THE TREATMENT OF ICTERIC SPIROCHÆTOSIS

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  • 1155THE BELGIAN DOCTORS AND PHARMACISTS RELIEF FUND.

    of the new regulations cannot be regarded as havingno criticism to pass upon them. On the contrary,apart from those members of the medical professionwho actively object to the panel system, there aremany--very many-who find the new regulationsfaulty, and it was due to this feeling that theconference was convened by the Federation.The conference kept admirably to the tone set

    by the chairmans brief introductory remarks, inthat small details were not discussed, bickeringswere avoided where principles were not concerned,and a real wish was shown by all the speakers toensure that the medical profession would act inunison with the authorities to secure for the

    public the best form of service. This note wasstruck when both Dr. E. H. M. STANCOMB, theproposer, and Dr. GORDON DILL, the seconderof the essential motion, asked that medical menshould have a freer hand than was providedthrough the regulations as regards the actualmethods by which panel patients receive treatment.Dr. A. LATHAMS remark that the regulations couldhave been as well drawn up in 1913 as in 1919 wasa severe criticism which appeared to meet withcommon agreement in the room, although thiswas tantamount to saying that all the vast advanceswhich have been gained for medicine during thewar are left out of account by the Ministry ofHealth, which takes no larger view of the medicalwants of the community to-day than could havebeen taken had no such advances been made. Asthere is reason to suppose that, when the PrimeMinister has been made aware of the out-come of the conference, he will receive adeputation, we trust that this point will betaken. Sir BERTRAND DAWSON, who is chair-man of the Medical Consultative Council ofthe Ministry of Health, but who attended theconference, of course, as a private individual,assured the audience that the Minister was anxiousto meet the medical profession and to work inharmony with it, and added that his Council weremaking an official inquiry into the best type ofmedical service, a report of which would soon beissued. Both Sir BERTRAND DAWSON and ColonelF. E. FREMANTLE, the Coalition candidate for Mid-Hertfordshire, agreed that a full-time medicalservice was not required, but that a fuller useshould be made of the vast and varying medicaltalent already at the disposal of the country inpublic, private, and mixed capacities. This, through-out, has been the attitude which we have.attemptedto maintain in these columns.The British Federation of Medical and Allied

    Societies have done thoroughly good work byconvening the conference, for the resolutionspassed after well-argued and reasonable speechesshow what is the general feeling of the medical !,profession, and of the bodies allied. By theinvitation of Sir WATSON CHEYNE, representativesof the Federation have met the Committee of

    Medical Members of Parliament on the matters

    at issue.

    Annotations.

    THE BELGIAN DOCTORS AND PHARMACISTSRELIEF FUND.

    "Ne quid nimis."

    THE last meeting of the constituents of theBelgian Doctors and Pharmacists Relief Fund tookplace on Monday afternoon last, when Dr. Pechere,the President of the Committee which, sitting inBrussels, took charge of the distribution of allmoneys, delivered a message of thanks to the sub-scribers. An account of the meeting, which washeld by the permission of the Royal Society ofMedicine in the house of the Society, is given else-where (see p. 1159), and Dr. Pecheres address will beread, we know, with real emotion. Speaking slowlybut clearly, his narrative gained in effect byits studied moderation. He stated the simple factsas he had seen them, or had learned them fromincontrovertible evidence, and as he spoke a pictureemerged of courage in misery, of tenacity interrorism, which will not be forgotten by hisaudience. Those who subscribed to the Fund willhave satisfaction in knowing how many theysuccoured, and what hope their practical sympathykindled in despairing breasts. And those whomanaged the Fund may congratulate themselvesupon the results of their work.

    THE TREATMENT OF ICTERIC SPIROCHTOSIS.

    Dr. Marcel Garniers comprehensive survey, inthe French Supplement to the present issue ofTHE LANCET, of the work done by his compatriotsduring the last three years in the field of diseasecaused by the Spirochta icterohmorrhagi con-tains no allusion to therapeutic measures. Therehas indeed been little time for the developmentof any useful experience in this direction, butat the Pasteur Institute in Paris MM. L. Martinand A. Pettit have prepared an antispirochaatosisserum by injecting, at the outset of their investiga-tions, emulsions of guinea-pig liver, and, later, purespirochaete cultures, into horses. The serum ofanimals prepared in this way acquired a moderateagglutinating power and manifestly immunising andspirochaete-destroying properties. The same workersalso obtained a serum, a dose of 1/20th c.cm. ofwhich neutralised 1 c.cm. of a thick emulsion ofthe parenchyma of guinea-pig liver rich inspirochaetes. Several observers have made use ofthe serum thus prepared. Dr. Garnier himselfemployed it in 13 cases, coming to the conclusion that,under the conditions in which he was placed andwith the doses he used, the serum did not seem tohave any obvious action on the development of I.Sp.But in one case N. Fiessinger and E. Leroy obtainedmarked amelioration. S. Costa and J. Troisier usedthe serum in a grave case of meningitic type, whenthe patient recovered after receiving the serumsubcutaneously and intrathecally. Renaux, andlater Wilmaers, obtained encouraging results in theBelgian army, observing that the eliminationperiod of the parasite was substantially reduced.Finally, in a case treated by Nolf and Firket theinjection of serum into the spinal theca was followedby considerable improvement. From these factsMM. Martin and Pettit conclude that when faced

    1 L. Martin et A. Pettit : La spirochtose ictro-hmorragique,Paris, 1919 ; Le serum contre la Spirochta de lictre hmorragique,Bull. Soc. med. Hp., Nov. 23rd, 1917.

  • 1156

    by an ascertained infection with I.Sp. specific sero-therapy should be adopted without delay. Thetechnique which they propose is to inject on thefirst day a dose of 60 c.cm. under the skin, followedby injections of 20 to 40 c.cm. each every two orthree days. The treatment must be regarded asbeing still in the experimental stage.

    THE DECLINE OF ALCOHOLISM IN GERMANYDURING THE WAR.

    THE decline of alcoholism during the war towhich several previous writers have drawn atten- ,tion is illustrated by Dr. Schweisheimer, of Munich,who gives the following figures: The number ofmale patients under treatment for alcoholism inpublic and private asylums in Germany was 3148 onJan. lst, 1914, and only 1896 on Dec. 31st, 1916, andthe number of female alcoholics fell during thesame period from 382 to 295. The decline in thenumber of fresh admissions for alcoholism was stillgreater, the male admissions being 6380 in 1914 and1986 in 1916, and the female admissions 541 in 1914and 280 in 1916. In striking contrast with thesefigures was the absence of any change in therelative frequency ofmental diseases not due toalcoholism. Thus the percentage of male admis-sions for dementia prsecox to the Berlin ChariteHospital was 83 in 1912, 88 in 1915, and 80 in1916; and of female admissions, 144, 160, and130 during the same years, showing that the warhad no effect upon this disease.

    THE PERILS OF THE RADIOLOGIST.

    THE tragic death by electrocution of a radio-logist in Paris draws attention to the rarity of suchaccidents, a sufficiently remarkable fact when weconsider the enormous voltages used in the ordi-nary course of radiological work. To receive ashock from some part of his apparatus is thefrequent experience of nearly every busy X rayoperator, and produces as a rule little more than amomentary annoyance. The reason for this is thatthe great majority of such shocks are from oneterminal only, the amount of current transmittedto the body being limited to its capacity as acondenser, which is small ; and this is especially soif the apparatus is installed in an ordinary roomwith a floor of dry wood or covered withthick linoleum. Uncovered floors of concrete allowdirect leakage of current to earth and materiallyincrease the severity of any shock; they shouldnot be permitted in an X ray room. Apartfrom this question of floor material, it occa-sionally happens through the development offaulty insulation that the operator becomesconnected with both terminals of the coil, andthis is a very unpleasant experience. Conceivablysuch an occurrence might be immediately fatal inthe case of an individual with a weak heart; innormal persons, however, the effects pass offrapidly and are soon forgotten. While the tensionor voltage is high, the quantity of current froman induction coil is very small, due less to thehigh resistance of the secondary winding than toself-induction and impedance. The availablecurrent can never rise above a limited numberof milliamperes, and as the induction coil is themost generally used means of exciting the X raytube, herein lies the explanation of the radiologistsimmunity from fatal accident.

    1 ffentliche Gesundheitspflege, 1919, iv., 256-260:

    To meet the demand for rapid exposures,something more powerful than the induction coilwas needed, and this led to the introduction ofthe high-tension transformer with its closedmagnetic circuit and rectifying device for keepingthe current impulses through the tube 7anidirec-tional. By its employment a greatly increasedcurrent passes through the X ray tube, and therisks to the operator are proportionately increasedin the event of personal contact with one or bothterminals when the machine is working at anythingapproaching its full power. The necessary precau-tions for the avoidance of accident are well knownto instrument-makers and to radiologists who use thistype of machine, and the circumstances of the Parisaccident suggest that some recognised safeguardswere not observed. The room was too small toallow sufficient freedom of movement clear of theapparatus, the high-tension wires were hanging in adangerous position, the tube stand was of metaland not earthed, and the floor was of concrete. Amovement of the stand brought it in contact withthe high-tension wire, allowing the current a freepassage to earth through the body of the radiologist-with the natural, and almost inevitable result.The tragedy should lead to more care in the in-stallation and use of high-power X ray generators.

    PUBLIC HEALTH CONGRESS IN BRUSSELS.

    THE resumption of the annual meetings of t heTHE resumption of the annual meetings of theRoyal Institute of Public Health will be welcomednot only by those who habitually attended thesecongresses, but also by the largely increasednumber of people now interested in public healthproblems. The congress was held at Berlin in 1912,and at Paris in 1913. The Edinburgh meeting in1914, at which the medal given by the institute forconspicuous service in the cause of preventivemedicine was awarded to Dr. James Niven, M.O.H.of Manchester, for his work towards the pre-vention of tuberculosis, was the last meeting held.A renewed invitation from Burgomaster AdolpheMax, of Brussels, and from the rectors of theUniversities of Belgium, has been accepted by thePresident and Council, and the next congress willbe held at Brussels in 1920, from May 20th to 24thinclusive. Delegates from the universities, muni-cipalities, and public bodies will be invited in duecourse, and full particulars, presumably includinga preliminary programme, will be issued shortly.Those who wish to participate in the congress areasked to communicate with the honorary secretaries,the Royal Institute of Public Health, 37, Russell-square, London, W.C. 1.

    COMBATING CANCER.

    Professor Alexander Fraenkel, secretary of theAustrian Society for Combating Cancer, has per-formed a public service by giving an excellentreview of the present position and prospects ofthe cancer problem in an article entitled " TheCurability of Cancer" in a recent number of theprincipal Vienna medical journal. The pathologicalfacts of human and animal cancer and the resultsof experimental study of the disease are set outclearly and in detail, and focussed to the conclusionthat the disease is local in origin. Due prominenceis given to the part played by chronic irritation andthe great variety of forms which this factor maytake, ranging from chemical irritants to gross

    1 Ueber die Heilbarkeit der Krebskrankheit, Wien. klin.Wochenschr., Nov. 13th, 1919.

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