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SANOCRYSIN IN TUBERCULOSIS.
934
ROEHAMPTON HOUSE.-SANOCRYSIN IN TUBERCULOSIS.
unless we wholly misconceive the content of the in painted deal. Roehampton House has had many word " administration." We can, indeed, allow our- owners and tenants, among them Dr. Markham, selves to admire the ingenuity of the scheme. What Archbishop of York, and latterly it was the abode of concerns us most is the fact that out of the surpluses the Earls of Leven and Melville, by one of whom it of approved societies, treatment benefits-which are was sold to Mr. A. M. Grenfell, who called in Sir " in the nature of medical benefit "-are in danger, Edwin Lutyens to make additions to it which nearly to an increasing extent, of being administered in a way trebled its size, but the hospital was established there contrary to the intentions of Parliament. While the before he was able to decorate the interior of the NIBS may not inappropriately be concerned with new portions. For the immediate purpose of the fine points, we are a little more concerned with the hospital-the replacing by artificial means of the lost limbs of men maimed in the war-a number of application of first principles. wooden huts were erected, most of which have now been superseded by permanent wards of brick. EARLY MOVEMENT AFTER ARTHROTOMY There are five of these wards, each of which contains AND ARTHROPLASTY. 40 beds-low, verandahed buildings connected by WRITING in the Presse Mgdicale of April lst, Dr. covered corridors. They face south and have forE. Desmarest discusses the lessons learnt from prospect a pleasant lawn. An operation block with operating on three cases of ankylosis of the knee by two theatres and wards for electro-therapy form part the method of arthroplasty with free fascia-flaps. He of the new equipment, and in another corner of lays stress on the importance of operating as early as the grounds are the workshops which are busily possible after active disease has ceased, for the reason turning out those cunningly articulated limbs which that muscular atrophy from disuse constitutes a very we have now learned to make with such astonishing serious drawback to functional recovery. The very skill and ingenuity. The inmates of the Special fact of the success of the operation, when strong and Surgical Hospital at Shepherd’s Bush have been, oractive muscles are able to control the joint in the are in process of being, removed to the infinitely more complete absence of the usual ligaments, is evidence restful and agreeable verge of Richmond Park, of the importance of a consideration of the state of where there will be room for between 1100 and 120& the muscles. Dr. Desmarest follows Murphy more than of them. Queen Mary’s Convalescent Auxiliary Putti in his operative technique, prefers a U-shaped Hospital at Roehampton will, however, no longerincision, and either divides the ligamentum patellae exist exclusively for the good of ex-soldiers and or detaches it together with a thin scale of bone from sailors. Men who are injured in limb on the railways its attachment to the tibia. Early massage and will also be treated there, and, no doubt, eventually active movement he considers essential if a good result the victims of mining and other dangerous trades is to be attained. The patient should be encouraged likewise. It may safely be claimed that, for its to begin active movements in the joint almost as soon special purpose, there is no hospital in the world as he recovers from the anaesthetic. Dr. Desmarest which excels Roehampton House, and probably gives as contra-indications to arthroplasty damage to nothing that equals it. the muscles of the thigh from osteomyelitis, old septic war injuries, with muscular atrophy and lesions of motor nerve trunks. SANOCRYSIN IN TUBERCULOSIS. Ankylosis from tuberculous disease is not suitable and the extremes of life should RECENT reports from Denmark show that there tool be avoided. In a communication to the American the treatment of tuberculosis with sanocrysin is still Journal of
WHOLE MILK IN INFANT FEEDING.
The patient was a woman infants. Dr. Hugh Thursfield supported the use of who died two days after the fourth injection of sano- boiled whole milk, stating that on purely clinical crysin, of which a total of 3-5 g. had been given. grounds it had proved to be the best substitute for Shortly before death she suffered from anuria and breast-feeding in the healthy infant. The case for the modification of cow’s milk was cyanosis, but there was no fall of temperature, nor evidence of a focal reaction in the lungs. The post- presented by Dr. Eric Pritchard and Dr. R. C. mortem examination showed hyperaemia of the colon, Jewesbury. They brought forward the argument haemorrhages in the small intestine, and severe that breast-milk is the best food for infants and that parenchymatous disease of the kidneys. The absence any substitute should approximate as closely as of a fall of the temperature and of clinical signs of possible in composition to breast-milk. Hence, oedema of the lungs suggests that this was not a case best results were to be expected and were obtained " of sanocrysin or tuberculin " shock, but rather one at their hands by modifying cow’s milk so as to of direct gold poisoning. Other interesting observa- make it as similar as possible to human milk. Dr. tions on patients undergoing sanocrysin treatment Pritchard pointed out that the problem is not the indicate that allergy is reduced, the rate of sedimenta- simple one of dealing with the protein, fat, and tion of the erythrocytes is hastened, and a considerable carbohydrate so as to obtain these three elements reduction of the haemoglobin in the blood occurs.in correct proportion, but the much more complicated Considering how little is yet known about the dosage one of adjusting the relative proportions of all the of sanocrysin and the indications for its different elements of milk, each of which plays it would be premature to pass judgment on its efficacy.some part in metabolism. He pleaded for some bioIt is on record that patients undergoing this treatmentchemical Darwin to correlate all the vast amount of have died, not merely in spite of it, but because of it. investigation carried out in this field. The problem It is also on record that patients have responded with not been solved by the simple dilution of milk, dramatic success ; febrile, debilitated and emaciated, any more than it had been solved by giving undiluted they have in a few weeks been restored to practically milk. The excess protein contained in cow’s milk complete health. Even in the hospitals in which was, in his opinion, dangerous both for its immediate leading to fermentation and the absorption experience has been gained, uncertainty still exists as to the prognosis of any case submitted to this or tne toxic products 01 1JillS process, ana. aiso ior ius treatment. remote effects, such as those produced in the liver and kidneys by the extra burden thrown on them and those taking place in that " long-suffering organ, the WHOLE MILK IN INFANT FEEDING. stomach " by the excessive acid production necessary WHILE experts argue about percentage feeding and for the of cow’s milk. Dr. Jewesbury also caloric values and this milk and that milk, the general drew a digestion of the results of high protein gloomy picture practitioner remains rather bewildered, knowing feeding, describing the clinical signs of restlessness, as he does that the public is rather unimpressed sleeplessness, constipation, colic, and flatulence, which by all the scientific jargon and that infants continue he believes are all caused by too much protein, and to thrive despite the use of foods which are denounced he adduced the excellent results obtained by the by the laboratory worker and the children’s physician simple modification of cow’s milk along the lines I alike as dangerous and monstrous introduced by Sir F. Truby King. Dr. H. C. Cameron Nevertheless, there is great value in a frank discussion uttered a warning against the taking of a rapid between experts of what appears on the surface to increase in weight as a proof of the success of one or be a relatively simple problem-namely, " Is the other method of infant-feeding. He looks upon most " modification of cow’s milk necessary in infant feed- artificial as in the nature of shots," feeding ing ? "-and this formed the subject at a meeting and the object of the physician shouldsighting be to discover of the Section for the Study of Disease in Children the best sighting shot. The general conclusions of the Royal Society of Medicine on Friday, April 24th. which arise from this discussion appear to be that Dr. Leonard Findlay made a strong case for the use the healthy infant boiled whole cow’s milk is as of whole cow’s milk, although he admitted that even for successful as any other food and that for the wasting he believed in the modification brought about by baby different schools still believe that their methods boiling, which he considers essential in view of the are the only successful ones. The wide differences impossibility of our ever obtaining an absolutely of opinion which appear to exist, however, are pure milk-supply. He discussed in the first place more likely to be modified by discussions of this nature, the differences between breast-milk and cow’s milk, and perhaps the public may one day get a unanimous pointing out that each of the constituents had been answer to its ever-persistent inquiry, " How are we singled out in turn as presenting sufficient divergences to feed our babies if we can’t breast-feed them ? " to warrant modification. The problem appeared to him to be much more subtle than the mere question of the relative differences of protein, for example, THE DIAGNOSIS OF HYDATID DISEASE. in the two milks, for the real difficulty here probably IT is in Australia where hydatid disease is comin rather than the amino-acids in the essential lay particular form in which they are presented in the paratively common that investigations of the serotwo milks, and any dilution of cow’s milk opened logical reactions occurring in this disease can be carried up the danger that certain amino-acids might be out over a sufficiently large number of cases to make the results of great value. At the Australian Medical so reduced in quantity as to give rise to disturbances in growth, just as the dilution frequently practised Congress of the British Medical Association held in I Melbourne in November, so reduced the iron intake of an infant as to 1923, Mr. Horace R. Dew anaemia. The available proof that an infant is unable and Miss F. Williams contributed a valuable paper to digest whole milk is to Dr. Findlay not convincing, on this subject, now republished in the Transactions and on the other hand, certain metabolism experiments of the Congress.! They report the results of three on marasmic infants had shown that these babies years’ work on the immunity reactions occurring in had no difficulty in dealing with cow’s milk. His hydatid disease. The three tests which have been clinical experience had gone to show that a vast carried out are the complement-fixation test, the majority of children digest and thrive on whole precipitin test, and the intradermal test of Casoni. cow’s milk, excluding cases where definite infective In the complement-fixation test the antigen used is - conditions of the digestive tract were present. fresh hydatid fluid and the test appears to be absolutely Dr. Findlay, in short, considers that the differences specific, giving a positive reaction in 80 per cent. of between cow’s milk and human milk present such all cases of hydatid disease. Certain cases with thickwalled cysts, barren of scolices, and dead cysts a fundamental and subtle problem that the attempt " to humanise " cow’s milk cannot possibly succeed, 1 Australian Medical Congress: Transactions of the First and that boiled whole milk gives better results than Session, Melbourne, 1923. Sydney: Sydney and Melbourne any modifications in all except the very youngest Publishing Co. 1924. Pp. 552.
interest in this connexion.
-
935
exhibition,30
had
effects in
____
I
productions.
produce
ROEHAMPTON HOUSE.-SANOCRYSIN IN TUBERCULOSIS.
unless we wholly misconceive the content of the in painted deal. Roehampton House has had many word " administration." We can, indeed, allow our- owners and tenants, among them Dr. Markham, selves to admire the ingenuity of the scheme. What Archbishop of York, and latterly it was the abode of concerns us most is the fact that out of the surpluses the Earls of Leven and Melville, by one of whom it of approved societies, treatment benefits-which are was sold to Mr. A. M. Grenfell, who called in Sir " in the nature of medical benefit "-are in danger, Edwin Lutyens to make additions to it which nearly to an increasing extent, of being administered in a way trebled its size, but the hospital was established there contrary to the intentions of Parliament. While the before he was able to decorate the interior of the NIBS may not inappropriately be concerned with new portions. For the immediate purpose of the fine points, we are a little more concerned with the hospital-the replacing by artificial means of the lost limbs of men maimed in the war-a number of application of first principles. wooden huts were erected, most of which have now been superseded by permanent wards of brick. EARLY MOVEMENT AFTER ARTHROTOMY There are five of these wards, each of which contains AND ARTHROPLASTY. 40 beds-low, verandahed buildings connected by WRITING in the Presse Mgdicale of April lst, Dr. covered corridors. They face south and have forE. Desmarest discusses the lessons learnt from prospect a pleasant lawn. An operation block with operating on three cases of ankylosis of the knee by two theatres and wards for electro-therapy form part the method of arthroplasty with free fascia-flaps. He of the new equipment, and in another corner of lays stress on the importance of operating as early as the grounds are the workshops which are busily possible after active disease has ceased, for the reason turning out those cunningly articulated limbs which that muscular atrophy from disuse constitutes a very we have now learned to make with such astonishing serious drawback to functional recovery. The very skill and ingenuity. The inmates of the Special fact of the success of the operation, when strong and Surgical Hospital at Shepherd’s Bush have been, oractive muscles are able to control the joint in the are in process of being, removed to the infinitely more complete absence of the usual ligaments, is evidence restful and agreeable verge of Richmond Park, of the importance of a consideration of the state of where there will be room for between 1100 and 120& the muscles. Dr. Desmarest follows Murphy more than of them. Queen Mary’s Convalescent Auxiliary Putti in his operative technique, prefers a U-shaped Hospital at Roehampton will, however, no longerincision, and either divides the ligamentum patellae exist exclusively for the good of ex-soldiers and or detaches it together with a thin scale of bone from sailors. Men who are injured in limb on the railways its attachment to the tibia. Early massage and will also be treated there, and, no doubt, eventually active movement he considers essential if a good result the victims of mining and other dangerous trades is to be attained. The patient should be encouraged likewise. It may safely be claimed that, for its to begin active movements in the joint almost as soon special purpose, there is no hospital in the world as he recovers from the anaesthetic. Dr. Desmarest which excels Roehampton House, and probably gives as contra-indications to arthroplasty damage to nothing that equals it. the muscles of the thigh from osteomyelitis, old septic war injuries, with muscular atrophy and lesions of motor nerve trunks. SANOCRYSIN IN TUBERCULOSIS. Ankylosis from tuberculous disease is not suitable and the extremes of life should RECENT reports from Denmark show that there tool be avoided. In a communication to the American the treatment of tuberculosis with sanocrysin is still Journal of
WHOLE MILK IN INFANT FEEDING.
The patient was a woman infants. Dr. Hugh Thursfield supported the use of who died two days after the fourth injection of sano- boiled whole milk, stating that on purely clinical crysin, of which a total of 3-5 g. had been given. grounds it had proved to be the best substitute for Shortly before death she suffered from anuria and breast-feeding in the healthy infant. The case for the modification of cow’s milk was cyanosis, but there was no fall of temperature, nor evidence of a focal reaction in the lungs. The post- presented by Dr. Eric Pritchard and Dr. R. C. mortem examination showed hyperaemia of the colon, Jewesbury. They brought forward the argument haemorrhages in the small intestine, and severe that breast-milk is the best food for infants and that parenchymatous disease of the kidneys. The absence any substitute should approximate as closely as of a fall of the temperature and of clinical signs of possible in composition to breast-milk. Hence, oedema of the lungs suggests that this was not a case best results were to be expected and were obtained " of sanocrysin or tuberculin " shock, but rather one at their hands by modifying cow’s milk so as to of direct gold poisoning. Other interesting observa- make it as similar as possible to human milk. Dr. tions on patients undergoing sanocrysin treatment Pritchard pointed out that the problem is not the indicate that allergy is reduced, the rate of sedimenta- simple one of dealing with the protein, fat, and tion of the erythrocytes is hastened, and a considerable carbohydrate so as to obtain these three elements reduction of the haemoglobin in the blood occurs.in correct proportion, but the much more complicated Considering how little is yet known about the dosage one of adjusting the relative proportions of all the of sanocrysin and the indications for its different elements of milk, each of which plays it would be premature to pass judgment on its efficacy.some part in metabolism. He pleaded for some bioIt is on record that patients undergoing this treatmentchemical Darwin to correlate all the vast amount of have died, not merely in spite of it, but because of it. investigation carried out in this field. The problem It is also on record that patients have responded with not been solved by the simple dilution of milk, dramatic success ; febrile, debilitated and emaciated, any more than it had been solved by giving undiluted they have in a few weeks been restored to practically milk. The excess protein contained in cow’s milk complete health. Even in the hospitals in which was, in his opinion, dangerous both for its immediate leading to fermentation and the absorption experience has been gained, uncertainty still exists as to the prognosis of any case submitted to this or tne toxic products 01 1JillS process, ana. aiso ior ius treatment. remote effects, such as those produced in the liver and kidneys by the extra burden thrown on them and those taking place in that " long-suffering organ, the WHOLE MILK IN INFANT FEEDING. stomach " by the excessive acid production necessary WHILE experts argue about percentage feeding and for the of cow’s milk. Dr. Jewesbury also caloric values and this milk and that milk, the general drew a digestion of the results of high protein gloomy picture practitioner remains rather bewildered, knowing feeding, describing the clinical signs of restlessness, as he does that the public is rather unimpressed sleeplessness, constipation, colic, and flatulence, which by all the scientific jargon and that infants continue he believes are all caused by too much protein, and to thrive despite the use of foods which are denounced he adduced the excellent results obtained by the by the laboratory worker and the children’s physician simple modification of cow’s milk along the lines I alike as dangerous and monstrous introduced by Sir F. Truby King. Dr. H. C. Cameron Nevertheless, there is great value in a frank discussion uttered a warning against the taking of a rapid between experts of what appears on the surface to increase in weight as a proof of the success of one or be a relatively simple problem-namely, " Is the other method of infant-feeding. He looks upon most " modification of cow’s milk necessary in infant feed- artificial as in the nature of shots," feeding ing ? "-and this formed the subject at a meeting and the object of the physician shouldsighting be to discover of the Section for the Study of Disease in Children the best sighting shot. The general conclusions of the Royal Society of Medicine on Friday, April 24th. which arise from this discussion appear to be that Dr. Leonard Findlay made a strong case for the use the healthy infant boiled whole cow’s milk is as of whole cow’s milk, although he admitted that even for successful as any other food and that for the wasting he believed in the modification brought about by baby different schools still believe that their methods boiling, which he considers essential in view of the are the only successful ones. The wide differences impossibility of our ever obtaining an absolutely of opinion which appear to exist, however, are pure milk-supply. He discussed in the first place more likely to be modified by discussions of this nature, the differences between breast-milk and cow’s milk, and perhaps the public may one day get a unanimous pointing out that each of the constituents had been answer to its ever-persistent inquiry, " How are we singled out in turn as presenting sufficient divergences to feed our babies if we can’t breast-feed them ? " to warrant modification. The problem appeared to him to be much more subtle than the mere question of the relative differences of protein, for example, THE DIAGNOSIS OF HYDATID DISEASE. in the two milks, for the real difficulty here probably IT is in Australia where hydatid disease is comin rather than the amino-acids in the essential lay particular form in which they are presented in the paratively common that investigations of the serotwo milks, and any dilution of cow’s milk opened logical reactions occurring in this disease can be carried up the danger that certain amino-acids might be out over a sufficiently large number of cases to make the results of great value. At the Australian Medical so reduced in quantity as to give rise to disturbances in growth, just as the dilution frequently practised Congress of the British Medical Association held in I Melbourne in November, so reduced the iron intake of an infant as to 1923, Mr. Horace R. Dew anaemia. The available proof that an infant is unable and Miss F. Williams contributed a valuable paper to digest whole milk is to Dr. Findlay not convincing, on this subject, now republished in the Transactions and on the other hand, certain metabolism experiments of the Congress.! They report the results of three on marasmic infants had shown that these babies years’ work on the immunity reactions occurring in had no difficulty in dealing with cow’s milk. His hydatid disease. The three tests which have been clinical experience had gone to show that a vast carried out are the complement-fixation test, the majority of children digest and thrive on whole precipitin test, and the intradermal test of Casoni. cow’s milk, excluding cases where definite infective In the complement-fixation test the antigen used is - conditions of the digestive tract were present. fresh hydatid fluid and the test appears to be absolutely Dr. Findlay, in short, considers that the differences specific, giving a positive reaction in 80 per cent. of between cow’s milk and human milk present such all cases of hydatid disease. Certain cases with thickwalled cysts, barren of scolices, and dead cysts a fundamental and subtle problem that the attempt " to humanise " cow’s milk cannot possibly succeed, 1 Australian Medical Congress: Transactions of the First and that boiled whole milk gives better results than Session, Melbourne, 1923. Sydney: Sydney and Melbourne any modifications in all except the very youngest Publishing Co. 1924. Pp. 552.
interest in this connexion.
-
935
exhibition,30
had
effects in
____
I
productions.
produce