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THE CONCENTRATING ACTIVITY OF THE GALL-BLADDER.
291 very serious drawback in its slow and sometimes very irregular absorption, which may in some cases produce severe intoxication, and in other cases a Treatment by inunctions feeble therapeutic effect. possesses the advantage of being reliable, effective, and painless. To obtain a rapid saturation of the body, the author suggests that it may be of advantage to give at the beginning of the inunction treatment an injection of the soluble salt of mercury, or simply a dose of 0’5 g. of calomel per os. The daily dose of ointment to be used should vary from 3 to 5 g. according to the size, &c., of the patient. The injection of soluble compounds of mercury is not employed very much nowadays owing to the necessity of daily treatment, but it is specially indicated in idiosyncrasia mercurialis, where a tendency to " hydrargyria cutanea " prevents the use of inunctions. a
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LONDON
PANEL PRACTICE.
THERE are just over 1million insured persons on the lists of insurance practitioners in London. Of these 4060, or 1 in 380, gave notice at the New Year that they were desirous of making a change of doctor. The names of 207 insured persons were removed from practitioners’ lists at request of the latter. During the third quarter of last year just over 1 million prescriptions were given to insured persons, an average of 0’67 a head at a cost of 9’64d. each prescription, the expense being almost equally divided between the cost of ingredients and the fee for dispensing. One practitioner, whose prescriptions for the first quarter of the year averaged I’ll (instead of 0’92) a head at a cost of 11’91d. (instead of 9’25d.) each prescription, was surcharged X24s. 8d. by the Insurance Committee on the ground that the drugs ordered were in excess of what was reasonably necessary for adequate treatment. Several of his patients received 25 or more mixtures each during this period. Only 47 insured persons applied to be allowed to make their own arrangements for medical benefit. Over 1,650,000 cards were issued for the new form of medical record which came into operation on Jan. 1st. The current issue of the London Panel Committee Gazette replies to certain general questions which have arisen as to the use of these cards. Practitioners are only required to record such clinical notes as they consider will be of use to them or to any practitioner who may subsequently have the care of an insured person. Where an independent record is kept of visits or attendances available for inspection by the regional medical officer it is allowed that after the first visit, or first three attendances, the total number of these may be entered weekly or monthly ; the date of the first (or initial) certificate and that of the last (or final) certificate only require to be recorded. THE CONCENTRATING ACTIVITY OF THE
GALL-BLADDER.
the common duct. From this it was collected into a, rubber balloon placed in the peritoneal cavity, the abdominal cavity being then closed. A control experiment was made by substituting a similar balloon for the gall-bladder, which showed that the separated portions of bile differed little in their pigment content, which was taken as the index of concentration. After 24 hours the gall-bladder, still undistended, was regularly found to contain only one-sixth to onetenth as much fluid as was shown on calculation to have reached it, but this, thick and dark, was six to ten times as concentrated in pigment as the control specimen in the rubber balloon. The results were the same when, without other variations in the experiment, the gall-bladder was fllled to the normal distension with sterile bile of known character prior to withdrawal of the catheter. At the autopsy the branches of the hepatic duct always contained a thin bile like that in the balloon, a direct proof that the thick contents of the gall-bladder had It is therefore not come as such from the liver. evident that the gall-bladder can concentrate bile with very great rapidity, and this raises the question whether concentration of the bile in periods of intermittent or partial stasis may not be an important favouring element in the formation of gall-stones.
FRIEDMANN’S VACCINE. THE controversy over the merits of Friedmann’s vaccine appears to be raging as vehemently as ever in the German medical press and at medical meetings, the discussions at which are marked rather by heated partisanship than a judicial preference for truth. In the Deutsche medizinische Wochenschrift for Jan. 6th Professor W. Kruse, of Leipzig, complains bitterly of the open hostility with which his address on the subject of Friedmann’s vaccine at the Medical Society of Berlin was greeted by his audience. He found it most galling, while voicing his conviction that this vaccine is of incalculable importance both as a prophylactic and as a remedy for tuberculosis in the early stages, to be constantly interrupted by cries of " Keep to the point." Professor J. Schwalbe’s answer to this complaint in the same number of this journal is to the effect that when a provincial professor comes to Berlin to teach his colleagues wisdom he should not exasperate them by mouthing platitudes. The audience at the meeting of the Berlin Medical Society had come to hear what the director of the Hygienic Institute of the University of Leipzig had to tell them of his experimental investigations into the action of Friedmann’s vaccine, and only after they had listened for some time to such truisms as "...... the germ of tuberculosis is evidently widely distributed and easily transmitted " had silent attention given place to interruptions. To outsiders unfamiliar with the petulant atmosphere in which the Friedmann controversy has been enveloped for several years, it must seem strange that after more than eight years’ trial the remedy should still hold such an equivocal position in the medical world.
IT has long been recognised that the gall-bladder must have a concentrating function, since bile from the gall-bladder is more concentrated or inspissated than that in the bile-ducts of the same animal. Previous experiment1 has shown that the fluid which collects in bile-ducts artificially obstructed is an inspissated CARCINOMA OF THE PROSTATE. tarry bile when the ducts communicate with the gallDr. H. C. Bumpus,1 of Rochester, Minnesota, has bladder, whereas in ducts unconnected with this viscus the fluid is thin and soon becomes free from made a study of 362 cases of carcinoma of the prostate pigments and bile salts. Mr. P. Rous and Mr. P. D. observed at the Mayo clinic from 1914 to 1919 inclusive, McMaster, of the Rockefeller Institute, taking with special reference to metastases. He considers advantage of the disposition of the bile-ducts in the that metastasis to the glands occurs more frequently dog, have sought to determine the rate of concentration. than is demonstrable clinically-in his series it was There are three hepatic ducts in the dog, which found in only 37, or 10’2 per cent.-because of the unite to form a common bile-duct, with the cystic inaccessibility of the glands first involved. He states duct opening high up into the central one. Through that clinically and microscopically carcinoma of the an opening near the lower end of this last a prostate presents two fairly distinct types of enlargecatheter was pushed into the neck of the gall- ment. In the first and more malignant type the gland bladder, which was emptied and washed with salt is so slightly enlarged, and gives rise to so few local solution, the duct being ligated after the catheter was symptoms, that the condition is often only recognised withdrawn. The bile from the middle lobes of the by the symptoms produced by metastasis. In the more liver thus had no escape save into the gall-bladder, common type of carcinomatous prostate urinary symwhile that from the lobes to either side still reached ptoms are more pronounced, and metastases occur later -
1 THE LANCET, 1920, ii., 864.
1
Surgery, Gynecology, and Obstetrics, January, 1921.
-
LONDON
PANEL PRACTICE.
THERE are just over 1million insured persons on the lists of insurance practitioners in London. Of these 4060, or 1 in 380, gave notice at the New Year that they were desirous of making a change of doctor. The names of 207 insured persons were removed from practitioners’ lists at request of the latter. During the third quarter of last year just over 1 million prescriptions were given to insured persons, an average of 0’67 a head at a cost of 9’64d. each prescription, the expense being almost equally divided between the cost of ingredients and the fee for dispensing. One practitioner, whose prescriptions for the first quarter of the year averaged I’ll (instead of 0’92) a head at a cost of 11’91d. (instead of 9’25d.) each prescription, was surcharged X24s. 8d. by the Insurance Committee on the ground that the drugs ordered were in excess of what was reasonably necessary for adequate treatment. Several of his patients received 25 or more mixtures each during this period. Only 47 insured persons applied to be allowed to make their own arrangements for medical benefit. Over 1,650,000 cards were issued for the new form of medical record which came into operation on Jan. 1st. The current issue of the London Panel Committee Gazette replies to certain general questions which have arisen as to the use of these cards. Practitioners are only required to record such clinical notes as they consider will be of use to them or to any practitioner who may subsequently have the care of an insured person. Where an independent record is kept of visits or attendances available for inspection by the regional medical officer it is allowed that after the first visit, or first three attendances, the total number of these may be entered weekly or monthly ; the date of the first (or initial) certificate and that of the last (or final) certificate only require to be recorded. THE CONCENTRATING ACTIVITY OF THE
GALL-BLADDER.
the common duct. From this it was collected into a, rubber balloon placed in the peritoneal cavity, the abdominal cavity being then closed. A control experiment was made by substituting a similar balloon for the gall-bladder, which showed that the separated portions of bile differed little in their pigment content, which was taken as the index of concentration. After 24 hours the gall-bladder, still undistended, was regularly found to contain only one-sixth to onetenth as much fluid as was shown on calculation to have reached it, but this, thick and dark, was six to ten times as concentrated in pigment as the control specimen in the rubber balloon. The results were the same when, without other variations in the experiment, the gall-bladder was fllled to the normal distension with sterile bile of known character prior to withdrawal of the catheter. At the autopsy the branches of the hepatic duct always contained a thin bile like that in the balloon, a direct proof that the thick contents of the gall-bladder had It is therefore not come as such from the liver. evident that the gall-bladder can concentrate bile with very great rapidity, and this raises the question whether concentration of the bile in periods of intermittent or partial stasis may not be an important favouring element in the formation of gall-stones.
FRIEDMANN’S VACCINE. THE controversy over the merits of Friedmann’s vaccine appears to be raging as vehemently as ever in the German medical press and at medical meetings, the discussions at which are marked rather by heated partisanship than a judicial preference for truth. In the Deutsche medizinische Wochenschrift for Jan. 6th Professor W. Kruse, of Leipzig, complains bitterly of the open hostility with which his address on the subject of Friedmann’s vaccine at the Medical Society of Berlin was greeted by his audience. He found it most galling, while voicing his conviction that this vaccine is of incalculable importance both as a prophylactic and as a remedy for tuberculosis in the early stages, to be constantly interrupted by cries of " Keep to the point." Professor J. Schwalbe’s answer to this complaint in the same number of this journal is to the effect that when a provincial professor comes to Berlin to teach his colleagues wisdom he should not exasperate them by mouthing platitudes. The audience at the meeting of the Berlin Medical Society had come to hear what the director of the Hygienic Institute of the University of Leipzig had to tell them of his experimental investigations into the action of Friedmann’s vaccine, and only after they had listened for some time to such truisms as "...... the germ of tuberculosis is evidently widely distributed and easily transmitted " had silent attention given place to interruptions. To outsiders unfamiliar with the petulant atmosphere in which the Friedmann controversy has been enveloped for several years, it must seem strange that after more than eight years’ trial the remedy should still hold such an equivocal position in the medical world.
IT has long been recognised that the gall-bladder must have a concentrating function, since bile from the gall-bladder is more concentrated or inspissated than that in the bile-ducts of the same animal. Previous experiment1 has shown that the fluid which collects in bile-ducts artificially obstructed is an inspissated CARCINOMA OF THE PROSTATE. tarry bile when the ducts communicate with the gallDr. H. C. Bumpus,1 of Rochester, Minnesota, has bladder, whereas in ducts unconnected with this viscus the fluid is thin and soon becomes free from made a study of 362 cases of carcinoma of the prostate pigments and bile salts. Mr. P. Rous and Mr. P. D. observed at the Mayo clinic from 1914 to 1919 inclusive, McMaster, of the Rockefeller Institute, taking with special reference to metastases. He considers advantage of the disposition of the bile-ducts in the that metastasis to the glands occurs more frequently dog, have sought to determine the rate of concentration. than is demonstrable clinically-in his series it was There are three hepatic ducts in the dog, which found in only 37, or 10’2 per cent.-because of the unite to form a common bile-duct, with the cystic inaccessibility of the glands first involved. He states duct opening high up into the central one. Through that clinically and microscopically carcinoma of the an opening near the lower end of this last a prostate presents two fairly distinct types of enlargecatheter was pushed into the neck of the gall- ment. In the first and more malignant type the gland bladder, which was emptied and washed with salt is so slightly enlarged, and gives rise to so few local solution, the duct being ligated after the catheter was symptoms, that the condition is often only recognised withdrawn. The bile from the middle lobes of the by the symptoms produced by metastasis. In the more liver thus had no escape save into the gall-bladder, common type of carcinomatous prostate urinary symwhile that from the lobes to either side still reached ptoms are more pronounced, and metastases occur later -
1 THE LANCET, 1920, ii., 864.
1
Surgery, Gynecology, and Obstetrics, January, 1921.