THE UNSOLVED MYSTERIES OF ARTERITIS.

918

gradually after the sixth month, leaving the child more RADIOLOGY AND PHYSIOTHERAPY. susceptible during the first six years than at any other IT was announced at the recent annual meeting of period of its life. The practical value of such a campaign, the British Association for the Advancement of of course, depends upon two assumptions—viz : 1. That the Schick reaction is a reliable indicator of Radiology and Physiotherapy that a certificate of susceptibility to diphtheria. 2. That the injection incorporation had just been secured. Dr. Robert of toxin-antitoxin actually confers active and lasting Knox, from the presidential chair, reviewed the work by the Association during the four years immunity. We pointed out some time ago that the ’, accomplished since its foundation, referring to the share taken in crucial test of the value of the reaction had not been carried out, as no cases giving a negative reaction had ’, the institution of the Cambridge diploma in medical been purposely infected with diphtheria. Whether i radiology and electrology. In conjunction with the toxin-antitoxin confers lasting immunity has yet to Institution of Electrical Engineers, the Association be demonstrated. So great, however, is the confidence ’, had been successful in founding the Society of in America that the methods proposed will stamp out ’, Radiographers, the Council of which was appointed diphtheria that public health authorities are beginning I, in equal ratio by the B.A.R.P., the Institution, and to hold parents responsible if their children contract the general body of its own members. The conthe disease. This standpoint is strikingly illustrated ’, stitution of the Society of Radiographers had been by the General Medical Council, inasmuch by a letter sent by the sanitary authority in North ’, approved Carolina to every home in which diphtheria occurred as its diploma of membership (M.S.R.) was obtainable by examination only, all its members underlast year :not to accept any patients for diagnosis or Dear Friend,-We regret that you had a case of diphtheria I taking treatment except under the direction of a qualified -in your home last year. We appreciate the care you took I to keep this disease from spreading to others in your home medical man. In addition to its educational activities, or community. In the future you will be responsible if you Dr. Knox mentioned the policy recently initiated by have a case of diphtheria, as the North Carolina State Board the B.A.R.P. of issuing authoritative statements on of Health is preparing to furnish the doctors and the health medical subjects to the daily papers. The issue of officers toxin-antitoxin. When three doses of this are given, manifestos approved by the Council but otherwise the person is protected against diphtheria for several years, to him to fulfil the joint requireunsigned appeared possibly for life." ment of being authoritative and at the same time The importance of the issue is great and is worthy free from any suggestion of personal bias. Dr. Knox of earnest consideration and investigation on the part a hope to see in London some day a worthy expressed of those responsible for the maintenance of public institute of radiology, having its own museum and health in this country. library, and perhaps its own clinic, and giving every possible facility for teaching and research. GENERAL PARALYSIS IN OLD AGE. "

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Herschmann,I assistant at the Psychiatric Department of the Vienna General Hospital, has made a clinical study of 84 cases of general paralysis which developed after the age of 60. Eighty of the patients were between 60 and 70 at the onset of the disease, and only four were over 70, the oldest being 75. Fifty-eight were males and 26, or about a third of the total, females. The relatively high proportion of women among aged general paralytics, a circumstance which had been previously observed by Kraepelin, Junius, and Arndt, is all the more remarkable as syphilitic infection after 50 is much rarer in women than in men. It is probable, therefore, that the interval between infection and the onset of general paralysis is longer in women than in men. The greater frequency of alcoholism in the Dr.

male

Heinrich

sex

and the

more

intense strain

on

the

nervous

system caused by the struggle for existence probably account for the shortening of the incubation period. Of the 84 cases in the present series, 66 were kept

under observation until their death, while the rest sent home. The average duration of the illness of the 66 cases, reckoning from the time of their admission to the clinic, was 263 days, so that senile general paralysis does not assume a particularly rapid course. In only 22 of the 66 cases was death due to cachexia alone, the causes of death in the other cases being convulsive attacks, pneumonia, The number myocarditis, atheroma, or enteritis. of cases of tabo-paralysis was high, no less than 21, or exactly one quarter of all the cases, showing tabetic symptoms. In the 20 cases in which the date of syphilitic infection could be determined the length of the interval between it and the onset of general paralysis was remarkable ; in six cases infection had occurred more than 40 years previously, in six more than 30 years, in seven more than 20 years, and in one 12 years before the onset of the psychosis. According to Dr. Herschmann, the special features of senile general paralysis are the rapid development of dementia, the loss of the power of orientation, nocturnal delirium, and, most of all, the frequency of the paranoid form. He suggests that this peculiar symptomatology is due to the histopathology of senile general paralysis, which will form the subject of a future communication. were

1

Medizinische

Klinik, Oct. 9th, 1921.

THE UNSOLVED

MYSTERIES OF ARTERITIS. WHEN a pathologist with an international reputation publishes a series of cases closely observed by skilled clinicians during life, and searchingly investigated after death ; and when his detailed summing-up ends in a frank avowal of ignorance, of inability to fix a truthfully descriptive label to the case, we are reminded that the sense of complete and nicely rounded-off knowledge is, most fortunately, withheld from every explorer. A few years ago our knowledge of the causes of arteritis was hardly even elementary, and when the relation of endarteritis to syphilis and of arteritis to tuberculosis had been noted, there was little more to be said-of importance, at any rate. Recent research has, indeed, added greatly to our appreciation of the part played by arteritis in such widely different diseases as CO poisoning, influenza, typhus and cerebro-spinal fever. That curious disease, periarteritis nodosa, is also better, though still imperfectly, understood. These recent advances should not, however, obscure the fact that we are still groping about the fringe of the problem, and this is the lesson on which Prof. F. Harbitz conscientiously insists when, in N orsk M agazin for Laegevidenskaben for September, 1921, he records one case after another of obscure arteritis observed at the PathologicalAnatomical Institute in Christiania. One of his cases was that of a man of 22 who was subject to idiopathic renal haemorrhage. After it had continued off and on for about a year decapsulation was performed, and a piece of kidney excised for microscopic examination. This showed nothing abnormal, but as the haemorrhage continued the whole kidney was removed. Its macroscopic appearance was normal, but the microscopic examination showed necrotic foci within which the arterioles were diseased ; their walls were swollen, and the lumen of each vessel was reduced, in some places to the point of obliteration. The swelling of the walls was partly due to proliferation of the intima, partly to hyaline degeneration of the connective and elastic tissues. There was no sign of inflammation, syphilis, or arterio-sclerosis, and if the case was one of periarteritis nodosa, then this disease does occasionally develop as a strictly localised phenomenon. Arousing without satisfying curiosity, this case shows that the term idiopathic renal hxmor-

919

rhage is apt to be misapplied, the haemorrhage being from each country represented. This proposition was due to organic disease of the kidney. In addition to accepted by the meeting, and Dr. Tricot-Royer another case of inflammation of the arteries and veins (Antwerp) was elected president, Dr. C. Singer (Great of the skin associated with purpura rheumatica, Prof. Britain), Profs. Giordano (Tta.ly), Menetrier, and Harbitz records two cases of arteritis of the brain. Jeansehne (France) were appointed vice-presidents, He concludes that true arteritis is much morecommon Dr. Fosseyeux archivist and secretary, and Dr. than was formerly supposed to be the case, that its Boulanger treasurer, of the Permanent Committee of the Bureau. causes are very varied, and that the task of disDr. Singer conveyed an invitation from the Section tinguishing between the yet unknown forms of arteritis and those of syphilis, periarteritis nodosa, and even of the History of Medicine of the Royal Society of Medicine for the third International Congress to meet of tuberculosis may be extraordinarily difficult. in London next year, which was cordially accepted, and’ the approximate date was fixed for the meeting for July 24th to 29th. 1922. The following subjects HEMIHYPERTROPHY AND MENTAL were suggested for the consideration of the members DEFECT. at the next Congress : (1) Principal seats of endemic Dr. Arnold Gesell,of New Haven, Connecticut, and epidemic diseases in the Classical Orient during who reports an example of hemihypertrophy associated the Middle Ages. (2) History of Anatomy. (3) with mental defect, describes hemihypertrophy as Revival of medical knowledge during the sixteenth one of the rarest of developmental anomalies. He century. The draft by-laws of the Association will be has collected 40 cases of true hemihypertrophy or submitted to the Permanent Committee of the Bureau total unilateral hypertrophy, including one under at the next meeting, which it is expected will be held his own care, and 30 examples of partial and crossed in December next. hypertrophy which is much more common. Of the 40 case only 5 were adults, 19 were males, 17 females, THE CAMBRIDGE CHAIR OF ANATOMY. and inthe sex was not specified. In 27, or almost IN an annotation of Oct. 15th upon the innervation 70 per cent., the hemihypertrophy was on the right side. In 15 cases it was definitely stated that all of striped muscle we alluded to Dr. J. T. Wilson as the tissues were involved in the hypertrophy, in Challis Professor of Anatomy in. the University of 19 cases abnormalities of the skin were mentioned Sydney. This was an error of forgetfulness, for Prof. Wilson has now succeeded the late Prof. Alexander as a complication, in 3 the skin was reported as normal, and in the remainder no details were given. Macalister as professor of anatomy in the University As regards the mental condition, in 29 cases no of Cambridge, and began his work there this term. information was supplied, in many instances the Prof. Wilson’s translation from Sydney to Cambridge subject being too young for mental examination, was due to the fact that the electors considered him build up a research in 6 cases the mentality was reported as normal, the most likely man possible and in 5 cases, or 13 per cent., it was reported as anatomical department in the University of Camdefective. According to Dr. Gesell, who maintains bridge. During his stay at Sydney he has educated a that hemihypertrophy is not a hereditary character long line of sound anatomists, notable among these but a morphological anomaly dating back to an early being Prof. Elliot Smith, while he is himself a pupil embryonic stage, hemihypertrophy may be inter- of that famous teacher of anatomists, Sir William preted as an atypical or imperfect form of twinning, Turner. Under Prof. Wilson the chair-of anatomy at a variant of the same process which may produce Cambridge should bring forth great things. a double-headed monster or a perfectly ordinary normal individual, the latter being an organism in whom there has been a precisely balanced inhibition UNIVERSITY OF SHEFFIELD: UNION OF of the biological process of bilateral doubling. The MEDICAL SCHOOL AND HOSPITAL. complication of mental defect is attributed to an Tmg in the of bilateral term new regulations come into force whereby which abnormality process twinning involves a disturbance of normal tissue development. an attempt is being made by the University of Sheffield to bring into closer contact the laboratory studies of anatomy and physiology, on the one hand, and the elementary principles of medicine and INTERNATIONAL ASSOCIATION OF HISTORY surgery on the other, and to show the student, whilst OF MEDICINE. still engaged in the former studies, their practical A MEETING to form an International Association of application to the latter. It is hoped to attain this the History of Medicine was held in Paris on Oct. 8th, object by making the third or middle year of the at the Faculty of Medicine, at which representatives curriculum into a kind of dove-tailed joint between from Great Britain, Holland, Belgium, Spain, Portugal, laboratory and hospital. In order to bring this second M.B. examination in general Denmark, Norway, Switzerland, Roumania, France, about the and anatomy physiology has to be taken at the end and other countries were present. The object of this Association is to pursue the study of the history of of the second year-that is to say, six months earlier medicine by means of research, bibliography, and com- than heretofore ; whilst a further examination in these munications presented by its members for discussion ’, subjects, with the addition of pathology and pharmaat the future meetings of the International Congress. cology, is held in the third M.B. examination at the Under this plan it is The Association is the outcome of the successful Inter- close of the fourth year. national Congresses, the first of which was held in obviously impossible for the second M.B. examination cover the whole of the subjects in detail, since Antwerp in 1920, and the second in July last in Paris. to It was then decided to form a permanent bureau or the students will have studied them for one year only. committee to meet in Paris to draw up a constitution The difficulty of the scheme lies in the proper disand make regulations to indicate to members various tribution of the teaching of the subjects before and after the second M.B., and the grading of the examinasubjects for research and investigation, so as to ensure tions. At present the scheme is in the experimental unity and continuity, and to make their work of The second M.B. examination held last June stage. value. Prof. Jeanselnie and practical (Paris) presided extended a cordial greeting to the foreign representa- was the first to be held at an earlier stage in the tives. Prof. Laignel-Lavastine, General Secretary of curriculum, and the results were distinctly encouraging. the Faculty of Medicine of Paris, then outlined the Possibly the anxiety of the teachers to show good certainly the keenness of the students proposed constitution. He suggested that the Per- results, and manent Committee should consist of a president, vice- to make the scheme a success, played some part here. Even those who were inclined to doubt the wisdom presidents, secretary and treasurer, and delegates of the innovation admitted that the outcome was better than anticipated. As regards the clinical 1 Archives of Neurology and Psychiatry, October, 1921. ___

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