SILVER SALVARSAN.

571 The whole problem of available power for the service of man is a question of the possible mode of transformation of the various forms of energy. Physical research has shown the laws which govern these transformations, but the new knowledge arising out of radio-active and associated problems has pointed to the indisputable fact that within the atoms a vast The question that confronts source of energy exists. the physicist to-day is whether this source of energy Only a comparatively may be made available. minute fraction of the atoms liberate any of their energy spontaneously, these being the radio-active ones. The probability of releasing energy on a large scale from the atoms which are the bricks of the structure we call the world, is difficult to estimate, but atomic studies are a necessary precursor to it. Medical interest in physical research has received a great stimulus as electricity and the many forms of radiation become more and more wielded in its service. It is impossible to read of the many benefactions to research in all its forms in America without some regrets that these are such seldom events in this country. Here the academic world is not, at the present time, getting the number of men it should to devote themselves to pure research. Should this state of affairs continue it will be a bad day for physical research, and the British school of physicists will hardly maintain its proud record. The need is not so much for institutes, since excellent laboratories exist throughout the country ; what is wanted is facilities whereby men can carry out researches after qualification and before taking up senior appointments which carry a livelihood with them.

application.

INFLUENCE OF ARSENICAL PREPARATIONS ON CUTANEOUS TESTS. AKS)’;N)<’ has a selective faction upon the skin in a number of ways not yet clearly understood. ()J’. Albert Strickler,1 professor of dermatology and syphilology at the Temple University, Philadelphia, has carried out a series of investigations to determine the influence of various arsenical preparations on the luetin, Pirquet, and anaphylactic food tests. The influence of a repetition of the luetin test was first examined without any arsenical preparation being used. Two Wasserrnann tests were made on each patient, both of which had to be negative before the cases were regarded as eligible. In the repetition of the luetin test positive reactions were obtained in three out of 14 cases. Dr. Strickler suggests that the positive reaction was due to sensitisation of the skin produced by the first inoculation of dead spirochaetes. The influence of intravenous injection of arsphenamin on the luetin test was then examined in 17 patients suffering from various skin affections, two negative Wassermann tests as in the first series having first been obtained. The patients were given from two to five injections of 0-4 g. before the luetin test was repeated in each case. Nine of the patients gave a positive luetin test on repetition, and eight responded negatively. Intravenous injection of cacodylate of soda acted in the same manner as arsphenamin, only A study of the influence of the intramore feebly. venous injection of arsphenamin on the Pirquet test showed that arsphenamin acted on the tuberculin test in the same way as it had acted on the luetin test, as in three out of ten cases a previously negative Pirquet test became positive. On the other hand, the anaphylactic food test made by either the endermic or scratch method did not seem to be influenced by the intravenous administration of either arsphenamin THE

OCULAR REACTIONS IN ANAPHYLAXIS. experiments have shown to what an extraordinary extent the excitability of the smooth or cacodylate. muscle of the uterus, intestine, blood-vessels, and lungs can be increased in guinea-pigs sensitised by SILVER SALVARSAN. anaphylaxis. R. Kodamal investigated the smooth H. Dr. Michelson and Dr. David M. Siperstein,22 E. of the eyeball and its surroundings in guineamusclesensitised by the injection of 0-01 c.cm. and in of the University of Minnesota, discuss the therapeutic pigs other experiments by injecting 2-5 c.cm. of horse value of silver salvarsan or silver arsphenamin as it The anaphylactic sensibility is known in America. The drug was suggested by serum under the skin. Ehrlich shortly before his death, and first used was after a few weeks produced by dropping the same Kolle in March, 1918, since when it has or serum into the conjunctiva, by intra-orbital, clinicallyabyconsiderable vogue in Germany, but does enjoyed intravenous, or subcutaneous injection, control not to havebeen used to any extent in this appear on non-sensitised made guineaexperiments being country or in the United States. From a study of pigs. The palpebral fissure and pupil were accurately the literature and their personal experience of a measured. In both normal and sensitised animals limited number of cases, the writers conclude that the application of horse serum to the conjunctiva caused at once a dilatation of the palpebral fissure silver salvarsan is an efficient spirochaeticide which and pupil, followed by narrowing of both. In sen- has a pronounced effect upon the visible lesions of sitised animals the reaction was both quicker and more syphilis. A distinct advantage is the absence of marked. The primary dilatation was due to the the characteristic and often nauseating garlic-like stimulation of the smooth elevator fibres of the odour noticed by the patient when receiving other of salvarsan intravenously. The effect of silver eyelids and the dilator of the iris. The secondary forms on the Wassermann reaction is variable. narrowing of the palpebral fissure and iris is due salvarsan to two factors-decrease of the tonus of the tarsal As a rule, however, in recent syphilis a positive muscle and dilator iridis, and contraction of the reaction becomes negative after the first course of six to ten injections of silver salvarsan. Authosphincter iridis and congestion of blood. The from differ considerably as to the optimum dosage. rities primary stimulation of the smooth muscle of the An initial dose of from 0-05 to 0-1 g. for a person of and dilator iridis a small eyelids requires only very is best with a routine dose of from average weight dose of the anaphylactic poison, whilst the sphincter 0-2 to 0-25 g. The following technique is recomon is acted and into action later is pupillse brought with more difficulty. These reactions of the smooth mended by the writers : Dissolve the necessary dose muscles of the guinea-pig seem to show that the in 10 c.cm. of sterile distilled water, draw into a terminations of the sympathetic nerve as well as 20 c.cm. Luer syringe, puncture the vein, aspirate 10 c.cm. of blood, and re-inject the entire those of the oculo-motorius are affected by the about solution slowly. The interval between the injections state. of into horse serum anaphylactic Injection should vary from four to seven days, and the number the orbital cavity, as well as intravenous injection, both in normal and sensitised animals, caused increased of doses in a series varies considerably. There is secretion of the lacrymal and Harderian glands as apparently no reaction peculiar to silver salvarsan well as vaso-motor disturbances, and sometimes which has not been noticed with any of the other preparations. No authentic case of argyria haemorrhage from the epibulbar and retinal vessels. salvarsan In anaphylactic death there was a sudden contraction has been reported. Immediate reactions are about of the pupil. All the reactions occurred equally, the same as with the other forms of salvarsan, but whether normal horse serum was used or serum that it is too early to speak with certainty of remote dangers. had been heated for some time at 56° C. 1 Archives of Dermatology and Syphilology, August, 1921. 1 Jour, of Infectious vol. 1921. RECENT

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Diseases,

xxviii.,

2 Ibid.