THE KING'S FUND AND LONDON HOSPITALS

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help when given by mouth we are reminded byWendt that in sodium thiosulphate (Na2 S2 Oa-5H2O)we have a detoxicating substance that has provedinvaluable in certain types of skin sensitisation.

Though it is used in this country, under variousproprietary aliases, in the treatment of arsenical(N.A.B.) and bismuth or mercury poisoning, toolittle recognition is perhaps given to its powers as anantidote to poisoning by heavy metals, including leadand antimony as well as arsenic (apart from itstrivalent and pentavalent compounds). FollowingRavaut, whose work is little known outside France,Wendt goes further and recommends the treatment of

allergic reactions by intravenous injection of sodiumthiosulphate. There are no risks in its administration,he says, provided extravenous leaks are avoided, andthere are no contra-indications. Doses of 0-3 to 1-0

gramme are given in 10 c.cm. of distilled water, andcan safely be given daily if thought desirable. Wendtmentions and advocates a new product, S-hydril, whichcontains 1-0 g. of the thiosulphate in stable solution.It is injected intravenously, the dose being one, oreven two, of the ampoules daily in severe cases ofallergic dermatitis. It is important to rememberthat the lesions must be allergic in character;primary lesions will not respond. Thus he describescases of secondary dermatitis or tricophytideswhich promptly cleared up after one or two injec-tions ; whereas similar treatment had no beneficialeffect whatever on the primary plaque-the originalringworm infection-which had to be dealt withafterwards by means of the usual applications. An

advantage from the patient’s point of view is thatthe intense pruritus is usually controlled by the firstinjection. Bromide acne is another condition in whichthe drug is said to be useful ; ordinary acne, as

might be expected on the above premise, is notaffected at all. Wendt quotes Wirtz and Treger asclaiming good results in dermatitis herpetiformis, andstates that once seborrhoeic dermatitis has led toeczema (allergy) thiosulphate injections will be foundof the greatest help. Pityriasis rosea, which usuallyruns a definite course of 4-6 weeks, is said to beaborted in a surprising way ; while, most importantof all, the majority of occupational eczemata, oncea secondary symmetrical (allergic) eruption has

developed, can be greatly benefited. (It should

again be emphasised that the original and initiallesions may prove refractory.) If this is a fact it is

certainly worth knowing ; anything that may helpto shorten the period of disability in compensationcases demands careful trial.

PROGNOSIS OF FEMORAL THROMBOSISTHE after-history of a series of patients who had

suffered at some time or other from " white-leg " wasdiscussed by Mr. Reginald Payne on Dec. 10th inthe course of an address to the Harveian Society. He

reported clinical observations on 85 cases, all asso-ciated with a definite setiological factor such as thepuerperal or post-operative state, an acute specificfever, or other acute infection ; in all there was anacute onset with pain, swelling, and oedema in oneor both limbs, and the patient was left with a limbin which the circulatory balance was grossly impaired.In no case in the series was the limb completelyrestored to normal. In 2 cases there appeared tohave been a thrombotic process as judged by thesubsequent development of an abdominal collateralcirculation. In 61 cases the condition seemed to beone of lymphatic obstruction, for either the oedemapersisted in varying degrees or developed again after

1 Wendt, H., Dtsch. med. Wschr. Dec. 3rd, 1937, p. 1832.

use of the limb. In the remaining 22 cases there wasevidence both of venous thrombosis and lymphaticobstruction. On clinical grounds this study supports.the view that in practically all cases of so-calledfemoral thrombosis lymphatic obstruction is the out-standing feature, and the results of abdominal

exploration during the acute phase, and of some

experimental observations, also favour this view.In the lower limb there seems to be no pathologicalprocess quite comparable to primary axillary throm-bosis. These observations have interest in relationto pulmonary emboli. In fatal cases the pulmonaryembolus is usually the first and final manifestation ofthe thrombotic process, and a clinically recognisable"

white-leg " has not usually been present. Mr.

Payne suggests, therefore, that it is the cases of" occult " deep thrombosis which are likely to leadto fatal pulmonary emboli. In the ones with" manifest " lesions thrombosis, if present, is secondaryto lymphatic involvement outside the vein. The clotin these cases is not merely a stagnation thrombus ;it is therefore much more adherent to the vein walland consequently less liable to migrate and causeembolus formation.

THE KING’S FUND AND LONDON HOSPITALS

THE vitality of the voluntary hospitals is remark-able. Their final financial submersion, both indi-vidually and collectively, is annually predicted, but.they keep on rising to the surface, like the cat withnine lives. Taking London as a whole the end ofthe year usually finds income slightly ahead of expen-diture, and if last year for the first time since 1926,it fell slightly behind this was not because incomefell but because expenditure rose-partly because ofincrease in work and partly because prices are higher.In his message to Tuesday’s meeting of King Edward’sHospital Fund the King said that " the enterpriseshown by the hospitals at this time certainly deservesevery support," and it is satisfactory to find the-Fund determined to maintain its distribution to

hospitals at the present high figure of 300,000, ofwhich 30,000 is for schemes of capital expenditureand about 270,000 for maintenance. For the pastthree years the Fund’s income has been E7000 or

8000 a year below the amount distributed, but, asthe president, the Duke of Kent, put it, " we thinkthis is a time when the King’s Fund should do whatit can to help the hospitals with their immediaterequirements rather than adopt a policy of safety-first." Though the income from investments is:S23,000 down, legacies have increased by 37,000 to81,500, and instalments are now being received ofa very large legacy from Mr. Percy Johnson. Whetherthis will go towards endowment or will be distributedto meet the present strain on the hospitals has notyet been decided.

Dr. Charles Newman has been appointed sub-deanat the British Postgraduate Medical School.

IT is announced that Sir Walter Kinnear, latecontroller of the insurance department of the Ministryof Health, and Mr. Thomas Lindsay, an assistantsecretary in the Ministry, are to visit Australia toassist the Commonwealth Government in preparinga scheme of national health insurance.ON Tuesday last the Duke of Gloucester was

formally made president of St. Bartholomew’s Hos-pital, London. At the request of Mr. Girling Ball,dean of the medical college, His Royal Highnesssigned the roll as a " perpetual student " of the hos-pital. This, said the dean, was the highest honour intheir power to offer.