schemes; his relationship with other early types is guessed fresh find, whether of actual bones or objects of culture, at, presumed, or asserted ; and yet, anthropologically dictates a pause ; it is not enough to attempt to fit the new speaking, his battle is unfought. As a geological relic he material into some gap in a preconceived scheme ; for the has taken permanent and proper place, but as an anthromaterial must be judged on its own merits and the scheme, if pological type he remains unchastened by criticism. He is necessary, be recast for its reception. Within the last two late Pliocene or early Pleistocene, but is he Eoanthropusyears our knowledge of the early remains of man has been a genus distinct from Homo ?1 It is for questions such as. admirably summarised in three separate publications, each these that the pause and the stock-taking are required. marked with its own distinctive individuality, by Keith, Sollas, and Duckworth. These excellent réS1tmés of the HERPES ZOSTER SIMULATING DISEASE WITHIN THE ABDOMEN. story of ancient man were all issued before the discovery of the remains of the individual, now famous as ’’ the Piltdown THE eruption of herpes zoster may be preceded for some skull,"was made known to the public ; but recently there has days by pain, and then a wrong diagnosis may easily appeared an English translation of the work of Professor be made. In the Journal of the American Medical Association H. v. Buttel-Reepen, which incorporates this Sussex find of May 31st Dr. L. Litchfield has reported two cases in among the forerunners of modern man.x We have therefore which intra-abdominal disease was suggested. In the first, an entirely up-to-date review of the position to which the a widow, aged 45 years, suffered from severe pains over the study of the early human forms has attained-a position from course of the left ureter, with exacerbations at night which which it is possible to take some survey of the past and of the kept her awake. The pain was not influenced by meals, future. It is curious to look back only 50 years in the story of defalcation, or micturition. On deep pressure tenderness the study of the history of man. It is less than 50 years was elicited over the left ureter and nowhere else. Owing ago that Huxley was seriously concerned in a vigorous and to the apparent urgency of the case radiograms were at weighty reply to Professor Mayer, of Bonn, and it is almost once taken. On the next day the eruption of herpes zoster startling to-day to think that this fighting effort was made in appeared in the site of the pain. In the second case Dr. order to refute Professor Mayer’s assertion that the celebrated Litchfield’s opinion as to the advisability of immediate Neandertal skull had belonged to no one more interesting operation was sought by colleagues. On Oct. 2nd, 1912, he than I Ia rickety Mongolian Cossack belonging to one of the saw a woman aged 70 years. She was taken ill on hordes driven by Russia, through Germany, into France in 25th with severe pain across the upper abdomen which Sept. 1814."" The exactly similar debate that was waged around kept her awake most of the night. On the following day the Trinil find of Dubois is a more familiar subject, and in the pain was less, but at night it again became severe. England Cunningham and Keith took up the cudgels in On Sept. 26th and 27th the pain was accompanied by abdodefence of the antiquity and primitive characters of minal distension and she vomited. On the 29th she was the Java man. Each fresh discovery has had pitched somnolent; she could be aroused, but immediately went to battle waged around it ; and from some the smoke sleep again. The bowels were kept open from the beginning of battle has not yet cleared away. It is healthy by calomel and other means. On Oct. lst gall-stones were and proper that this atmosphere of doubt and debate diagnosed and immediate operation was recommended by a should be the one into which such ancient relics are surgeon. On the 2nd the abdomen was much distended. The 1 Man and His Forerunners. pain had not been severe since Sept. 28th. There was By H. v. Buttel-Reepen. Authorised Translation by A. G. Thacker, A.R.C.S Lond. With a frontispiece, a well-marked eruption of herpes zoster in the right hypo70 figures in the text, and three tables. London: Longmans, Green, chondriac and subscapular regions. At first the rash was and Co. 1913. Price 2s. 6d. net.
Pp.96.
410 :attributed to mustard plasters and turpentine stupes which had been used. Only when characteristic vesicles were discovered in the same segment posteriorly was the nature of ’, Close inspection of the anteriorI the case recognised. ,patches showed the characteristic grouped vesicles of herpes zoster. Marinacci has reported a case of herpes zoster in which intense pain across the lower abdomen with marked tenderness in the hypogastrium and both iliac fossae, fever, small frequent pulse, persistent vomiting, hiccough, and Dr. Henry Head has drawn face suggested peritonitis. mentioned the fact that cases of herpes zoster in the preeruptive stage have been admitted to London hospitals as examples of pleurisy and pneumonia.
by an ascending invasion from the bladder or by lymphatic infection from the intestinal tract or from the lower urinary organs, the common origin is by hmmatogenous infection. They believe that most cases of pyelonephritis are probably unilateral in the beginning. They also state that the great majority of cases of unilateral nephritis have occurred in women, and the explanation they offer is that it is due to the frequency of displacement of the right kidney and the greater tendency to intestinal stasis in that sex. Following Brewer, they describe three types of unilateral nephritis, a severe one in which the local symptoms are obscured by an occur
intense toxaemia, and an intermediate type with severe initial symptoms but without grave toxasmia, going on, however, to renal abscess, perinephritic abscess, pyelonephritis ACUTE UNILATERAL NEPHRITIS. or pyonephrosis unless recognised and treated ; the third AN interesting account of the condition of acute unilateral form is of mild character, with tenderness over the costonephritis with the report of a case is published in the vertebral angle as the only symptom, frequently mistaken for Archives of Internal Medioine of June 15th, by Dr. David subacute appendicitis or cholecystitis. To this they add a Riesman and Dr. George P. Muller, of Philadelphia. The fourth type in which the chief and perhaps the only symptom patient was a woman, aged 22 years, who was seized in the is hasmaturia. The treatment recommended is that the early morning with sudden pain in the left loin after vomit. acute form should be operated upon as soon as the diagnosis ing. The temperature rose to 1020 F. and the pulse to 120. can be made, nephrectomy or nephrotomy being performed. There was rigidity of the lumbar muscles, with tenderness In mild cases rest in bed, milk diet, urinary antiseptics, in the costo-vertebral angle. The leucocytes were 7000 purgatives, and abundance of water usually suffice to bring ,per cubic millimetre on the first day, but two days later had about recovery. risen to 13,000. The urine was highly coloured, contained THE ENDOWMENT OF MEDICAL RESEARCH. .albumin, and on microscopical examination showed hyaline WE are not without examples in this country of and granular casts, but no pus cells. The pain and fever but the About subsided, magnificent generosity for philanthropic purposes, though rigidity persisted. gradually so far they have mainly been of one pattern. The benefits a week after the onset of the attack the patient insisted derived from increasing knowledge of pathology are conon getting out of bed, after which her symptoms recurred, and pus appeared in the urine. The pain was stantly placed at the disposal of our sick poor by charitable in the left loin and left hypochondrium, radiating at times rich. This is the side of philanthropic endeavour that most There was insistently thrusts itself upon the practical man. We may down to the groin, at others to the back. tenderness to pressure at the costo-vertebral angle extending refer, for example, to the munificence of the late Mr. George forwards to the crest of the ilium. There was rigidity of the Herring, who, besides large donations during life to hospitals muscles in the loin, with some fulness on palpation, but no and the Hospital Sunday Fund, to the Salvation Army’s At this time examination of the philanthropic work, and to the establishment and endowtumour could be felt. urine showed erythrocytes and pus cells in addition to the ment of various charitable institutions, bequeathed at albumin and casts. Unilateral infection of the kidney was his death in 1906 the residue of his vast estate to the Metrodiagnosed. Hot fomentations were applied to the kidney politan Hospital Sunday Fund. But before philanthropic region, and urotropine, abundant water to drink, liquid diet, endeavour can effectively be applied to the relief of suffering and purgation were prescribed. For about ten days the knowledge must first be gained, and the work of those who patient varied, sometimes improving, but eventually relapsing. devote themselves to seeking that knowledge and estabHer temperature continued at about 102°, and her general lishing therefrom the principles of action whereby such appearance indicated increasing sepsis, so that an operation knowledge can effectively be applied must be adequately was deemed advisable. The symptoms were throughout supported. The endowment of research, therefore, serves unilateral and localised in the region of the left kidney. At humanity, as it were, in geometrical progression, for as the operation the perinephric fat was found to be infiltrated achievement is added to achievement in knowledge methods -and inflamed, and on further exploration an abscess was of application become multiplied many fold. Suppose that opened containing 3 or 4 ounces of thick pus. On exposing an absolute preventive of and cure for cancer were discovered the kidney it was found to be the seat of a diffuse suppurative to-morrow, can we doubt that money in abundance would be process. Nephrectomy was performed and the patient slowly forthcoming to help to distribute its benefits as widely as recovered. She was discharged 44 days after admission to the possible‘! Everyone could see the practical utility of that. .hospital with a small sinus which closed shortly afterwards. But it is a far harder matter to get money to search for such About six weeks later a swelling of the right submaxillary a cure. The reason, doubtless, is because the cure once found, salivary gland developed and pus was found to exude from its application is speedily fruitful of obvious results-there Wharton’s duct. Examination by X rays showed the is a sure return for the money expended-while money The gland was removed under laid out in research offers merely a possibility of definite presence of a calculus. - ether ansesthesia. Subsequently the patient became results being derived therefrom in the uncertain future. and miscarriage occurred. About 10 months Public spirited men in America are more alive to the pregnant after the original attack she was passing an average off pregnant possibilities of research from the practical point 40 ounces of urine in 24 hours, the urine being normal in of view, and are more ready to devote money to its prosecucharacter. Examination of the pus in the kidney at the tion, secure in the conviction that sooner or later it will time of operation and later of the discharge from the fructify to the good of suffering humanity. Recently ’wound showed the presence of micrococcus pyogenes aureus. the American Ambassador, Dr. Hines Page, startled his Dr. Riesman and Dr. Muller, in discussing the origin ofEnglish hearers at the dinner of the Anglo-Saxon Club ’unilateral nephritis, maintain that although infection mayby the announcement that the sum of 100 million dollars ------