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THE BLOOD PRESSURE IN MENSTRUATION.
923
impression given both as to the nature and of the error, and the candour of its author. Within the past few months two professors of medicine been pilloried in medical on the Continent have journals on this score. Both were pecuniarily interested Both in remedies which they had personally devised. published a practically unbroken series of successful results, and it was left to others to collect and publish with unaffected glee the not infrequent cases of failure or serious injury inflicted by-these remedies. Had these records of failure been published by the authors of the remedies concerned, their own reputation for candour would not have suffered at all, and the reputation of their remedies would have suffered less. It would, however, be unjust to brand as knaves those who do not publish their mistakes ; j9op!Ms vult decipi is a law applicable to others than the grossly illiterate, and the advocate of a remedy whose mental astigmatism allows him to see only an unbroken series of successes may be more fool than knave. With regard, however, to such perennial mistakes as the legacy of a swab in the peritoneal cavity it should be borne in mind that of rumour, and that, as the secrecy is the mother " drummer said : Honesty, I have found, is the better policy, having tried both."
an incorrect
frequency
and need a free supply of oxygen for their production. From the immunological aspect of the question we are tempted immediately to ask if these bactericidal substances are related to the bacteriolytic substances produced by certain tissue fluids, blood serum, and phagocytes. On the practical side of clinical pathology a large number of issues are raised. Not the least interesting, in addition to the questions suggested by the authors, is the presence or absence of these bactericidal substances in the group of obligate aerobes such as the tubercle bacillus on the one hand and obligate anaerobes such as the tetanus bacillus and its allies on the other. As the authors point out, some very interesting lines of investigation are opened out, and we trust that a stimulus has been given to research in a field which has hitherto been more or less of a " dark continent.’’f -
THE CAUTERISATION
OF
PLEURAL ADHESIONS.
WHEN, at the International Medical Congress in London ’in 1913, Professor H. C. Jacobaeus gave an account of his preliminary attempts to convert a partial, artificial pneumothorax into one that was complete by the division of pleural adhesions with the thermo-cautery, he roused some interest and much sceptical criticism. Those who were present at his THE BLOOD PRESSURE IN MENSTRUATION. lecture may remember how unconvinced several of his hearers were ; his method was regarded rather as a THE question of the changes in blood pressure before clever and daring freak than as an operation calculated and during menstruation is of no little interest, both to prove of general utility in lung collapsetherapy. theoretical and practical, for it may account for many events to have belied this early Subsequent symptoms ; yet it is strange that in most of the text- judgment, and in appear his most recent publication1 books there is very little to be found of an authoritative Jacobaeus is able to show that this operation has nature bearing on this, and in several works on blood already been performed in about 100 cases, with pressure it seems to be ignored. One of the few referbrilliantly successful results in several, and withouta ences to the matter is in Dr. Blair Bell’s " Principles of operative death from heamorrhage, air embolism, single GYllaecology"; another mention of the subject is con- or other cause. His own cases number 40, and tained in J. Novak’s " Monograph." A brief note by in 30 he succeeded in collapsing the lung by C. D. Mosher, published in the Johns Hopkins Hospital In four of these 30 the severance of adhesions. Bulletin, 1901, may also be mentioned. We understand cases the operation provoked a tuberculous empyema that Professor Winifred Cullis, D.Sc., has conducted from which only one of the four patients recovered. some investigations on the question at the London In the remaining 26 cases the conversion of a School of Medicine for Women, but the work has not to a partial pneumothorax proved of great yet been published. In another column of this issue of benefit owinglarge to the improved immobilisation THE LANCET will be found a query on the subject, and of the lung. A reference to Professor C. Saugman’s2 it would be interesting to our correspondent and to recent paper on pneumothorax treatment of pulmonary many of our readers to have some definite account tuberculosis will show how greatly the benefits of of the blood pressure changes in connexion with this treatment depend on the completeness of the menstruation. immobilisation achieved, and his comparison of complete with incomplete cases of pneumothorax may be BACTERICIDINS. taken as the measure of the value of Jacobaeus’s In about 50 per cent. of his cases the THE interesting paper in our present issue by Dr. operation. J. W. McLeod and Mr. P. Govenlock on the production cauterisation gave rise to a pleural effusion. This was, of bactericidins by micro-organisms raises a number of in many cases, simply due to thermal irritation, and any questions which cannot fail to influence the study of it disappeared in a week or two without causing four immunity. The subject is one which has hitherto permanent ill-effects. Far more serious were the aroused remarkably little attention in English bacterio- cases,of pleural effusion which subsequently turned logical literature. We are familiar with the fact that into chronic tuberculous empyema. This, then, one species of bacterium may outstrip its fellows in would seem to be the gravest complication which operator need anticipate, and it alone was growth on artificial media owing to the chemical com- the the cause of the post-operative mortality of 8 per of of the the incubation, medium, temperature position and other circumstances. This is met with daily in the cent. to which Professor Jacobaeus confesses.. Only in cultivation of throat swabs and in the isolation of acid- one case did he see a haemorrhage amounting to as fast bacteria from a mixed flow, to name two instances much as 100 to 200 c.cm., and he suggests that this at random. But the .bactericidal effect which one complication can be largely avoided by not heating the organism may have upon another-even on another cautery to more than a dull red glow. Other complicavariety of its own species-excites little comment. tions such as surgical emphysema did not threaten life, And conversely we are almost equally ignorant and complications such as septic infection of the on the question of symbiosis. By means of an pleural cavity by injury to the lung did not occur ingenious modification of Eijkman’s agar disc method once, although spread of mixed infection from a cavity Dr. McLeod and Mr. Govenlock have studied the in the lung to the pleural cavity has been dreaded as bactericidal substances elaborated by the pneumo- a sequel to this operation. Thus, the most serious coccus and a number of other species. The results objection to this treatment seems to be the possibility are in several instances very striking. The pneumo- of a tuberculous empyema, and Professor Jacobaeus coccus, for instance, appears to have a definite admits that there is little prospect of eliminating this inhibitory effect not only on organisms of other groups risk altogether by improvements in the technique of his but also on other varieties of pneumococcus. It is operation. An account of the technique was given in also interesting to note that ubiquitous organisms such 1919 by Dr. W. Holmboe.3 as the staphylococcus and the colon bacillus show less 1 Acta Chirurgica, Scandinavica, 1921, vol. liii., fasc. 4. inhibitory powers. The inhibitive substances appear to be 2 THE LANCET, 1920, ii., 685. 3 Tubercle, 1919, vol. i., No. 1. labile bodies heat at 80°-85° C." "relatively destroyed by
impression given both as to the nature and of the error, and the candour of its author. Within the past few months two professors of medicine been pilloried in medical on the Continent have journals on this score. Both were pecuniarily interested Both in remedies which they had personally devised. published a practically unbroken series of successful results, and it was left to others to collect and publish with unaffected glee the not infrequent cases of failure or serious injury inflicted by-these remedies. Had these records of failure been published by the authors of the remedies concerned, their own reputation for candour would not have suffered at all, and the reputation of their remedies would have suffered less. It would, however, be unjust to brand as knaves those who do not publish their mistakes ; j9op!Ms vult decipi is a law applicable to others than the grossly illiterate, and the advocate of a remedy whose mental astigmatism allows him to see only an unbroken series of successes may be more fool than knave. With regard, however, to such perennial mistakes as the legacy of a swab in the peritoneal cavity it should be borne in mind that of rumour, and that, as the secrecy is the mother " drummer said : Honesty, I have found, is the better policy, having tried both."
an incorrect
frequency
and need a free supply of oxygen for their production. From the immunological aspect of the question we are tempted immediately to ask if these bactericidal substances are related to the bacteriolytic substances produced by certain tissue fluids, blood serum, and phagocytes. On the practical side of clinical pathology a large number of issues are raised. Not the least interesting, in addition to the questions suggested by the authors, is the presence or absence of these bactericidal substances in the group of obligate aerobes such as the tubercle bacillus on the one hand and obligate anaerobes such as the tetanus bacillus and its allies on the other. As the authors point out, some very interesting lines of investigation are opened out, and we trust that a stimulus has been given to research in a field which has hitherto been more or less of a " dark continent.’’f -
THE CAUTERISATION
OF
PLEURAL ADHESIONS.
WHEN, at the International Medical Congress in London ’in 1913, Professor H. C. Jacobaeus gave an account of his preliminary attempts to convert a partial, artificial pneumothorax into one that was complete by the division of pleural adhesions with the thermo-cautery, he roused some interest and much sceptical criticism. Those who were present at his THE BLOOD PRESSURE IN MENSTRUATION. lecture may remember how unconvinced several of his hearers were ; his method was regarded rather as a THE question of the changes in blood pressure before clever and daring freak than as an operation calculated and during menstruation is of no little interest, both to prove of general utility in lung collapsetherapy. theoretical and practical, for it may account for many events to have belied this early Subsequent symptoms ; yet it is strange that in most of the text- judgment, and in appear his most recent publication1 books there is very little to be found of an authoritative Jacobaeus is able to show that this operation has nature bearing on this, and in several works on blood already been performed in about 100 cases, with pressure it seems to be ignored. One of the few referbrilliantly successful results in several, and withouta ences to the matter is in Dr. Blair Bell’s " Principles of operative death from heamorrhage, air embolism, single GYllaecology"; another mention of the subject is con- or other cause. His own cases number 40, and tained in J. Novak’s " Monograph." A brief note by in 30 he succeeded in collapsing the lung by C. D. Mosher, published in the Johns Hopkins Hospital In four of these 30 the severance of adhesions. Bulletin, 1901, may also be mentioned. We understand cases the operation provoked a tuberculous empyema that Professor Winifred Cullis, D.Sc., has conducted from which only one of the four patients recovered. some investigations on the question at the London In the remaining 26 cases the conversion of a School of Medicine for Women, but the work has not to a partial pneumothorax proved of great yet been published. In another column of this issue of benefit owinglarge to the improved immobilisation THE LANCET will be found a query on the subject, and of the lung. A reference to Professor C. Saugman’s2 it would be interesting to our correspondent and to recent paper on pneumothorax treatment of pulmonary many of our readers to have some definite account tuberculosis will show how greatly the benefits of of the blood pressure changes in connexion with this treatment depend on the completeness of the menstruation. immobilisation achieved, and his comparison of complete with incomplete cases of pneumothorax may be BACTERICIDINS. taken as the measure of the value of Jacobaeus’s In about 50 per cent. of his cases the THE interesting paper in our present issue by Dr. operation. J. W. McLeod and Mr. P. Govenlock on the production cauterisation gave rise to a pleural effusion. This was, of bactericidins by micro-organisms raises a number of in many cases, simply due to thermal irritation, and any questions which cannot fail to influence the study of it disappeared in a week or two without causing four immunity. The subject is one which has hitherto permanent ill-effects. Far more serious were the aroused remarkably little attention in English bacterio- cases,of pleural effusion which subsequently turned logical literature. We are familiar with the fact that into chronic tuberculous empyema. This, then, one species of bacterium may outstrip its fellows in would seem to be the gravest complication which operator need anticipate, and it alone was growth on artificial media owing to the chemical com- the the cause of the post-operative mortality of 8 per of of the the incubation, medium, temperature position and other circumstances. This is met with daily in the cent. to which Professor Jacobaeus confesses.. Only in cultivation of throat swabs and in the isolation of acid- one case did he see a haemorrhage amounting to as fast bacteria from a mixed flow, to name two instances much as 100 to 200 c.cm., and he suggests that this at random. But the .bactericidal effect which one complication can be largely avoided by not heating the organism may have upon another-even on another cautery to more than a dull red glow. Other complicavariety of its own species-excites little comment. tions such as surgical emphysema did not threaten life, And conversely we are almost equally ignorant and complications such as septic infection of the on the question of symbiosis. By means of an pleural cavity by injury to the lung did not occur ingenious modification of Eijkman’s agar disc method once, although spread of mixed infection from a cavity Dr. McLeod and Mr. Govenlock have studied the in the lung to the pleural cavity has been dreaded as bactericidal substances elaborated by the pneumo- a sequel to this operation. Thus, the most serious coccus and a number of other species. The results objection to this treatment seems to be the possibility are in several instances very striking. The pneumo- of a tuberculous empyema, and Professor Jacobaeus coccus, for instance, appears to have a definite admits that there is little prospect of eliminating this inhibitory effect not only on organisms of other groups risk altogether by improvements in the technique of his but also on other varieties of pneumococcus. It is operation. An account of the technique was given in also interesting to note that ubiquitous organisms such 1919 by Dr. W. Holmboe.3 as the staphylococcus and the colon bacillus show less 1 Acta Chirurgica, Scandinavica, 1921, vol. liii., fasc. 4. inhibitory powers. The inhibitive substances appear to be 2 THE LANCET, 1920, ii., 685. 3 Tubercle, 1919, vol. i., No. 1. labile bodies heat at 80°-85° C." "relatively destroyed by