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NEOSALVARSAN AS A PULMONARY ANTISEPTIC.
32
psycho-analysis (in the strict sense) a weight to solutions is a powerful antiseptic, especially against no other system of mental analysis is prima streptococci, and it is natural that the attempt should facie entitled. Psycho-analysis, both as a theory be made to utilise it at the site of infection instead of of psychology and as a therapeutic technique (the in the blood stream alone. Edel has gone further word covers both senses), deserves to be treated and has injected solutions of similar strength (from with the greatest respect. And though the Committee 0-15 to 0-6 g. dissolved in 10 c.cm. of water) into the are non-committal about the most important issues, bronchial tree in cases of bronchiectasis. His method they pronounce quite definitely on some of the has been similar to that used for the introduction of criticisms to which psycho-analysis has been subjected. lipiodol into the lung, namely, cocainisation of the They reply to the suggestion that " psycho-analysis trachea and direct injection through a laryngeal applied as medical treatment may cause insanity catheter. In the few patients he has so far treated in the patient" with the categorical " No proof Edel reports considerable success, the total quantity of this charge has been discoverad by the Committee." of neosalvarsan used being in one case as much as They refute the suggestions that psycho-analysis 5-25 g. Another patient suffering from ri;ht-sided ignores the relation of the body to the mind, that pulmonary gangrene and empyema received in all it is materialistic and that it is inordinately 0-9 g. into the pleura and 2-7 g. into the lung, a expensive. They are satisfied that it is impossible total of 3-6 g. The patient became afebrile two days to make a verbal record of an actual psycho-analysis after the first injection and in 12 days the empyema in order to present it to a sceptical public. On all had disappeared, " cure " resulting in seven weeks, these points the contentions of the psycho-analysts though the X ray still showed some thickening of the are upheld. pleura. The local application of arsenical bactericides The summary of " modern psycho-analytical in pulmonary conditions is a method to be watched methods and teaching," which the Committee with interest, although clinicians may hesitate to correct as far as it copy the high dosage employed by Dr. Edel until.: has reason to believe " to be goes," lays great stress on the resistances which further results have been reported. prevent the emergence into consciousness of parts of the unconscious mind, and describes the aim of a psycho-analysis as the overcoming of these LOSS OF APPETITE IN CHILDHOOD. resistances. In the replies to criticisms of psychoTHE literature of anorexia in children is voluminous. analysis, which replies (provided by the President of the British Psycho-Analytical Society) and and the underlying causes sponsored by individual criticisms the Committee " leaves to the judgment writers innumerable. Some fresh light has, however, of the reader," the element of resistance in the been recently thrown on the subject by a stimulating attacks of critics is emphasised. Thus the Committee, article from the pen of Dr. Joseph Garland,l who while declining to commit itself upon the truth or attributes the trouble essentially to a failure of’ value of Freudian psycho-analysis, may fairly be management in the earliest weeks of life and consaid both to treat it with respect and to recognise firmed in childhood by improper training and that the charge of emotional prejudice which psycho- discipline. Thus he suggests that the initial loss of analysts make against their critics may have some weight that occurs before the establishment of’ foundation. complete lactation is in itself an advantage to the baby, as during these first few days the sensation of appetite has time to develop, a sensation that the NEOSALVARSAN AS A PULMONARY is never likely to lose subsequently. Once baby ANTISEPTIC. breast feeding has been established a transient loss INTEREST in chronic lung diseases and the of appetite is a usual occurrence during acute febrile applications of surgery to their treatment has been disturbances, and may in fact be interpreted as a greatly stimulated by Dr. R. A. Young’s masterly protective mechanism since the gastro-intestinal review of this subject in his Lumleian Lectures tract, under the circumstances, is not commonly delivered in London in March of this year.l Of such prepared for the reception and utilisation of food. conditions there are few that demand greater care It is frequently found that the mother’s greatest and judgment on the part of the physician than source of anxiety during the illness of a child is the that of empyema, particularly when streptococcal in failure to take nutriment, and it may require conorigin, and of chronic bronchiectasis. In the former siderable patience to explain the situation to her. there is general agreement that too early operation In many cases it should be realised that the appetitemay and in fact usually does lead to that troublesome difficulty is not a real one at all, but exists only in of the fertile imagination of the over-anxious parent. This result condition, chronic empyema.
to
which
"
"
I
treatment by open operation has led many workers to treat such cases by continuous aspiration, with or without irrigation of the cavity with some form of That most usually employed antiseptic solution. has been Dakin’s solution-neutral 0-5 per cent. solution of sodium hypochlorite—though others have also found their advocates. Recently Dr Hans Edel2 has recorded a few cases which he has treated with intrapleural injection of neosalvarsan. His treatment has been to aspirate the pus through a needle of moderate size, using the same needle to inject at once a solution of neosalvarsan. Edel has found that the pleura is able to withstand large doses of this solution without undue reaction ; thus his usual initial dose has been 0-45 g. dissolved in 10 c.cm. distilled water, which is gradually increased up to 0-6 g. according to the general reaction and the degree of refilling of the empyema. The surprising tolerance shown by the pleura to such high dosage suggests to Edel that considerable local thrombosis occurs round the site of the injection. It is, of course, well known that neosalvarsan even in far weaker
1 THE LANCET, 1929, i., 593, 697, and 805. Die Lokalbehandlung eitriger Lungenprozesse mit intrahorakalen Neosalvarsan-injektionen, Med. Klin., April 26th, 2
929.
This is often the case with infants at the breast who take their feeds so rapidly that the mother becomes obsessed with the idea that little or no milk has been taken; weighing the baby before and after feeds will generally banish this illusion. Sometimes an artificially fed infant will fail to finish its carefully calculated allowance but continues to gain at a satisfactory rate. This baby does not require as much food as another infant of’ the same age and weight. One of the greatest boons that could be granted mankind would be an appreof the fact that all human beings are individuals with varying digestive capacities with varying temperatures, levels of activity, and caloric requirements. The period of starting new foods, which includes
ciation
definitely the weaning period, presents often the first great obstacle to the continuation of a, normal appetite. Habits of feeding have become firmly fixed, and infants, like their elders, resent, change. Where such difficulties arise it is absolutely essential to ensure firmness in management on the part of mother and nurse, even if this entails two or three days’ misery for all concerned. The physical very
1 Garland, J.: New Eng. Jour. of Med., 1929,
cc., 1135.
psycho-analysis (in the strict sense) a weight to solutions is a powerful antiseptic, especially against no other system of mental analysis is prima streptococci, and it is natural that the attempt should facie entitled. Psycho-analysis, both as a theory be made to utilise it at the site of infection instead of of psychology and as a therapeutic technique (the in the blood stream alone. Edel has gone further word covers both senses), deserves to be treated and has injected solutions of similar strength (from with the greatest respect. And though the Committee 0-15 to 0-6 g. dissolved in 10 c.cm. of water) into the are non-committal about the most important issues, bronchial tree in cases of bronchiectasis. His method they pronounce quite definitely on some of the has been similar to that used for the introduction of criticisms to which psycho-analysis has been subjected. lipiodol into the lung, namely, cocainisation of the They reply to the suggestion that " psycho-analysis trachea and direct injection through a laryngeal applied as medical treatment may cause insanity catheter. In the few patients he has so far treated in the patient" with the categorical " No proof Edel reports considerable success, the total quantity of this charge has been discoverad by the Committee." of neosalvarsan used being in one case as much as They refute the suggestions that psycho-analysis 5-25 g. Another patient suffering from ri;ht-sided ignores the relation of the body to the mind, that pulmonary gangrene and empyema received in all it is materialistic and that it is inordinately 0-9 g. into the pleura and 2-7 g. into the lung, a expensive. They are satisfied that it is impossible total of 3-6 g. The patient became afebrile two days to make a verbal record of an actual psycho-analysis after the first injection and in 12 days the empyema in order to present it to a sceptical public. On all had disappeared, " cure " resulting in seven weeks, these points the contentions of the psycho-analysts though the X ray still showed some thickening of the are upheld. pleura. The local application of arsenical bactericides The summary of " modern psycho-analytical in pulmonary conditions is a method to be watched methods and teaching," which the Committee with interest, although clinicians may hesitate to correct as far as it copy the high dosage employed by Dr. Edel until.: has reason to believe " to be goes," lays great stress on the resistances which further results have been reported. prevent the emergence into consciousness of parts of the unconscious mind, and describes the aim of a psycho-analysis as the overcoming of these LOSS OF APPETITE IN CHILDHOOD. resistances. In the replies to criticisms of psychoTHE literature of anorexia in children is voluminous. analysis, which replies (provided by the President of the British Psycho-Analytical Society) and and the underlying causes sponsored by individual criticisms the Committee " leaves to the judgment writers innumerable. Some fresh light has, however, of the reader," the element of resistance in the been recently thrown on the subject by a stimulating attacks of critics is emphasised. Thus the Committee, article from the pen of Dr. Joseph Garland,l who while declining to commit itself upon the truth or attributes the trouble essentially to a failure of’ value of Freudian psycho-analysis, may fairly be management in the earliest weeks of life and consaid both to treat it with respect and to recognise firmed in childhood by improper training and that the charge of emotional prejudice which psycho- discipline. Thus he suggests that the initial loss of analysts make against their critics may have some weight that occurs before the establishment of’ foundation. complete lactation is in itself an advantage to the baby, as during these first few days the sensation of appetite has time to develop, a sensation that the NEOSALVARSAN AS A PULMONARY is never likely to lose subsequently. Once baby ANTISEPTIC. breast feeding has been established a transient loss INTEREST in chronic lung diseases and the of appetite is a usual occurrence during acute febrile applications of surgery to their treatment has been disturbances, and may in fact be interpreted as a greatly stimulated by Dr. R. A. Young’s masterly protective mechanism since the gastro-intestinal review of this subject in his Lumleian Lectures tract, under the circumstances, is not commonly delivered in London in March of this year.l Of such prepared for the reception and utilisation of food. conditions there are few that demand greater care It is frequently found that the mother’s greatest and judgment on the part of the physician than source of anxiety during the illness of a child is the that of empyema, particularly when streptococcal in failure to take nutriment, and it may require conorigin, and of chronic bronchiectasis. In the former siderable patience to explain the situation to her. there is general agreement that too early operation In many cases it should be realised that the appetitemay and in fact usually does lead to that troublesome difficulty is not a real one at all, but exists only in of the fertile imagination of the over-anxious parent. This result condition, chronic empyema.
to
which
"
"
I
treatment by open operation has led many workers to treat such cases by continuous aspiration, with or without irrigation of the cavity with some form of That most usually employed antiseptic solution. has been Dakin’s solution-neutral 0-5 per cent. solution of sodium hypochlorite—though others have also found their advocates. Recently Dr Hans Edel2 has recorded a few cases which he has treated with intrapleural injection of neosalvarsan. His treatment has been to aspirate the pus through a needle of moderate size, using the same needle to inject at once a solution of neosalvarsan. Edel has found that the pleura is able to withstand large doses of this solution without undue reaction ; thus his usual initial dose has been 0-45 g. dissolved in 10 c.cm. distilled water, which is gradually increased up to 0-6 g. according to the general reaction and the degree of refilling of the empyema. The surprising tolerance shown by the pleura to such high dosage suggests to Edel that considerable local thrombosis occurs round the site of the injection. It is, of course, well known that neosalvarsan even in far weaker
1 THE LANCET, 1929, i., 593, 697, and 805. Die Lokalbehandlung eitriger Lungenprozesse mit intrahorakalen Neosalvarsan-injektionen, Med. Klin., April 26th, 2
929.
This is often the case with infants at the breast who take their feeds so rapidly that the mother becomes obsessed with the idea that little or no milk has been taken; weighing the baby before and after feeds will generally banish this illusion. Sometimes an artificially fed infant will fail to finish its carefully calculated allowance but continues to gain at a satisfactory rate. This baby does not require as much food as another infant of’ the same age and weight. One of the greatest boons that could be granted mankind would be an appreof the fact that all human beings are individuals with varying digestive capacities with varying temperatures, levels of activity, and caloric requirements. The period of starting new foods, which includes
ciation
definitely the weaning period, presents often the first great obstacle to the continuation of a, normal appetite. Habits of feeding have become firmly fixed, and infants, like their elders, resent, change. Where such difficulties arise it is absolutely essential to ensure firmness in management on the part of mother and nurse, even if this entails two or three days’ misery for all concerned. The physical very
1 Garland, J.: New Eng. Jour. of Med., 1929,
cc., 1135.