450 , Recent Literature

RECENT LITERATURE.

CRITICAL SUMMARIES AND ABSTRACTS.

MEDICINE.

By JOHN D. COMRIE, M.A., B.Sc., M.D., F.R.C.P., Lecturer on History of Medicine, University of Edinburgh.

Wassermann Reaction.

The literature concerned with the presence of the Wassermann

reaction in diseases other than syphilis has been collected and

analysed by Marchildon (Interstate Med. Journ., September 1912). It has generally been assumed that this reaction is quite pathogno- monic of syphilis, but since Much and Eichelberg (Med. Klinik, No. 18, 1908) showed that it-was commonly present in scarlet fever?their results gave 45 positive reactions in 100 cases?other workers have accumulated statistics bearing upon its reliability as a specific test. For example, Brack and Cohn found the reaction

present in 8 out of 28 scarlet fever cases examined at the height of this disease. Most of those who have experimented with regard to scarlet fever have found that either twice as much of the patient's serum as usual was required for a positive reaction, or the reaction was given only with some extracts used as antigen and not with others, or

the reaction was a fleeting one, which disappeared when the patient recovered. Similarly in pulmonary tuberculosis Weil and Braun out of 21 cases got 2 positive results, while Boas among 49 extensive cases of this disease found 3 that reacted positively. The writer had obtained

two positive results in very advanced cases of pulmonary tuberculosis in which he had no reason to suppose that syphilis was also present. In

typhoid fever, frequently in malaria, sometimes in malignant tumours, especially tumours of the nervous system (sarcoma, psammoma, fibroma, etc.), and also in lead-poisoning, after anaesthesia, in leprosy, and in

eclampsia, positive results have been recorded. The writer of the

article concludes, as the result of his own observations and those of

others, that while a positive Wassermann reaction sometimes occurs in the tropical diseases mentioned, it is not the rule even in these

conditions; and in a non-tropical clmate the unusual occurrence of these does not lessen the practical value of the test. In scarlet fever

the reaction disappears so quickly that this disease need not be con- sidered as a fallacy. Thus though the test may be given apart from

syphilis, it must, for practical purposes, be considered characteristic of that disease.

Medicine 451

Hereditary Cranio facial Dysostosis.

A new type of dystrophy in the cranio-facial bones is described by Crouzon (Presse med., 7th September 1912) under the name of heredi- tary cranio-facial dysostosis. This record concerned two cases, mother and son, who presented a great frontal boss with transversely running crest, prognathism carrying the lower jaw several centimetres to the front, and a very much hooked nose ; they also showed marked external strabismus and enlargement of the thyroid gland. Two collaterals, first cousins of the son, showed a slight crest of the frontal bone. The

writer regards his cases as belonging to the group of teratological anomalies which are to be found in certain families, passing through a great number of generations, like the prognathism of Charles V.

and his descendants, and often found with such stigmata of degenera- tion as hare-lip and infantilism. The exophthalmos and divergent strabismus, which were very noticeable in these two cases, he attributes

simply to osseous malformation of the orbital walls.

Treatment of Epilepsy.

Five years' experience in the treatment of epilepsy by the salt

deprivation method is detailed by Ulrich (Munch, med. Wochenschr , 3rd September 1912), the director of the institution for epileptics at Ziirich. Few physicians, he states, have pursued this form of treatment for more than a few months at a time, and therefore he records the results attained by the administration of bromide in the absence of salt from

the diet over a period of five years. The cases are given in full detail, but the features of one may be taken as typical of all. The epileptic attacks had in this case lasted for 30 years, during which the total number of seizures had been about four thousand. During at least sixteen years bromide treatment had been carried out to the extent

of one and a half to two drachms of this drug daily. There had been

no improvement?indeed the number of attacks was rising, and in 1907, when the patient was on bromide only, there were 20/ attacks; while after the salt-free diet was combined with bromide administra-

tion the attacks fell to 37 in 1908, 51 in 1909, and none at all in 1910. In another patient aged 31 there had been 3300 attacks in 12 years of bromide treatment. Starting a salt-free diet in 1907 she had only 152 seizures as against 226 in the previous year. Next year they fell to 39, and then for two years she had complete freedom. In several other

cases there was either a complete stoppage of the fits or a reduction of their number by about 50 per cent, when the salt-free diet was instituted. Maier (ibid.) describes the results obtained both with these cases and with others in a psychiatric clinic by using a soup made from "Sedobrom" tablets. These contain each about 16 grains of bromide of soda, a very

452 - Recent Literature

little salt, and sufficient extractive and fat to taste like a strong meat

soup when dissolved in 100 c.c. of water. Two of these tablets were

given night and morning and were well borne. The rest of the food

was made as poor in salt as possible.

Electro-Magnetic Treatment of Cancer.

Various forms of radiation have been tried of recent years in cancer

and rodent ulcer, sometimes with benefit, sometimes with none.

Spude (Munch, med. JVochenschr., 30th July 1912) describes a method of combined electro-magnetic application with arsenic which he has

found successful in healing up two cases. One case was that of a

cancer affecting the inner canthus of the eye. The other cancer was

situated in the centre of the forehead. The method consisted in the

injection of a suspension of black oxide of iron directly into the

tumour near its margin, and the subsequent application of an electro- magnet over its surface. After 60 seances spread over 4 months the eye tumour had become covered with healthy epithelium, but a mass remained until the writer also began intravenous injections of atoxyl at intervals of 4 to 8 days. After 5 weeks of this combined treat-

ment the tumour completely disappeared. In the other case the iron

and arsenic were both injected locally, the main mass of the tumour was removed with the sharp spoon, and complete disappearance had taken place in about thirty weeks.

Effect of High Voltage Currents on the Brain.

The large number of accidents that now constantly take place from the escape of industrial electric currents make the communica-

tion by Spitzka and Iiadasch upon the brain lesions caused by electricity as observed after legal electrocution (Amer. Journ. Med. Sci., Septem- ber 1912) of great interest. The brain and cord had been removed

from the bodies of five criminals executed by electricity, and had been immersed in formalin within 15 minutes after death. The lesion was

a very striking one of the same character in all the cases. Sections

both of the brain and of the cord showed circular areas, ranging from 25 to 300 /x. in diameter and mostly from 150 to 200 [x. These con-

tained a central rarefied and a peripheral condensed zone, while in

most was situated a small blood-vessel surrounded by a delicate small- meshed reticulum representing the central four-fifths of the area with its fibrils in the main directed radially. The peripheral zone stained more deeply than the surrounding tissue and appeared to be con-

densed. Where a blood-vessel ran longitudinally in the sections it

appeared surrounded by a series of these circular areas strung on it like a row of beads. This is very evident in the photo-micrographs that accompany the article. The writers conclude that the bead-like

Medicine 453

arrangement of the lesions along the blood-vessels, the condensation zone limiting each lesion, and the radially-arranged fibres and torn tissue would seem to indicate a sudden liberation of bubbles of gas, due to the electrolytic properties of the current as it seeks the path of least resistance along the v essels. To this escape death appears to be due. The currents used were mostly of about 1800 volts and 9 or 10

amperes.

Blood-Pressure in Renal Disease.

The relation of arterial hypertension to urinary excretion is dealt with by Lawrence (Amer. Journ. Med. Sci., September 1912). He first

gives a general review of the opinions expressed by observers of note

upon the subject. Bright's theory of a poison circulating in the blood and stimulating the heart to increased activity and hypertrophy is

opposed to Traube's idea that the increased tension and consequent cardiac hypertrophy are due simply to the mechanical effect of the blockage set up by destruction of vessels in the diseased kidneys. The generally accepted view of Cohnheim is a combination of these, whereby the changed character of the blood is supposed to set up con- traction of the renal vessels, so that to maintain the circulation through the kidneys an increase of pressure with consequent hypertrophy becomes necessary. Experimental evidence, however, raises objections to the idea that the increased pressure is of a beneficent purposive nature; thus Senator showed that ligature of the renal artery or

extirpation of the kidney does not produce a general rise of pressure, while other observers have found that an artificial increase of the general

blood-pressure does not cause an increased blood-flow through these

organs nor an increase of the urinary secretion. Clinically, too, it is observed that when the blood-pressure is very high in acute Bright's disease or in uremia a beneficial effect is produced by administering drugs to lower this. The writer accordingly undertook the observa- tion of 20 patients suffering from cardio-renal disease with a blood-

pressure over 180 mm. of mercury so as to determine the effect upon the kidney function of artificially varying the pressure. In all 205

observations were made.' Three cases, all of patients in the last stages of cardio-renal disease, showed a lessened urinary output when the

blood-pressure was lowered, while on the contrary 12 cases showed an increase in urine and urinary solids when the systolic pressure was lowered by the administration of nitrites For example, one patient with a systolic pressure of 230 mm. secreted 90 c c. of urine in one

hour, while after lowering of the blood-pressure by sodium nitrite to 190 mm. he secreted 485 c.c. of urine in one hour. The writer, how-

ever, came to the general conclusions that (1) no definite relation can be established between changes in the systolic or diastolic pressure per se and a change in urinary output; (2) when, however, the pulse

454. , Recent Literature

pressure increases in the presence of a falling systolic pressure {i.e. when diastolic pressure falls more than systolic pressure) there is a

diuresis.

Tubercle Bacilli in Blood-Stream.

Several workers have recently published the results of their investi-

gations upon the presence of tubercle bacilli in the blood. For

example Hilgermann and Lossen (Deutscli. med. IVochensr.hr, No. 19,

1912) examined the blood in 64 ca-es of pulmonary tuberculosis and found the bacilli present in the blood of 17, i.e. about one-quarter of all the cases. These were not by any means cases of the most advanced

type, but in some instances were at an early stage of the disease.

There was no apparent relationship betvvt en rise of temperature and the finding of the bacilli, and their presence is not to be regarded as a sign of the onset of miliary tuberculosis. Nevertheless the disease

appears to run a more unfavourable course in those whose blood con-

tains bacilli than in those the examination of whose blood is negative.