OPHTHALMOSCOPIC SIGNS IN HEART DISEASE

397 The writers conclude that ophthalmoscopic examinashe was allowed to enter a regular dormitory. tion yields negative results in heart disease unless This scheme worked very well over a year, and for this is due to or associated with hypertension, coronary the second year the boys and girls were allowed toI sclerosis, or subacute bacterial endocarditis. Of the the interference of the " psycho- 137 cases, 8 had subacute bacterial endocarditis, carry on without " with equally satisfactory results. The death being due to septicaemia in all cases. Embolic pediatrician second plan which Dr. Wile employed was to wake lesions were noted in 2 cases. Thirty-two patients all male enuretics at 9 P.M., 12 midnight, 2 A.M., and were classified under the heading of hypertension ; 5 A.M., the child being made to get up and visit the of these, 25 died of cardiac decompensation with or closet. The percentage of cures in this group was without uraemia, 4 of hemiplegia, 2 after operations, somewhere in the neighbourhood of 30 to 40 per and 1 after an accident. All but one out of the 32 cent., while by the " team " method the results showed sclerosis of the retinal arteries of " hyperseemed slightly lower, although their assessment was tension type " ; by this the authors mean generalised Dr. Hamill claims for his plan of constriction of the calibre of the arteries with exaggeramore difficult. putting the responsibility on the child that it greatly tion of the arterial reflex stripe, irregularities in the aids in the development of character, by encouraging lumen of the arteries, and arterio-venous compression. the inhibition of impulses without conscious effort, In addition to these changes, 17 showed retinitiswhile Dr. Wile says that the cured children in his i.e., scattered cotton-wool patches and haemorrhages series " reflect their new power in personality and in and cedema of the retina, occasionally even oedema of physical health, together with some intangible the disk. In three other cases there were haemorrhages immeasurable advantages along the line of better not severe enough to come under the term retinitis. emotional stability, greater intellectual application, In this series, therefore, very nearly all those cases and finer social balance." Such claims have never of heart disease which were dependent on high blood been made for the old-fashioned belladonna method, pressure alone showed retinal changes. Among but the percentage of cures obtained was probably 25 cases in which coronary sclerosis was found, 19 deaths had been due to causes purely cardiac and very much about the same. six followed operations. In many of these cases, and also in 11 cases of mixed type, high blood pressure was present and fundus changes had been recorded. THE IMMUNISING DOSE OF VACCINIA. These changes were often merely indicative of what the THE Rolleston Committee on Vaccination, in their authors term senile arterio-sclerosis-that is, only report to the Ministry of Health last year, pointed an alteration in the light reflex, difficult to diagnose out that definite experiments do not seem to have without marked constriction of the retinal been made " to determine the minimal dose sufficient veins or any alterations in the calibre of the arteries. to give rise constantly in the human being to the Leaving these mild cases aside, the investigation to showed characteristic vesicular manifestation and that out of the 137 cases under review 52 had In the been immunity lasting for a reasonable time." as having retinal arterio-sclerosis diagnosed light of their suggestion that " experimental of the more severe or unmistakable type with or observations be made to ascertain if it is feasible to without retinitis. Even more interesting is the increase the dilution of vaccine lymph beyond the observation, in the 32 cases in recorded, that, already present degree without impairing its efficiency," it which hypertension was the only cause of cardiac is interesting to note some results obtained by Dr. disease discovered, typical retinal changes had been Peter Clearkin,l of Tanganyika, in an investigation in 31. present of vaccinal immunity in monkeys. He used a variolous strain obtained from a case of small-pox DIABETIC COMA. in 1920. Its virulence was maintained by alternate Dr. E. P. Joslindoes well to point out that passage from calf to animal, and the titre was ascertained by the intradermal injection of 0-1 c.cm. of although seven years have now passed since the serial dilutions on the shaved abdomen of the discovery of insulin, diabetic coma goes on taking monkey. The highest dilution causing vesiculation its toll. It is, as he says, high time that deaths from was taken as the titre, and the minimal infective dose this cause became very rare, and the simple outline The immunity of the of treatment which he sets out would go far towards was calculated from it. was tested, from 14 to 28 days later, by achieving this if it were generally carried out. The monkeys insertions of serial dilutions of a fresh, very active treatment of the emergency of coma should, he says, vaccine. The number of monkeys used was not take precedence over everything else and as soon as large and the estimation of the minimal infective the diagnosis has been made insulin should be injected dose in this way is rough, but the experiments subcutaneously every half hour in doses of from showed that very small quantities of vaccinia virus 10-40 units or more until returning consciousness, The immunity normal respiration, and decreasing glycosuria show protect against enormous doses. given by 66 minimal doses was as strong as that that recovery is beginning. To meet dehydration, a given by 20,000, and protected against 50,000 quart of normal saline should be injected subIn another experiment, cutaneously at once, because in coma it is dangerous minimal infective doses. two minimal infective doses protected against to trust to retention and absorption of liquids by the 100,000. Dr. Clearkin thinks that these results form mouth or rectum. Intravenous injections are satisa useful guide in the vaccination of human beings, factory if given slowly to avoid distension of the since the dermal reactions of the monkey are very heart. The circulation, he suggests, may be stimumuch the same as those of man. He points out, lated by caffeine sodiobenzoate in doses of grs. 7Iff however, that the whole problem of anti-variolous given if necessary four-hourly. The stomach should immunisation is bound up with the production of a be gently washed out so that liquids will be retained, and fluid containing about 50 g. of carbohydrate stable vaccinia virus. should be given in the first 24 hours. A gradual return to simpler articles of regular diet may then be OPHTHALMOSCOPIC SIGNS IN HEART DISEASE made, the dose of insulin being regulated by frequent A PAPER by Wallan M. Yater and Henry P. Wagener, urinary tests, at first every two hours and later of the Mayo Institute2 analyses the post-mortem every four or six hours. The dose of insulin should findings in 137 cases of heart disease, in which the bel5 units for a red reaction with Benedict’s solution, fundi had been examined ophthalmoscopically during 10 for a yellow, and 5 for a green, and no insulin is life. The cases were classified first according to required if the urine is sugar-free. however, is better than treatment and species of heart disease and secondly according to thePrevention, patient must be taught to avoid coma. He must character of the changes observed in the fundus. never omit insulin, in Joslin’s opinion, so long as 1 Brit. Jour. Exper. Path., August, 1929, p. 237. 2 Amer. Jour. Med. Sci., July, 1929, p. 105. 1 Jour. Amer. Med. Assoc., 1929, xciii., 33.

enuretic teams had remained dry for four weeks he or

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