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THE WORK OF THE PELLAGRA INVESTIGATION COMMITTEE.
1084 data collected it seems that the physio-I(We published full details of the organisation of the com-logical activity of all epinephrin-like bodies can be mittee in THE LANCET of Sept. llth, 1909, p. 813 ) The assayed by the blood pressure method and their effi- remaining papers contain respectively a list of questions to ciency expressed in terms of the pure epinephrin be addressed to the post-graduate associations in each It has been found that dogs yield the most country concerning the ordinary academic and clinical base. constant and uniform results, the method used being that instruction on all subjects of the medical curriculum availdescribed in Bulletin No. 55 of the Hygienic Laboratory. able therein, the legal regulations for the courses of study Four of the seven brands of epinephrin solution under exa- and examinations, and the organisation of systematic A further list of mination were found to vary from 3’75 to 71 per cent. of instruction for military surgeons. the required activity, those of weak strength being more or questions asks for detailed particulars concerning the less worthless, and perhaps dangerous, from the physician’s post-graduate courses in existence, the fees requisite for point of view. Some solutions, though showing a high their use, and so on. The final paper contains the agenda degree of activity upon opening the original package, for an extraordinary meeting of the committee which is to be quickly deteriorated in spite of the extra precautions taken held during the centennial celebration of the University to guard against conditions known to further this process. of Berlin. They deal with the coordination of the Two of the solutions, adrenalin solution and supracapsulin information which will result from the committee’s inquiries solution, were found to be equal to the standard in activity. and the possible alteration of the lists of questions to be An examination of synthetic suprarenin solution showed it circulated, the organisation of an international information to be only one-half as active as the standard. The keeping bureau concerning post-graduate facilities in different properties of solutions of the synthetic substance are appa-- countries, and the amount of the subscriptions to be rently very good when kept sealed in the original package, contributed by individual countries to the international but not when diluted, even though kept under the most committee, which we imagine will not be on a uniform scale. This is shown by the rapid colour The office of the committee is situated at Kaiserin Friedrichsuitable conditions. an and change appreciable loss in physiological Haus, Luisenplatz 2-4, Berlin, N.W. 6. by activity. Dr. Schultz made some preliminary experiments on the relation existing between the different shades THE ARTHRITIC DIATHESIS. of colour developed in solutions of epinephrin and their AT a meeting of the Academy of Medicine of Paris respective physiological activity. He found that the on March 8th last Sir Dyce Duckworth read a paper method of expressing the amount of colour in units of the ordinary colorimeter is unsatisfactory, for not only do the entitled " Etude Clinique sur les Particularitesde laDiathese solutions develop different degrees of depth of colour, but Arthritique." He referred mainly to the arthritic diathesis more than one tint is involved. In the presence of sulphites in relation to gout, which he regarded as an endogenous and other deoxidising agents a solution may show but little malady following in the course of errors of metabolismin 11 colour, even when exposed to air and light, while at the subjects disposed to arthritism," and to neurotic manifestations in certain phases. He referred to the characteristics same time it may possess but little vaso-constrictor action. In the absence of such abnormal conditions the strength of of thegouty temperament,"such as a tendency to urinary the solution is roughly in inverse proportion to the colour concretions, to asthma, and to eczema. He also drew attenthat usually develops in solutions of epinephrin upon stand- tion to the digestive peculiarities of gouty subjects, such as ing. The colour is not always a safe criterion by which the inability to digest certain fruits, and the predisposition to to judge the value of a solution of epinephrin. The presence gouty attacks after the ingestion of tomatoes, rhubarb, lemon, of a precipitate points to the probability of serious deteriora- or acid wines. He also mentioned another phase of the subject which has been especially studied by French tion in activity. physicians--namely, the remarkable immunity of the arthritic constitution to tuberculosis. In the gouty subject THE INTERNATIONAL COMMITTEE FOR POSTthe soil is GRADUATE COURSES. particularly unfavourable, and if infection does occur the progress of the disease is slow and has a marked IT will be remembered that during the Congress of to arrest with fibrosis and chalky formations. Sir Medicine last year at Budapest an international committee tendency Duckworth’s Dyce paper is published in the ,7
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1085 Sometimes these jerk-like phenomena are all that is ever noted. They are either unilateral or bilateral, and affect some definite region of the body ; sudden adduction or extension of one or both arms, and sudden flexion or extension of the trunk are the commonest. In no fewer than 103 out of 150 female epileptics, and in 82 out of 150 male, regional convulsions were present at some or other period of the disease. They correspond to what Sir William Gowers has described as multimuscular contractions, and are OF THE INTESTINE RESECTION SUCCESSFUL FOR MESENTERIC THROMBOSIS. rarely localised in one muscle or part of a muscle. A comof their main clinical features with those described l IN the Boston Med’ical and Surgical Jozirrnal of March 17th} parison as shows certain special points of similarity in the what be the ninth myoclonus Dr. E. A. Codman has reported appears to t and leads to the conclusion that each should be consuccessful case on record of intestinal resection for mesenterictwo, A compensatory thrombosis. A man, aged 45 years, was admitted into the.sidered a subtype of genuine epilepsy. Hisrelation between regional convulsions and complete epileptic Massachusetts General Hospital on Oct. 21st, 1909. illness began three weeks before with dull abdominal pain. jfits can often be discovered. It is very well known that The pain persisted in the upper abdomen on the left side.]healthy individuals on going to sleep or during the night often Acute exacerbations lasting about an hour occurred. The wake up with a sort of jerk, and on the other hand epileptics pain was increased by exercise and by eating. The bowelsare often met with who suffer from sleeplessness brought on acted every day until the last three days. On admission the by a continual waking up from their sleep by repeated jerking abdomen was full and somewhat rigid but not tender. There movements. Why these times should be associated with the were a leucocytosis of 35,000 and a systolic murmur. Onappearance of jerks and regional minor discharges we are at Oct. 23rd the patient was seized with severe pain in the left a loss to know. Sometimes the jerks occur with peculiar The pain was constant, but violence while the individual is dressing. In view of the upper abdominal quadrant. attended with paroxysms lasting 10 to 15 minutes. After curious indifference of the lay mind to this pathological two hours the abdomen had the rigidity of peritonitis, the condition until the major fits have established themselves, patient became intensely pale and covered with cold their early diagnostic significance ought to be impressed on perspiration, and the pulse was rapid and thready. Perfora- the general practitioner. tion of some viscus into the general peritoneal cavity was LUMBAR PUNCTURE IN MENINGITIS. suspected. Under ether an indistinct mass was felt to of the umbilicus. A 6-inch incision was made the left ALL who have much experience in the treatment of children at this spot and much bloody fluid was found in are agreed that lumbar puncture is frequently of great value Beneath the incision were two dark-red in diagnosis, especially in cases of meningitis, and in the the abdomen. coils of small intestine, evidently in a condition of present issue of THE LANCET we print a careful paper by hsemorrhagic ga ngrene. A search was made tor other areas Dr. G. Stirling Landon on this subject, based on a large Resection of the number of cases which he had observed himself. 50 of the of infarction, b ut none were found. Much difficulty was expe- cases were suffering from meningitis, and about half of these affected area was performed. rienced in tying off the mesentery, which was cedematous were tuberculous in nature. Four of the cases suffered from and friable. As the upper part of the jejunum was affected chronic hydrocephalus and four from acute poliomyelitis. For several days There are some who regard lumbar puncture as dangerous, end-to-end anastomosis was performed. the patient was in a critical condition with a bad pulse, but if due care be taken the risks are slight, except when bloody diarrhoea, and hsematemesis. Typical acute gastro- there is partial or complete closure between the cranial mesenteric obstruction developed and was relieved by lavage and spinal portions of the cerebro-spinal canal, and and change of position. The leucocytosis did not begin to in this case the distended brain may be pushed down diminish until 10 days after the operation. During con- into the foramen magnum and a fatal result may ensue. It valescence there appeared to be some free fluid in the may also be mentioned that the risk of lumbar puncture is abdomen. The portion of intestine removed was 4 feet long, decidedly greater in cases of cerebral tumour than in cases The middle 2 feet were of meningitis. The most important clinical characters of and its veins were thrombosed. dark red, and a foot on each side was of doubtful vitality. the cerebro-spinal fluid are its cytology and its bacteriology. About 214 cases of mesenteric thrombosis have now been In the cytology the most critical matter is to determine recorded, of which 50 were operated on. Although thewhether any leucocytosis is mononuclear or polymorph, for mortality of operation is very great it offers a better chance it may be said that if the effusion is polymorph in character than expectant treatment. The diagnosis before operation the leucocytosis is probably caused by a microbic infection is almost impossible. rather than by tubercle, though this rule is by no means without exception. It has been suggested that a polynuclear REGIONAL AND MYOCLONIC CONVULSIONS. effusion may result from the irritation caused by the needle If this be so, subONE of the most distinctive and at the same time least iin making the lumbar puncture. known features of genuine epilepsy is the occurrence of isequent tappings would be vitiated. The most conof all positive results which can be obtained jerks or jerk-like movements without loss of consciousness. < While they are rarely complained of spontaneously by the1from examination of the withdrawn fluid are furnished I a bacteriological examination. The fluid itself forms an patient, it is often found on careful inquiry that he hasby suffered from them for years, usually the first thing in the 4excellent culture medium and by this means organisms may 1 discovered which would otherwise have been missed. In morning, or during the night, and particularly for a longer or be shorter time before the first paroxysmal fit. According to 1the cases of tuberculous meningitis the organisms were Dr. L. J. J. Muskens of Amsterdam, who devotes an article Jfound in all the 14 cases which were examined for it. It to their consideration in Epilepsia for 1909, they are presentmay i be said that while positive results in lumbar puncture, in the early stages of the disease more frequently than any
Mr. Amornso to Brusaporto, while Captain Siler and Mr. Baldini went to Albano and Torre dei Reveri. At Brusaporto S4 cases of pellagra were found in a population of 1000, and Captain Siler reported numerous cases at Albano, but none at Torre dei Reveri. The countryside is sorely afflicted with typhoid fever, measles, and diphtheria, while in Albano rabies is said to be present.
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1085 Sometimes these jerk-like phenomena are all that is ever noted. They are either unilateral or bilateral, and affect some definite region of the body ; sudden adduction or extension of one or both arms, and sudden flexion or extension of the trunk are the commonest. In no fewer than 103 out of 150 female epileptics, and in 82 out of 150 male, regional convulsions were present at some or other period of the disease. They correspond to what Sir William Gowers has described as multimuscular contractions, and are OF THE INTESTINE RESECTION SUCCESSFUL FOR MESENTERIC THROMBOSIS. rarely localised in one muscle or part of a muscle. A comof their main clinical features with those described l IN the Boston Med’ical and Surgical Jozirrnal of March 17th} parison as shows certain special points of similarity in the what be the ninth myoclonus Dr. E. A. Codman has reported appears to t and leads to the conclusion that each should be consuccessful case on record of intestinal resection for mesenterictwo, A compensatory thrombosis. A man, aged 45 years, was admitted into the.sidered a subtype of genuine epilepsy. Hisrelation between regional convulsions and complete epileptic Massachusetts General Hospital on Oct. 21st, 1909. illness began three weeks before with dull abdominal pain. jfits can often be discovered. It is very well known that The pain persisted in the upper abdomen on the left side.]healthy individuals on going to sleep or during the night often Acute exacerbations lasting about an hour occurred. The wake up with a sort of jerk, and on the other hand epileptics pain was increased by exercise and by eating. The bowelsare often met with who suffer from sleeplessness brought on acted every day until the last three days. On admission the by a continual waking up from their sleep by repeated jerking abdomen was full and somewhat rigid but not tender. There movements. Why these times should be associated with the were a leucocytosis of 35,000 and a systolic murmur. Onappearance of jerks and regional minor discharges we are at Oct. 23rd the patient was seized with severe pain in the left a loss to know. Sometimes the jerks occur with peculiar The pain was constant, but violence while the individual is dressing. In view of the upper abdominal quadrant. attended with paroxysms lasting 10 to 15 minutes. After curious indifference of the lay mind to this pathological two hours the abdomen had the rigidity of peritonitis, the condition until the major fits have established themselves, patient became intensely pale and covered with cold their early diagnostic significance ought to be impressed on perspiration, and the pulse was rapid and thready. Perfora- the general practitioner. tion of some viscus into the general peritoneal cavity was LUMBAR PUNCTURE IN MENINGITIS. suspected. Under ether an indistinct mass was felt to of the umbilicus. A 6-inch incision was made the left ALL who have much experience in the treatment of children at this spot and much bloody fluid was found in are agreed that lumbar puncture is frequently of great value Beneath the incision were two dark-red in diagnosis, especially in cases of meningitis, and in the the abdomen. coils of small intestine, evidently in a condition of present issue of THE LANCET we print a careful paper by hsemorrhagic ga ngrene. A search was made tor other areas Dr. G. Stirling Landon on this subject, based on a large Resection of the number of cases which he had observed himself. 50 of the of infarction, b ut none were found. Much difficulty was expe- cases were suffering from meningitis, and about half of these affected area was performed. rienced in tying off the mesentery, which was cedematous were tuberculous in nature. Four of the cases suffered from and friable. As the upper part of the jejunum was affected chronic hydrocephalus and four from acute poliomyelitis. For several days There are some who regard lumbar puncture as dangerous, end-to-end anastomosis was performed. the patient was in a critical condition with a bad pulse, but if due care be taken the risks are slight, except when bloody diarrhoea, and hsematemesis. Typical acute gastro- there is partial or complete closure between the cranial mesenteric obstruction developed and was relieved by lavage and spinal portions of the cerebro-spinal canal, and and change of position. The leucocytosis did not begin to in this case the distended brain may be pushed down diminish until 10 days after the operation. During con- into the foramen magnum and a fatal result may ensue. It valescence there appeared to be some free fluid in the may also be mentioned that the risk of lumbar puncture is abdomen. The portion of intestine removed was 4 feet long, decidedly greater in cases of cerebral tumour than in cases The middle 2 feet were of meningitis. The most important clinical characters of and its veins were thrombosed. dark red, and a foot on each side was of doubtful vitality. the cerebro-spinal fluid are its cytology and its bacteriology. About 214 cases of mesenteric thrombosis have now been In the cytology the most critical matter is to determine recorded, of which 50 were operated on. Although thewhether any leucocytosis is mononuclear or polymorph, for mortality of operation is very great it offers a better chance it may be said that if the effusion is polymorph in character than expectant treatment. The diagnosis before operation the leucocytosis is probably caused by a microbic infection is almost impossible. rather than by tubercle, though this rule is by no means without exception. It has been suggested that a polynuclear REGIONAL AND MYOCLONIC CONVULSIONS. effusion may result from the irritation caused by the needle If this be so, subONE of the most distinctive and at the same time least iin making the lumbar puncture. known features of genuine epilepsy is the occurrence of isequent tappings would be vitiated. The most conof all positive results which can be obtained jerks or jerk-like movements without loss of consciousness. < While they are rarely complained of spontaneously by the1from examination of the withdrawn fluid are furnished I a bacteriological examination. The fluid itself forms an patient, it is often found on careful inquiry that he hasby suffered from them for years, usually the first thing in the 4excellent culture medium and by this means organisms may 1 discovered which would otherwise have been missed. In morning, or during the night, and particularly for a longer or be shorter time before the first paroxysmal fit. According to 1the cases of tuberculous meningitis the organisms were Dr. L. J. J. Muskens of Amsterdam, who devotes an article Jfound in all the 14 cases which were examined for it. It to their consideration in Epilepsia for 1909, they are presentmay i be said that while positive results in lumbar puncture, in the early stages of the disease more frequently than any
Mr. Amornso to Brusaporto, while Captain Siler and Mr. Baldini went to Albano and Torre dei Reveri. At Brusaporto S4 cases of pellagra were found in a population of 1000, and Captain Siler reported numerous cases at Albano, but none at Torre dei Reveri. The countryside is sorely afflicted with typhoid fever, measles, and diphtheria, while in Albano rabies is said to be present.
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