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THE TIME OF CONCEPTION.
BIOLOGICAL DATA.--THE TIME OF CONCEPTION.
599
praiseworthy, and shows that he realises the necessity the four parts which go to produce the first volume of making his milk safe for human beings. It willI the supplement which is to form volume 7 of the probably be agreed that he should be given sympa- original publication ; it is to contain approximately thetic help in order that the progress of recent years 420 pages when complete. Subscribers to the may be maintained. original work are to receive the present volume at the reduced sum of R.M. 48. and to them the acquisiof
____
B
tion of this volume will be essential, while the possession of the earlier volumes will be indispensable to those who think of purchasing this volume. Many of the subjects comprised in this supplement are of the nature of additions to or amplifications of data contained in the original work, but, with the rapidly extending knowledge of the subject of biology, To attempt to give new sections have been added. a summary of the contents would be like describing the subject matter of a dictionary ; suffice it to say that the needs of every branch of biology are well provided for. Thus while medical readers will find ample data on the vitamin, iodine, or mercury content of food materials, on experimental phonetics, or on the physiological effects of work or athletics, the pure physiologist will value the tables of physico-chemical constants of blood and tissue fluids, or the alcohol content of various organs of fowls exposed to an atmosphere saturated with alcohol-to take a few examples . at random. For the plant cytologist there is an exhaustive list of chromosome numbers extending over 35 pages. References to the original sources and found the of the data sinus, longitudinal though they perisupplied are given throughout, and the vascular zones of demyelination described by other work will be invaluable as a means of tracing those authors, these contained so much effused blood that ’pertaining to every branch of biological science. they were inclined to attribute the destruction of the nervous tissues to haemorrhage rather than to a THE TIME OF CONCEPTION. neurolytic process. They did not think, however, is usually reckoned to take place on CONCEPTION that the haemorrhage resulted directly from the sinus the actual of cohabitation. There are, however, day thrombosis, but rather that both were due to an several factors which may cause appreciable delay encephalitic process. On the other hand, A. Ferraro between coitus and impregnation. Prof. R. Krduter1 and I. H. Scheffer2 have lately published reports of the pathological examination of six cases of measles points out that in order to give satisfactory answers to the questions, often put, of whether impregnation encephalitis in New York, two of which occurred in can occur at any time, whether there is a sterile May and June, 1928, and four in March, April, and period and whether there is an optimum period, it is May, 1930. The lesions were almost the same in all, necessary to know certain factors. These are the and consisted mainly of a perivascular demyelination time taken for the spermatozoon to enter the cervix with some destruction of axis-cylinders and proliferaand find the ovum ; the viability of sperm ; the tion of microglia. They consider that the lesion time of ovulation and the viability of the ovum. which they observed is " comparable to and even most authorities, the semen usually identical with " those which have been described in According to enters the cervix at or shortly after ejaculation and post-vaccinal encephalitis, and in the " paralytic is distributed by the rhythmical contractions of the accidents " of rabies vaccination. Whether it is a but delay may be caused if it is voided into true inflammatory process or a special form of uterus, the anterior vault or near the orifice of the vagina. encephalopathy they leave an open question, since The time the spermatozoa take to reach the ovum inflammatory cells are scanty in or even absent from in the ampulla is not definitely established, but Lott the lesions. They incline to the view that this form calculated from their rate of chemiotactic movementof acute disseminated encephalomyelitis is a toxic about 3-6 mm. per minute-that it would be between reaction of the central nervous system developing of an hour and an hour. This may in a number of different virus infections, but they three-quarters be extended by any cause of obstruction, but Birch make no attempt to explain the undoubted fact that and Hirschfeld have, according to Prof. Krauter, this form of encephalomyelitis has become much demonstrated seed in the tubes 14 to 16 hours after more common of recent years. coitus. Views on the viability of semen in the female genitalia are very varied, some authors holding that it lives only for two days, and one—Nurnberger— BIOLOGICAL DATA. WITH the completion of the six volumes of Tabulae that it keeps its motility for a fortnight. It is, doubtful, as Prof Krauter points out, Biologicse in 1930, the original purpose of this work however, whether a motile seed is necessarily still fertile. was accomplished, but in order to keep such a comprehensive reference book up to date, it has been found The time at which ovulation takes place is equally necessary to issue supplementary volumes in the form dubious, but from a symposium of observations Prof. of a quarterly journal, under the title of Tabulae Krauter deduces that in a normal cycle of 28 days may occur at any time between the seventh and Biologicae Periodicse. We have before us3 three of it the nineteenth days from the beginning of the 1 Bull. et mém. Soc. méd. des hôp. de Paris, 1931, xlvii., 898. menstrual period-most probably between the four2 Arch. Neurol. and Psych., 1931, xxv., 748. 3 Tabulæ Biologicæ Periodicæ. Vol. I. Edited, with the coöpera- teenth and sixteenth days. He could find no record tion of a of THE PATHOLOGY OF MEASLES ENCEPHALITIS. CONTROVERSY still centres on the nature of the encephalomyelitis which occasionally follows measles, and two recent papers throw some fresh light on it. F. Wohlwill in 1928 gave a clear description of the pathology in two cases in which he found as the chief lesion perivascular zones of demyelination in the brain and spinal cord. This description was soon after confirmed by investigations on the Continent and in America, as well as in this country. At present there is little question that the lesion is histologically very similar to that of post-vaccinal encephalomyelitis, .and is not, at least in the great majority of cases, a haemorrhagic encephalitis, as was at one time supposed. Undoubtedly the latter condition may also occur after measles, but since the characteristic perivascular demyelination of this form of encephalitis has been recognised the hsemorrhagic nature of the condition has fallen somewhat into the background. The report of a case from Paris by P. Lechelle, I. Bertrand, and E. Fauvert1 reopens this question. Their case was complicated by thrombosis of the superior
number experts, by C. Oppenheimer and L. Pincussen. Berlin: W. Junk. 1931. R.M.55,or to subscribers R.M.48.
1 Zeits. f. ärztl. Fortbildung, May 1st, p. 276.
600
LIVER EXTRACTS FOR PARENTERAL
of ovulation in the last four days before a period. In qualification of these data, he reminds readers that ovulation may be much modified by various stimuli, such as disorders of menstruation, drugs, operations, and even possibly by coitus. It is, he says’, agreed that the ovum enters the tube immediately, but its viability is a matter of speculation and is given by some writers as a few hours and by some as several days. Doderlein thinks it remains fertile for fourteen
USE.
are apparently almost unanimous in their approval of haemostatic bags. A few of those who took part in the discussion at the New York Academy of Medicine
appeared to prefer the use of gauze packing but all agreed that the best method of dealing with oozing from the prostatic bed was by means of pressure rather than by an open operation that aimed at ligature of bleeding points. It must be borne in mind that the majority of those who took part in the
American discussion were advocates of the two. So far as these observations go, it appears that stage operation in which a free exposure of the coitus at any time between two periods may lead to prostatic bed is difficult or impossible. A point on conception. If it takes place immediately after which American and British genito-urinary surgeons menstruation, an early ovum may be fertilised or agree is the value of blood transfusion in diminishing the seed may remain active until ovulation. If the danger of post-operative haemorrhage. it occurs shortly before menstruation, however, it is not likely to lead to pregnancy, unless the ovum remains fertile for longer than is generally believed. LIVER EXTRACTS FOR PARENTERAL USE. Statistics quoted by Prof. Kråuter show that almost THE satisfactory treatment of the pernicious 50 per cent. of the conceptions in the group studied anaemia syndrome is dependent upon adequate occurred in the interval, 41 per cent. in the’ of liver or its substitutes. In chronic cases dosage postmenstruum, and 9 per cent in the premenstruum. Beebe and Lewishave given as much as 3 lb. of But he does not define these terms exactly. Accurate liver a day and in certain instances even such large figures are not easily obtained, and it may be noted, doses are without effect. There have therefore that Knaus2 insists that in the ordinary 26-30 day been repeated attempts to obtain some alternative cycle conception is only possible between the eleventhl and more effective method of administering the and seventeenth effective principle. Last year Cohn, McMeekin, and Minot described excellent results following the THE TREATMENT OF HÆMORRHAGE intravenous use of highly purified extracts, but the technical difficulties of preparation made such FOLLOWING PROSTATECTOMY. Gansslen , THE respective merits of various methods of extracts impracticable for general use. then results a from reported satisfactory stopping haemorrhage during and following operations: case of Addisonian anaemia, that had failed treating to respond for removal of-the prostate were discussed last year at a meeting of the Section of Urology of the Royal to oral administration, with an intramuscular extract. French observers have also reported2 a more rapid Society of Medicine.3 Mr. Kenneth Walker, who to intramuscular injection than to liver opened the discussion, had tried packing to stop response but mouth, by they gave no details oozing after the Freyer operation in earlier days of the method ofunfortunately In our own columns preparation. but found it unsatisfactory owing to necrosis and the Castle and showed that i., 857) (1931, Taylor of the bladder when the packing unpleasant state G of the fraction Cohn, Minot, and their original was removed. Then he had tried haemostatic which is the associates, equivalent of certain combags, but these did not always control the haemorrhage mercial extracts for oral use, can with suitable care and often did not exert uniform pressure on the in administered by be preparation satisfactorily prostatic cavity. Mr. Walker said that he now intravenous fraction The contained a injection. preferred the open operation where possible, and blood if but pressure reducing substance, given at a did not spend long in trying to secure bleeding points rate less than 4 c.cm. a minute, the effects were only deep in the prostatic cavity. If bleeding did not and transitory. Strauss, Taylor, and Castle3 cease after placing the suture, he used light packing. In slight have now also found that by a slight modification in cases not suited for the open operation he used packing, of the solution the same G fraction can preparation situ six for or seven days, and leaving the pack in as a basis for an intramuscular extract. be used trusting to the frequent instillation of mercurochrome The injection of the equivalent of 10 grammes of after its removal to clear up the sepsis. Mr. Swift liver daily of such an extract gave a maximum Joly also praised the Thomson-Walker open operaresponse in typical cases of pernicious reticulocyte tion, which gave more perfect haemostasis than the earlier methods. In his experience the flavine anaemia within five to seven days. They suggest necessary for a week’s treatment pack gave pain and haemorrhage was apt to follow that the extractmouth when may, if given by daily intragiven by its removal. Sir John Thomson-Walker explained muscular suffice for five to six months. injection, that he himself did not prolong the operation by for intravenous use were found to be 15 to 30’ Extracts a round but catheter. seeking bleeding points packed He removed the packing in 48 hours, but replaced times as potent as the equivalent amount given by it if bleeding recurred. Mr. G. E. Neligan and mouth. Further, certain patients responded to Mr. Jocelyn Swan alone advocated the use of a intravenous treatment after oral administration had Pilcher’s bag to control haemorrhage. These diverse failed. It is clear therefore that the active principle opinions from British genito-urinary surgeons are is more effective when given by parenteral injection of interest in view of a discussion held at the New than when given by mouth. The discrepancy adds York Academy of Medicine on post-operative treat- support to Castle’s original suggestion that failure ment of urological cases, more especially cases of of absorption of haematopoietic factors contained in the food or elaborated in the stomach is an prostatectomy. The opening paper of this discussion by Dr. H. G. 1 Beebe, R. T., and Lewis, G. E. : Amer. Jour. Med. Sci., clxxxi., 796. Bugbee of New York is printed in the July number of 1931, 2 Archand, C., and Hamburger, M. : Presse Méd., 1930, xxxviii., the American Journal of Surgery. American specialists 1273; Aubertin, C., and Voillemin : Bull. et Mém. de la Soc.
days.
t
days.
,
,
.
2 Quoted
in Jour. Amer. Med. Assoc., August 8th, 3 See THE LANCET, 1930, i., 1185.
p. 408.
Méd. d. Hôp. d. Paris, 1930, liv., 749. 3 Strauss, M. B., Taylor, F. H. L., Castle, W. B.: Jour. Amer. Med. Assoc., August 1st, p. 313.
599
praiseworthy, and shows that he realises the necessity the four parts which go to produce the first volume of making his milk safe for human beings. It willI the supplement which is to form volume 7 of the probably be agreed that he should be given sympa- original publication ; it is to contain approximately thetic help in order that the progress of recent years 420 pages when complete. Subscribers to the may be maintained. original work are to receive the present volume at the reduced sum of R.M. 48. and to them the acquisiof
____
B
tion of this volume will be essential, while the possession of the earlier volumes will be indispensable to those who think of purchasing this volume. Many of the subjects comprised in this supplement are of the nature of additions to or amplifications of data contained in the original work, but, with the rapidly extending knowledge of the subject of biology, To attempt to give new sections have been added. a summary of the contents would be like describing the subject matter of a dictionary ; suffice it to say that the needs of every branch of biology are well provided for. Thus while medical readers will find ample data on the vitamin, iodine, or mercury content of food materials, on experimental phonetics, or on the physiological effects of work or athletics, the pure physiologist will value the tables of physico-chemical constants of blood and tissue fluids, or the alcohol content of various organs of fowls exposed to an atmosphere saturated with alcohol-to take a few examples . at random. For the plant cytologist there is an exhaustive list of chromosome numbers extending over 35 pages. References to the original sources and found the of the data sinus, longitudinal though they perisupplied are given throughout, and the vascular zones of demyelination described by other work will be invaluable as a means of tracing those authors, these contained so much effused blood that ’pertaining to every branch of biological science. they were inclined to attribute the destruction of the nervous tissues to haemorrhage rather than to a THE TIME OF CONCEPTION. neurolytic process. They did not think, however, is usually reckoned to take place on CONCEPTION that the haemorrhage resulted directly from the sinus the actual of cohabitation. There are, however, day thrombosis, but rather that both were due to an several factors which may cause appreciable delay encephalitic process. On the other hand, A. Ferraro between coitus and impregnation. Prof. R. Krduter1 and I. H. Scheffer2 have lately published reports of the pathological examination of six cases of measles points out that in order to give satisfactory answers to the questions, often put, of whether impregnation encephalitis in New York, two of which occurred in can occur at any time, whether there is a sterile May and June, 1928, and four in March, April, and period and whether there is an optimum period, it is May, 1930. The lesions were almost the same in all, necessary to know certain factors. These are the and consisted mainly of a perivascular demyelination time taken for the spermatozoon to enter the cervix with some destruction of axis-cylinders and proliferaand find the ovum ; the viability of sperm ; the tion of microglia. They consider that the lesion time of ovulation and the viability of the ovum. which they observed is " comparable to and even most authorities, the semen usually identical with " those which have been described in According to enters the cervix at or shortly after ejaculation and post-vaccinal encephalitis, and in the " paralytic is distributed by the rhythmical contractions of the accidents " of rabies vaccination. Whether it is a but delay may be caused if it is voided into true inflammatory process or a special form of uterus, the anterior vault or near the orifice of the vagina. encephalopathy they leave an open question, since The time the spermatozoa take to reach the ovum inflammatory cells are scanty in or even absent from in the ampulla is not definitely established, but Lott the lesions. They incline to the view that this form calculated from their rate of chemiotactic movementof acute disseminated encephalomyelitis is a toxic about 3-6 mm. per minute-that it would be between reaction of the central nervous system developing of an hour and an hour. This may in a number of different virus infections, but they three-quarters be extended by any cause of obstruction, but Birch make no attempt to explain the undoubted fact that and Hirschfeld have, according to Prof. Krauter, this form of encephalomyelitis has become much demonstrated seed in the tubes 14 to 16 hours after more common of recent years. coitus. Views on the viability of semen in the female genitalia are very varied, some authors holding that it lives only for two days, and one—Nurnberger— BIOLOGICAL DATA. WITH the completion of the six volumes of Tabulae that it keeps its motility for a fortnight. It is, doubtful, as Prof Krauter points out, Biologicse in 1930, the original purpose of this work however, whether a motile seed is necessarily still fertile. was accomplished, but in order to keep such a comprehensive reference book up to date, it has been found The time at which ovulation takes place is equally necessary to issue supplementary volumes in the form dubious, but from a symposium of observations Prof. of a quarterly journal, under the title of Tabulae Krauter deduces that in a normal cycle of 28 days may occur at any time between the seventh and Biologicae Periodicse. We have before us3 three of it the nineteenth days from the beginning of the 1 Bull. et mém. Soc. méd. des hôp. de Paris, 1931, xlvii., 898. menstrual period-most probably between the four2 Arch. Neurol. and Psych., 1931, xxv., 748. 3 Tabulæ Biologicæ Periodicæ. Vol. I. Edited, with the coöpera- teenth and sixteenth days. He could find no record tion of a of THE PATHOLOGY OF MEASLES ENCEPHALITIS. CONTROVERSY still centres on the nature of the encephalomyelitis which occasionally follows measles, and two recent papers throw some fresh light on it. F. Wohlwill in 1928 gave a clear description of the pathology in two cases in which he found as the chief lesion perivascular zones of demyelination in the brain and spinal cord. This description was soon after confirmed by investigations on the Continent and in America, as well as in this country. At present there is little question that the lesion is histologically very similar to that of post-vaccinal encephalomyelitis, .and is not, at least in the great majority of cases, a haemorrhagic encephalitis, as was at one time supposed. Undoubtedly the latter condition may also occur after measles, but since the characteristic perivascular demyelination of this form of encephalitis has been recognised the hsemorrhagic nature of the condition has fallen somewhat into the background. The report of a case from Paris by P. Lechelle, I. Bertrand, and E. Fauvert1 reopens this question. Their case was complicated by thrombosis of the superior
number experts, by C. Oppenheimer and L. Pincussen. Berlin: W. Junk. 1931. R.M.55,or to subscribers R.M.48.
1 Zeits. f. ärztl. Fortbildung, May 1st, p. 276.
600
LIVER EXTRACTS FOR PARENTERAL
of ovulation in the last four days before a period. In qualification of these data, he reminds readers that ovulation may be much modified by various stimuli, such as disorders of menstruation, drugs, operations, and even possibly by coitus. It is, he says’, agreed that the ovum enters the tube immediately, but its viability is a matter of speculation and is given by some writers as a few hours and by some as several days. Doderlein thinks it remains fertile for fourteen
USE.
are apparently almost unanimous in their approval of haemostatic bags. A few of those who took part in the discussion at the New York Academy of Medicine
appeared to prefer the use of gauze packing but all agreed that the best method of dealing with oozing from the prostatic bed was by means of pressure rather than by an open operation that aimed at ligature of bleeding points. It must be borne in mind that the majority of those who took part in the
American discussion were advocates of the two. So far as these observations go, it appears that stage operation in which a free exposure of the coitus at any time between two periods may lead to prostatic bed is difficult or impossible. A point on conception. If it takes place immediately after which American and British genito-urinary surgeons menstruation, an early ovum may be fertilised or agree is the value of blood transfusion in diminishing the seed may remain active until ovulation. If the danger of post-operative haemorrhage. it occurs shortly before menstruation, however, it is not likely to lead to pregnancy, unless the ovum remains fertile for longer than is generally believed. LIVER EXTRACTS FOR PARENTERAL USE. Statistics quoted by Prof. Kråuter show that almost THE satisfactory treatment of the pernicious 50 per cent. of the conceptions in the group studied anaemia syndrome is dependent upon adequate occurred in the interval, 41 per cent. in the’ of liver or its substitutes. In chronic cases dosage postmenstruum, and 9 per cent in the premenstruum. Beebe and Lewishave given as much as 3 lb. of But he does not define these terms exactly. Accurate liver a day and in certain instances even such large figures are not easily obtained, and it may be noted, doses are without effect. There have therefore that Knaus2 insists that in the ordinary 26-30 day been repeated attempts to obtain some alternative cycle conception is only possible between the eleventhl and more effective method of administering the and seventeenth effective principle. Last year Cohn, McMeekin, and Minot described excellent results following the THE TREATMENT OF HÆMORRHAGE intravenous use of highly purified extracts, but the technical difficulties of preparation made such FOLLOWING PROSTATECTOMY. Gansslen , THE respective merits of various methods of extracts impracticable for general use. then results a from reported satisfactory stopping haemorrhage during and following operations: case of Addisonian anaemia, that had failed treating to respond for removal of-the prostate were discussed last year at a meeting of the Section of Urology of the Royal to oral administration, with an intramuscular extract. French observers have also reported2 a more rapid Society of Medicine.3 Mr. Kenneth Walker, who to intramuscular injection than to liver opened the discussion, had tried packing to stop response but mouth, by they gave no details oozing after the Freyer operation in earlier days of the method ofunfortunately In our own columns preparation. but found it unsatisfactory owing to necrosis and the Castle and showed that i., 857) (1931, Taylor of the bladder when the packing unpleasant state G of the fraction Cohn, Minot, and their original was removed. Then he had tried haemostatic which is the associates, equivalent of certain combags, but these did not always control the haemorrhage mercial extracts for oral use, can with suitable care and often did not exert uniform pressure on the in administered by be preparation satisfactorily prostatic cavity. Mr. Walker said that he now intravenous fraction The contained a injection. preferred the open operation where possible, and blood if but pressure reducing substance, given at a did not spend long in trying to secure bleeding points rate less than 4 c.cm. a minute, the effects were only deep in the prostatic cavity. If bleeding did not and transitory. Strauss, Taylor, and Castle3 cease after placing the suture, he used light packing. In slight have now also found that by a slight modification in cases not suited for the open operation he used packing, of the solution the same G fraction can preparation situ six for or seven days, and leaving the pack in as a basis for an intramuscular extract. be used trusting to the frequent instillation of mercurochrome The injection of the equivalent of 10 grammes of after its removal to clear up the sepsis. Mr. Swift liver daily of such an extract gave a maximum Joly also praised the Thomson-Walker open operaresponse in typical cases of pernicious reticulocyte tion, which gave more perfect haemostasis than the earlier methods. In his experience the flavine anaemia within five to seven days. They suggest necessary for a week’s treatment pack gave pain and haemorrhage was apt to follow that the extractmouth when may, if given by daily intragiven by its removal. Sir John Thomson-Walker explained muscular suffice for five to six months. injection, that he himself did not prolong the operation by for intravenous use were found to be 15 to 30’ Extracts a round but catheter. seeking bleeding points packed He removed the packing in 48 hours, but replaced times as potent as the equivalent amount given by it if bleeding recurred. Mr. G. E. Neligan and mouth. Further, certain patients responded to Mr. Jocelyn Swan alone advocated the use of a intravenous treatment after oral administration had Pilcher’s bag to control haemorrhage. These diverse failed. It is clear therefore that the active principle opinions from British genito-urinary surgeons are is more effective when given by parenteral injection of interest in view of a discussion held at the New than when given by mouth. The discrepancy adds York Academy of Medicine on post-operative treat- support to Castle’s original suggestion that failure ment of urological cases, more especially cases of of absorption of haematopoietic factors contained in the food or elaborated in the stomach is an prostatectomy. The opening paper of this discussion by Dr. H. G. 1 Beebe, R. T., and Lewis, G. E. : Amer. Jour. Med. Sci., clxxxi., 796. Bugbee of New York is printed in the July number of 1931, 2 Archand, C., and Hamburger, M. : Presse Méd., 1930, xxxviii., the American Journal of Surgery. American specialists 1273; Aubertin, C., and Voillemin : Bull. et Mém. de la Soc.
days.
t
days.
,
,
.
2 Quoted
in Jour. Amer. Med. Assoc., August 8th, 3 See THE LANCET, 1930, i., 1185.
p. 408.
Méd. d. Hôp. d. Paris, 1930, liv., 749. 3 Strauss, M. B., Taylor, F. H. L., Castle, W. B.: Jour. Amer. Med. Assoc., August 1st, p. 313.