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THROMBOSIS OF THE RECEPTACULUM CHYLI AND CHYLOUS ASCITES IN CIRRHOSIS OF THE LIVER.
243 the upper part of the leg, indicating the line of demarcation. the notification of infectious diseases......." There is, of The patient suffered from intolerable pain and amputation course, no such thing in England as a fee for filling up a was perfurmed on April lst. It was necessary to amputate in death certificate and the correspondent has evidently conthe upper third of the thigh in consequence of the imper- fused the shilling paid to the medical officer of a public meability of the arteries. Recovery was uneventful. At the institution for notifying a case of infectious disease. Howoperation the femoral artery was obliterated at the point ever, the Austrian medical men are going to strike and the where it was divided. In the upper part, corresponding to communal authorities are said to have replied that if the the middle third of the thigh, the artery formed a hard medical men will no longer vaccinate there are plenty of rounded cord. Lower it became irregular and had a quacks who will. This is a, foolish argument, but no more moniliform appearance. In the popliteal space the artery foolish than kindred arguments put forth by antivaccinawas enlarged and flattened and its contents were softened. It is for the interests of a comtionists in this land. These changes were also found in the tibial and peroneal munity to see that its medical men are paid a salary which arteries and in their branches. Two abscesses were found in will not only enable them to live but which will also enable the muscles-one of the size of a walnut in the adductor them to devote their best energ’es to the task of guarding magnus and the other, of the size of a hazel nut, in the the health of their fellows against the inroads of disease. vastus internus. Around the abscesses the muscles had a greyish tinge. Microscopic examination showed only WHAT IS DISTILLED WATER ? slight change in the upper part of the femoral artery. There were some collections of leucocytes in the adventitia FOR the purposes of the Sale of Food and Drugs Act and the endothelium was a little thickened. The vessel was distilled water has been held to be a drug, and odd as this The popliteal artery was definition occluded by a fibrinous clot. it after all be difficult to to be would may appear much more altered. It contained pure pus and its walls find more Distilled water is suitable any appellation. The internal coat had comwere in process of destruction. even a chemists’ form, and has commodity, may practically. pletely disappeared, the middle coat was infiltrated with formed, the sole item in a medical prescription, and it polynuclear leucocytes, and the adventitia was replaced by a is an official preparation of, and is defined in, the British mass of leucocytes, traversed in places by fibres of connective Pharmacopoeia. This last fact implies its use as a drug tissue. At a higher level the changes in the artery were in medicine. In the proceedings taken at Marylebone police less intense and it contained fibrinous clot. Still higher court against a druggist, the defendant " was summoned for there was only endarteritis. In the contents of the femoral selling to the prejudice of the purchaser a drug-namely, artery and in the pus of the muscular abscesses the typhoid a pint of distilled water-which was not of the nature, bacillus was found in pure culture. Thus the bacillus was substance, or quality of the drug demanded." Sir the cause of the obliterative arteritis. a Thomas Stevenson stated that he had
analysed
ROYAL COLLEGE
OF
PHYSICIANS
OF
LONDON.
present year to be delivered before of Royal College Physicians of London, Pall Mall as are follows :-The Milroy lectures will be East, S.W., Hamer on March lst, 6th, and 8th, given by Dr. W. H. the subject being Epidemic Disease in England-the Evidence of Variability and of Persistency of Type ; the Goulstonian lectures will be given by Dr. H. Batty Shaw on March 13th, 15th, and 20th, the subject being Auto-intoxiation; the Lumleian lectures will be: given by Dr. D. Ferrier on March 22nd, 27th, and 29th, the: lectures being on Tabes Dorsali; and the Oliver-Sharpey lectures will be given by Dr. E. I. Spriggs on April 3rd and 5th, the subject being the Bearing of Metabolism Experiments upon the Treatment of Some Diseases The days of the week for the delivery of the lectures are Tuesdays and Thursdays and the hour of delivery is 5 P.M. THE lectures of the
the
,
.
.
,
,
sample of the water and had found it to be very dirty and full of mouldy growths and that it gave an appreciable deposit. The British Pharmacopoeia redistilled water be to colourless, tasteless, and odourquires less and when evaporated it should leave " at most a scarcely visible residue." Clearly the sample in question did not conform to these requirements and, legally speaking, any substance defined in the Pharmacopoeia is a drug. The defence was that it was assumed that the water was required for photographic purposes but no question on this point was asked at the time the purchase was being made. The defence was hardly justifiable since it is essential in photographic processes to employ distilled water and it is hardly likely that photographers would incur the expense of procuring distilled water if ordinary tap water would answer the same purpose equally well. The defendant was fined 10s. with E33s. costs, the magistrate remarking that it was not suggested that he had done anything fraudulent or that reflected on his character.
PARISH MEDICAL OFFICERS IN AUSTRIA.
correspondent of the Standard, in the issue THROMBOSIS OF THE RECEPTACULUM CHYLI AND CHYLOUS ASCITES IN CIRRHOSIS journal of Jan. 20th, gives a grim account of the
THE Vienna
of that
OF THE LIVER. of parish medical men in Austria. The total number of these officials in Lower Austria is, he says, 450. IN the liledieal News (New York) of Nov. 11th, 1905, Of these, only 340 are able to keep themselves respectably. Dr. H. J. Nichols has reported a case of cirrhosis of the Only 170 can educate their children and 145 can only live by liver complicated with thrombosis of the receptaculum and chylous ascites. Cases have been recorded of taking extra work themselves or by their wives doing the same thing. That is to say, the medical men act as wine thrombosis of the thoracic duct near its junction with the merchants on commission or take some similar post and subclavian and jugular veins but not of thrombosis at a The patient was a man, aged 74, years, their wives do needlework or act as post-mistresses or lower level. of He was admitted to ho-pital on More than half addicted to the medical alcohol. manageresses shops. men in question are compelled to send their children March 18th, 1905. The abdomen was distended and out to work. The average salary is about C25 per annum tympanitic and covered with a network of enlarged veins and although some get more yet others get less. The which extended to the lower part of the chest. In these fee for vaccination is 2d., which includes the vaccina- the blood flowed from below upwards. At the bases of tion, filling up two certificates, and attendance for eight the lungs resonance was impaired and a few liquid days. The correspondent continues : " For death certi- râles were heard. The heart was slightly enlarged to ficates he does not get even the English shilling nor for tie left ard a mitral systolic murmur was heard. The legs
position
chyli
244 oodematous. The liver dulness extended in the nipple line from the fourth to the seventh ribs. There was some dulness in the flanks. Incisions were made in the legs and saline purgatives and infusion of digitalis were given without relief. The legs became more distended and the abdomen more swollen, with marked dulness in the flanks, fluctuation, and dyspnoea. On March 28th paracentesis was performed and yielded 5700 cubic centimetres of fluid. The abdomen became lax and the oedema disappeared. The fluid reaccumulated. On April 6th 6200 cubic centimetres were removed and on the 16th 7800. On each occasion the fluid presented the same striking appearance. It was milky white, with a tinge of pink. On standing the pink colour disappeared and a red deposit formed. The fluid contained 1 per cent. of albumin and 1’3 par cent. of fat. Microscopic examination showed no large fat globules but a number of fine granules in constant motion. There were 24,000 erythrocytes and 1800 leucocytes per cubic centimetre. The latter consisted of small lymphocytes, 665 per cent. ; large lymphocytes and transitionals, 13’per cent. ; and polymorphonuclears, 20 per cent. The patient became comatose A necropsy was made. The and died on April 26th. abdomen contained about 2800 cubic centimetres of pink fluid similar to that removed during life. There was a typical hobnail liver which weighed 1400 grammes. The ,receptaculum chyli and thoracic duct were occluded by a firm fibrous clot. The mitral valves were thickened and insufficient. Very few cases of chylous ascites associated with cirrhosis of the liver have been recorded. The nature of the connexion between these conditions is not clear. were
POISONING
BY OLEANDER.
collected in one part of France, the Vosges, produces a marked physiological effect, whereas in other parts as much as from four to eight grammes are given, while in Roumania so large a dose as from 12 to 15 grammes of the powdered leaves has been given without producing toxic effects. According to Allen3 the leaves of oleander contain two glucosides, oleandrin and neriin, having physiological effects closely analogous to those exhibited by digitalis. Oleandrin is alleged to have basic properties, though it is free from nitrogen, while neriin is not improbably identical with
digitalein. A
-
REDUCTIO AD ABSURDUM PHARMACY ACT.
OF
THE
THE announcement was recently made in the Financial Timcs that a company had been registered to acquire a druggist’s business at Newmarket with a unique directorate. Of the seven gentlemen holding the position of director five are professionally connected with horse-racing; they are A. D. Sadler, S. Loates, and G. Chaloner, trainers of racehorses ; G. H. Martin, jockey; and E. Moore, turf commission agent; the remaining two directors being an auctioneer and a butcher. It is noteworthy that the board of directors is singularly lacking in members possessed of even allied a nodding acquaintance with pharmacy and the The situation of these gentlemen is decidedly sciences. Are we to think that they have been chosen Gilbertian. with a view of bringing their special knowledge to bear on any branch, however remote it might be, of the art of pharmacy. The Financial Times ironically suggests that this may be an application of the joint-stock principle to the medical treatment of horses and that the butcher and auctioneer may come in useful after the other "druggists" have had their innings. It emphasises an anomaly in the Pharmacy Act of 1868, whereby it is possible for limited companies of unqualified persons to practise as druggists and to use the title of druggist. The only safeguard to the public consists in the fact that the assistants employed in the shops of such companies must possess a pharmaceutical qualification in order to sell or to dispense scheduled poisons.
IN THE LANCET of Dec. 30th, 1905, p. 1894, Dr. F. Lucas Benham referred to the poisonous nature of oleander and desired information as to what instances of poisoning by In the event of no records of that shrub are known. its toxic effect being forthcoming there is direct and corroborative evidence sufficient to suggest the symptoms to be expected in cases of poisoning by oleander. It has been shown by M. Dubigadoux and M. Durieu1 that the branches of the Algerian oleander yield on incision a poisonous, milky THE STRAITS SETTLEMENTS POISON juice, from which can be isolated a substance chemically and ORDINANCE, 1905. the to identical with physiologically strophanthin, glucoside COLONIAL legislators frequently have the advantage over which strophanthus owes its activity. The generic name of oleander is Nerium and it belongs, as does strophanthus, to those who make laws for the mother country in that they do the natural order Apocynaceæ or the periwinkle family. To not always have to consider old-established customs or the same order belongs the ouabaio tree, the wood of which vested interests. In the Pharmaceutical Journal of Jan. 6th yields the glucoside ouabain, resembling strophanthin in its are given to the new rules made by the Governor in chemical constitution and physiological action but being Council under Section 13 of the Straits Settlements Poison much more toxic. Apocynum or Canadian hemp, another Ordinance, 1905, which afford a case in point. They include member of this family, contains two active principles several wise restrictions which are not imperative in this which act as cardiac tonics in a similar way to digitalis. country. The new Ordinance contains Schedule A, Parts I. Another member of the family, the white quebracho, is and II., almost similar to Schedule A of the Pharmacy Act, exceedingly active, affecting and, finally, paralysing the 1868, and the same precautions have to be observed in the It is retail sale of poisons in both parts of the schedule as obtain respiration, central nervous system, and heart. evident that the well-known members of the family to in this country. It is noteworthy that sulphonal is included In addition the rules provide that no poison which oleander belongs have a powerful action on the heart. in Part I. Digitalis itself, the best known of the cardiac tonics, is a shall be sold to any person under 18 years of age. member of a closely allied family, the scrophulariaceas. It is Licences to sell by retail the several poisons named and probable, therefore, that oleander also exerts an action on described in Schedule A shall be issued only to such persons the heart. It does not necessarily follow that the plant is as are duly registered as licensed chemists and druggists equally active when grown in other countries-e.g., in South under the Morphine Ordinance (XIV. of 1905). Schedule B Australia. It is well known that drugs vary enormously in is a new and commendable feature of the Ordinance. It respect of their active principles and potency according to includes several poisons which can only be sold wholesale the climate and soil in which they grow. Digitalis affords a by such persons as may be granted a wholesale licence good example of this. It has been shown by M. François under the provisions of the Ordinance. The quantities Franckthat from 0’ 2 to 1’ 0 gramme of the leaves shown opposite each poison in Schedule B shall be deemed minimum amount constituting a wholesale transaction. ———————————————————————————— 1 Journal de Pharmacie et de Chemie, 1898, p. 433. 3 Commercial 2 Archives de Organic Analysis, vol. iii., part 3, p. 137. Physiologie, 1891 and 1892. -
the
analysed
ROYAL COLLEGE
OF
PHYSICIANS
OF
LONDON.
present year to be delivered before of Royal College Physicians of London, Pall Mall as are follows :-The Milroy lectures will be East, S.W., Hamer on March lst, 6th, and 8th, given by Dr. W. H. the subject being Epidemic Disease in England-the Evidence of Variability and of Persistency of Type ; the Goulstonian lectures will be given by Dr. H. Batty Shaw on March 13th, 15th, and 20th, the subject being Auto-intoxiation; the Lumleian lectures will be: given by Dr. D. Ferrier on March 22nd, 27th, and 29th, the: lectures being on Tabes Dorsali; and the Oliver-Sharpey lectures will be given by Dr. E. I. Spriggs on April 3rd and 5th, the subject being the Bearing of Metabolism Experiments upon the Treatment of Some Diseases The days of the week for the delivery of the lectures are Tuesdays and Thursdays and the hour of delivery is 5 P.M. THE lectures of the
the
,
.
.
,
,
sample of the water and had found it to be very dirty and full of mouldy growths and that it gave an appreciable deposit. The British Pharmacopoeia redistilled water be to colourless, tasteless, and odourquires less and when evaporated it should leave " at most a scarcely visible residue." Clearly the sample in question did not conform to these requirements and, legally speaking, any substance defined in the Pharmacopoeia is a drug. The defence was that it was assumed that the water was required for photographic purposes but no question on this point was asked at the time the purchase was being made. The defence was hardly justifiable since it is essential in photographic processes to employ distilled water and it is hardly likely that photographers would incur the expense of procuring distilled water if ordinary tap water would answer the same purpose equally well. The defendant was fined 10s. with E33s. costs, the magistrate remarking that it was not suggested that he had done anything fraudulent or that reflected on his character.
PARISH MEDICAL OFFICERS IN AUSTRIA.
correspondent of the Standard, in the issue THROMBOSIS OF THE RECEPTACULUM CHYLI AND CHYLOUS ASCITES IN CIRRHOSIS journal of Jan. 20th, gives a grim account of the
THE Vienna
of that
OF THE LIVER. of parish medical men in Austria. The total number of these officials in Lower Austria is, he says, 450. IN the liledieal News (New York) of Nov. 11th, 1905, Of these, only 340 are able to keep themselves respectably. Dr. H. J. Nichols has reported a case of cirrhosis of the Only 170 can educate their children and 145 can only live by liver complicated with thrombosis of the receptaculum and chylous ascites. Cases have been recorded of taking extra work themselves or by their wives doing the same thing. That is to say, the medical men act as wine thrombosis of the thoracic duct near its junction with the merchants on commission or take some similar post and subclavian and jugular veins but not of thrombosis at a The patient was a man, aged 74, years, their wives do needlework or act as post-mistresses or lower level. of He was admitted to ho-pital on More than half addicted to the medical alcohol. manageresses shops. men in question are compelled to send their children March 18th, 1905. The abdomen was distended and out to work. The average salary is about C25 per annum tympanitic and covered with a network of enlarged veins and although some get more yet others get less. The which extended to the lower part of the chest. In these fee for vaccination is 2d., which includes the vaccina- the blood flowed from below upwards. At the bases of tion, filling up two certificates, and attendance for eight the lungs resonance was impaired and a few liquid days. The correspondent continues : " For death certi- râles were heard. The heart was slightly enlarged to ficates he does not get even the English shilling nor for tie left ard a mitral systolic murmur was heard. The legs
position
chyli
244 oodematous. The liver dulness extended in the nipple line from the fourth to the seventh ribs. There was some dulness in the flanks. Incisions were made in the legs and saline purgatives and infusion of digitalis were given without relief. The legs became more distended and the abdomen more swollen, with marked dulness in the flanks, fluctuation, and dyspnoea. On March 28th paracentesis was performed and yielded 5700 cubic centimetres of fluid. The abdomen became lax and the oedema disappeared. The fluid reaccumulated. On April 6th 6200 cubic centimetres were removed and on the 16th 7800. On each occasion the fluid presented the same striking appearance. It was milky white, with a tinge of pink. On standing the pink colour disappeared and a red deposit formed. The fluid contained 1 per cent. of albumin and 1’3 par cent. of fat. Microscopic examination showed no large fat globules but a number of fine granules in constant motion. There were 24,000 erythrocytes and 1800 leucocytes per cubic centimetre. The latter consisted of small lymphocytes, 665 per cent. ; large lymphocytes and transitionals, 13’per cent. ; and polymorphonuclears, 20 per cent. The patient became comatose A necropsy was made. The and died on April 26th. abdomen contained about 2800 cubic centimetres of pink fluid similar to that removed during life. There was a typical hobnail liver which weighed 1400 grammes. The ,receptaculum chyli and thoracic duct were occluded by a firm fibrous clot. The mitral valves were thickened and insufficient. Very few cases of chylous ascites associated with cirrhosis of the liver have been recorded. The nature of the connexion between these conditions is not clear. were
POISONING
BY OLEANDER.
collected in one part of France, the Vosges, produces a marked physiological effect, whereas in other parts as much as from four to eight grammes are given, while in Roumania so large a dose as from 12 to 15 grammes of the powdered leaves has been given without producing toxic effects. According to Allen3 the leaves of oleander contain two glucosides, oleandrin and neriin, having physiological effects closely analogous to those exhibited by digitalis. Oleandrin is alleged to have basic properties, though it is free from nitrogen, while neriin is not improbably identical with
digitalein. A
-
REDUCTIO AD ABSURDUM PHARMACY ACT.
OF
THE
THE announcement was recently made in the Financial Timcs that a company had been registered to acquire a druggist’s business at Newmarket with a unique directorate. Of the seven gentlemen holding the position of director five are professionally connected with horse-racing; they are A. D. Sadler, S. Loates, and G. Chaloner, trainers of racehorses ; G. H. Martin, jockey; and E. Moore, turf commission agent; the remaining two directors being an auctioneer and a butcher. It is noteworthy that the board of directors is singularly lacking in members possessed of even allied a nodding acquaintance with pharmacy and the The situation of these gentlemen is decidedly sciences. Are we to think that they have been chosen Gilbertian. with a view of bringing their special knowledge to bear on any branch, however remote it might be, of the art of pharmacy. The Financial Times ironically suggests that this may be an application of the joint-stock principle to the medical treatment of horses and that the butcher and auctioneer may come in useful after the other "druggists" have had their innings. It emphasises an anomaly in the Pharmacy Act of 1868, whereby it is possible for limited companies of unqualified persons to practise as druggists and to use the title of druggist. The only safeguard to the public consists in the fact that the assistants employed in the shops of such companies must possess a pharmaceutical qualification in order to sell or to dispense scheduled poisons.
IN THE LANCET of Dec. 30th, 1905, p. 1894, Dr. F. Lucas Benham referred to the poisonous nature of oleander and desired information as to what instances of poisoning by In the event of no records of that shrub are known. its toxic effect being forthcoming there is direct and corroborative evidence sufficient to suggest the symptoms to be expected in cases of poisoning by oleander. It has been shown by M. Dubigadoux and M. Durieu1 that the branches of the Algerian oleander yield on incision a poisonous, milky THE STRAITS SETTLEMENTS POISON juice, from which can be isolated a substance chemically and ORDINANCE, 1905. the to identical with physiologically strophanthin, glucoside COLONIAL legislators frequently have the advantage over which strophanthus owes its activity. The generic name of oleander is Nerium and it belongs, as does strophanthus, to those who make laws for the mother country in that they do the natural order Apocynaceæ or the periwinkle family. To not always have to consider old-established customs or the same order belongs the ouabaio tree, the wood of which vested interests. In the Pharmaceutical Journal of Jan. 6th yields the glucoside ouabain, resembling strophanthin in its are given to the new rules made by the Governor in chemical constitution and physiological action but being Council under Section 13 of the Straits Settlements Poison much more toxic. Apocynum or Canadian hemp, another Ordinance, 1905, which afford a case in point. They include member of this family, contains two active principles several wise restrictions which are not imperative in this which act as cardiac tonics in a similar way to digitalis. country. The new Ordinance contains Schedule A, Parts I. Another member of the family, the white quebracho, is and II., almost similar to Schedule A of the Pharmacy Act, exceedingly active, affecting and, finally, paralysing the 1868, and the same precautions have to be observed in the It is retail sale of poisons in both parts of the schedule as obtain respiration, central nervous system, and heart. evident that the well-known members of the family to in this country. It is noteworthy that sulphonal is included In addition the rules provide that no poison which oleander belongs have a powerful action on the heart. in Part I. Digitalis itself, the best known of the cardiac tonics, is a shall be sold to any person under 18 years of age. member of a closely allied family, the scrophulariaceas. It is Licences to sell by retail the several poisons named and probable, therefore, that oleander also exerts an action on described in Schedule A shall be issued only to such persons the heart. It does not necessarily follow that the plant is as are duly registered as licensed chemists and druggists equally active when grown in other countries-e.g., in South under the Morphine Ordinance (XIV. of 1905). Schedule B Australia. It is well known that drugs vary enormously in is a new and commendable feature of the Ordinance. It respect of their active principles and potency according to includes several poisons which can only be sold wholesale the climate and soil in which they grow. Digitalis affords a by such persons as may be granted a wholesale licence good example of this. It has been shown by M. François under the provisions of the Ordinance. The quantities Franckthat from 0’ 2 to 1’ 0 gramme of the leaves shown opposite each poison in Schedule B shall be deemed minimum amount constituting a wholesale transaction. ———————————————————————————— 1 Journal de Pharmacie et de Chemie, 1898, p. 433. 3 Commercial 2 Archives de Organic Analysis, vol. iii., part 3, p. 137. Physiologie, 1891 and 1892. -
the