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THE OTAGO MEDICAL SCHOOL.
1257
requirements ; over £14,000 worth of these goods was tuberculosis, it was possible bv help of the S.R. to sold by the department during the year. With eliminate this diagnosis. Dr. Katz concludes that regard to professional occupation, an annual grant is when the S.R. is normal, there is either no tuberculosis made to the Association of Certificated Blind Masseurs, present or it is perfectly latent. When it is above and the bureau which deals with employment of blind normal, other pathological conditions, and certain telephone operators and stenographers is able to state physiological conditions, such as pregnancy, must be that not a single man who has left St. Dunstan’s excluded before it can be regarded as proof positive of with a training in these lines of work is now unem- active tuberculosis. The test being quantitative as well ployed. The after-care scheme also includes close as qualitative, it is a valuable guide to prognosis and attention to the social lives of the men and of their treatment and, aboveall, it is of importance in coming families, especially with regard to health and the to a decision as to whether tuberculosis has become treatment of minor ailments, to which severewounds have, in many cases, left the blind ex-soldier susceptible. The private hospital at 14, Sussex-place, Regent’s Park, dealt, during the year, with 149 patients admitted for treatment or operations, and with 360 out-patients. Special payments to meet business difficulties, and the supply of St. Dunstaners’ typewriters, watches, and Braille games and reading are also included in the after-care scheme. The report contains sections devoted to the various professions and crafts, including letters from men who are making good in their occupations. In these letters, and in others from employers, clients; and customers who have availed themselves of the services of St. Dunstan’s men, appears the fruit of the devotion adult welfare work. on this splendid example of Those responsible for that work hope to maintain it on a voluntary basis, claiming that an independent entity is best fitted to give the type of training and re-education desired. Capital has had to be utilised to make up deficiencies in income, as was to be expected in a period of general trade depression, and it is hoped that wide perusal of this report will lead to further public support of Sir Arthur Pearson’s work now ably carried on by Captain Ian Fraser and his colleagues. _____
ERYTHROCYTE SEDIMENTATION TEST. THE
papers
which
continue
to
appear
on
the
suspension stability of the red blood cells confirm the earlier reports on the value of this test. Dr.
arrested or not. Further accounts of this test may be found in Medical Science for January and March, 1922.
THE OTAGO MEDICAL SCHOOL. WE havelately received a copy of the Proceedings of the Otago Medical School comprising a collection of papers by members of the staff, edited by Prof. D. W. Carmalt-Jones. It affords welcome evidence of activity and progress in a variety of fields. Some of the contributions deal with problems of local interest such as the physiological action of tutin (Drs. F. Fitchett and J. Malcolm), the activeglucoside of the poisonous tutu plant which, since it killed the sheep imported by Captain Cook in 1773, has given constant trouble with stock and children, and the food values of New Zealand fish (Mrs. D. E. Johnson). Prof. L. E. Barnett discusses the " hydatid thrill," a sign better known in theory than in practice, and points out that it is really very uncommon and apparently occurs only when there are so few daughter cysts that they can readilv move about. Another group of papers is devoted to the local aspects of more general problems-the surgical anatomy of the thyroid (Mr. W. P. Gowland), the Allen treatment of diabetes (Dr. J. W. Hall).. aneurysms of cerebral arteries (Prof. A. M. Drennan), the choice of an anaesthetic (Dr. A. P. Marshall)-and there is a series of short accounts of cases of interest, among which is an example of acquired diaphragmatic hernia due to a wound of the diaphragm made in incising an empyema. Finally, we have a philosophical discourse by the editor on the meaning of the word " symptom," a topic of universal import. The whole forms an interesting record of the activities of a school of medicine which is evidently determined to be better than good. There is only one point to quarrel with. The papers are mostly reprinted from the New Zealand Medical Journal and the Transactions of the New Zealand Institute : some of these have the original, some a fresh pagination: no details are given of their original place of publication. Bibliographically, this arrangement is very undesirable ; it makes reference almost impossible and will, we hope, be corrected in the next volume of the Proceedings.
G. Katz,1 of Berlin, has studied the rate at which sedimentation of the red cells (S.R.) occurs in tall, fine glass tubes, and his examination of 10Q cases has convinced him that, though it is no more specific than a high temperature, pulse- or respiration-rate, it is remarkably delicate, and provides evidence of morbid conditions long after the temperature and other clinical indications point to recovery. The chief factor in the S.R. seems to be the quantity of fibrinogen in the blood, and this is determined by the degree of morbid tissue destruction going on in the system. Whenever such destruction is proceeding, whether it be due to extensive burns, malignant tumours or germs, the S.R. is raised. Dr. Katz publishes some very instructive charts, showing the S.R. and temperature curves of patients suffering from various diseases. Up to a certain point these curves run parallel ; but after the temperature has been normal for some time, the S.R. curve continues to decline gradually, taking some time to reach normal. In health this process of sedimentation takes eight to nine hours, but in disease it may be completed in 40 to 50 minutes, and it may also take as long as 24 hours. As the rate varies from 2 to 130 mm. in the hour. according to the degree of tissue destruction, the test is extraordinarily delicate. In an acute disease like pneumonia, the S.R. may vary a great deal from day to day, and its oscillations are a faithful index to prognosis. In two cases patients insisted on discharge from hospital because they felt One had suffered from a sore throat, so much better. the other from broncho-pneumonia complicating influenza. In both the S.R. had not returned fully to normal, and both patients were readmitted ten days later with relapses. In 64 cases both the clinical evidence and the S.R. indicated pulmonary tuberculosis, and in 23 other cases, suspected of pulmonary 1 Zeitschr. f. Tuberk., 1922, Band xxxv.. Hft. 6.
CIRCULATORY CHANGES IN ACAPNIA. RECENT years have produced much discussion of the phenomena of acapnia and their possible relation to conditions of shock. In a series of papers Yandell Henderson and his colleagues have shown that a depressed condition of the circulation follows on the application of prolonged and excessive artificial respiration to dogs. It has often been supposed that this circulatory failure was of the same nature as that seen in surgical shock, which was inferentially also due to the condition of acapnia, or excessive removal of carbon dioxide from the blood, brought about by over ventilation during the induction of anaesthesia, as well as in the course of the operative procedure. In a recent paper1 H. H. Dale and C. Lovatt Evans give the results of experiments on excessive ventilation in the cat. They show that the fall of blood pressure in this animal, when rapid and excessive artificial ventilation is applied, is much more sudden than in the dog, and appears to be undoubtedly the direct result of the removal of 1
Journal of
Physiology, 1922, lvi.,
125.
requirements ; over £14,000 worth of these goods was tuberculosis, it was possible bv help of the S.R. to sold by the department during the year. With eliminate this diagnosis. Dr. Katz concludes that regard to professional occupation, an annual grant is when the S.R. is normal, there is either no tuberculosis made to the Association of Certificated Blind Masseurs, present or it is perfectly latent. When it is above and the bureau which deals with employment of blind normal, other pathological conditions, and certain telephone operators and stenographers is able to state physiological conditions, such as pregnancy, must be that not a single man who has left St. Dunstan’s excluded before it can be regarded as proof positive of with a training in these lines of work is now unem- active tuberculosis. The test being quantitative as well ployed. The after-care scheme also includes close as qualitative, it is a valuable guide to prognosis and attention to the social lives of the men and of their treatment and, aboveall, it is of importance in coming families, especially with regard to health and the to a decision as to whether tuberculosis has become treatment of minor ailments, to which severewounds have, in many cases, left the blind ex-soldier susceptible. The private hospital at 14, Sussex-place, Regent’s Park, dealt, during the year, with 149 patients admitted for treatment or operations, and with 360 out-patients. Special payments to meet business difficulties, and the supply of St. Dunstaners’ typewriters, watches, and Braille games and reading are also included in the after-care scheme. The report contains sections devoted to the various professions and crafts, including letters from men who are making good in their occupations. In these letters, and in others from employers, clients; and customers who have availed themselves of the services of St. Dunstan’s men, appears the fruit of the devotion adult welfare work. on this splendid example of Those responsible for that work hope to maintain it on a voluntary basis, claiming that an independent entity is best fitted to give the type of training and re-education desired. Capital has had to be utilised to make up deficiencies in income, as was to be expected in a period of general trade depression, and it is hoped that wide perusal of this report will lead to further public support of Sir Arthur Pearson’s work now ably carried on by Captain Ian Fraser and his colleagues. _____
ERYTHROCYTE SEDIMENTATION TEST. THE
papers
which
continue
to
appear
on
the
suspension stability of the red blood cells confirm the earlier reports on the value of this test. Dr.
arrested or not. Further accounts of this test may be found in Medical Science for January and March, 1922.
THE OTAGO MEDICAL SCHOOL. WE havelately received a copy of the Proceedings of the Otago Medical School comprising a collection of papers by members of the staff, edited by Prof. D. W. Carmalt-Jones. It affords welcome evidence of activity and progress in a variety of fields. Some of the contributions deal with problems of local interest such as the physiological action of tutin (Drs. F. Fitchett and J. Malcolm), the activeglucoside of the poisonous tutu plant which, since it killed the sheep imported by Captain Cook in 1773, has given constant trouble with stock and children, and the food values of New Zealand fish (Mrs. D. E. Johnson). Prof. L. E. Barnett discusses the " hydatid thrill," a sign better known in theory than in practice, and points out that it is really very uncommon and apparently occurs only when there are so few daughter cysts that they can readilv move about. Another group of papers is devoted to the local aspects of more general problems-the surgical anatomy of the thyroid (Mr. W. P. Gowland), the Allen treatment of diabetes (Dr. J. W. Hall).. aneurysms of cerebral arteries (Prof. A. M. Drennan), the choice of an anaesthetic (Dr. A. P. Marshall)-and there is a series of short accounts of cases of interest, among which is an example of acquired diaphragmatic hernia due to a wound of the diaphragm made in incising an empyema. Finally, we have a philosophical discourse by the editor on the meaning of the word " symptom," a topic of universal import. The whole forms an interesting record of the activities of a school of medicine which is evidently determined to be better than good. There is only one point to quarrel with. The papers are mostly reprinted from the New Zealand Medical Journal and the Transactions of the New Zealand Institute : some of these have the original, some a fresh pagination: no details are given of their original place of publication. Bibliographically, this arrangement is very undesirable ; it makes reference almost impossible and will, we hope, be corrected in the next volume of the Proceedings.
G. Katz,1 of Berlin, has studied the rate at which sedimentation of the red cells (S.R.) occurs in tall, fine glass tubes, and his examination of 10Q cases has convinced him that, though it is no more specific than a high temperature, pulse- or respiration-rate, it is remarkably delicate, and provides evidence of morbid conditions long after the temperature and other clinical indications point to recovery. The chief factor in the S.R. seems to be the quantity of fibrinogen in the blood, and this is determined by the degree of morbid tissue destruction going on in the system. Whenever such destruction is proceeding, whether it be due to extensive burns, malignant tumours or germs, the S.R. is raised. Dr. Katz publishes some very instructive charts, showing the S.R. and temperature curves of patients suffering from various diseases. Up to a certain point these curves run parallel ; but after the temperature has been normal for some time, the S.R. curve continues to decline gradually, taking some time to reach normal. In health this process of sedimentation takes eight to nine hours, but in disease it may be completed in 40 to 50 minutes, and it may also take as long as 24 hours. As the rate varies from 2 to 130 mm. in the hour. according to the degree of tissue destruction, the test is extraordinarily delicate. In an acute disease like pneumonia, the S.R. may vary a great deal from day to day, and its oscillations are a faithful index to prognosis. In two cases patients insisted on discharge from hospital because they felt One had suffered from a sore throat, so much better. the other from broncho-pneumonia complicating influenza. In both the S.R. had not returned fully to normal, and both patients were readmitted ten days later with relapses. In 64 cases both the clinical evidence and the S.R. indicated pulmonary tuberculosis, and in 23 other cases, suspected of pulmonary 1 Zeitschr. f. Tuberk., 1922, Band xxxv.. Hft. 6.
CIRCULATORY CHANGES IN ACAPNIA. RECENT years have produced much discussion of the phenomena of acapnia and their possible relation to conditions of shock. In a series of papers Yandell Henderson and his colleagues have shown that a depressed condition of the circulation follows on the application of prolonged and excessive artificial respiration to dogs. It has often been supposed that this circulatory failure was of the same nature as that seen in surgical shock, which was inferentially also due to the condition of acapnia, or excessive removal of carbon dioxide from the blood, brought about by over ventilation during the induction of anaesthesia, as well as in the course of the operative procedure. In a recent paper1 H. H. Dale and C. Lovatt Evans give the results of experiments on excessive ventilation in the cat. They show that the fall of blood pressure in this animal, when rapid and excessive artificial ventilation is applied, is much more sudden than in the dog, and appears to be undoubtedly the direct result of the removal of 1
Journal of
Physiology, 1922, lvi.,
125.