1229

a protection against women not qualified to attend them. a

Similar protection in pathological troubles is not vouchsafed qto the other members of the public or to women not in child- a

birth. Other unqualified practice of medicine and surgery Iremains uncontrolled and women in childbirth can employ r

"men midwives" who are unregistered, so long as these men I’ do not pretend to be on the Medical Register.

EXOPHTHALMOS IN CHRONIC NEPHRITIS.

IN the Amzeriean Joqtrnal of the Medical Sciences for

October Professor L. F. Barker of the Johns Hopkins IUniversity and Dr. F. M. Hanes have called attention to a Iremarkable sign of chronic nephritis which does not appear a

to have been previously noticed-exophthalmos. During the a

first four months of the present year 33 patients suffering 1from chronic nephritis were admitted to the Johns Hopkins sHospital, and exophthalmos was found in 16 (48’ 4 per tcent.). The exophthalmos varied much in degree as did the (

gravity of the nephritis. In cases showing evidence of tserious intoxication (ursemic or suburasmic symptoms)exophthalmos was most frequent and was combined withone or more allied ocular signs-anisocoria, von Graefe’s, jMoebius’s, or Stellwag’s sign. Exophthalmos was an

obvious sign in all the patients who died from chronic

nephritis in the hospital since Jan. lst, 1909. Also

in the cases in which albuminuric retinitis was presentduring this period exophthalmos, with one or more

of the other ocular signs, was always present. All theseclassical signs of Graves’s disease may be present in chronicnephritis without any apparent affection of the thyroid gland.Professor Barker and Dr. Hanes therefore conclude that in

both diseases a chronic intoxication affecting the sympatheticnervous system causes the ocular manifestations. In 12 out

of the 16 cases there was high blood pressure (above160 millimetres), but its absence in the other cases showsthat the exophthalmos cannot be ascribed to it. Evidentlyboth conditions are due to chronic intoxication. The

following are two of the cases. A painter, aged 51 years,and addicted to alcohol, was admitted on Jan. 15th, 1909,complaining of severe pain all over the body and head-ache. In 1901 he was treated for lead poisoning andperipheral neuritis. He was subject to severe headachesas long as he could remember. His sight had been failingfor the last five years and for the last two years he had

suffered from attacks of palpitation and orthopncea. He

passed large quantities of urine by day and night. He was

thin and anaemic, and his skin was dry and harsh. The eyeswere prominent and staring. The heart was slightly en-larged and the arteries were sclerotic. Ophthalmoscopicexamination showed albuminuric retinitis, oedema, exuda-

tion, and haemorrhages. The urine was pale, of specificgravity 1012, and contained albumin, many granular casts,and pus and epithelial cells. On the day after admissionconvulsions occurred, and on the following day the patientdied. At the time of death the exophthalmos was much lessmarked. The necropsy showed advanced acute and chronicdiffuse nephritis, oedema of the brain, hypertrophy of theheart, broncho-pneumonia, pleural cedema, and acute peri-carditis. In another case a metal polisher, aged 46 years, wasadmitted on March 4th, 1909, complaining of shortness of ’,breath and pain in the back and left side. His illness beganfour weeks before with dyspnoea and palpitation. He got upsix or eight times at night to pass urine. His legs were some-times swollen in the mornings. He was well nourished,The eyes were very prominent and the conjunctivas wereslightly cedematous. The pupils were small and reacted tolight. Moebius’s and Stellwag’s signs were present. Therewere marked retinal arterio-sclerosis and typical albuminuricretinitis. The heart was enlarged and marked general

arterio-sclerosis was present. The urine was increased in

quantity, pale, of specific gravity 1012, and contained

albumin and hyaline and finely granular casts. The blood

pressure was high, ranging from 200 to 230 millimetres ofmercury. The patient’s family’ said that his eyes had grownprominent in the last eight months.

PROFESSOR OSLER’S ADVICE TO LONDONSTUDENTS.

ON Oct. 15th Professor William Osler visited the London

Hospital to declare open the new laboratories for chemistry,physics, and pathology, which have been erected_ recentlyat a cost of some 8000. He was received by the Principaland the Vice-Chancellor of’ the University of London.Mr. Sydney Holland, chairman of the hospital, and thestaff and lecturers of the hospital, who conducted himthrough the new laboratories, after which the openingceremony was held in the Physiological Laboratory underthe presidency of Dr. Leonard Hill. Professor Osier deliveredan address which was’ divided between the praise of

research and the’impeachment of the University of Londonfor not having found a way to’ provide a readily accessibleM.D. degree for the industrious London student. Of researchhe said that every student should cultivate it without thoughtof examinations, and that he should regard it as the com-plement of his clinical studies and not as a thing apart. Of

the University of London he declared that there was " some-thing rotten in the State," and reminded his hearers that"the Lord helps those who help themselves." In a

word, the students should organise and agitate in a

constitutional manner, and then they would get their

degree within a year or two. The Vice-Chancellor,who replied to Professor Osler, threw the blame on

the Taculty of Medicine with its 400 teachers, which,although the University had been reconstituted for nine years,had not sent up a definite proposal on the subject that couldbe considered by the Senate, a quarter of whose membershad medical qualifications. He supported Professor Osler,however, in his advice to the students to organise to dealwith the matter. The proceedirigs were brought to a con-clusion by the delivery, in the library, of Professor Osler’sSchorstein address on the Relation of Aneurysm to Syphilis.

BRITISH RADIUM.

THE announcement that radium is to be both quarried andrecovered from its ore in England must be regarded withsatisfaction. We believe, however, there are still mines in

Cornwall from which a comparatively rich pitchblende is sentto Germany for the extraction of its radium. The foundation-stone of the radium and uranium works of the St. Ives

Consolidated Mines, Ltd., and the British Radium Corpora-tion, which are to be erected in Limehouse, was laid by

, Lady Ramsay on Saturday, Oct. 16th. ’It appears that some: stimulus has been given to the enterprise by Sir William: Ramsay’s discovery of a process which will considerably: diminish the time taken to recover radium from its ore.

Hitherto the process has involved some months’ working,i whereas now it is stated that it can be done in as many or,

even less number of weeks. This is a step of considerablel importance, having regard to the, infinitesimal quantity of. radium present in the raw material. Sir William Ramsay. said that when his attention had been called to the occur-

rence of pitchblende in Cornwall he did not foresee that the demand for radium would be great, while he also thoughtþ that the difficulty of supplying it would be. considerable.i With the formation of a radium institute he felt bound to) withdraw his former opinion. The, question whether sub-l sequent investigation’ will show radium to’-be of still greater

1230

value in medical science must remain open. So far theresults had been encouraging, and the success which hasattended the application of radium rays in some diseases israpidly opening up new questions of the greatest interest.But what we may term photo-therapy is still only in its

infancy, and as the analysis of radium rays proceeds it is

just possible that rays of the nature of radium rays may beobtained by mechanical means, in which case we shouldnot be so dependent upon radium, That would be an un-doubted advantage, seeing what small quantities of radiumare available and what labour is involved to separate them.

THE LATE PROFESSOR LOMBROSO.

Professor Cesare Lombroso, who died suddenly from heartdisease on Tuesday last at his residence in Turin, had aworld-wide reputation as the author of works which havegreatly exercised the minds and pens of criminologists,psychologists, social reformers, and other students of humandegeneracy in its various aspects. Of Jewish descent, hewas born at Verona in 1835, took a medical degreeat Padua, and served in the Italian campaign againstAustria in 1859. His literary career commenced at a veryearly age, and was for more than 40 years extremelysuccessful, although the somewhat fantastic ideas embodiedin several of his works have gained but few adherents in

England. His "L’Uomo Delinql1ente" and" L’Uomo di

Genio " contain a full presentment of his anatomical, patho-logical, and atavistic theories of crime and genius.

A TYPHOID CUTANEOUS REACTION.

IN 1907 von Pirquet described his tuberculin cutaneous

reaction, which was soon after followed by the announce-ment of the tuberculin conjunctival reaction by Calmette.Inspired by these discoveries Professor Chantemesse investi-gated the effect of the toxins of the typhoid bacillus on theconjunctiva in typhoid fever and discovered a typhoidreaction analogous to the tuberculin reaction. Calmette’sreaction proved a trustworthy test for the diagnosis of tuber-culosis, but in some cases the reaction proved severe andeven provoked ulceration of the cornea. Hence it has beento a large extent abandoned in favour of the safer cutaneousreaction. In the University of Pennsylvania Medioal Bulletinfor August Dr. S. J. Deehan has described a typhoid cutaneousreaction analogous to the tuberculin cutaneous reaction whichpromises to be useful in the diagnosis of typhoid fever. Heundertook the investigation because the dangers of thetuberculin conjunctival reaction suggested to him that thetyphoid conjunctival reaction might also be dangerous. His

technique was as follows. A strain of virulent typhoidbacilli was grown on agar-agar for 24 hours. The bacilliwere then washed from the medium with normal saline

solution and shaken up in a test-tube so as to distribute

them and break up the clumps. The fluid was incubatedfor four days at 37 ’ 50 C. At the end of this time it became

partly clear from sedimentation of the bacilli, which weremore or less disintegrated. The fluid was then sterilised

at 60° C. for half an hour, and centrifugalised for

from two to six hours. The clear supernatant fluid was

pipetted off into sterile tubes. The number of bacilli

per cubic centimetre was determined by Wright’s methodof standardising vaccines. A solution of the strengthof three billions of bacilli to the cubic centimetre wasfound to give the best results. The fluid was tested bycultures to ensure its sterility-a point of great importance.This fluid contained the toxin of the bacilli. The morevirulent the bacilli used and the less they were modified bycultivation, the more powerful the extract. The fluid retainedits strength for several weeks and then gradually grew

weaker until nearly inert. The cutaneous reaction was

obtained as follows. A drop of the fluid was placed on theskin, and then with a lancet a slight abrasion was made

under the drop. Only the most superficial layers of the

epidermis need be removed, as it is necessary only to openthe superficial lymph channels and unnecessary, and even

undesirable, to draw blood. At a distance of about

an inch a control abrasion should be made under a

drop of normal sterile saline solution. There are

three grades of positive reaction : 1. A feeble reaction,which consists of a byperaemic zone 2 to 4 millimetresin diameter, in the centre of which is a papule; theskin is slightly swollen and hard. 2. A medium reaction.The hypersemic zone is 4 to 8 millimetres in diameter andthere are numerous very prominent papules. Sometimes theskin is cedematous throughout the area. The redness maypersist for hours or for one or two days. 3. A strong reoaction-an intensification of the last reaction. The area

of reaction is very resistant to touch and the area of

hyperaemia is 2 to 3 centimetres in diameter. If the sub-

jacent cedematous area is marked there is an appearance ofurticaria. Occasionally at the points of scarification serousfluid exudes. 12 cases diagnosed clinically as typhoid fevergave a positive reaction in from 15 to 24 hours. The day of thedisease on which the test was applied varied from the seventhto the twenty-second. The test did not cause the patientsany annoyance or discomfort. The test was also tried in

eight control cases of various diseases-heart disease,neurosis, acute gastritis, chronic bronchitis, acute rheu-

matism, pulmonary tuberculosis, cardiac asthma, and cancerof the uterus. In none was there the slightest evidence of areaction. Dr. Deehan concludes that the typhoid cutaneousreaction is of considerable diagnostic value and is withoutdanger. It was frequently obtained several days before apositive result with the Widal test could be got, and there-fore in a doubtful case would enable a diagnosis to be madeearlier than by this method. But its greatest value lies in

the fact that it can be performed by the practitioner himselfwithout any laboratory assistance.

THE PHARMACOLOGY OF THE LEECH BITE.

THE leech, it seems, is to take a place among thoseempiric remedies which in these later scientific days havebeen established by the discovery of a rational basis for

their employment. Wiel and Boyé,l in comparing the effectof a true leech-bite with that of the scarification made byan artificial leech, call attention to their observation that

while haemorrhage ceases soon after the removal of the

latter blood continues to ooze from the wound of a leech

long after it has gorged itself and fallen off, in some casesfor as long as 36 hours. Moreover, the clot which forms atthe end of this period is soft and non-adherent, and ifit be lifted off the wound bleeding may start again. A

study of the blood collected from a leech-bite showsthat in its method and rate of coagulation it imitatesthat of the blood in heamophilia, and the likenessis completed by the effect of adding human serum, twodrops of which suffice in both cases to accelerate the

process of clotting. The retardation of clotting was

found to vary in the blood from different leech-bites,and this variation was further shown to depend, not on thepatient, but on the leech. This tallies with the observationsof Haycraft, who found a substance hostile to coagulation inthe head of the leech, contained apparently in certain

salivary glands. This substance, as Weil and Boy6 show,exercises its influence mainly, but not solely, at the spotbitten ; the coagulation time of the blood from remote

1 La Semaine Medicale, 1909, No. 36, p. 421.