bluuebunny/crossref_metadata_2025 huggingface dataset:
A Series of Consecutive Cases in which the Mastoid has been operated on for Acute Suppurative Inflammation, B.I.P. (bismuth, iodoform, and liquid paraffin) inserted, and the External Wound sutured in its Entire Length at the Close of the Operation.
Authors: Tilley Herbert
Published: July 2019

Hitherto the exhibitor has been in the habit of leaving the greater part of the post-aural wound open and allowing the bony wound of the mastoid antrum and cells to granulate from the bottom. Drainage was provided for by loose wicks of gauze, a drainage tube, or by simply leaving the wound open without the insertion of any foreign body. As a general rule such cases took from three and a half to five weeks to heal completely. The wounds in the cases shown today have been sutured entirely at tbe, close of the operation and the dressing removed on the fourth or fifth day. In most instances the patients have been able to go home within a fortnight.
Carbon-Dioxide Thermo-Saline Springs in the Light of Modern Research
Authors: Schott Adolf
Published: July 2019

Investigations on the influence of natural Nauheim standing and running effervescent CO2thermo-saline baths on the subcutaneous CO2and O2tension in gas under the skin in rabbits showed a decrease of the CO2tension in all experiments. The O2tension increased in 50 per cent. of the experiments, in the others it remained unaffected. The results are interpreted as due to an increase in ventilation and an increase in peripheral blood-flow, the peripheral blood-vessels being dilated. Plain water baths of the same temperature and duration did not show this effect on the peripheral circulation, both CO2and O2tension being decreased after the bath. The relations between these researches and other investigations on the effect of natural thermo-saline baths are discussed as well as the difference between the effect of natural and artificial baths. The special curative properties of fresh natural mineral springs are in some way connected with the composition of the salts as complex compounds and their molecular structure. These complex compounds being decomposed by heat, light or access of air, the special activity is lost. The presence of the salts as complex compounds in fresh natural mineral springs is supposed to be due to the special geological conditions under which these compounds are formed.
A Radiological Study of the Bone Changes in Renal Infantilism
Authors: Teall C. G.
Published: July 2019

Definite changes in the radiographic appearance of the bones are found in renal infantilism. The radiographs show two distinct types of change which I have called the “rachitic” and the “woolly” types. The rachitic type is practically identical with ordinary rickets. The woolly type is characteristic, and is sufficiently typical to be of diagnostic value. The lesions found in this woolly type are asymmetrical, and may be much more marked in one bone than another. The marked deformities in renal infantilism are produced by a collapse of the bone in the metaphysis, which throws the end of the bone out of line.
The Formation of Urinary Calculi
Authors: Joly J. Swift
Published: July 2019

Normal urine is always grossly super-saturated in regard to the stone-forming salts, which are kept in solution by the action of the colloids. This action is best explained by the theory of adsorption.

The amount of the stone-forming salts which can be held in solution depends on the surface area of the colloid, and therefore on its state of subdivision. Precipitation of these salts is due to failure of the colloid to hold them in solution. It may be due to an insufficient quantity, but is more probably due to coagulation of the colloid.

When precipitation occurs in the urinary passages, the crystals are usually retained in the lower calyx of the kidney. A crystalline deposit tends to grow into crystalline concretions under the action of surface energy, thus forming true primary calculi. Stones of this type soon irritate the wall of the cavity in which they are contained and cause a reactionary exudate. The laminated stone is formed by continued deposition of crystals, coupled with rhythmic precipitation of a foreign colloid derived from the exudate. Stones originating in infected media are formed in a similar manner.
President's Address
Authors: Kidd Frank
Published: July 2019

Twenty-four cases of purpura of the urinary tract are discussed and analysed.

Purpura of the kidney may be a cause of painless hæmaturia. In some cases nephrectomy may be necessary to check the bleeding.

Purpura of the bladder is a cause of painful hæmaturia. In such cases the diagnosis can be made with the cytoscope.

A number of the cases appear to be caused by a streptococcal infection of throat, teeth or bowel.

The exhibition of horse serum by the mouth usually has an immediate effect in checking the bleeding tendency

Splenectomy should be considered in severe chronic recurrent cases.

Purpura is a symptom and not a disease. It can attack the kidney or bladder in any type of case. The attacks may be simple, recurrent or fulminating. In many cases no cause can be discovered, in others it is associated with acute rheumatism. In a number of cases a proximate cause can be discovered, in the nature of a bacterial infection, a chemical poison, a thrombocytopenia, splenomegaly, or the deprivation of some vitamin.
Season and Disease
Authors: Stallybrass C. O.
Published: July 2019

The seasonal variations in disease, as is the case in the spread of infective diseases generally, depend upon three primary factors: (1) the presence of the micro-organisms of adequate virulence and infectivity; (2) the means of transmission to (3) the susceptible tissues of the susceptible individual. All other factors, in this relation largely climatic, can act directly only through these three primary factors and are therefore termed secondary. The paper is largely an attempt to express the effect of the variations in the secondary factors in terms of the alterations they produce in the primary factors. The total effect of the three primary factors in the spread of infection is termed “dispersability” and a ratio or measure of dispersability is described. This ratio emphasizes occurrences in the pre-epidemic period.

The relationship of temperature and humidity to the alimentary, respiratory and percutaneous diseases and to the ectodermoses, is investigated. In the autumnal group of infections, attention is drawn to the action of carriers in causing a rise in dispersability in the spring and the frequent occurrence of a double wave of dispersability.

The effect of climatic changes is often cumulative, and this is most evident in the autumnal group of infections, the seasonal occurrence of which cannot be directly explained by temperature changes, or even by the action of light on phagocytes. The possibility of vitamin deficiency or excess producing cumulative effects is considered.

Secular changes in seasonal periodicities are investigated and these are associated with other changes, such as the intrinsic periodicities, mode of spread, etc., the combined changes being described by the terms aggradation and degradation of disease.

Slides covering the majority of the infective diseases of temperate climates and exhibiting the secular changes in Liverpool, and various geographical differences, in some 175 curves displayed.
The Pathology and Treatment of Traumatic (Wound) Shock
Authors: Cowell Ernest
Published: July 2019

Shock may be defined as “The clinical condition which follows an injury producing depressed vitality, associated with lowered blood-pressure, deficient circulating fluid, diminished intracellular oxygenation and reduced body temperature.” Such a condition results from the presence of one or more of the following four factors, acting either singly or in combination: (1) Pain, (2) hæmorrhage, (3) cold, (4) toxæmia, either of bacterial, tissue, or other origin. Secondary traumatic shock is the common type and only becomes established slowly. Prevention is successful in many cases, even under front line conditions and in war surgery. Treatment of an established case: (1) Application of warmth and mental rest. (2) Relief of pain, (3) restoration of deficient circulation, giving fluids by mouth, rectally, or by 10 per cent. glucose saline solution intravenously (1 litre in two hours). (4) Increase of deficient intracellular oxygenation by insulin hypodermically (5 units at beginning and end of glucose injection). (5) If operation is needed, by choosing a local or gas and oxygen anæsthesia.
Discussion on the Treatment of Urethral Stricture and Fistulæ by Excision
Authors: Kidd Frank
Published: July 2019

For hard tunnel strictures and in cases of perineal fistula we should be bolder to adopt the principle of excision rather than that of mere external urethrotomy.

A preliminary suprapubic cystotomy is advised, and also the avoidance, as far as possible, of the indwelling catheter. All fistulæ should be excised completely, not merely opened, scraped and drained.

The operator should not be in too great a hurry to pass sounds of too large a calibre after the operation, as in many cases there is little tendency to re-formation of the stricture.
Observations on the Radium Treatment of Vesical Carcinoma
Authors: Morson A. Clifford
Published: July 2019

A review of the position of radium-therapy in 1913 and of the knowledge of this subject acquired by the year 1914.—The discoveries of the relationship of the fibroblast to the control of cancer.—In elaborating the technique for vesical carcinoma, a comparison of the methods of approaching the tumour must be carefully studied, sepsis controlled and the difficulty of determining the sensitiveness of the individual's cell realized.—Possible damage to the ureter and the iliac vessels and other complications of radium applications must also be considered.—It is possible that chemical substances which give off secondary radiations may prove of great assistance in association with radium treatment.—A record is given of twelve cases which have been treated since 1925.
Endotracheal Anæsthesia
Authors: Magill I. W.
Published: July 2019

(1) With certain exceptions, endotracheal anæsthesia is the best method for operations on the head and neck and for any other operation in which there may be a difficulty in controlling the patient's air-way. (2) Expiration should be provided for, in endotracheal anæsthesia, either by means of a second tube or by a tube of calibre sufficient to permit to-and-fro respiration. (3) Cocainization of the upper air-passages has decided advantages in endotracheal anæsthesia. (4) “Blind” intubation through the nose renders the method possible in cases where it is impossible to use a speculum. (5) The insufflation method is not specially indicated in abdominal surgery. (6) The routine use of endotracheal anæsthesia in teaching-hospitals for every class of case is detrimental to the production of sound anæsthetic knowledge in students who are likely to become general practitioners.
Unsolved Problems in Salmonella Food Poisoning
Authors: Savage William G.
Published: July 2019

Salmonella groups of organisms are recognized as predominant in food poisoning outbreaks, but knowledge of the primary source of Salmonella bacilli and of paths of infection to implicated food is incomplete.—Unsolved problems discussed.—Food animals suffering from Salmonella infection are common in Germany but comparatively rare in this country and in most outbreaks the original food is shown to have been sound.—Infection of food from a human carrier is extremely rare. Detailed study of individual outbreaks brings out the striking fact that the Salmonella strains which cause food poisoning are just those types capable of causing disease in both man and animals. The hypothesis which best explains bacterial causation of most outbreaks is that the source of infection is derived, in most cases, from animals suffering from Salmonella disease or acting as carriers of these bacilli. Many facts favour this view, including the widespread extent of Salmonella infections in animals associated with food. Examples: Cows suffering from Salmonella infections with these bacilli in the milk; the widespread prevalence of such infections in rats and mice; the considerable extent to which pigs are infected with Salmonella bacilli.—Attention is directed to the presence of specific agglutinins in the blood of food animals such as bullocks and pigs, also to the fact that while in man a carrier condition for food-poisoning bacilli is extremely rare and at best a transient condition in animals. It is a well attested phenomenon. The causes of this difference are worthy of further study.

Not only are there numerous types within the Salmonella group but these types exhibit characteristic and definite differences of pathological behaviour. Bacillus paratyphosus B and Bacillus aertrycke furnish a good illustration and these two types are critically contrasted.

While our present knowledge is imperfect, it is suggested that the types in this group fall into three groups, i.e., ( a) Strains pathogenic to man but not to animals; ( b) strains pathogenic to animals but harmless to man; ( c) strains pathogenic both to man and to animals. Only the last group cause food-poisoning outbreaks and represent the original and less specialized types.

Varying virulence of Salmonella strains and problems thus raised in relation to food poisoning outbreak are discussed.
A Note on the Association of Extensive Hæmangiomatous Nævus of the Skin with Cerebral (Meningeal) Hæmangioma, Especially Cases of Facial Vascular Nævus with Contralateral Hemiplegia
Authors: Weber F. Parkes
Published: July 2019

The main type of the cases under consideration is that in which extensive capillary nævus of the skin, especially of trigeminal distribution, is associated with contralateral spastic hemiplegia, developing in early life, probably sometimes connected with intracranial hæmorrhage from the abnormal blood-vessels of a diffuse leptomeningeal angioma on the same side as the main vascular nævus of the face. Various points related to such cases are referred to.
Light Therapy in Mental Hospitals
Authors: Cormac H. Dove
Published: July 2019

The position of actinotherapy in Mental Hospitals in this country is reviewed. An investigation of the results of ultra-violet irradiation in mental disorders at Parkside Mental Hospital is described and it is shown that certain types of the psychoses appear to benefit. The physiological action of actinic rays in relation to mental disorders is discussed and their mode of action on the nervous system suggested. Reference is made to substances which sensitize the body tissues to sunlight and ultra-violet radiation. An allusion is made to glass, penetrable by a portion of the actinic rays, and its uses. The need for ultra-violet ray apparatus in every mental hospital is urged both for treatment of mental and physical conditions and for the study of its action.
Discussion on Vertigo
Authors: Scott Sydney
Published: July 2019

Symptoms revealing a state of consciousness, attributable to incoördination of afferent impulses connected with the vestibular system—disturbances of muscle-sense—vestibular ocular tracks—vestibular-spinal tracks.

Different Vertigo-Complexes.—Destructive lesions of labyrinth, or of vestibular tracks, partial or complete.—Heterogeneous stimulations of the paired intact vestibular-end organs.—The hypersensitive labyrinth.—Clinical manifestations of vertigo, associated with nausea, headache, visual disturbances, nystagmus, diplopia, staggering gait, vasomotor and cardiovascular symptoms, pallor, flushing, sweating, dyspnœa, fainting, vomiting and diarrhœa.

Objective Examination.—The tympanic membrane.—Middle-ear track.—Upper air passages.—Hearing tests.—Oculomotor tests.—Labyrinthine reactions.—Postural, caloric, galvanic tests.—Differentiation between destructive and non-destructive disturbances of labyrinth.—Discrimination between peripheral and central lesions.—Vertigo associated with acute, non-perforative otitis media, with chronic otitis media, with labyrinthine fistula, with otosclerosis, post-suppurative adhesions; with peripheral nerve deafness, gun deafness; with rhinitis, ethmoiditis, sinusitis, nasal polypi, postnasal catarrh and dental infections.—Influence of general health on recurrent vertigo and vice versa.—Other factors. Syphilis, malaria, etc.

Principles of Treatment.—Seek the cause, which, if peripheral, may be removed by operations on the ear, nose, throat, or even by extraction of dead teeth.—If central, by intracranial surgery, decompression, or by neuropathic medical treatment.

Controversial Problems.—(1) Medicinal treatment: Iodide, bromides, atropine, quinine. (2) Attention to upper air-passages. (3) Fenestration of tympanic membrane. (4) Possible value of Küster's operation in certain cases. (5) Exploration of the saccus-endolymphaticus. (6) Fenestration of the external semicircular canal. (7) Indications for destroying the labyrinth.
Puerperal Fever and Pyrexias
Authors: Joe Alexander
Published: July 2019

A classification is made of 219 cases notified as puerperal fever or puerperal pyrexia. Of these, 71 were local uterine infections; 47, pelvic or general peritonitis; 11, pelvic cellulitis; 20, septicæmia or pyæmia; 12, pyelitis, and 58, febrile conditions not due to infection of the genital tract. Fatal cases were all due to general peritonitis or blood infections and the general death-rate for infections of the genital tract is 21·4 per cent. Of 32 maternal deaths, 7 followed abortion; 11 occurred in primiparæ, the preponderance of whom showed more or less severe trauma, and 13 in multiparæ in whom trauma was absent in the great majority. Similar antecedent circumstances were found in recovered cases of puerperal infection; from these figures an attempt is made to assess the importance of trauma in the production of sepsis. Two cases of puerperal scarlet fever are described and the transmission of infection in puerperal sepsis is discussed. A study has been made of sensitiveness to the hæmolytic streptococcal toxin in 103 cases of puerperal sepsis and the results do not bear out the suggestion that infection by the streptococcus in the puerperium is correlated with toxin sensitiveness.
The Story of a Small Campaign: The Medical Arrangements during the Burma Rebellion, 1931
Authors: West J. W.
Published: July 2019

(1) A general description of Burma, its climate and seasons.—(2) The medical experience of former campaigns in Burma.—(3) Medical resources available and methods adopted to preserve the health of the troops, with special reference to accommodation, water supplies, malaria, heat-stroke and veneral disease.
Bilateral Urinary Calculi
Authors: Joly J. Swift
Published: July 2019

Cases in which stones are found on both sides at the same time are alone considered. They form 9·4% of the admissions for stone in the upper urinary tract at St. Peter's Hospital. Figures from Continental clinics vary from 11% to 14%, while those obtained from post-mortem records are nearly 50%.

Four groups of cases are considered: (1) Calculi due to a special diathesis, e.g., cystine stones. (2) Aseptic bilateral calculi. (3) Infected bilateral calculi. (4) Cases complicated by anuria.

(1) Cystinuria should be treated medically, by diet and alkalis, but stones may form, in spite of treatment. They can be passed easily, and operation is only indicated when impaction occurs.

(2) The calculi are comparatively small, and it is rare to find more than one on each side. If the renal function is approximately the same on both sides, simultaneous removal is advisable. When this is impossible, the interval between the two operations should not exceed fourteen days. When the function is unequal, the first operation should be performed on the more damaged kidney.

(3) When both sides are infected, the calculi are often very large, and the kidneys severely damaged. Infection is usually the primary factor, but its source cannot always be determined. The symptoms are slight, often merely persisting pyuria. If the value of both kidneys is the same: (a) no operation may be possible; (b) pelvic stones should be removed; (c) “stag horn” calculi are best left alone, unless there is evidence of fluid distension of the kidneys. When the function is unequal, an absolutely useless pyonephrotic kidney should be removed or drained, but if urine is secreted by both it is advisable to operate on the better kidney first.

(4) In cases of calculous anuria, the obstruction is usually found in the upper portion of the ureters. An attempt should be made to relieve it by passing ureteric catheters. If it fails, or if the anuria recurs, immediate operation is necessary. The kidney last obstructed should be drained. The stones should be removed as soon as the effects of the anuria have passed.
The Psychopathology of Sexual Perversions
Authors: Bennet E. A.
Published: July 2019

Current views on causation of sexual perversion.

An alternative to these, based on the relationship of the pervert with others, is put forward.

Sexual perversions and psychoneuroses are not positive and negative aspects of infantile sexual components.

Verbatim extracts from the analysis of a patient with sexual perversion are given to illustrate and support the following views: ( a) The emotional relationship between the pervert and others is an essential element in the condition. ( b) The physical aspects of the perversion are of secondary importance to the mental. ( c) The perversion indicates a failure in personal and social integration; and an effort is made to alter this by means of aggressiveness, adopted child-like conduct, and perversions. ( d) The perversions were manifold in type but uniform in purpose. ( e) The policy of the illness was to regain a satisfying personal and social life. ( f) The same policy is found in the psychoneuroses.
The Physiological Basis of the Neuroses
Authors: Ashby W. Ross
Published: July 2019

In many ways in physiology and psychology one sees evidences of “patterns.” Sensory stimuli are usually received as a pattern and most motor responses take the form of a clear-cut pattern of movements. The majority of the reactions in the central nervous system are concerned with patterns of impulses rather than a single nerve impulse.

It is suggested that when two patterns meet, the interaction is subject to two definite laws:—

(1) Similar patterns integrate and become one pattern, the differences between them building up to a new pattern.

(2) Dissimilar patterns are dealt with by the complete acceptance or establishment of one pattern and the total rejection of the other.

Examples are given to illustrate these two laws.

It is suggested that whether two patterns are treated as similar or dissimilar will depend on: (1) The nature of the patterns themselves and; (2) the state or type of the nervous system.

It is suggested that in the neuroses, what is really happening is that the person is treating as dissimilar certain patterns which are usually considered to be similar.

Clinical applications are discussed.
Anæsthesia in Gynæcology
Authors: Fairlie H. P.
Published: July 2019

The operations of gynæcology are divided into two classes: (1) Minor: including perineal repairs, colporrhaphies, vaginal hysterectomies, dilatations and curettings, etc., and (2) Major: abdominal sections. For both groups routine premedication is a combination of morphia and nembutal, the former in ⅙-grain, and the latter in 3-grain doses.

For Group 1 three methods of anæsthesia are described: ( a) Ethylene and oxygen, producing in nearly all cases an adequate depth of anæsthesia without the addition of ether. A safe type of anæsthesia and one from which recovery takes place quickly. ( b) Planocaine in 20% solution, made up with sodium bisulphate, as a spinal anæsthetic, described by Mr. Dickson Wright. The dose usually injected is 0·5 c.c. ( c) Sodium evipan given intravenously, though rather uncertain in action seems to serve well for such minor operations as curettage and insertion of radium.

In Group 2 (major operations), the author's choice is between ( a) ether administered with a little additional oxygen to counteract the asphyxial tendency which the Trendelenburg position occasions, and ( b) spinal anæsthesia with percaine. For intra-abdominal pelvic surgery the latter is a very safe method for two reasons: (1) The dose required is comparatively small, and (2) the Trendelenburg position helps materially to prevent the fall of blood-pressure which a spinal anæsthetic tends to produce.
The Smallpox Pandemic of 1870–1874
Authors: Rolleston J. D.
Published: July 2019

The Vaccination Act of 1853 inspired by the Epidemiological Scoiety of London was the cause of the incidence and fatality of the pandemic being less in the United Kingdom than in foreign countries.

Origin of pandemic in France before outbreak of Franco-Prussian War. Its spread through the country. Vaccination state of civilian population and army in France in 1870.

Incidence, fatality and characteristics of the pandemic in England and Wales, London, Scotland and Ireland and foreign countries with special reference to Germany and German army. Lack of hospital accommodation for smallpox cases in London. M.A.B. hospitals opened. Absence of ambulance service. Aerial convection of smallpox. Smallpox fatality in the various Metropolitan boroughs.

Incidence and fatality of smallpox heavy in civilian population in Germany as compared with the well-vaccinated army, but lower in Southern German States, where primary vaccination was compulsory, than in Prussia and Saxony which had no vaccination laws.

Further statistics illustrating difference in smallpox fatality in different countries and groups of individuals according to their vaccination state.
The Reaction and Regeneration of Cementum in Various Pathological Conditions
Authors: Stones H. H.
Published: July 2019

(1) The reaction of cementum and its adjoining tissues to induced pathological conditions associated with the gingival sulcus is described.

(2) After subjecting the sulcus to interference, its histological appearance is compared with that of definite parodontal disease.

(3) Various methods were adopted for these experiments, which were performed on monkeys.

(4) Artificial pockets were produced by detaching the subgingival epithelium and underlying connective tissue from the cementum. Results: ( a) Cementum is easily removed accidentally, when scraping monkeys' teeth. ( b) Reattachment of connective tissues to cementum is effected, but is usually incomplete. ( c) Epithelium always firmly reunites with cementum. ( d) The artificial sulcus which is usually deeper than normal does not show, microscopically, the same pathological changes as in parodontal disease.

(5) In other experiments, in addition to deepening the sulcus, the cementum lining the pockets was also removed, leaving denuded dentine in contact with the connective tissue. A similar condition was achieved by another method in which a dental bur was inserted between two teeth below the gum margin.

Results: ( a) The gingival epithelium is capable of forming a weak attachment to the dentine, though this does not usually occur. It always proliferates down and unites with the nearest layer of cementum. It seems to have a peculiar affinity for this tissue. ( b) Underlying connective tissue does not usually unite with the dentine. When this happens it is effected by the regeneration of cementum, this new tissue being lined by new cementoblasts. ( c) The width of the periodontal membrane, which was increased by the experiment, is reduced to a more normal level by deposition of new alveolar bone, and to a lesser extent by regeneration of cementum. ( d) In this series of experiments the artificial pocket is permanent and somewhat resembles that of parodontal disease. This is probably due, not so much to the injury, but to its effects creating a space which forms an area of chronic stagnation.
The Innervation and Vascular Supply of the Antrum
Authors: Strong Cecil
Published: July 2019

An attempt has been made to obtain information about the condition of the pulp of teeth, immediately below the bony incision, made in the lateral antral wall in radical antrotomy, and to investigate the conditions obtaining in the vascular supply of that neighbourhood.

The investigation has two parts: (1) Experimental; (2) Clinical.

Experimental.—( a) Injections of specimens of the superior maxillæ were made with lipiodol, then X-rayed. These showed vascular anastomoses along the antral floor.

( b) Sections of the lateral antral wall and floor were cut and stained to show nerves and blood spaces.

( c) The external carotid artery was injected with Prussian Blue and the maxilla then removed.

( d) Transverse sections of the teeth denervated were cut and their pulps examined. Clinical.—The patients who had been submitted to operation were taken, and their teeth examined by:—

( a) Transillumination. ( b) Percussion. ( c) Thermal tests. ( d) Faradic currents. ( e) Radiography. From these investigations it appears that the teeth are denervated but not devitalized by the trauma to the lateral antral wall above their apices. Their blood-supply is still present, and probably comes through a collateral anastomosis, along the antral floor and partly through the antral mucosa.
Therapeutics with Hormones of the Ovary
Authors: Kaufmann C.
Published: July 2019

The proliferation of the endometrium in the first half of the normal cycle is caused by the follicular hormone. The transformation into the secretion phase in the second half is caused by the hormone developed by the yellow substance of the corpus luteum. The term “menstrual” bleeding must be preserved for the discharged endometrium which has been proliferated first by the follicular hormone, and then transformed into the secretion phase (pregravid phase) by the corpus luteum hormone. The growth of the uterus in childhood and its pubescence depends on the follicular hormone (vegetative activity of the ovary), just as does the preservation of turgor in the genitals of the puberal woman. Many years ago, cyclic genital activity in the castrated animal was first produced by the injection of hormone, and this effect is now employed as a test for ovarian hormones. I succeeded eighteen months ago in producing complete menstruation in the castrated woman. The size of the doses of ovarian hormones administered is the important factor. In numerous experiments I have shown that—according to our present conceptions—very large doses of follicular hormones are required to produce the proliferation phase of the endometrium. The required dose is about 200,000 mouse units (= 1 million international units). For transformation of the proliferated endometrium into the secretion phase, 35 rabbit units of corpus luteum hormone are needed. The doses of follicular hormones up to now employed in therapeutics do not exert any traceable influence on the endometrium of the castrated woman. Neither have I noticed, that with doses of 600 or 1,000 mouse units, a shrivelling of the uterus which is due to long lasting functional troubles may be done away with. I have therefore proceeded to treat serious hormonal affections of the ovaries with very large doses of ovarian hormones.

This paper reports on: ( a) The effect of the follicular hormone on the hypoplastic uterus, in primary and secondary amenorrhœa; ( b) spontaneous regulation of the cycle in secondary amenorrhœa also after treatment; ( c) the treatment of symptoms produced by castration and at the climacteric; ( d) the treatment of genital bleeding with corpus luteum hormone.
Diaphragmatic Paralysis: A Critical Review of its Use as a Therapeutic Measure in Respiratory Disease
Authors: Campbell A. J.
Published: July 2019

Diaphragmatic paralysis first suggested as a therapeutic measure in lung disease by Steurtz (1911), who did simple phrenicotomy. Felix (1922) showed in 25% of cases this was ineffective owing to the presence of an accessory phrenic, and suggested phrenic exairesis, i.e. complete evulsion of the phrenic nerve. Goetze (1922) suggested radical phrenicotomy, i.e. division of the phrenic and excision of the nerve to the subclavius.

Effects of diaphragmatic paralysis.—The diaphragm rises to the full expiratory position (4–8 cm.). Paradoxical movement (Kienböch's phenomenon) on affected side. Muscle atrophies. Collapse of the lung produced, affecting base and apex also. Lung volume reduced by ⅙th to ⅓rd.

Physical signs.—Indrawing of the epigastrium. Thoracic breathing. Litten's sign absent. Less resistance to abdominal palpation on affected side. Diminished resonance at border of sternum and at base. Deficient inspiratory murmur at base.

Radiography.—Paradoxical movement. Bittorf's test.

Indications.—(A) Pulmonary tuberculosis.

I. As the sole therapeutic measure.

(1) In cases where pneumothorax has failed.

(2) For relief of symptoms such as: ( a) hæmoptysis; ( b) cough; ( c) tachycardia ( d) nausea and vomiting; ( e) pain; ( f) hiccup.

II. Combined with pneumothorax.

( a) For basal adhesions; ( b) alternative to bilateral pneumothorax; ( c) to lengthen interval between refills; ( d) at conclusion of pneumothorax treatment.

III. Combined with thoracoplasty.

(B) Other diseases.

Unresolved pneumonia, fibrosis of the lung, bronchiectasis, abscess of the lung, hydatid disease.
The Estimation of Fœtal Maturity by a New Method of X-ray Cephalometry: Its Bearing on Clinical Midwifery
Authors: Reece L. N.
Published: July 2019

A plea is made for routine use of X-rays in antenatal work. A new method of cephalometry is described, depending on the fact that the fœtal head is a rough ovoid. It is shown that the shadows cast by ovoids may be oval or circular, but that always the diameter of the greatest circular section of an ovoid is represented in its shadow—by the diameter if the shadow be circular or by the short axis if oval. The results are applied to estimate the actual proportions of fœtal head and maternal pelvis, and also to estimate fœtal maturity.

The accuracy of the method of cephalometry was tested in 100 cases of labour induced by rupture of membranes.

A simple method of pelvimetry is described, and it is suggested that pelvimetry should be carried out in the early months and not later when the pelvis is obscured.

No special apparatus is required and any cottage-hospital X-ray set will serve.
The Glands of the Stomach in Relation to Pernicious Anæmia; with Special Reference to the Glands in the Pyloric Region
Authors: Meulengracht E.
Published: July 2019

The researches have had in view the anatomical localization of the anti-anæmic factor (Castle's “intrinsic factor”) in the stomach.

As the pig's stomach is peculiarly constructed, having a so-called cardiac-gland region, a fundus-gland region and a pyloric gland region continued in the glands of Brunner in the duodenum, preparations have been made from each of these regions, and tests of the effectiveness of each of these separate portions have been made in cases of pernicious anæmia. It has previously been pointed out (Meulengracht and Schiødt) that the production of hydrochloric acid, pepsin and rennin was confined to the glands of the fundus region (peptic glands) with their oxyntic cells and chief cells.

The experiments showed that the extract of the fundus-gland portion was inactive in cases of pernicious anæmia, that of the so-called cardiac-gland portion was mildly active, that of the pyloric-gland portion was strongly active, and that of the duodenal portion was also strongly active. The feebler activity of the cardiac portion might be shown to be a result of the smaller number of glands to the unit area in that region.

The conclusion drawn from the experiments is that the so-called cardiac glands, the pyloric glands and the Brunner glands in the duodenum, which anatomically may be said to be very nearly identical, may also be taken to be functionally identical, at any rate with regard to the production of the anti-anæmic factor.

This collective gland region, which it is proposed to call the pyloric-gland region, is the site of the production of the anti-anæmic factor. There is thus attributed to these glands a definite, well-defined and vitally important function.

It is further concluded from the experiments that pernicious anæmia in human beings is due to atrophy and inactivity of that part of the stomach which comprises the pyloric-gland region. The experiments may thus be said to have anatomically localized pernicious anæmia in human beings.

Experimental pernicious anæmia will presumably be producible by the deliberate removal of the pyloric-gland region.

Stomach preparations for the treatment of pernicious anæmia will with advantage be producible from the pyloric-gland region alone.
Therapeutic Observations on Non-Specific Colitis
Authors: Hare Dorothy C.
Published: July 2019

The clinical characteristics of non-specific colitis and its tendency to spontaneous recovery and relapse make it difficult to assess the results of treatment, but no treatment has been found that acts as a specific cure in an acute attack or which will prevent relapse.

The tissues of the colon are highly sensitive to trauma in colitis; treatment by colon lavage therefore often does harm and surgical procedures involving local manipulation are contra-indicated in acute colitis.

Antidysenteric serum and Bargen's streptococcal serum and vaccine do not appear to produce a specific curative reaction, and their effect is uncertain.

A generous well-balanced diet promotes recovery in convalescence, and long hours of fasting or scanty diet favour relapse. Experimental diets deficient in vitamin B complex produce colitis in monkeys, but in this country diet deficiencies do not appear to be the cause of human colitis, and a complete diet does not protect from relapse.

Liver therapy has been found of no value in either acute or chronic colitis, except in a single case with a macrocytic anæmia.

Iron in large doses given in chronic colitis with hypochromic anæmia is of striking benefit.

Atropine has been used successfully to relieve spasm of the colon causing colic and fæcal constipation.
The Innervation of Teeth
Authors: Bradlaw Robert
Published: July 2019

The author, using the staining methods of Bielschowski, Gross, Beckwith, Weigert-Pal and Cajal in frozen and serial paraffin and celloidin sections, has investigated the dental innervations of man, monkey, dog, cat, and guinea-pig in health and disease. He discusses the anatomy and physiology of the dental innervation and the effect of section of the inferior dental nerve on the trophic, vasomotor, protective, and sensory functions, with special reference to the relation between dental disease and neuropathies. He describes the innervation of the tooth germ and the nature of the growing fibrils seen before calcification in the dentinal papilla and draws attention to the innervation of the periodontal membrane. He has found that these nerves anastomose across the crest of the interdental septa with their fellows and demonstrates coiled sub-cemental nerve-endings. He has been unable to find any difference in the eruption and casting of teeth after section of the inferior dental nerve, and does not find degeneration of the nerves of deciduous teeth prior to casting to be inevitable. He discusses the effect of local anæsthesia on the dental pulp, some of the causes of odontalgia and neuralgia and the effect of old age and general disease on the dental innervation. He has failed with lethal or continued sublethal doses of ethyl and methyl alcohol, lead or tetanus and diphtheria toxins, using the oral, gastric, subcutaneous and intravenous route, to produce dental neuronic change. The effects of fracture of teeth and jaws, the introduction of arsenic into the pulp chamber and amputation and extirpation of the pulp are examined. The vital resistance of the pulp and the significance of granulomata as a protective mechanism are discussed. The author has found that after extraction although there is at first degeneration of the nerve-fibres concerned, there may subsequently be regeneration, sometimes in the form of plexiform neuroma. He has produced degenerative changes in both the nerves and the Gasserian ganglia on both the operated and unoperated sides by the introduction of tetanus and diphtheria toxins into extraction sockets, where the neuronic involvement is proportionate to the degree of trauma with which the extraction is effected. The rôle of innervation in tooth movement during eruption and orthodontic correction, and after the extraction of anterior teeth, has been investigated, the latter by roentgencinematography.
Review of the Observations Which Have Accumulated with regard to the Significance of Diphtheria Types in the Last Four Years (1931–1935)
Authors: Cooper K. E. , Happold F. C. , McLeod J. W. , De C. Woodcock H. E. , Anderson J. S. , Elliot W. M. , Leete H. M. , Saunders J. C. , Warren S. H.
Published: July 2019

In a series of more than 6,000 cases of diphtheria gathered from many parts of the country and from Germany during the last five years, at least 95% of the strains have fallen within three principal types described in 1933 as Gravis, Intermediate, and Mitis. Of these the Gravis strains have been found to be associated with the highest case death-rate and the greatest incidence of paralysis. The Intermediate strains are more nearly related to Gravis than to Mitis in respect of their case death-rate, and at least equal to Gravis in tending to produce hæmorrhagic phenomena. The “Mitis” strains are the most likely of all to produce lesions extending to the larynx and lungs, but apart from such complications are rarely the cause of death. The suggested nomenclature for the types is further justified by observations on the incidence of diphtheria in the immunized and on diphtheria mortality in areas in which different types predominate. Also, it is justified though not so definitely by observations on animal pathogenicity. Typical Gravis strains are so constantly pathogenic to animals that virulence tests with such strains are superfluous. The stability of the types both in the animal and in the human body is marked although a number of observations are extant suggesting fluctuation of type in vitro. It seems most probable, although open to question, that the fluctuations of type observed in many areas over a period of years are due to the waxing and waning of virulence of a number of independent races, rather than to mutations from one to another. The discrepancy between the clinical severity of Gravis infections and their poor capacity to produce toxin in vitro has not yet received any adequate explanation. The nasal carrier is the most important factor in the spread of diphtheria. Clauberg's suggestion that the variants from the three well-defined types which are met may best be explained by rough to smooth variation within the types, the rougher strains representing the more virulent forms in each type, receives a good deal of support from a wide survey of the accumulated observations. A considerable group of freely growing and rough-non-starch fermenting forms which are non-pathogenic would form an exception to this rule as these would be classified as rough “Mitis.” These may, however, eventually prove with further investigation to be diphtheroid strains distinct from “Mitis.”
Vitamin B1 in Human Diets
Authors: Baker Audrey Z. , Wright Margaret D.
Published: July 2019

Constituents of beri-beri-producing diets, borderline diets, and protective diets given by Braddon and others were analysed for vitamin B1 content by Cowgill. He used a long series of assays published by numerous investigators and calculated the various units and percentage values as milligram equivalents of a yeast powder. He thus obtained approximate vitamin B1 values for these diets. He showed that these values, together with the incidence of beri-beri, justified the application to man of a formula obtained experimentally and gave an indication of man's minimum requirement of the vitamin.

In this paper the vitamin B1 value of the same diets has been obtained from direct assays against the International Standard of the constituent foods, raw or cooked, as usually eaten. These are in good agreement with the values drawn from the less direct calculation, and indicate that man's minimum requirement may vary according to weight and food intake between 200 and 500 units daily.

The desirable level of B1 intake for adults and children has been studied by analysing in the same way a series of diets recommended by public bodies or by dietitians in England and America. Adults on good diets consume 450 to 750 units daily. High vitamin diets may contain about 1,500 units.

Diets recommended for children show relatively higher levels than those for adults, that of a child aged 4 years having nearly 400 units and that of a child aged 11 years having about 650.
Labyrinthine Reactions and Their Relation to the Clinical Tests
Authors: McNally W. J.
Published: July 2019

The rapid tilt test has shown that the vertical semicircular canals are in close connexion with the whole postural body musculature. Nystagmus reactions are only a small part of semicircular canal sphere of control.

Further knowledge of the reaction-pattern of the body musculature resulting from the stimulation of each semicircular canal will help in diagnosing a lesion, not only of the individual semicircular canals, but also—even more important—of its intracranial connexions. The few reaction patterns already known, but not recognized as such, namely post-pointing, falling, and head turning, are true compensatory reactions, more easily understood if so considered and grouped with the protective reactions to the tilt tests.

Recognition of the two modes of utricular action is essential to a correct analysis of tilt test reactions. The slow tilt described by Grahe and others, is an excellent test for “first mode” utricular action, but not for “second mode” action or for vertical semicircular canals.

The quick tilt is primarily a test of vertical semicircular canal action, but normally the reaction is complicated by reactions from “second mode” utricular stimulation. If this fact is not taken into account the analysis of a reaction to a quick tilt may be misleading. When performing a quick tilt test, in addition to watching for the absence of the protective reaction (due to loss of one or both labyrinths), the investigator should try to note whether there is a tendency for the patient to be more easily thrown in the direction of the tilt—owing to a lesion of the vertical canals, the utricles being intact (“second mode” utricular action)—or whether there is a tendency for the patient to over-compensate (owing to a lesion of the utricles, the vertical canals being intact).

If, in addition to the usual equilibrial tests, the quick tilt test is used in this way and a careful analysis is made of the reactions of patients with labyrinthine or intracranial lesions, diagnosis of lesions of individual labyrinthine end-organs or of their intracranial connexions may become a routine procedure in the clinic just as it is now possible in the laboratory.