1925 BMJ (Clinical Research Edition)  
lkandea-ux, March 15th, 1925, p. 163) record a case in a female infant, aged 2 years, admitted to hospital for cough and loss of flesh during the previous six months. On admission dullness, weakness of breath sounds, and subcrepitant rales were found at the right base. Four days after admission the breath became very fetid, and examination of the sputum obtained from the pharynx showed numerous organisms, among which fusfform bacilli and spirilla predominated. Deathoccurred ten days after
more » ... en days after admission. The autopsy showed right pyopneumothorax, gangrene of the right lung, and muliary tuberculosis of the l1ug and spleen. Fusiform bacilli and spirilla were found in large quantities in the walls ofthe gangrenous lesions. The lesions found were not those of embolic gangrene, and there was no otitis, appendicitis, or any other affe'tion present liable to give rise to metastatic gangrene. The fuso-spirillar infection probably originated in the bucco-pharyngeal region, andl, favoured by pre-existing tuberculosis, spread to the smallest ramifications of the bronchi. The pulmonary lesions were of the bronchopneumontl type, with foci disseminated throughout the lobules. 573. Progosis of Chronic Infective Endocarditis. AcCO-RDING to reports in medical literature, chronic infective endocarditis is nearly always fatal; but A. D. BIGGS (Arch. Intern. Med., March 15th, 1925, p. 402) records that of 57 patients with bacterial endocarditis treated at St. Luke's Hospital, Chiicago, 24 are living, and many of themn seem to have recovered from the heart-valve infection. Biggs states thatin order to make the diagnosis certain the clinical indications of the disease need to be supported by demuonstrating the presence of bacteria in the blood. Pathogenic bacteria were detected by blood cultures in each of the cases of the disease at St. Luke's Hospital: in 54 of the 57 cases the organismn was the Streptococcus viridans; in 3 cases haemolytic streptococci were found. Almost all of the 24 patients living are without fever or other signs of infection, and many are able to do light work. One has been well for thirteen years, two for seven years, one for two and a half years; thirteen are in the second year and seven in the first year of clinical observation. L74. Erythromelalgia as a Complication of Rubella. A. GANS (Nederl. Tijd8chr. v. Geneesk., April 25tlh, 1925, p. 1915, who records an illustrative case, states that erythromelalgia is usually an entirely independent condlition, though occasionally it maybe a manifestation of nervous or vascular disease. Cassirer distinguishes two forms of erythrowelalgia. Theflrst occurs in the areas served by definite nerves, and is explained as an irritative con-ition of the peripheral nerves, especially of the vaso-dilator and secretory fibres. The second form, in which the extrenmities of the limbs are attacked, is closely related to acroparaesthesia and Raynaud's disease, in which last condition the vaso-constrietors, and not the vaso-dilators, are.affected. Gans's case occurred in his own daughter, aged 8, who during the last days of the incubation period of rubella (leveloped attacks of erythromelalgia in both feet, lasting for about an hour. A few days after disappearance of the rash the attacks ceased. Gans suggests that the swollen lymphatic glands were the cause of the attacks, owing to their pressure on the sympathetic ganglion or peripheral vaso-dilator fibres. This supposition is supported by the fact that the glanduilar enlargemi.ent appeared some days before the eruption, and was still perceptible a (ay before the last attack of erythromelalgia. 575. Vesicular Eruption during Antirabic Treatment. D. IoNEsco (Bull. et M1em. Soc. Mld. HMp. de Bucarest, January 14tlh. 1925, p. 14) remarks that the most important complication of treatment for rabies is the occurrence of transient paralyses. Various eruptions, such as urticaria and erythema ziultiforme, may also occur. He reports a case in a boy, agedl 14, who on the eighth day of treatment for a bite on the lip developed a generalized papulo-vesicular eruption which lasted six days; it was accompanied by an eosinophilia of 4 per cent. and a generalized enlargement of the lymnphatic glands. lonesco has been unable to find any similar cases on record. Association of Diabetes with Tuberculosis. E. LUNDBERG (Acta Mcd. Scand., April 1st, 1925, I). 1) gives an account of fourteen cases of combined diabetes andtuberculosis in which a detailed study was miade of tue a(-tloml of insulin and the effect of the tuberculosis on the patient's carbohydrate tolerance. It wvas found that as tle tuberculosis advanced the glycosuria and aetonuria regressed, carbohydrate tolerance increased, and the patient's insulin requirements decreased. Further, it was noticed ttat the patients undergoing insulin treatment were subject to attaeks of sudden hypoglyeaemia. The ultimate cause of death was tuberculosis in every case, not diabetes. The authtor believes he has discovered in the tissues of the tuberculous patient a substance reducing the blood sugar. He has not been able to demonstrate this substance, vhich he calls para-insuiln, in tubercle bacilli, in tuberculin, or in the tissues of healthy persons. With regard to the treatment of diabetics suffering from tuberculosis, he advises a regime suitable, for both diseases; plenty of food, rich in carbohydrates, should be given, and the dosage of insulin regulated according to the amount of food consumed and the patient's general state of health. 577. Infantile Eczema and Food Proteins. F. J. CORPER (Amer. Journ. Dis. Child., March, 1925, p. 354) reviews a series of 100 cases of true infantile eczema treated, on the evidence of a positive skin reaction to food proteins, by elimination or reduction of the offending element. Of the 53. infauts showing positive skin reactions only 38 were found to be proper subjects for this study. It was noted that positive reactions maight be obtained to proteins not included in the dietary. Of the 38 cases recorded improvement occurred in 14, and a definite subsidence of symptoms in 7. Patients sensitive to animal proteins were found more likely to respond to specific treatment than those sensitive to cereals, fruit, and miscellaneous proteins. The author thinks that though positive cutaneous reactions are undoubtedly associated with infantile eezema this relationship should at presenit (nly be regarded as a guide todiagnosis an(d treatment, and as a possible stepping-stone to the discovery of the actual etiology. Surgery. 578. Treatment of Peptic Ulcers. A. EISELSBERG (Acta Chir. Scand., March 21st, 1925, p. 71) givesanl account of the progress made in the operative treatment of gastric and duodenal ulcer in his hospital in Vienna, where there has of-late been a considerable increase in the number of such cases. This increase may, he suggests, be partlydue to such influenaces as the coarse food entailed by the xvar. Since 1918 about 900 operations have been performed at his hospital, the operation mortality being 4.45 per cent. Sowe of these operations were performed for stenosis of the stomach. Tihe operationsmost in favour were Billroth's resections-132 Billroth I and 466 BillrothII orerations being performed.-Transverse resection was performed in only 41 cases, and gastro-enterostomy in 82 cases. The place of gastro-enterostomy, the most l)ol)ular operation for some decades, has now been largely taken by resections, but the author doubts whether this vogue wvill last. It is distasteful to him to resect a large part of the stomach and all of the pylorus when he fluds a single small ulcer, and he confesses to feeling horrified when he finds, after resectingthe pylorus on the strength of a careful consideration of the symptoms, a positive x-ray examination, and apparent hardness of the pylorus, that there is no sign of ulcer in the parts removed.
doi:10.1136/bmj.1.3363.e103 fatcat:e5mqj7s5xrcrvdezlrel4zuto4