- Email: [email protected]
THE CALCUTTA SCHOOL OF TROPICAL MEDICINE.
1268 cent. of the cases the tricuspid valve alone was affected, in 56 the aortic, and in 40 the mitral. In the Johns Hopkins Hospital Bnlletin for November Dr. H. M. Thomas and Dr. D. O’Hara have reported the following case :-
A man, aged 45 years, was admitted on May 19th, 1920, the fourth day of an attack of pneumonia. The whole of the lower lobe of the right lung and a small patch of the The leucocyte lower lobe of the left were consolidated. count was 16,500. The sputum contained the pneumococcus of Type 1. Antipneumococcic serum was given intravenously. On the 23rd the temperature had fallen to 100° F. and on the 24th to normal. But it rose again on the evening of the 25th and on the 26th was 101°, with a diffuse urticarial rash. This was thought to be serum sickness. On the 30th the lung signs were nearly the same as on admission. On June 5th the pneumococcus was still present in the blood. For the pneumococcus septicaemia, which was continuing after the crisis, it was decided to resume the intravenous treatment, but in order to avoid anaphylaxis from horse serum Mulford’s antipneumococcus antibody extract wasgiven. The temperature fell and the patient seemed improved, but on the 7th he had a chill and his temperature rose to 1040. Then it was decided to desensitise the patient for horse serum and resume the serum treatment. On the 9th a blood culture showed 3000 colonies of pneumococci per cubic centimetre of blood. At the right angle of the scapula the breath sounds were somewhat amphoric, with medium to large consonating rales. X ray examination suggested pulmonary abscess. As the original attack of pneumonia had apparently been recovered from the lung condition did not seem adequate to account for the septicaemia. In spite of the absence of murmurs at any time it was thought that acute endocarditis might be responsible for the symptoms. On June 13th the signs of consolidation were more marked at both bases, and the general condition much worse. Death occurred on the 14th. The necropsy showed lobar pneumonia of the left and right lower lobes, and an abscess measuring 4 by 3 by 2 cm. in the right lower lobe, a haemorrhagic infarct of the left upper lobe, right and left healed pleurisy, acute vegetative endocarditis of the tricuspid valve, focal meningitis, chronic aortitis and arterio-sclerosis, and acute splenic tumour. There was no gross evidence of resolution in the consolidated areas. The vegetation was composed of masses of fibrin and cellular débris enclosing collections of Gram-positive diplococci. The meningitis was localised near Broca’s area, and consisted of greenish purulent material lying beneath the Smears from the pus showed Gram-positive arachnoid. diplococci. The recorded cases suggest that Type 1 pneumococcus is responsible for the majority of the cases of pneumococcic endocarditis.
Rs. 50,000 a year for fiveyears to finance the existing research appointments. The original proposal of foundation was put forward in 1910 by Sir Leonard Rogers, to whose initiative and ten years’ untiring effort the school His plan was approved by the owes its existence. Government of India on the advice of the late Sir Pardey Lukis, then Director-General, Indian Medical Service, but unexpected difficulties were early encountered, and when, in 1914, the scheme was almost ready for the commencement of work, the outbreak of war rendered it impossible to assemble an adequate staff. Sir Leonard Rogers was, however, enabled, with the aid of influential commercial and private support, to build Carmichael Hospital. Research work has begun, the funds for which are administered by a governing body composed of medical men and representatives of the subscribing tea, jute, and mining associations. The Government of India is still unable to spare the necessary staff of seven professors, but it is hoped that these officers will be available by March, 1921, when the school will be fully opened. It is a curious fact that for 15 years after the founding of two schools of tropical medicine in England no similar institution existed in any tropical portion of the British Empire. The city of Calcutta and the provinces of Bengal, Bihar, and Orissa contain a vast quantity of clinical material for the study of tropical diseases; the possibilities in front of the Calcutta school are limited only by financial considerations. The endowment of medical research is an investment which repays the original expenditure many times over in improved conditions of public health, and all whose concern is the advancement of science and the welfare of India and the world must hope that the necessary support will speedily be forthcoming.
I the
BENIGN
DECIDUAL TUMOURS OF THE
UTERUS.
Dr. John Benjamin Nicholls,’ of Washington, D.C., draws attention to the occasional though rare occurrence of benign uterine tumours, exhibiting predominantly decidual characters, and containing little or no traces of chorionic tissue. Two classes of these growths may be
distinguished-namely, ante-partum deciduomata,which
appear during pregnancy and prior to parturition, and constitute the truest type of the tumour, and postDr. Thomas and Dr. O’Hara think that the present partum deciduomata, which develop after delivery or case indicates the advisability of frequent early blood after the death of the embryo from bits of retained cultures during convalescence from pneumonia when- decidua. Of the nine cases of benign deciduomata ever a rise in temperature occurs, and that serum treatcollected from literature, including two from Dr. ment, though not promising, is the only means of Nicholls’s own practice, four were definite examples of ante-partum tumours, and consisted of one case combating the septicaemia. of intra-uterine decidual adenoma appearing at a fullterm labour and three cases of decidual polyps THE CALCUTTA SCHOOL OF TROPICAL protruding from the external os in the third to fifth MEDICINE. months of pregnancy. Of the last 3 cases, 2 aborted THE Calcutta School of Tropical Medicine and Hygiene and 1 went to full term. The subsequent history of consists of the following four combined sections or the patients for two to four years gave evidence of institutions: (a) the Carmichael Hospital for Tropical the benign character of the growth. Whether these Diseases, with accommodation for 116 patients (43 tumours arose de novo from the decidua, or were European and 73 Indian), which represents the first previously existing polyps which underwent decidual introduction into India of the modern system of hospitals transformation as the result of pregnancy, cannot be constructed for research work and associated with large decided, but Dr. Nicholls is in favour of the former research laboratories ; (b) the School of Tropical view. Medicine, with laboratories designed and constructed AT a meeting of the General Council of King Edward’s throughout for the special purposes for which they Fund for London held on Dec. 14th the total are intended ; (c) the Institute of Hygiene, which includes the Public Health Laboratories for Bengal; sum available for distribution was estimated at .6193,000. and (d) various research endowments, having amongst their objects of research kala-azar, ankylosTHE House and Library of the Royal Society of tomiasis, leprosy, diabetes, and the epidemic respiratory diseases associated with the mining Medicine will be closed from Friday, Dec. 24th, until industry. The purposes of the scheme of which the Tuesday, Dec. 28th, both days inclusive. Calcutta School is a result are " to furnish postgraduate teaching and training in tropical medicine and Dr. F. R. Fraser has been appointed Director of the hygiene, and to provide full facilities for continued and coordinated research work in tropical diseases." An Medical Professorial Clinic at St. Bartholomew’s appeal for financial support, together with a memo- Hospital Medical School for a period of four years.’ randum of the present position of the school, has now This appointment carries with it a professorship of been issued; for immediate purposes a sum of Rs. 100,000 medicine in the University of London. is urgently needed properly to equip the Carmichael 1 American Journal of the Medical Hospital, and also the provision of at least a further Sciences, November, 1920. ___
Hospital
’
A man, aged 45 years, was admitted on May 19th, 1920, the fourth day of an attack of pneumonia. The whole of the lower lobe of the right lung and a small patch of the The leucocyte lower lobe of the left were consolidated. count was 16,500. The sputum contained the pneumococcus of Type 1. Antipneumococcic serum was given intravenously. On the 23rd the temperature had fallen to 100° F. and on the 24th to normal. But it rose again on the evening of the 25th and on the 26th was 101°, with a diffuse urticarial rash. This was thought to be serum sickness. On the 30th the lung signs were nearly the same as on admission. On June 5th the pneumococcus was still present in the blood. For the pneumococcus septicaemia, which was continuing after the crisis, it was decided to resume the intravenous treatment, but in order to avoid anaphylaxis from horse serum Mulford’s antipneumococcus antibody extract wasgiven. The temperature fell and the patient seemed improved, but on the 7th he had a chill and his temperature rose to 1040. Then it was decided to desensitise the patient for horse serum and resume the serum treatment. On the 9th a blood culture showed 3000 colonies of pneumococci per cubic centimetre of blood. At the right angle of the scapula the breath sounds were somewhat amphoric, with medium to large consonating rales. X ray examination suggested pulmonary abscess. As the original attack of pneumonia had apparently been recovered from the lung condition did not seem adequate to account for the septicaemia. In spite of the absence of murmurs at any time it was thought that acute endocarditis might be responsible for the symptoms. On June 13th the signs of consolidation were more marked at both bases, and the general condition much worse. Death occurred on the 14th. The necropsy showed lobar pneumonia of the left and right lower lobes, and an abscess measuring 4 by 3 by 2 cm. in the right lower lobe, a haemorrhagic infarct of the left upper lobe, right and left healed pleurisy, acute vegetative endocarditis of the tricuspid valve, focal meningitis, chronic aortitis and arterio-sclerosis, and acute splenic tumour. There was no gross evidence of resolution in the consolidated areas. The vegetation was composed of masses of fibrin and cellular débris enclosing collections of Gram-positive diplococci. The meningitis was localised near Broca’s area, and consisted of greenish purulent material lying beneath the Smears from the pus showed Gram-positive arachnoid. diplococci. The recorded cases suggest that Type 1 pneumococcus is responsible for the majority of the cases of pneumococcic endocarditis.
Rs. 50,000 a year for fiveyears to finance the existing research appointments. The original proposal of foundation was put forward in 1910 by Sir Leonard Rogers, to whose initiative and ten years’ untiring effort the school His plan was approved by the owes its existence. Government of India on the advice of the late Sir Pardey Lukis, then Director-General, Indian Medical Service, but unexpected difficulties were early encountered, and when, in 1914, the scheme was almost ready for the commencement of work, the outbreak of war rendered it impossible to assemble an adequate staff. Sir Leonard Rogers was, however, enabled, with the aid of influential commercial and private support, to build Carmichael Hospital. Research work has begun, the funds for which are administered by a governing body composed of medical men and representatives of the subscribing tea, jute, and mining associations. The Government of India is still unable to spare the necessary staff of seven professors, but it is hoped that these officers will be available by March, 1921, when the school will be fully opened. It is a curious fact that for 15 years after the founding of two schools of tropical medicine in England no similar institution existed in any tropical portion of the British Empire. The city of Calcutta and the provinces of Bengal, Bihar, and Orissa contain a vast quantity of clinical material for the study of tropical diseases; the possibilities in front of the Calcutta school are limited only by financial considerations. The endowment of medical research is an investment which repays the original expenditure many times over in improved conditions of public health, and all whose concern is the advancement of science and the welfare of India and the world must hope that the necessary support will speedily be forthcoming.
I the
BENIGN
DECIDUAL TUMOURS OF THE
UTERUS.
Dr. John Benjamin Nicholls,’ of Washington, D.C., draws attention to the occasional though rare occurrence of benign uterine tumours, exhibiting predominantly decidual characters, and containing little or no traces of chorionic tissue. Two classes of these growths may be
distinguished-namely, ante-partum deciduomata,which
appear during pregnancy and prior to parturition, and constitute the truest type of the tumour, and postDr. Thomas and Dr. O’Hara think that the present partum deciduomata, which develop after delivery or case indicates the advisability of frequent early blood after the death of the embryo from bits of retained cultures during convalescence from pneumonia when- decidua. Of the nine cases of benign deciduomata ever a rise in temperature occurs, and that serum treatcollected from literature, including two from Dr. ment, though not promising, is the only means of Nicholls’s own practice, four were definite examples of ante-partum tumours, and consisted of one case combating the septicaemia. of intra-uterine decidual adenoma appearing at a fullterm labour and three cases of decidual polyps THE CALCUTTA SCHOOL OF TROPICAL protruding from the external os in the third to fifth MEDICINE. months of pregnancy. Of the last 3 cases, 2 aborted THE Calcutta School of Tropical Medicine and Hygiene and 1 went to full term. The subsequent history of consists of the following four combined sections or the patients for two to four years gave evidence of institutions: (a) the Carmichael Hospital for Tropical the benign character of the growth. Whether these Diseases, with accommodation for 116 patients (43 tumours arose de novo from the decidua, or were European and 73 Indian), which represents the first previously existing polyps which underwent decidual introduction into India of the modern system of hospitals transformation as the result of pregnancy, cannot be constructed for research work and associated with large decided, but Dr. Nicholls is in favour of the former research laboratories ; (b) the School of Tropical view. Medicine, with laboratories designed and constructed AT a meeting of the General Council of King Edward’s throughout for the special purposes for which they Fund for London held on Dec. 14th the total are intended ; (c) the Institute of Hygiene, which includes the Public Health Laboratories for Bengal; sum available for distribution was estimated at .6193,000. and (d) various research endowments, having amongst their objects of research kala-azar, ankylosTHE House and Library of the Royal Society of tomiasis, leprosy, diabetes, and the epidemic respiratory diseases associated with the mining Medicine will be closed from Friday, Dec. 24th, until industry. The purposes of the scheme of which the Tuesday, Dec. 28th, both days inclusive. Calcutta School is a result are " to furnish postgraduate teaching and training in tropical medicine and Dr. F. R. Fraser has been appointed Director of the hygiene, and to provide full facilities for continued and coordinated research work in tropical diseases." An Medical Professorial Clinic at St. Bartholomew’s appeal for financial support, together with a memo- Hospital Medical School for a period of four years.’ randum of the present position of the school, has now This appointment carries with it a professorship of been issued; for immediate purposes a sum of Rs. 100,000 medicine in the University of London. is urgently needed properly to equip the Carmichael 1 American Journal of the Medical Hospital, and also the provision of at least a further Sciences, November, 1920. ___
Hospital
’