243

time a sterile toxin may be obtained by this method. Dr.

Row concluded with an elaborate comparison between theproperties of this salted toxin and those of Haffkine’s plagueprophylactic. -

APEPSIA.

SINCE the late Dr. S. Fenwick in 18701 described the con-zlition of atrophy of the stomach, a large number of observa-tions have clearly demonstrated that in certain cases the

chemical processes which normally occur in the stomach maybe entirely abolished. Pathological observation has confirmedthe view of Dr. Fenwick that this condition is the result of amore or less complete atrophy of the glands of the mucous,membrane of the stomach. In addition to the name of

6 ‘ apepsie which has been applied to the condition byFrench authors, it has been called "anadenia ventriculi’’

by Ewald, "phthisis ventriculi" by Georges Meyer, and’achylia gastrica" by Einhorn. An interesting and ex-haustive monograph has been published on the subjectby Dr. H. Français.2 In his historical account he states

that the term "apepsia" was introduced by Galen andused by Moliere in his " Malade Imaginaire " ; Rokitanskyin 1843 refers to a stomach showing a marked condition ofatrophy, but undoubtedly the credit of first recognising anddescribing the condition belongs to Dr. Fenwick. Ponfick,in 1873, and Ql1incke in 1876 described examples of gastricatrophy in association with pernicious anaemia. Apart from,records of cases little advance was made from the publica-tion of Dr. Fenwick’s second paper in 1877 until Ewald in1886 proved that hydrochloric acid was absent from the

stomach in these cases. From that time onwards a largeamount of work has been devoted to the chemistry of thegastric contents, among the most important being that ofM. Hayem and his collaborators who have shown the

importance of the organically combined chlorides in regardto gastric digestion and have investigated their quantity inthis condition. Dr. Francais comes to the conclusion thatapepsia is not a pathological entity but a syndrome occurringin association with various morbid states, and characterised

by the abolition of the digestive functions of the

stomach. In the most advanced type examination of the If.gastric contents shows an entire absence of free hydro-chloric acid and of organic combinations of that

acid; in others there may be an absence of free acidbut a certain amount of organically combined chlorine. In iboth groups the digestive power of the juice is found to bewanting as tested by its action on proteins. Dr. Français,describes the condition of chronic apeptic gastritis as thatwith which apepsia is most frequently associated. This

disease is much more common in women and may be a

sequel of any chronic inflammatory process affecting thegastric mucous membrane. Alcoholism, lead poisoning, and- excessive tobacco smoking are all regarded as possible causes,the last condition accounting for a considerable proportionof the cases in men. The pathological anatomy com-

prises various forms of inflammatory and degenerativechanges in the mucous membrane, especially parenchy-matous or glandular gastritis, interstitial or mixed forms of.gastritis, mucous transformation, and complete atrophy.In the last condition, which is that which most formstend to reach, the mucous membrane may have a thickness,not greater than half a millimetre and may consist of little

more than a low cylindrical epithelium on a founda-tion of connective tissue with a few short glandular tubes.Clinically there may be recognised a latent form in whichthe symptoms may be very slightly marked, a form asso-ciated with great pain either shortly after food or from an

1 THE LANCET, July 16th, 1870, p. 78.2 De l’Apepsie, par le Docteur Henri Français. Paris : G. Steinheil.

1906.3 THE LANCET, July 7th (p. 1), 14th (p. 39), and 21st (p. 77), 1877.

hour to two hours later, and a form associated with severediarrhoea. A similar condition of apepsia is not infrequentlyseen in association with cancer, either of the stomach orother organs, with pernicious anaemia, and with certaininfections and intoxications-such as typhoid fever, uraemia.and diabetes. Dr. Frangais, in collaboration with M. Lion,was able to produce experimentally a condition of apepsiain dogs by means of the injection of a gastro-cytolysineprepared from the rabbit, an observation throwing con-siderable light upon the production of the condition throughinfective fevers and intoxications. It is also maintained

by some observers that apepsia may occur in associationwith chronic nerve diseases, such as tabes dorsalis, and withneuroses and neurasthenia. The diagnosis of the conditionof. apepsia is usually easy and depends upon the results ofthe examination of a test meal, but the differentiation of thecondition giving rise to the apepsia, whether gastritis, cancer,pernicious anasmia, or other chronic disease, is often a

matter of great difficulty necessitating a careful considera-tion of the history, symptoms, physical signs, and of theblood count. For treatment Dr. Francais recommends acareful regulation of the diet, avoiding fatty foods, andgiving lightly boiled eggs and meat in small quantity. He

finds that kephir is most valuable in these cases, especiallyin those with diarrhoza, commencing with a diet of kephironly and gradually introducing other food substances. In

cases of gastric cancer with pyloric obstruction kephir is,however, contra-indicated. M. Soupault has obtained goodresults in the cases with diarrhoea from the administrationof dilute hydrochloric acid given with lemon juice in theform of lemonade during the meal.

THE HYGIENIC EFFICIENCY OF GAS FIRES.

AN elaborate series of practical observations on the use ofgas fires for the warming of apartments will be found in apaper read by Mr. John H. Brearley of Longwood before theInstitution of Gas Engineers and published in the Engineerof July 12th. Mr. Brearley considered that the best gas firefor warming a room was the one which gave the greatestproportion of radiation and the products from which werenot allowed to enter the room. As sources of radiation hefound that iron frets were superior to fire-clay " fuel " in theproportion of 136 to 125. Air-heating tubes or chambers atthe back of a fire reduced the radiation. A thin body of"fuel" was essential to a high radiative efficiency. With

regard to the loss of heat carried away with waste products(flue heat) Mr, Brearley said that it varied a great dealaccording to the method in which the fire was connected.The chimney should be allowed to draw a large portion of theair from the room without an excessive" vacuum " in the

stove flue-pipe, as was the case when the whole of the airwhich left the room was drawn through the stove itself. Forthis reason those stoves which were provided with ventilatingoutlets, in addition to the flue-pipe, were to be commended.Where such devices were not used the whole of the chimneyopening should never be blocked up. It was often assumedthat the heating efficiency of a gas-fire stove was increasedby doing this, whereas the reverse was the case. Tests thatwere made for carbon monoxide showed that this sub-stance was either completely absent or else present insuch small traces as to warrant the inference that gasfires did not produce carbon monoxide when properlyconstructed and kept clean. It was known thatwhen a gas flame came into contact with a coldsurface carbon monoxide was produced, but so far as gasfires were concerned this was almost entirely avoidable, andin cases of neglect it could only continue during the first fewseconds after the fire was lighted. Flueless stoves should notbe fixed in rooms which were habitually occupied as muchcarbonic gas escaped from them. These stoves were not so