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THE CAUSE OF AURICULAR FIBRILLATION
RECENT WORK ON LEPROSY.
405
The normal sebaceous secretion can be altered by cacao products, has examined other fruits and vegethe excessive intake of fat or by the ingestion of table products. Having regard to the requirements special forms of fat; excess of carbohydrate and of the Public Health (Preservatives) Regulations, alcohol are known to promote seborrhoea. While 1925, he has tested certain vegetable products which admitting adjuvant factors like heredity, age, sexual enter into the composition of cakes, buns, min.cemeat,.. evolution, and intestinal toxeemia, Dr. Barber wines, jams, and sauces. He found in currants, maintains that the error of metabolism expressed raisins, muscatels, and sultanas, both from Empire in the seborrhaeic state is to be countered by vigorous sources and from Europe and California, an amount out-of-door life with light clothing in a bracing of boric acid varying from 0-010 to 0’022 per centon the fruit as received, whilst the dry matter consunny climate. tained rather more. In such dried fruits as apricots, dates, cherries, figs, peaches, prunes, pears, and THE CAUSE OF AURICULAR FIBRILLATION the amounts varied from 0’003 to 0-025 TWENTY years ago Lewis put the finishing touches apple-rings, of the same order as the dried grapes already cent., per to Mackenzie’s most important work by proving that mentioned. It is worthy of note that the amounts " delirium cordis " in the human subject is nothing seem to be to the species examined. For specific more nor less than the familiar auricular fibrillation Australian apricots contained 0-022 and example, observed in animal experiments. Delirium cordis Californian 0-023 per cent. ; Australian and Californian had long been known to clinicians as a characteristic contained, peaches respectively, 0-025 and 0-022 feature of the later stages of rheumatic heart disease ; per cent. ; whilst two samples of French and one of but, before the investigations of Mackenzie it was Californian prunes all contained 0-003 per cent. generally believed that this peculiar irregularity Black and red currants, cherries, gooseberries, cranof the pulse was a result of heart failure. We now berries, and tomatoes in the fresh condition contained know that it is the other way about. It is not the from 0-003 to 0-006 per cent., varying from 0-03 heart failure which leads to fibrillation, but the in the matter of black currants to 0-109 in that dry development of fibrillation which is often the deter- of tomatoes. The large quantity found in the dry mining factor in precipitating the onset of heart matter of tomatoes is interesting in view of Johnston’s failure. We may now go a step farther and inquire : work on these fruits, but it does not amount to What is the cause of fibrillation ? The answer to much on the fresh fruit. Minute amounts of boric that question is considered in a paper by Dr. John acid have been found by A. Hebebrand in the juice Cowan in the current number of the Quarterly Journal whilst the Government and lemons, oranges of Medicine. Cowan points out that there are two of chemist found mere traces in the edible portions of namely, established and the fruit. J. T. Dunn and H. C. L. Bloxham found types of fibrillation paroxysmal. The former is often associated with in the peel of oranges from California, the West definite structural changes in the auricular wall, the Indies, and South Africa, from 0-005 to 0-033 per result either of an old rheumatic infection or of a cent of boric and from 0-002 to 0-008 in the acid, degenerative fibrosis. In some cases, however, the pulp. Wines have been found to contain less than auricles are found at autopsy to be devoid of any 0-01 per cent. It does not appear that any food macroscopic or microscopic evidence of disease. product in a state adapted for consumption would Sometimes, as for example in exophthalmic goitre, be at all likely to contain an amount of boric acid the disorder is clearly attributable to’ a definite approaching what would be added in order to act toxasmia, and normal rhythm may return when the as a preservative. An analyst would be ill-advised source of that toxaemia is removed ; but at other in reporting as added amounts of boric acid less times one may seek in vain for an adequate exciting than 1 grain per lb. (0-014 per cent.). This is often true in the paroxysmal type of cause. fibrillation. Between attacks there may be absolutely no evidence of any cardiac defect, the patient appearRECENT WORK ON LEPROSY, ing to be a perfectly healthy man. As Cowan points ALTHOUGH there can be little doubt that leprosy these of fibrillation are out, paroxysms frequently associated with flatulence and other digestive disinfectious, not much is accurately known about turbances. This he regards as evidence of intoxi- the way in which it is transferred or how the organisms cation from the gastro-intestinal tract ; but may enter the body. In a recent paper1 E. B. Vedder there not possibly be an alternative explanation, a points out that whilst the disease is often familial, reflex disturbance produced through the vegetative close contact does not necessarily favour its spread. nervous system ? The innervation of the heart is Married couples, one of whom is leprous, have lived in intimate relationship as long as ten years without so closely related to that of the abdominal viscera that it is not difficult to imagine that a disturbance the infection being conveyed and, under experimental in one part of the vagal field may excite reflexly conditions, it has been by no means easy to transmit disorders in more distant organs. It seems probable leprosy from one person to another. Thus, between that many hearts are on the verge of fibrillation, for 1844 and 1858, Danielssen repeatedly inoculated patients often attribute the onset of their palpitation himself and other volunteers, numbering 20 in all, or distress to some unusual physical effort. Cowan with material obtained from leprous nodules and did spring-cleaning as the provoking cause not get a single positive result. The question of instances in one of his patients, and oddly enough it was age-susceptibility, which is referred to by an American the wife and not the husband who suffered. correspondent on p. 412 of our present issue, is not yet fully understood, but in the Philippines it has been calculated that close and intimate association with a leper for at least two years is required for BORIC ACID AS A NATURAL CONSTITUENT the transmission of leprosy even to children. The OF FOODS. occasional incidence of the disease amongst Europeans J. A. Voelcker has shown that boric acid is a who appear to have had no contact, however casual. necessary iri.-redient of soils for the growth of many with lepers, has with other considerations suggested agricultural crops, and E. S. Johnston has come to the possibility of transmission by insects, and Vedder the conclusion, based on experiments on tomato and records that a study of its epidemiology in the potato plants, that boron should be added to the Philippines has been undertaken in the hope that list of elements necessary for plant growth. Boric further light might be shed upon the problem. The acid may therefore be expected as a constituent of resultant figures seem, however, to show that some vegetable food products, and the public analyst and local condition other than contiguity or density physician alike will want to know to what extent of population is the most important factor influencing it is naturally present. Two pieces of work reported the spread of leprosy. Under experimental conin the January issue of the Analyst are therefore of ditions a number of mosquitoes (Aedes aegypti), whicii considerable interest. Mr. A. Scott Dodd, continuing earlier work on the occurrence of boron compounds in 1 Philippine Jour. of Sci., 1928, xxxvii., 215. ____
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Iis
405
The normal sebaceous secretion can be altered by cacao products, has examined other fruits and vegethe excessive intake of fat or by the ingestion of table products. Having regard to the requirements special forms of fat; excess of carbohydrate and of the Public Health (Preservatives) Regulations, alcohol are known to promote seborrhoea. While 1925, he has tested certain vegetable products which admitting adjuvant factors like heredity, age, sexual enter into the composition of cakes, buns, min.cemeat,.. evolution, and intestinal toxeemia, Dr. Barber wines, jams, and sauces. He found in currants, maintains that the error of metabolism expressed raisins, muscatels, and sultanas, both from Empire in the seborrhaeic state is to be countered by vigorous sources and from Europe and California, an amount out-of-door life with light clothing in a bracing of boric acid varying from 0-010 to 0’022 per centon the fruit as received, whilst the dry matter consunny climate. tained rather more. In such dried fruits as apricots, dates, cherries, figs, peaches, prunes, pears, and THE CAUSE OF AURICULAR FIBRILLATION the amounts varied from 0’003 to 0-025 TWENTY years ago Lewis put the finishing touches apple-rings, of the same order as the dried grapes already cent., per to Mackenzie’s most important work by proving that mentioned. It is worthy of note that the amounts " delirium cordis " in the human subject is nothing seem to be to the species examined. For specific more nor less than the familiar auricular fibrillation Australian apricots contained 0-022 and example, observed in animal experiments. Delirium cordis Californian 0-023 per cent. ; Australian and Californian had long been known to clinicians as a characteristic contained, peaches respectively, 0-025 and 0-022 feature of the later stages of rheumatic heart disease ; per cent. ; whilst two samples of French and one of but, before the investigations of Mackenzie it was Californian prunes all contained 0-003 per cent. generally believed that this peculiar irregularity Black and red currants, cherries, gooseberries, cranof the pulse was a result of heart failure. We now berries, and tomatoes in the fresh condition contained know that it is the other way about. It is not the from 0-003 to 0-006 per cent., varying from 0-03 heart failure which leads to fibrillation, but the in the matter of black currants to 0-109 in that dry development of fibrillation which is often the deter- of tomatoes. The large quantity found in the dry mining factor in precipitating the onset of heart matter of tomatoes is interesting in view of Johnston’s failure. We may now go a step farther and inquire : work on these fruits, but it does not amount to What is the cause of fibrillation ? The answer to much on the fresh fruit. Minute amounts of boric that question is considered in a paper by Dr. John acid have been found by A. Hebebrand in the juice Cowan in the current number of the Quarterly Journal whilst the Government and lemons, oranges of Medicine. Cowan points out that there are two of chemist found mere traces in the edible portions of namely, established and the fruit. J. T. Dunn and H. C. L. Bloxham found types of fibrillation paroxysmal. The former is often associated with in the peel of oranges from California, the West definite structural changes in the auricular wall, the Indies, and South Africa, from 0-005 to 0-033 per result either of an old rheumatic infection or of a cent of boric and from 0-002 to 0-008 in the acid, degenerative fibrosis. In some cases, however, the pulp. Wines have been found to contain less than auricles are found at autopsy to be devoid of any 0-01 per cent. It does not appear that any food macroscopic or microscopic evidence of disease. product in a state adapted for consumption would Sometimes, as for example in exophthalmic goitre, be at all likely to contain an amount of boric acid the disorder is clearly attributable to’ a definite approaching what would be added in order to act toxasmia, and normal rhythm may return when the as a preservative. An analyst would be ill-advised source of that toxaemia is removed ; but at other in reporting as added amounts of boric acid less times one may seek in vain for an adequate exciting than 1 grain per lb. (0-014 per cent.). This is often true in the paroxysmal type of cause. fibrillation. Between attacks there may be absolutely no evidence of any cardiac defect, the patient appearRECENT WORK ON LEPROSY, ing to be a perfectly healthy man. As Cowan points ALTHOUGH there can be little doubt that leprosy these of fibrillation are out, paroxysms frequently associated with flatulence and other digestive disinfectious, not much is accurately known about turbances. This he regards as evidence of intoxi- the way in which it is transferred or how the organisms cation from the gastro-intestinal tract ; but may enter the body. In a recent paper1 E. B. Vedder there not possibly be an alternative explanation, a points out that whilst the disease is often familial, reflex disturbance produced through the vegetative close contact does not necessarily favour its spread. nervous system ? The innervation of the heart is Married couples, one of whom is leprous, have lived in intimate relationship as long as ten years without so closely related to that of the abdominal viscera that it is not difficult to imagine that a disturbance the infection being conveyed and, under experimental in one part of the vagal field may excite reflexly conditions, it has been by no means easy to transmit disorders in more distant organs. It seems probable leprosy from one person to another. Thus, between that many hearts are on the verge of fibrillation, for 1844 and 1858, Danielssen repeatedly inoculated patients often attribute the onset of their palpitation himself and other volunteers, numbering 20 in all, or distress to some unusual physical effort. Cowan with material obtained from leprous nodules and did spring-cleaning as the provoking cause not get a single positive result. The question of instances in one of his patients, and oddly enough it was age-susceptibility, which is referred to by an American the wife and not the husband who suffered. correspondent on p. 412 of our present issue, is not yet fully understood, but in the Philippines it has been calculated that close and intimate association with a leper for at least two years is required for BORIC ACID AS A NATURAL CONSTITUENT the transmission of leprosy even to children. The OF FOODS. occasional incidence of the disease amongst Europeans J. A. Voelcker has shown that boric acid is a who appear to have had no contact, however casual. necessary iri.-redient of soils for the growth of many with lepers, has with other considerations suggested agricultural crops, and E. S. Johnston has come to the possibility of transmission by insects, and Vedder the conclusion, based on experiments on tomato and records that a study of its epidemiology in the potato plants, that boron should be added to the Philippines has been undertaken in the hope that list of elements necessary for plant growth. Boric further light might be shed upon the problem. The acid may therefore be expected as a constituent of resultant figures seem, however, to show that some vegetable food products, and the public analyst and local condition other than contiguity or density physician alike will want to know to what extent of population is the most important factor influencing it is naturally present. Two pieces of work reported the spread of leprosy. Under experimental conin the January issue of the Analyst are therefore of ditions a number of mosquitoes (Aedes aegypti), whicii considerable interest. Mr. A. Scott Dodd, continuing earlier work on the occurrence of boron compounds in 1 Philippine Jour. of Sci., 1928, xxxvii., 215. ____
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