1924 BMJ (Clinical Research Edition)  
f/qlll. (le V.4ssoc. Fran-.J dit Cancer, FeoruarY, 1924, p. 128) record the cale of a girll, aged 17, witl a large inmediastinal tu'iour which gave rise to iiD synmptotns anappeare(d to beloIng to that very rare group lknown as lhaematopoietic tuin}lours. Shiortlly before deathi thio patieint p)resented the typical synd(Iroin of acute leukaeI11ia.. The girl was admnitted to hos4pital for severe ppistaxis, and died two days later. At theo subsequent, examination a large intrathoraciC tum1ouir
more » ... foIund, yellowish-white in colour, an(d indlependIent of the tlhoracic organs. Thlere was also a tumuour in the left ovary similar in appearance and consistency. Examination of the blood showed 806C00 red cells and 258,000 white cells per cubic millimnetre. The pathology of the condition is obscure where leukaemia is associate(d with the presence of nev growtlh. The case presented the characteristics clinically of a lymphosareoma, but the metastases dliffered in the variouis organs. For the inost part there was an infiltration with lymrtphocytes, as seeu in leukaemia, an(d well shown in the kidlneys, whereas the ovary contained a true secondary deposit of a neoplastic type. The case appears intermediate in type between a leulkaemia and a sarcoma, and it sugests thiat leukaemnia may be a real cancer of the blootd, as suggested by Banti. The mediastinal tumour appeared to arise in the thymu.s, but it was not possible to identify aniy Hassall's corpuscles. It is not unlikely thiat the niediastinal tumour was simply a proliferation of the lymphoid tissue of the mediastinum. 513. February 21st, 1924, p. 295j regardls systematic application of the Schickc test aud active toxin-anititoxin inmmunization of susceptible adlults as most effective preventive measures against (liphtheria, especially an-iong those who are likely to be in close andi prolonged conitact withl the (lisease. The idleal is tlhe proluction of active immulnity in every clili before reaching 2 years of age, since 80 per cent. of tlhe deaths occur in chiildren of pre-school age. Among those nursing the disease its incidence averaged 25 per cent., lut snlice those susceptible lhave been imnmxiunized the incidlence has falleni to 0.74 per cent. The clanger of anaphylaxis is so extrernely rare that it cannot be mreade an excuse for vitlliholding the treatment, atid even slhould hor-se serutii lhypersensitiveiness become0 comnmion it is possible to erm ploy in toxiu-antitoxin -mixtures an imimiune serumn from the goat. Susceptibility to diphtheria is present in about (0 per cent. of young adults, and of these tlhree-fourthls can be immuniized by one series of toxin-antitoxin injections, while a second series for those who remaini Schick-positive is equally effective. By using the local reaction as a guide in dosage severe systemic reactions can 1)3 reduce(d withoutt lessening antitoxin production, and, as a general rule, a gradient of 0.2, 0.4, 0 6, 0.8, andl i ln. can be followel. By such measures the incidence of clinical diphthieria in a tested group was reuticed by 95 per cent. 514. Grape Sugar Injsctions In Accidental Pneumothorax. 1I. FOGELBERG and I. WALLGREN (Firnska Lakcrresdllslapets L1andlingar, January and February, 1924, p. 38) discuss the recurrent, accidenital pneunmothor ax in otherwise apparently healthy persons, wlhen the communication between the pulmonary alveoli and pleural cavity remains patent or is reopened periodically. They record twvo cases in wvhich the procedure advocated by Spengler in 1915 proved most successf ul in inducing a pleural effusion which obstruLcted the valvelilke commnunicatiou between the alveoli and( the pleural cavity. He injected one oLunce of a sterile 30 per cent. glucosie solution in normual salinie. The autihor's first patient wvas a lad, aged 16, in whorm recurrent attack;s of spontaneous left pneumiiotliorax were associated witlh (lyspnoea, pain, andl displacenment of the lcar'& andI imedi.stinuui, withoLit cough cr fever. 'I'he aspiration of air fromti the left pleural cavity was followed by only partial re-expansion of the lung, and aim xay examination six days later slhowe(d thiat the collapse of time lung, was again conmplete. T'lhe injection of one ounice oL S:)engler's solution provoked great (lyspnoea and violent pain, tichi passed off in a fewv hours Nvithout any pyrexia. Pleural effuisioii folhtowecd, au(I the lung gradually re-expaunde(, the l)atienit being dlischarged in perfect health. In tile secoid(I case mlorphine wvas giveni as a precautLionary measure before Spmenr,ler's solution was intro nlceel. There wvas no shock onlly-sligh1t paimi. A l)lemiral effusion formed, and( vitlh its gradual absorption, and that of the air iu the pleuiral cavity, re-expansion. of thiC lunu occtirred. Thle authDr adds that thlis treatmient is inldicated only wlheni thle pneuneolhorax is 'dry," air conitinues to eseape iuno thee pleural cavity, and it is considered desirable to obtain early re-expansion of the ludll. Atropine In Congenital Stenos.s of the Pylorus. A. JOHANNESSEN (Ugeskri3t Jor Lacyer, February 7tlh, 1924, p. 113) notes that in America and EniglaDd thle lmost popular treatnment for congenital stenosis of tl e pylorus is operat ive, whereas iu the scandinavian countries the treatmiienit is alnost exclusively conservative. In sul)port of tlhe latter course he records in (letail 7 cases in. whlich atropine Wa3 given and recovery effected. That this recovery depencledl on the atropine was proved iin 4 cases by the fact that Nvhen' the atropine was temporarily -withheld the vomiting recurred. To avoidl unpleasant surprises due to idiosyncrasy to atropine, the author began with only 1 msinim of a 0.1 per cent. solution of atropine sulphate. His inaximiutn dose was 2 ininiims of this solution given seven times a day-that is, 0.7 mDg. of atrolpine sulphate in all-and hiis average total dose-for the tNventy-four hours was 0.5mng. The atropine wvas given lhalt an lhou-r before a meal so as to relax the pylorus at the Imlost pr-opitious moment. It usually took from ten to fouirteen days for the optimum effect to be obtaiued, and it was found desirable in severe cases to continue the atropine for nine to ten weeks after the cessation of the vomiting. In 3 cases there were no signs of atropine poisoning, and in 3 other cases these signs, were slight and negligible. But in one case the signs were alarming, and the drua was therefore witlheld. This led to a return of the signs of pyloric obstructioni, and the infant's state was so parlous that the risk was taken of resuming the atropine, under renewed treatment withi which the infant recovered. 516. Registration of Tremors in Graves's Disease. N. STENSTROM (HIygiea, February 15th, 1924, p. 90) has employed an electrocardiographic apparatus to record the tremor of the ftigers in 49 cases suspected of or suffering froin lhvperthyroidisnm. As the rate of tremlor was founld to be the same for the (lifferent fingers, it was necessary only to register the movements of one finger, which, in the author's series of investigations, was the middle finger of the left hiand. Although the treirorwass continuous, it proved to be irregular both with regardl to extent aud time, and the average rate of tremor per minute wvas 620, the extremes being 460 and 780. When tIme extent of the tremor was as smnall as 0.5 mm. it could har(dly be (letected by the nakecl eye, anid in suLch cases inspection alone may fail to reveal a tremor which actually exists. A study of the graphic recordIs taken at lifferent times in the same patient sllowed in several cases that when improvement was effected by an operation onl the thyroidl or by x-ray treatment and rest, there was a reduction in the rate of tremor. No definite relationship could be established between the rate of the tremor and the severity of the Graves's disease as indicate(d by the basal inetabolisun. In eases of par-alysis agitans and of other orgauic diseases of the nervous system associated with tremor of the arms, the rate of the trenmor was found to be about 400; in a ease of Wilson's disease it was 260. The rate of tremor of the -muscles of healthy persons, tired out by certain muscular exereises, was also investigated and found in soine cases to be sinmilar to that of Graves's disease. 517. Wassermann Test as Criterion of Cure. D. L. BELDING (1Boston Mled. and Satrg. Joitrn., February 21st, 1924, p. 301) points out that the Wa3sermaun test as a criterion of cuire for syphilis is inferior to the complete serological exaiminat!on of the bloo(d and spinal fltitd, since a ne(ativo reactioni alone does not necessarily indicate that treatmenit may be stopped, nor does a persistent positive reaction alwaYs pcint to the ree(d for futther treatment. T1he reaction in treat d and(I untLeated syphilis represents an immunological response on the part of the patient quite apart from thie clitnical course of the disease, and, though in. mnost cases tllese run a parallel course, the reaction in the individual mlay or mimay not be comparable to the clinlical findings, and it canniot be regardedI as an absolute nmeasurement of the patient's reis;tamre, nor of thie activity of the disease. The test mietely records the narrowv range betweeni a strongly positive and a native reaction, an(d is less satisfactoiy than the quantitalive test Nhichll gives time titratedl strength of the antibo(y, whichl in untreatedl caves may be; of progios' ic value, anldl ia 162 A
doi:10.1136/bmj.1.3313.e93 fatcat:4uwydukgzrbivfvi7lkkuypale