THE BEGINNINGS OF LOCAL ANÆSTHESIA.

THE BEGINNINGS OF LOCAL ANÆSTHESIA.

976 ance of an editorial committee of which Mr. J. T. Humphrey is chairman, and the medical members oí which are Dr. J. H. Burn, Dr. H. H. Dale, a...

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976 ance

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secretes a substance which nourishes and activates the sperm and states that spermatozoa are more active in the tail of the epididymis than they are in the head. Oslund was not able to confirm these observations and believes that the main motive power of the spermatozoa is derived from the pressure of secretion from behind. As far as he could see there is in man very little storage of spermatozoa anywhere in the genital tract. Certainly the vesiculae seminales cannot be regarded as reservoirs and spermatozoa found within them in cadavers must be regarded as invaders rather than as normal inhabitants. As the result of the constant passage of sperm from the testis towards the urethra spermatozoa are found frequently in the urethra and in the urine. During coitus there occurs a speeding up of the movement of the sperm along the vas deferens. This is due to contraction of the muscles of the epididymis and vas deferens including the ampulla which decreases the volume of the tubules and forces spermatic fluid towards the urethra. These contractions are observed after stimulation of the hypogastric nerves;they also occur spontaneously and more especially during coitus when they supply the chief mechanism for the transportation of spermatic fluid.

THE DOG AND CAT IN DERMATOLOGY. So far as we know, the only cutaneous diseases that can be contracted from the dog or cat are scabies and ringworm, but in these days of domestic pets the chances of such infection are by no means remote. Hudelo and Rabutstate that the scabies of dogs, which is caused by an acarus morphologically similar but smaller than that of human scabies, is less common than the feline variety, which is due to the Notaeriris cati, an even smaller parasite. Both infections seem to require prolonged and intimate contact with the offending animal-e.g., in bed-and neither parasite burrows in the human skin, thus rendering diagnosis a matter of doubt and difficulty. The presence of isolated intensely pruriginous papules, capped sometimes by a minute blister, usually on the flexor aspects of one or both forearms, or on the abdomen, or one shoulder, should arouse the suspicions of the practitioner and, in spite of the absence of acarine runs in the finger webs, on the THE BLOOD IN TUBERCULOSIS. breasts, or the penis should suggest an atypical scabietic AFTER a cytological study of the blood in The possibility of animal transmission infection. may make it necessary to examine the animal patients suffering from pulmonary tuberculosis, suspected. In the dog, according to Hudelo and R. S. Cunningham and Edna H. Tomkins1 claim Rabut, scabies is manifested by fine desquamation on that in this disease the white cells undergo very the anterior borders of the ears ; in advanced cases definite changes in number and character, and in there is patchy loss of hair and an eruption of papules particular that the monocytes are always multiplied. and pustules over most of the body. In the cat it may The " supra-vital " technique introduced by Sabin set up a generalised inflammation with greyish crusts was employed in their investigation, as it facilitates spreading from the scalp, which is denuded of its differentiation between the monocytic and lymphohair, as far as the neck, such a condition being often cytic types. So convinced are these observers -of the severe and sometimes even fatal. A characteristic sign importance of this change that they would hesitate is coexistent infection of the paws from violent scratch- to accept a diagnosis of pulmonary tuberculosis if ing of the ears. The treatment of scabies contracted the patient’s blood failed to show an elevation of the from a cat is simple and the infection subsides almost monocyte count. The lymphocytes show a reciprocal as soon as the animal is removed. The canine variety relationship to the monocytes. Thus the latter is not so easily eliminated, and the inunction of increase during infection while the former decrease, sulphur or some antiparasitic ointment is usually the monocyte serving as an index of dissemination A progressive As regards ringworm, the identification and the lymphocyte of resistance. necessary. of the various species will demand a careful cultural decrease of the lymphocyte count suggests a grave technique, which Sabouraud has elaborated in his prognosis. It is possible that some specific toxin of Les Teignes." There are three great tuberculosis acts as a stimulant to the monocytes famous work, classes, the trichophytons, the microsporons, and and a depressant to the lymphocytes, so that the favus.’ They may attack the glabrous skin and the ratio between the two types of cell may thus be used hair both of the scalp and beard, and recently the as an index of the relation of the processes of infection important observation has been made that follicular to those of resistance. Enumeration of the white eruptions on the back and chest of children are cells of the blood may thus, they consider, be useful sometimes attributable to trichophytides. which have in both diagnosis and prognosis. reached this secondary site by way of the blood ____

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stream. THE STORAGE OF SPERMATOZOA. WE have still much to learn about the physiology of the male reproductive system. Dr. Robert M. Oslund2 tells us that in the course of a series of experiments involving ligation and resection of the vas deferens in animals he became interested in the question of the storage of spermatozoa. He found that in the seminiferous tubules there occurs an accumulation of colloid material derived from the breaking down of spermatocytes and spermatids. This colloidal fluid moves slowly along the tubules, its movement being determined by the vis a tergo rather than by active contraction on the part of the When the fluid enters the seminiferous walls. epididymal canal it comes under the action of the ciliated lining, but in the author’s opinion the influence of this is insignificant in comparison with the force exerted by the accumulation of spermatic material behind it. The motility possessed by the spermatozoa probably does not exercise much influence on the progress of the fluid or of the spermatozoa through the tubules. Benoit has reported that the epididymis 1 Paris Médical, Jan. 21st, p. 56. 2 Jour. Amer. Med. Assoc., March 17th, 1928.

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THE BEGINNINGS OF LOCAL ANÆSTHESIA. THE inestimable benefit that cocaine has proved to be as a local anaesthetic in eye surgery and the perhaps equal services that its synthetic derivatives now afford for infiltration anaesthesia render the history of the first employment of the drug of considerable interest. It is to Dr. Carl Koller, formerly of Vienna, now of New York, that ophthalmic surgeons owe the discovery of its practical application. In a personal communication he informs us that long before 1884 he had been conducting experiments with such substances as chloral, bromides, and morphia in the hope of obtaining an efficient local anaesthetic for the eye, but without success. The alkaloid cocaine had been isolated from coca leaves brought from Peru so long ago as 1860, and its numbing effects on the nerves of the tongue had been recorded, but lost sight of in view of the overshadowing effects of the drug on the central nervous system. "

When in the course of preparing for these physiological writes Dr. Koller, " I realised that I had in my possession the local anaesthetic which I had been previously striving for, I went at once to Stricker’s laboratory, made a solution of cocaine, and instilled a drop in the

experiments,"

1 American Review of Tuberculosis, March, 1928.

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frog, and afterwards of a guinea-pig. I found the and conjunctiva anaesthetic—that is, insensitive to mechanical, chemical, thermic, and faradic stimulation. Afterwards I repeated these experiments on myself, some colleagues, and many patients. I made the first preliminary communication relative to this subject on Sept. 15th, 1884, at the Heildelberg meeting of the German Ophthalmological Society. Dr. Brettauer, of Trieste, read a short paper which I had given him together with the solution to On take to the meeting, and showed the experiments. Oct. 17th of the same year I read before the Gesellschaft der Aerzte of Vienna a more elaborate paper which was published in the Wiener Medizinische Wochenschrift for Oct. 25th, 1884, and translated in THE LANCET (London) of Dec. 6th, 1884, and the New York Medical Record."

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of the production of volatile and non-volatile in approximately equal proportions, In the third phase non-volatile acid commences. radicles alone are produced. The second period of growth (about the twenty-eighth day) is chiefly characterised by the conversion of non-volatile acid radicles into equivalent amounts of volatile acids, and the content of volatile acids reaches its maximum by the time the second peak of growth has been reached. The inorganic phosphorus content also varies in relation to the organic phosphorus content. These and other chemical changes are best studied in relation to the charts shown. A further the same authors deals with The news of the new drug which did away with the effects of report3 by certain salts upon changes in hydrogen-ion the necessity of a general anaesthetic in nearly all concentration, and with the r6le of creatinine in the eye operations spread with remarkable celerity. control of reaction in cultures. The points discussed, Already before the end of the year 1884 three papers on which are of considerable technical interest, can only it were read before the Ophthalmological Society of be appreciated by a study of the report itself. the United Kingdom by the late Arthur H. Benson, the late E. Nettleship, and the late Walter J-essop.1 Nettleship had already operated with cocaine for COMPARATIVE IMMUNITY. 18 senile cataracts, besides numerous other operations, bis first operation having been on Oct. 10th, less NEW journals devoted to one or anotheraspect than a month after Dr. Koller’s paper had been read of the medical sciences continue to emerge at frequent at Heidelberg. Its use soon became and has intervals. Among the latest is the Archives roumaines remained universal among ophthalmic surgeons. At Dr. de pathologie experimentale et de microbiologie, published Koller’s suggestion the drug was shortly afterwards in French, in Paris, and edited by Prof. J. Cantacuzene, utilised by his laryngological colleagues. The employ- of Bucharest, who occupies the greater part of the ment of infiltration anaesthesia was a subsequent first number with an instalment of his researches on development. It is fitting that these facts should not the mechanism of immunity in the marine gephyrean be forgotten during the lifetime of the discoverer. It is a classical field, for it was worm Sipunculus. when he was working with similar material, and when, as he tells us, his family had gone to a circus to see some extraordinary performing apes, that the revelaCHEMICAL CHANGES IN CULTURE MEDIA. tion came to Metchnikoff, at Messina, in the early IT has been a reproach for many years to the days of 1883, that phagocytosis was a means of bacteriologist that he has been too much occupied protection against injury and disease. In the with certain aspects of his studies, particularly with special case which he has investigated Prof. pathogenicity and special differentiating tests, to pay Cantacuzene shows that foreign bodies, such as proper attention to the nature of the chemical changes bacteria or sheep’s red corpuscles, injected into the taking place in the media which he employs. These coelomic cavity are enveloped in leucocytes and media are of a very complicated character, the difficulties gathered up into masses by the mucous secretion of their investigation are correspondingly great, and of the urns," enormous ciliated cells whose function progress cannot be other than slow. Reliable methods has long been something of a mystery. By these of estimation are, of course, a necessary precursor for means the ccelom is soon cleared, and one is reminded 2 any clear advance, and a recently issued report of the way in which leucocytes and platelets clear embodies studies of this order and adds to the number the blood and the omentum clears the peritoneal of trustworthy methods now available. By the use of cavity in mammals. Specimens of Sipunculus which Foreman’s alcohol titration method and its modifica- have previouslv been vaccinated react in the same tions it is possible to obtain what the authors call way, but quicker, the secretion of the "urns" reliable balance-sheets, in which the total values for is more acid and hence more adhesive and, in constituents estimated in groups are equal to the sum addition, agglutinins and cytolysins are produced, of the values for the subgroups. The methods used though, as is usual in invertebrates, the cellular The " total alcohol value " side of the defence is much more active than the are described in the text. of ’*alcohol extracts" made from such fluids as humoral. From which it may be surmised that the meat extract media, can be successfully differentiated protective effect of vaccination is likely to be less into subvalues for the different classes of, and radicles specific than in the higher vertebrates. Such has embraced by, new rapid methods, and the results can indeed lately been shown by Chorine,4who found be checked by balance-sheet methods. The medium that various bacteria would immunise the caterpillars used was a plain ox heart extract with tap water and of the wax moth Galleria against the variety of without salt or peptone additions. The Staphylococcus Bacillus subtilis which is pathogenic for it. aureU8 was grown in such extracts of differing concentration and the chemical and bacteriological changes were studied under different conditions. TUMOURS OF THE LUNG. These changes are complex and only a few points can be noted. MEDIASTINAL tumours have always had special The curve of bacterial growth is characterised by two peaks, the first reaching its interest, clinically and pathologically. Their increase maximum on about the fourth day and the second on in recent years and the recognition that the majority about the twenty-eighth day. Between them is a are not sarcomas of mediastinal glands but carcinomas period in which the numbers are small, while after arising from the larger bronchi makes any further’ the second peak the numbers again decrease. These information about them of value and we welcome a phases correspond to definite chemical changes. For survey by Prof. T. Shennan of his experience in example, during the first period of rapid growth there Aberdeen.The 31 cases accumulated in some 12 years is the production of volatile bases alone, unaccompanied inc’ude a spindle-cell sarcoma of mediastinal glands, by any appreciable development of acids. Apparently a lymphosarcoma of thymus, 4 tumours arising amino-acids are not the source of the volatile bases. in the thymus with a structure resembling lymphBefore this first phase is completed the second phase, and 3 secondary thyroid carcinomas ; the

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Trans. Ophth. Soc., 1885, vol. v. The Changes Produced in Meat Extracts by the Bacterium Staphylococcus aureus. By F. W. Foreman and G. S. GrahamSmith. Food Investigation Board Special Report. No. 31. 1928. H.M. Stationery Office. 2s. 2

3 The Control of Reaction in Cultures and Enzyme Digests. No. 32. Food Investigation Board Special Report. 1928. H.M. Stationery Office. 9d. 4 Comp. Rend. Soc. Biol., 1927, xcvii., 1395. 5 Jour. of Path. and Bact., 1928, xxxi., 365.