682 THE ASIATIC SOCIETY OF BENGAL : MEDICAL SECTION.

THE ASIATIC SOCIETY OF BENGAL:MEDICAL SECTION.

Leprosy Cases Treated by Sodium Gynooardate andChaulmoograte Intravenously.

A MEETING of this section was held on Sept. 12th, Lieu-tenant-Colonel Sir LEONARD ROGERS, I.M.S., Vice-President,being in the chair.

Sir LEONARD ROGERS showed 12 cases of Leprosy, togetherwith coloured drawings, photos and lantern slides of casestaken before and after treatment with sodium gynocardateand chaulmoograte intravenously. In February, 1916, hehad recorded in THE LANCET promising results in thedisease by the use of gynocardates orally and subcutaneously,and in October of the same year he described in the BritisAMedical J’ozcrnal the intravenous use of the same drug. Hehad now had a further year’s experience and had treated anumber of advanced cases for sufficient time to eliminatetemporary spontaneous improvement and to allow a fairlydefinite opinion to be formed regarding the value of the newtreatment. He had also found that the soluble sodium saltsof the higher melting point acids (490 to 620 C.) were moreactive in leprosy than the lower ones (370 to 40° C.), whichhe had at first mainly used, thus effecting a furtherconcentration of the active portion of the oil. Thishad resulted in considerably more rapid improvement incases during the last six months than he had formerlyobtained. As, according to Hooper, the term gynocardicacid was first applied by Moss to a mixture of fattyacids with a melting-point of 29° C, obtained fromtrue chaulmoogra oil of the seeds of Taraktogenos kurziiand the higher melting-point acids recently separated con-tained chaulmoogric acid (and probably also some hydno-carpic acid), the salts now being used for intravenous andsubcutaneous injection in leprosy cases might be more

correctly termed for the present sodium gynocardate andchaulmoograte with given melting-points until pure sub-stances could be isolated and tested. Dr. Sudhamoy Ghosh,D.Sc., was continuing his chemical investigations of the oilfrom Taraktogenos kurzii, which alone had been used in thecases shown, the Indian Research Association having kindlycontinued their grant for this purpose through the lateSir Pardey Lukis. More favourable results were firstobtained with preparations of fatty acids with a melting-point of from 49-51° C., which proved more active andreliable than those of from 370 to 40° C. melting-point, andat present one with a melting-point of 540 C. was being usedwith favourable effects. Messrs. Smith, Stanistreet and Co.,of Calcutta, were now making the higher melting-point pre-parations in place of the less active lower melting-pointones they previously supplied at the speaker’s suggestion. A3 per cent. solution was made, with the addition of 1/2 per cent.sodium citrate (to prevent clotting in the vein after injection,which was more likely to occur with the higher than withthe lower melting-point preparations), and after sterilising inan autoclave 1/2 per cent. carbolic acid was added, or thecarbolic acid might first be added and the solution heatedon a water-bath to 100° C. for 20 minutes. The doses were

gradually increased by ; to 1 c. c. at a time, beginning with1 c.c. and pushing it up to 4 or 5 c.c., as long as severegiddiness was not produced, the injection being made slowlywhen given intravenously. In addition, 2-grain pills or tabletswere given by the mouth after meals on the days the intra-venous injections were not made, beginning with 3 pills aday and increasing by one daily until 10 or 12, or even as manyas 20, pills were taken each day provided the digestion wasnot disturbed. Many of the cases had been successfullytreated by intravenous injections once or twice a week withoutthe pills, but progress was more rapid with the combinedmethod, although it was more expensive. By the intravenousmethod alone cases could be treated for a year at a cost ofonly two to three shillings each for the drug. The treatmentmust be continued for long periods, usually a year or over,although one early tubercular case cleared up in five monthsand had remained free for six months after cessation oftreatment, while in another the tubercles and the bacillidisappeared in six months, but the patient had been lostsight of It was probable that progress would be more rapidwith the new higher melting-point preparations, which hadonly been in use for a few months. With the more painfulsubcutaneous method a number of patients ceased attendingbefore they had derived much benefit, but with the almost

painless intravenous one this was seldom the case. Themost striking feature of the intravenous method was theoccurrence of febrile and local reactions, the thickenedtissues becoming swollen and soft and sometimes discharg-ing numerous broken-down bacilli. These reactions were

always followed by more rapid improvement and had neverdone any harm. The apparent local destruction of thebacilli through an intravenous injection of a vegetable sub-stance was a most remarkable and encouraging sign. Verylarge nodules might be treated with advantage by injectinga few drops of a 1 in 1000 solution into them occasionally.The following table summarised the results of the treatmentLeprosy Cases Treatecl with S’ubcutaneous and Intravenous

Injections of Sodium Gynocaràate and Chaulmoograte.

of all the cases who attended for three months and upwardsduring the last two years, including both the subcutaneousand intravenous methods. A fuller account of the treat-ment, with brief notes of all the cases and some colouredillustrations and photos, is to be published in an earlynumber of the Indian Journal of Medical Research. By" lesions disappeared" was meant the complete subsidenceof the macules or nodules with disappearance of the

leprosy bacilli, as shown by microscopical examination ofsmears and sections from the most likely looking places, intubercular cases, and the disappearance of the discolouredpatches and of the loss of sensation in the anxsthetic ones.The cases so classed included 7 tubercular and 3 anaestheticcases, comparatively few of the latter type having beentreated. The previous duration of the disease before treat-ment varied in the recovering cases from 2 to 6 months intwo cases, 1 to 2 years in three, and in the remaining twocases 3 and 10 years respectively. It was still too early tosay if the results would be permanent or to speak of cures.The speaker concluded that the problem of finding a com.pletely satisfactory treatment of leprosy was not yet solved,but he thought that some progress had been made in the rightdirection by his investigations, which were being continued.

New Inventions.A PORTABLE ANESTHETIST’S SCREEN.

THE need for an adaptable method of shutting off theanxsthetist and the difficulty in so doing with the towel rodsand supports obtainable, suggested the one here illustrated.The sketch needs little description. A trouser-press form ofclamp attaches it to a leg of the operating table; a telescopic

____;ut-__________f 1a nv3 ..

tube permits the desiredheight and angle to beobtained. The towel baris hinged, so that in

operations on the neckor axilla the towel screenmay be brought roundand the operation fieldabsolutely shut off from

, B, Scrfw; c, clamp; n, binge ; the anaesthetist. The costT, table-leg; x, hinge (with lateral of material is small, andmovement); Y, fixed joint z, clamp. it; can be made by any

netal-worker. The one illustrated was made in the workshopit the Military Orthopaedic Hospital and is in use in the opera-ting theatre there. CHARLES T. W. HiRSCH,

Temporary Captain, R.A..M.C.; Anaesthetist, MilitaryHyde Park Gate, S.W. Orthopaedic Hospital. Shepherd’s Bush. I