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THE HEART IN DIPHTHERIA.
1256
T
falls into the
sea
as if struck dead.
A rare
complication theI
is the appearance of hsemorrhagic patches.
gross pathological finding was dilatation of the right side of the heart. On histological examination in only one out of 19 cases was definite myocarditis noted.
If
sting is not treated, the pain may last for hours or throughout the day, and on account of the importance The principal histological lesions were more or less of poisoning by fish venoms among fishermen at sea, cloudy swelling and fat accumulation with slight Dr. Evans is of the opinion that our smacks and increase in the number of interstitial cells, which drifters should be obliged to carry a simple outfit for were mostly mononuclears. Comparative studies of
the treatment of such cases. The most useful method the heart in cases in which death occurred from some is to inject into the puncture a few minims of a 5 per infection other than diphtheria and a third group cent. solution of permanganate of potash, and a in which the heart was presumably normal showed simple outfit, consisting of a small glass hypodermic that the differences between the three groups were syringe, rustless needles, and some small ampoules quantitative rather than qualitative. There was no containing a solution of permanganate of potash, sharp line between the normal and abnormal, and no would cost little and might prevent much suffering. clear-cut difference could be detected in the hearts Brom diphtheria cases and those from other types of Two patients treated by Dr. Evans in this obtained immediate relief from the pain, and there infection. Injection of lethal or sub-lethal doses of It diphtheria toxin into guinea-pigs produced degenerawas no subsequent inflammation or gangrene. would be interesting to learn if the fish venom changes in the heart muscle similar to those seen introduced into the human body parenterally by a in the human heart after diphtheria, but a true stab has any connexion with the symptoms of inflammatory reaction was not produced. poisoning induced by eating certain fish. There is a THE FAR EASTERN ASSOCIATION OF possibility that in both forms of poisoning the suprarenals may be involved, and in this connexion it is TROPICAL MEDICINE. instructive to note that a Danish physician has Congress of the Far Eastern Association recently recorded two cases of severe asthma following of THE Fifth Medicine was held in Singapore from Tropical a large meal of uncooked mussels. In both cases the 3rd to 17th last under the Presidency of Dr. most distressing dyspnoea was associated with Sept. cutaneous phenomena-a scarlatiniform rash in one A. L. Hoops, principal civil medical officer of the Straits Settlements. From the formidable list of case, and severe itching in the other. In both cases the hypodermic injection of a little adrenalin had a 78 scientific papers submitted at this Congress, as most dramatic effect, normal respiration being well as from the large number of medical men of many nationalities who attended, we may gather restored within two minutes. The pathological action of venoms will probably that much important work was done. Accompanybe unravelled by observations on the lower forms of ing the official report are three scientific contributions animal life. Mussel poisoning may give rise to various which have already been printed. Dr. A. T. Stanton, clinical types-an exanthematous type, with itching in discussing the control of beri-beri in the Far East, and a rash, a gastro-intestinal type, and a paralytic considers that the over-milling of rice is the chief in the production of this disease ; and this type. In 1907 Richet obtained from the mussel factor deficiency theory is supported, not only (Mytilus edilis) a toxic substance analogous to the vitamin the results of animal experiments, but also by by he had which extracted previously actino-congestine on outbreaks of the human disease. anemones. sea from Mytilo-congestine causes observations diarrhoea, vomiting, prostration, and, most significant He further considers that the theory is supported by of all, a fall of the arterial blood pressure. The necropsy the result of preventive measures undertaken during shows intense hsemorrhagic congestion of the mucous- the past ten years, and by the effects of food control membranes. Actino-congestine produces a similar on the incidence of the disease in Malaya. For the clinical picture. Closely allied to the latter venom is effective control of beri-beri the first essential is to meduso congestine obtained from the jelly-fish ensure that a supply of under-milled rice is availas an ordinary market produce, and that it is {Rhizostoma cuvieri), which causes local irritation and able it to compete with the oedema, and in some cases intense dyspnoea, prostration, sold at a price which enables and severe diarrhoea in rabbits and guinea-pigs. The over-milled variety. This should be accomplished post-mortem findings include oedema of the lungs, by taxes on over-milled rice, inasmuch as an intervisceral haemorrhages, and congestion of the liver, national convention to prohibit its production seems present impracticable. On the whole he believes kidneys, and intestine. But the most significant at lesions are those of the suprarenal capsules which are that education and propaganda methods amongst engorged with dark blood. It is interesting to note employers of labour and other classes in the comthat the venom of the weever also causes intense munity are the most effective means of combating visceral congestion and internal haemorrhages. It is this disease. W. A. Sawyer made a contribution on probable that the dried venom of the jelly-fish is the advantages of international organisation for responsible for the frequent attacks of intense coryza control of disease, with special reference to hookand even asthma observed among the men when nets work disease and beri-beri. He also advocates some are mended after the summer drift fishing. These are international action with reference to the taxing of but a few of the many points of great interest raised unsuitable rice. Apparently in Australia such a tax by the researches of Dr. Evans and others, and it is has long been in existence, having been instituted to protect the milling industry in that to be hoped that future investigations will add much to what we already know of a fascinating subject. country. With reference to hookworm disease, the campaign at present being conducted in Australia is described. An admirable review of recent work upon THE HEART IN DIPHTHERIA. vitamins, which contains a few original observations, It is hoped that AFTER a review of the literature, in which she is contributed by M. Barrowcliff. shows that there is by no means unanimity of opinion the full Transactions, comprising nearly all the communications, in two volumes, will be published before as to the cause of cardiac failure in diphtheria, Dr. Mathilde Loth,l of the Department of Pathology and the middle of 1924. Bacteriology of Yale University, describes her own WE regret to announce the death of the well-known observations on the heart in diphtheria, which Prof. Robert Tigerstedt, at Helsingfors consisted chiefly of (1) investigations of human cases on Dec. in his seventieth year. 2nd, coming to autopsy and (2) observations on the effect of diphtheria, toxin on the guinea-pig heart. Physical APPLICATIONS are invited for the office of Milroy of the cases which came to autopsy for 1925. The lectures have to deal with -Lecturer showed enlargement of the heart to percussion. feeble heart sounds, and gallop rhythm. The chief State medicine or public health, and carry an honorarium of 60 guineas. Suggestions are kept in 1 Archives of Internal Medicine, 1923, xxxi., 637. print for the guidance of lecturers.
manner
tive
primarily
____
,
examination
’
I physiologist,
T
falls into the
sea
as if struck dead.
A rare
complication theI
is the appearance of hsemorrhagic patches.
gross pathological finding was dilatation of the right side of the heart. On histological examination in only one out of 19 cases was definite myocarditis noted.
If
sting is not treated, the pain may last for hours or throughout the day, and on account of the importance The principal histological lesions were more or less of poisoning by fish venoms among fishermen at sea, cloudy swelling and fat accumulation with slight Dr. Evans is of the opinion that our smacks and increase in the number of interstitial cells, which drifters should be obliged to carry a simple outfit for were mostly mononuclears. Comparative studies of
the treatment of such cases. The most useful method the heart in cases in which death occurred from some is to inject into the puncture a few minims of a 5 per infection other than diphtheria and a third group cent. solution of permanganate of potash, and a in which the heart was presumably normal showed simple outfit, consisting of a small glass hypodermic that the differences between the three groups were syringe, rustless needles, and some small ampoules quantitative rather than qualitative. There was no containing a solution of permanganate of potash, sharp line between the normal and abnormal, and no would cost little and might prevent much suffering. clear-cut difference could be detected in the hearts Brom diphtheria cases and those from other types of Two patients treated by Dr. Evans in this obtained immediate relief from the pain, and there infection. Injection of lethal or sub-lethal doses of It diphtheria toxin into guinea-pigs produced degenerawas no subsequent inflammation or gangrene. would be interesting to learn if the fish venom changes in the heart muscle similar to those seen introduced into the human body parenterally by a in the human heart after diphtheria, but a true stab has any connexion with the symptoms of inflammatory reaction was not produced. poisoning induced by eating certain fish. There is a THE FAR EASTERN ASSOCIATION OF possibility that in both forms of poisoning the suprarenals may be involved, and in this connexion it is TROPICAL MEDICINE. instructive to note that a Danish physician has Congress of the Far Eastern Association recently recorded two cases of severe asthma following of THE Fifth Medicine was held in Singapore from Tropical a large meal of uncooked mussels. In both cases the 3rd to 17th last under the Presidency of Dr. most distressing dyspnoea was associated with Sept. cutaneous phenomena-a scarlatiniform rash in one A. L. Hoops, principal civil medical officer of the Straits Settlements. From the formidable list of case, and severe itching in the other. In both cases the hypodermic injection of a little adrenalin had a 78 scientific papers submitted at this Congress, as most dramatic effect, normal respiration being well as from the large number of medical men of many nationalities who attended, we may gather restored within two minutes. The pathological action of venoms will probably that much important work was done. Accompanybe unravelled by observations on the lower forms of ing the official report are three scientific contributions animal life. Mussel poisoning may give rise to various which have already been printed. Dr. A. T. Stanton, clinical types-an exanthematous type, with itching in discussing the control of beri-beri in the Far East, and a rash, a gastro-intestinal type, and a paralytic considers that the over-milling of rice is the chief in the production of this disease ; and this type. In 1907 Richet obtained from the mussel factor deficiency theory is supported, not only (Mytilus edilis) a toxic substance analogous to the vitamin the results of animal experiments, but also by by he had which extracted previously actino-congestine on outbreaks of the human disease. anemones. sea from Mytilo-congestine causes observations diarrhoea, vomiting, prostration, and, most significant He further considers that the theory is supported by of all, a fall of the arterial blood pressure. The necropsy the result of preventive measures undertaken during shows intense hsemorrhagic congestion of the mucous- the past ten years, and by the effects of food control membranes. Actino-congestine produces a similar on the incidence of the disease in Malaya. For the clinical picture. Closely allied to the latter venom is effective control of beri-beri the first essential is to meduso congestine obtained from the jelly-fish ensure that a supply of under-milled rice is availas an ordinary market produce, and that it is {Rhizostoma cuvieri), which causes local irritation and able it to compete with the oedema, and in some cases intense dyspnoea, prostration, sold at a price which enables and severe diarrhoea in rabbits and guinea-pigs. The over-milled variety. This should be accomplished post-mortem findings include oedema of the lungs, by taxes on over-milled rice, inasmuch as an intervisceral haemorrhages, and congestion of the liver, national convention to prohibit its production seems present impracticable. On the whole he believes kidneys, and intestine. But the most significant at lesions are those of the suprarenal capsules which are that education and propaganda methods amongst engorged with dark blood. It is interesting to note employers of labour and other classes in the comthat the venom of the weever also causes intense munity are the most effective means of combating visceral congestion and internal haemorrhages. It is this disease. W. A. Sawyer made a contribution on probable that the dried venom of the jelly-fish is the advantages of international organisation for responsible for the frequent attacks of intense coryza control of disease, with special reference to hookand even asthma observed among the men when nets work disease and beri-beri. He also advocates some are mended after the summer drift fishing. These are international action with reference to the taxing of but a few of the many points of great interest raised unsuitable rice. Apparently in Australia such a tax by the researches of Dr. Evans and others, and it is has long been in existence, having been instituted to protect the milling industry in that to be hoped that future investigations will add much to what we already know of a fascinating subject. country. With reference to hookworm disease, the campaign at present being conducted in Australia is described. An admirable review of recent work upon THE HEART IN DIPHTHERIA. vitamins, which contains a few original observations, It is hoped that AFTER a review of the literature, in which she is contributed by M. Barrowcliff. shows that there is by no means unanimity of opinion the full Transactions, comprising nearly all the communications, in two volumes, will be published before as to the cause of cardiac failure in diphtheria, Dr. Mathilde Loth,l of the Department of Pathology and the middle of 1924. Bacteriology of Yale University, describes her own WE regret to announce the death of the well-known observations on the heart in diphtheria, which Prof. Robert Tigerstedt, at Helsingfors consisted chiefly of (1) investigations of human cases on Dec. in his seventieth year. 2nd, coming to autopsy and (2) observations on the effect of diphtheria, toxin on the guinea-pig heart. Physical APPLICATIONS are invited for the office of Milroy of the cases which came to autopsy for 1925. The lectures have to deal with -Lecturer showed enlargement of the heart to percussion. feeble heart sounds, and gallop rhythm. The chief State medicine or public health, and carry an honorarium of 60 guineas. Suggestions are kept in 1 Archives of Internal Medicine, 1923, xxxi., 637. print for the guidance of lecturers.
manner
tive
primarily
____
,
examination
’
I physiologist,