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THE TREATMENT OF MEASLES BY SERUM.
826 effect is wanted. Dr. Case’s work is
a
very elaborate
made
use
of the
serum
of
patients
with measles
attempt to provide a large number of stereoscopic who had not been treated by drugs, had no clinical skiagrams of actual instances of disease and disorder complication, and were in early convalescence. The of the alimentary canal, and we can unreservedly best results were obtained from a polyvalent serum, praise the results which have been obtained. consisting of equal parts taken from three patients. There are in all 100 stereoroentgengrams, as the The amount injected varied, according to the case author calls them, of which four deal with the and severity of the disease, from 15 to 20 c.c., and apparatus and not with disease, but these are the injections were practised-5, 10, 20 c.c.-every very helpful, as they assist us to appreciate the 24 hours. The cases treated were eight in number, The stereoaccuracy of the stereoscopic effect. Dr. as Case are best examined, grams says, with a Wheatstone’s stereoscope, which was indeed the original instrument, but the more common form is more portable. By the help of skiagrams such as these the practitioner and student will be enabled to obtain a much better idea than in any other way of those affections of the alimentary tract which can be examined in this manner, and they will also assist the surgeon in the interpretation of skiagrams of cases under his own care. No. 76 shows gall-stones more satisfactorily than we have ever yet seen in a skiagram. Every picture is accompanied by an explanation of the appearances shown. We cannot doubt that the value of the work is enhanced by the fact that the roentgenologist who took the skiagrams is also a surgeon. A
HABITUAL
CRIMINAL.
" You will undergo three years’ penal servitude," Mr. Wallace, K.C., said to William Saunders, a prisoner at the London sessions recently, " and you will spend the time in the prison The man upon whom he was passing sentence was 69 years of age, and since 1861 had been condemned to 23 periods of imprisonment, including ten years’ penal servitude meted out to him in 1881, when he was convicted for stealing boots. He must then have been out of prison for some time, as the sentence which immediately preceded was one of seven years passed in 1867. Since 1890, however, when he was sent to prison for 21 days, he had undergone 14 periods of incarceration, including one The chairman’s prophecy that of five years. he would spend the next three years in the prison infirmary may have been prompted by his obvious physical incapacity, but it is to be hoped that the mental as well as the physical condition of the convict will receive serious consideration, and that means may be found, if he survives, to prevent his release. Whether mentally defective or not, he is not likely to remain honest if turned loose again when over 70 years of age, and it must be remembered that on 24 occasions honest citizens have had to undergo robbery at his hands and to face the trouble and inconvenience of appearing to
probably
infirmary."
prosecute.
--
THE TREATMENT OF MEASLES
A
BY SERUM.
epidemic of measles at Ancona in 1914 a mortality of 2’89 per cent. induced U. Majoli1 to try the effect of treating some of cases with the serum of patients who were conSEVERE
resulting
Dr. the valescent
in
from
the
disease.
Of the 1938
cases
occurring in the town 58 were admitted into the hospital, for the most part between 2 and 10 years of age, and among these the mortality was 25’86 per cent. The reason of this high mortality was due to the fact that only the severe and complicated cases were sent to the hospital. Dr. Majoli 1 Il Policlinico,
Sept. 12th, 1915.
the majority about 9 years of age. There was no instance of serum disease, the duration of the fever was shortened-four to five days, the eruption faded early, and no complication occurred in any of the
cases. ____
THE IMMEDIATE PLATING OF COMPOUND FRACTURES.
IN another part of our present issue we print an article in which the author, Lieutenant Vernon Pennell, R.A.M.C., urges that the best treatment for the compound fractures which are so common in war is the immediate application of some form of internal splinting; he advises this in all cases of compound fracture in which an incision is needed for ample drainage and efficient cleaning and where skiagraphy shows malposition with conservative treatment. In some cases he affixes a plate and in others he sutures the fragments with silkworm gut, and in other cases when there is much loss of bone he employs a bone graft from the tibia or fibula. As to his results, Mr. Pennell tells us that they are all he could wish, and that the position of the fragments is much better than could have been obtained by any other treatment. We will hardly venture on a definite expression of opinion at present until the method has been employed more widely, but we must mention that the results he has obtained are not in accordance with those obtained by men who have attempted the early operative fixation of septic compound fractures. In this connexion we have heard of some most The matter is ripe for disunfortunate results. cussion, as individual experiences must now be very numerous and opinions appear to be discordant. ____
PYLOROSPASM IN
THE
INFANTS.
etiology of
the disease sometimes known of the pylorus in infants is not known. It is believed that it is not a congenital state of affairs in many cases, and that there is no stenosis of the pylorus in many cases also; in all, however, there is spasm of the hypertrophied circular muscle of the pylorus, so that the name " pylorospasm"seems to have advantages, and in addition to be nonThe cause of this muscular hypercommittal. trophy is not clearly known. Some hold that it is the result of unduly rapid but otherwise normal developmental processes. Others attribute it to overexercise secondary to excessive nervous stimulation, of a reflex character. The literature of the subject is very extensive, and is discussed by Dr. Delprat1 at some length, as is the treatment. Of the operative procedures, whether anterior gastro-enterostomy, stretching of the pylorus, or, most commonly, pyloroplasty, Dr. Delprat says little. Treatment by dieting has varied considerably in the hands of different experts. Some lay stress on the administration of small quantities of food at short intervals, others do not ; some insist on the as
congenital hypertrophic stenosis
1
Nederl. Tijdschr.
v.
Geneesk., Amsterdam, 1915, ii., 1316.
a
very elaborate
made
use
of the
serum
of
patients
with measles
attempt to provide a large number of stereoscopic who had not been treated by drugs, had no clinical skiagrams of actual instances of disease and disorder complication, and were in early convalescence. The of the alimentary canal, and we can unreservedly best results were obtained from a polyvalent serum, praise the results which have been obtained. consisting of equal parts taken from three patients. There are in all 100 stereoroentgengrams, as the The amount injected varied, according to the case author calls them, of which four deal with the and severity of the disease, from 15 to 20 c.c., and apparatus and not with disease, but these are the injections were practised-5, 10, 20 c.c.-every very helpful, as they assist us to appreciate the 24 hours. The cases treated were eight in number, The stereoaccuracy of the stereoscopic effect. Dr. as Case are best examined, grams says, with a Wheatstone’s stereoscope, which was indeed the original instrument, but the more common form is more portable. By the help of skiagrams such as these the practitioner and student will be enabled to obtain a much better idea than in any other way of those affections of the alimentary tract which can be examined in this manner, and they will also assist the surgeon in the interpretation of skiagrams of cases under his own care. No. 76 shows gall-stones more satisfactorily than we have ever yet seen in a skiagram. Every picture is accompanied by an explanation of the appearances shown. We cannot doubt that the value of the work is enhanced by the fact that the roentgenologist who took the skiagrams is also a surgeon. A
HABITUAL
CRIMINAL.
" You will undergo three years’ penal servitude," Mr. Wallace, K.C., said to William Saunders, a prisoner at the London sessions recently, " and you will spend the time in the prison The man upon whom he was passing sentence was 69 years of age, and since 1861 had been condemned to 23 periods of imprisonment, including ten years’ penal servitude meted out to him in 1881, when he was convicted for stealing boots. He must then have been out of prison for some time, as the sentence which immediately preceded was one of seven years passed in 1867. Since 1890, however, when he was sent to prison for 21 days, he had undergone 14 periods of incarceration, including one The chairman’s prophecy that of five years. he would spend the next three years in the prison infirmary may have been prompted by his obvious physical incapacity, but it is to be hoped that the mental as well as the physical condition of the convict will receive serious consideration, and that means may be found, if he survives, to prevent his release. Whether mentally defective or not, he is not likely to remain honest if turned loose again when over 70 years of age, and it must be remembered that on 24 occasions honest citizens have had to undergo robbery at his hands and to face the trouble and inconvenience of appearing to
probably
infirmary."
prosecute.
--
THE TREATMENT OF MEASLES
A
BY SERUM.
epidemic of measles at Ancona in 1914 a mortality of 2’89 per cent. induced U. Majoli1 to try the effect of treating some of cases with the serum of patients who were conSEVERE
resulting
Dr. the valescent
in
from
the
disease.
Of the 1938
cases
occurring in the town 58 were admitted into the hospital, for the most part between 2 and 10 years of age, and among these the mortality was 25’86 per cent. The reason of this high mortality was due to the fact that only the severe and complicated cases were sent to the hospital. Dr. Majoli 1 Il Policlinico,
Sept. 12th, 1915.
the majority about 9 years of age. There was no instance of serum disease, the duration of the fever was shortened-four to five days, the eruption faded early, and no complication occurred in any of the
cases. ____
THE IMMEDIATE PLATING OF COMPOUND FRACTURES.
IN another part of our present issue we print an article in which the author, Lieutenant Vernon Pennell, R.A.M.C., urges that the best treatment for the compound fractures which are so common in war is the immediate application of some form of internal splinting; he advises this in all cases of compound fracture in which an incision is needed for ample drainage and efficient cleaning and where skiagraphy shows malposition with conservative treatment. In some cases he affixes a plate and in others he sutures the fragments with silkworm gut, and in other cases when there is much loss of bone he employs a bone graft from the tibia or fibula. As to his results, Mr. Pennell tells us that they are all he could wish, and that the position of the fragments is much better than could have been obtained by any other treatment. We will hardly venture on a definite expression of opinion at present until the method has been employed more widely, but we must mention that the results he has obtained are not in accordance with those obtained by men who have attempted the early operative fixation of septic compound fractures. In this connexion we have heard of some most The matter is ripe for disunfortunate results. cussion, as individual experiences must now be very numerous and opinions appear to be discordant. ____
PYLOROSPASM IN
THE
INFANTS.
etiology of
the disease sometimes known of the pylorus in infants is not known. It is believed that it is not a congenital state of affairs in many cases, and that there is no stenosis of the pylorus in many cases also; in all, however, there is spasm of the hypertrophied circular muscle of the pylorus, so that the name " pylorospasm"seems to have advantages, and in addition to be nonThe cause of this muscular hypercommittal. trophy is not clearly known. Some hold that it is the result of unduly rapid but otherwise normal developmental processes. Others attribute it to overexercise secondary to excessive nervous stimulation, of a reflex character. The literature of the subject is very extensive, and is discussed by Dr. Delprat1 at some length, as is the treatment. Of the operative procedures, whether anterior gastro-enterostomy, stretching of the pylorus, or, most commonly, pyloroplasty, Dr. Delprat says little. Treatment by dieting has varied considerably in the hands of different experts. Some lay stress on the administration of small quantities of food at short intervals, others do not ; some insist on the as
congenital hypertrophic stenosis
1
Nederl. Tijdschr.
v.
Geneesk., Amsterdam, 1915, ii., 1316.