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SYMPATHETIC OPHTHALMIA AS A SEASONAL AFFECTION
1127
healthy. In addition, there of separate group 15 patients subject to ulcerating chilblains. It was found that while chilblains were much commoner among the offspring of healthy parents than among the offspring of tuberculous parents, their course was more benign in the latterwhich Stephani-Cherbuliez compares a difference with the observation that tuberculosis developing in previously healthy stock is liable to run a comparatively violent course. Chilblains, she argues, are an allergic response to the tubercle bacillus which itself may not be present in the chilblain but in some other part of the body where it may even play the part allotted to it by the Germans in their conception of the Primdrkomplex. If this were so, chilblains might come to be regarded as a valuable warning-i.e., as evidence of tuberculous activities which demand that precautions should be taken by the patient lest But while none will deny that worse befall him. chilblains and tuberculosis are often associated, it will take much new evidence to persuade us 1 hat the association is essential. culous and 100
were
was a
SYMPATHETIC OPHTHALMIA AS A SEASONAL AFFECTION
No important advance has been made for many years in explaining the pathology of sympathetic ophthalmia. Our Budapest correspondent tells us of an elaborate study made by Dr. Bela Waldmann which was recently awarded the prize of the Oradea Medical Society. Dr. Waldmann believes that sympathetic ophthalmia depends upon some toxic agent conveyed to the eyeball from an accessory nasal sinus, and thence to the second eye via either the optic or the ciliary nerve. His belief is founded on the fact that out of 69 cases of which he has personal knowledge 53 started during what he terms the influenza months (October to April), while during the summer months (May to September) less than a quarter started. To test his theory from further statistics he sent inquiry forms to various eye clinics
(in Baltimore, Berlin, Budapest, Ghizeh, London, Madras, Manchester, Munich, Stockholm, and Vienna), and by this means obtained answers respecting 124 additional cases and these told the same story. Three-quarters of the cases began during the cold half of the year and only one-quarter during the In Prof. Meller’s clinic in Vienna the ratio warm. was 7 : 1. On the strength of these data Dr. Waldmann feels justified in asserting that sympathetic ophthalmia is a seasonal affection. This is a new observation and, whether or not his suggestion as to the channel of infection should ultimately prove to be justified, it is one that should not be lost sight of. THE RELATIONS OF THE ŒSOPHAGUS SURROUNDED
by
and aortic arch
translucent
lung tissue,
the heart
favourably placed for radiographical inspection. But the posterior surface of the heart and the descending aorta, because of their proximity to the spinal column, are not always readily visualised. The oesophagus, in traversing the thorax, is closely applied to the back of the heart, the aorta, and the tracheo-bronchial tree, so that its course is easily influenced by changes in cardiovascular structure. When filled with a suitable emulsion of barium, the oesophagus serves as a valuable radiological landmark in the chest. Kreuzfuchs (1921) made use of the barium-filled oesophagus in measuring the diameter of the aortic arch. Gabert (1924) studied the displacement of the oesophagus caused by enlargement of the left auricle, thus extendare
the anatomical investigations of Kovács and Stoerk (1910). Renander (1926), Biedermann (1931), and others noted the characteristic cesophagogram associated with a right-sided aortic arch, a congenital anomaly which occasionally causes dysphagia. Parkinson and Bedford described in our own columns (1931, ii., 337) the middle oesophageal impression, due to the left bronchus and indirectly to the right pulmonary artery, and discussed its clinical significance in relation to cardiovascular disease. A further valuable contribution to our knowledge of the oesophagus in relation to the heart and aorta has been made by Dr. William Evans, in a report1 issued by the Medical Research Council. Dr. Evans has made an extensive study of the normal aesophagogram in healthy subjects, confirming his interpretations of the various impressions by anatomical dissection. He establishes four normal cesophageal impressions made, from above down, by the aortic arch, the left bronchus, the left auricle, and the descending aorta. Each of these is described first as seen in healthy subjects, then as modified by different pathological changes in the heart and aorta. A large series of radiograms is given, each with its anatomical interpretation, illustrating in turn the different forms of oesophagogram found in health and in cardiovascular disease. Dr. Evans’s monograph, which combines with his own investigations a survey of previous work on the subject, should lead to a better appreciation of the importance of the visualised oesophagus in relation to the heart.
ing
THE BRITISH HEALTH RESORTS
THE waning popularity of the continental health resorts and the renewed vigour of their British rivals is referred to in the report on page 1137 of the conference of the British Health Resorts Association at Woodhall Spa. In his foreword to the Association’s Handbook for 1936,2 Sir Kingsley Wood writes : "It is true to say that the benefits which British Health Resorts can offer in a great variety of cases are not known or used to the extent they deserve. Modern research has done much to explore and explain the relation of environment to health, and to add to our knowledge of the precise importance of factors like climate, air, and medicinal waters in the treatment and prevention of disease. But this increased knowledge cannot have its full effect unless it reaches the public. It is the object of the British Health Resorts Association to ensure that it shall. The task which the Association has undertaken is threefold ; to bring before the public the claims of British spas and watering places to possess curative resources in no way inferior to continental health resorts; to offer to the medical profession and its clients expert advice on the natural conditions most favourable to the Successful treatment of the maladies with which they are concerned ; and to inform them where these conditions may be found in this country." The handbook, now in its fourth edition as a separate work, ably serves all these purposes. Considerable changes have been made in the new and enlarged edition, which will increase its usefulness both to the general public and to the medical profession. The information about the British wintering places has been augmented by detailed meteorological reports on the climate during each of the winter months; these are in 1 Spec. Rep. Ser. No. 208, pp. 93, 2s. 6d. 2 British Health Resorts : Spa, Seaside, Inland. Official Handbook of the British Health Resorts Association. Edited for the Association by A. Fortescue Fox, M.D., F.R.C.P. London: J. & A. Churchill, Ltd. 1936. 1s.
healthy. In addition, there of separate group 15 patients subject to ulcerating chilblains. It was found that while chilblains were much commoner among the offspring of healthy parents than among the offspring of tuberculous parents, their course was more benign in the latterwhich Stephani-Cherbuliez compares a difference with the observation that tuberculosis developing in previously healthy stock is liable to run a comparatively violent course. Chilblains, she argues, are an allergic response to the tubercle bacillus which itself may not be present in the chilblain but in some other part of the body where it may even play the part allotted to it by the Germans in their conception of the Primdrkomplex. If this were so, chilblains might come to be regarded as a valuable warning-i.e., as evidence of tuberculous activities which demand that precautions should be taken by the patient lest But while none will deny that worse befall him. chilblains and tuberculosis are often associated, it will take much new evidence to persuade us 1 hat the association is essential. culous and 100
were
was a
SYMPATHETIC OPHTHALMIA AS A SEASONAL AFFECTION
No important advance has been made for many years in explaining the pathology of sympathetic ophthalmia. Our Budapest correspondent tells us of an elaborate study made by Dr. Bela Waldmann which was recently awarded the prize of the Oradea Medical Society. Dr. Waldmann believes that sympathetic ophthalmia depends upon some toxic agent conveyed to the eyeball from an accessory nasal sinus, and thence to the second eye via either the optic or the ciliary nerve. His belief is founded on the fact that out of 69 cases of which he has personal knowledge 53 started during what he terms the influenza months (October to April), while during the summer months (May to September) less than a quarter started. To test his theory from further statistics he sent inquiry forms to various eye clinics
(in Baltimore, Berlin, Budapest, Ghizeh, London, Madras, Manchester, Munich, Stockholm, and Vienna), and by this means obtained answers respecting 124 additional cases and these told the same story. Three-quarters of the cases began during the cold half of the year and only one-quarter during the In Prof. Meller’s clinic in Vienna the ratio warm. was 7 : 1. On the strength of these data Dr. Waldmann feels justified in asserting that sympathetic ophthalmia is a seasonal affection. This is a new observation and, whether or not his suggestion as to the channel of infection should ultimately prove to be justified, it is one that should not be lost sight of. THE RELATIONS OF THE ŒSOPHAGUS SURROUNDED
by
and aortic arch
translucent
lung tissue,
the heart
favourably placed for radiographical inspection. But the posterior surface of the heart and the descending aorta, because of their proximity to the spinal column, are not always readily visualised. The oesophagus, in traversing the thorax, is closely applied to the back of the heart, the aorta, and the tracheo-bronchial tree, so that its course is easily influenced by changes in cardiovascular structure. When filled with a suitable emulsion of barium, the oesophagus serves as a valuable radiological landmark in the chest. Kreuzfuchs (1921) made use of the barium-filled oesophagus in measuring the diameter of the aortic arch. Gabert (1924) studied the displacement of the oesophagus caused by enlargement of the left auricle, thus extendare
the anatomical investigations of Kovács and Stoerk (1910). Renander (1926), Biedermann (1931), and others noted the characteristic cesophagogram associated with a right-sided aortic arch, a congenital anomaly which occasionally causes dysphagia. Parkinson and Bedford described in our own columns (1931, ii., 337) the middle oesophageal impression, due to the left bronchus and indirectly to the right pulmonary artery, and discussed its clinical significance in relation to cardiovascular disease. A further valuable contribution to our knowledge of the oesophagus in relation to the heart and aorta has been made by Dr. William Evans, in a report1 issued by the Medical Research Council. Dr. Evans has made an extensive study of the normal aesophagogram in healthy subjects, confirming his interpretations of the various impressions by anatomical dissection. He establishes four normal cesophageal impressions made, from above down, by the aortic arch, the left bronchus, the left auricle, and the descending aorta. Each of these is described first as seen in healthy subjects, then as modified by different pathological changes in the heart and aorta. A large series of radiograms is given, each with its anatomical interpretation, illustrating in turn the different forms of oesophagogram found in health and in cardiovascular disease. Dr. Evans’s monograph, which combines with his own investigations a survey of previous work on the subject, should lead to a better appreciation of the importance of the visualised oesophagus in relation to the heart.
ing
THE BRITISH HEALTH RESORTS
THE waning popularity of the continental health resorts and the renewed vigour of their British rivals is referred to in the report on page 1137 of the conference of the British Health Resorts Association at Woodhall Spa. In his foreword to the Association’s Handbook for 1936,2 Sir Kingsley Wood writes : "It is true to say that the benefits which British Health Resorts can offer in a great variety of cases are not known or used to the extent they deserve. Modern research has done much to explore and explain the relation of environment to health, and to add to our knowledge of the precise importance of factors like climate, air, and medicinal waters in the treatment and prevention of disease. But this increased knowledge cannot have its full effect unless it reaches the public. It is the object of the British Health Resorts Association to ensure that it shall. The task which the Association has undertaken is threefold ; to bring before the public the claims of British spas and watering places to possess curative resources in no way inferior to continental health resorts; to offer to the medical profession and its clients expert advice on the natural conditions most favourable to the Successful treatment of the maladies with which they are concerned ; and to inform them where these conditions may be found in this country." The handbook, now in its fourth edition as a separate work, ably serves all these purposes. Considerable changes have been made in the new and enlarged edition, which will increase its usefulness both to the general public and to the medical profession. The information about the British wintering places has been augmented by detailed meteorological reports on the climate during each of the winter months; these are in 1 Spec. Rep. Ser. No. 208, pp. 93, 2s. 6d. 2 British Health Resorts : Spa, Seaside, Inland. Official Handbook of the British Health Resorts Association. Edited for the Association by A. Fortescue Fox, M.D., F.R.C.P. London: J. & A. Churchill, Ltd. 1936. 1s.