1177JUBILEE OF THE FINSEN INSTITUTE.

cases having been recorded to establish this fact

beyond dispute. Seven of 42 cases of inoperablecancer of the cervix have been cured in Frankl’s

dinique, while he reports that 58-8 per cent. of casessubjected to ray treatment subsequent to operationhave remained well after a period of five years. Inthe treatment of haemorrhage from the uterus dueto the presence of myomata or unconnected withobvious signs of disease the rays act upon the folli-cular elements in the ovary, and by destroying thesebring about a cessation of the ovarian secretion andso produce amenorrhoea. Just as small doses mayhave a stimulating effect upon the cells of a malignantgrowth, so they may stimulate the follicular epithe-lium of the ovary, and it has been suggested thereforethat they might be employed in the treatment ofobstinate amenorrhoea.Both these lectures are included in a very full

report which appears in the Dublin Journal of ?tledicalScience for November.

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JUBILEE OF THE FINSEN INSTITUTE.

A FEW weeks ago the Finsen Institute in Copenhagen,celebrated a double event-its 25-year jubilee, and theopening of an annexe for the light treatment of surgicaltuberculosis. Some conception of the size and import-ance of this Institute can be gleaned from the followingfigures. The staff includes 22 doctors, 168 nurses, and84 other employees ; the annexe for surgical tuber-culosis has cost three million kroner, accommodates145 in-patients, and is equipped for the daily treatmentof 150 patients. Niels Finsen’s hope that lighttreatment could be extended to deep-seated disease,notably heart disease, was not realised in his life-time,but his successors have kept his aims in view, and in1913 they began that treatment of surgical tuberculosiswith carbon arc light which has now come into generaluse at the Institute.

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PLAGUE AND SMALL MAMMALS.

PLAGUE was imported into coastal towns of SouthAfrica many years ago, but as little or no manifesta-tion of the disease was reported for some years, it washoped that the infection had died out. Quite recentlyan entirely new series of outbreaks have been occurringinland and far remote from towns. In his interestingpaper in our last issue, Dr. L. G. Haydon, assistanthealth officer for the Union of South Africa, set outclearly the peculiarities of these outbreaks-viz.,1) they were confined to a scattered rural population ;(2) no

" domestic " rats could be found in the farms ;and (3) the time-intervals between the small groups ofcases showed that they were not closely connectedto each other. These new manifestations could not atfirst be brought into line with the ordinary epidemio-logy of plague, which requires flea-infested rats living inthe same house with human beings; consequently itwas necessary to look round for some other agent indisseminating the disease. After long and carefulinvestigation into the fauna of the infected parts ofthe country it was discovered that two varieties ofsmaller mammals, which lived in numbers in the fields,were extensively infected with the disease-namely,the gerbille (Tatera lobengulae) and the maltimammatemouse (Rattus coucha), animals living in close contactwith each other and the commonest of the animalscaptured for identification. The human cases of plaguewere confined to people who lived in the open andfollowed an agricultural or pastoral occupation : in z,one case a history was elicited of having taken meals isitting on the ground riddled with burrows of these z,animals.Dr. Haydon’s short communication is of great

importance. It shows that the chain of infection tothe human being is in reality the same in both townand’ country ; in the latter case two small rodents,very similar in habit to the field-mouse, are theresponsible agent for disseminating the virus ; in thetown, the " domestic " black and grey rat perform thisfunction. Similar epidemics have been reported fromother parts of the world. In the early part of this

century there was an epizootic of plague amongstfield rodents in Essex followed by a few human cases.In India outbreaks have occasionally been reportedamongst field-mice on the threshing floors aroundinfected villages. Comparatively little is known aboutthe extent and duration of these outbreaks amongstfield-rats, but in the light of recent work done byKunhardt and Chitre it is safe to say that providedclimatic conditions are favourable for flea-breedingand the mean temperature does not remain for longbelow 50 °F., the disease will be kept alive by theabortive epizootic that occurs at the commencementof the colder weather. In these conditions the diseasewill spread like an ulcer, healing in the middle butalways creeping further afield at the edges. When thenon-spreading or quiescent period of the year (pre-sumably the cold weather) approaches, active mani-festation will remain in abeyance, but will commenceagain where it ceased as soon as favourable climaticconditions return. Dr. Haydon points out that anymeasures for getting rid of these small mammals are eextremely difficult to carry out ; the best results have,he says, been obtained with carbon bisulphide. Wewould point out that no measure yet designed for theextermination of rodents is anything like so satis-factory as the epizootic of plague itself. Taking intoaccount the scattered nature of the population, theright course would appear to be (1) to warn the peopleof the danger of sitting about on the ground, parti-cularly if rat-burrows are plentiful; and (2) to pushthe ordinary inoculation against plague in order tosave the lives of the human beings who, in spite ofwarning, expose themselves to the danger of infectionin the course of their daily work. Whether or no thedisease will die out amongst the small mammals ofthe countryside depends largely on climatic conditionsof which our knowledge is very incomplete.

ANTIHÆMORRHAGIC SERUM.

IT is a characteristic peculiar to medical discoveriesthat they nearly always have their origin in somechance clinical observation. To this M,11. Dufour andLe Hello owe the discovery of an antihaemorrhagicserum which they have named " Anthema " which theycredit with a hypercoagulant property, particularlyrapid and responding to the most urgent and seriousrequirements which are so constantly met with inmedical and surgical practice. In a communicationto the Progres Medical of July 16th, 1921, they relatethe case of a young woman admitted into the BroussaisHospital with purpura heemorrhagica, epistaxis, andgingival and uterine hemorrhages. The usual anti-hsemorrhagic remedies were applied without success.She had in particular several injections of anti-diphtheritic horse serum which seemed without effect.when some days after the last injection the temperaturerose suddenly to 40’ C., and a generalised erythemamade its appearance. At the same time the hmmor-rhages ceased. Five days later they recurred andanother injection of the serum was given, followed byfresh local reaction, urticarial eruption, and rise oftemperature. At the same time, as in the first instance.the hxmorrhages stopped, but this time permanently.These facts led the authors to think that the voluntaryproduction of these phenomena would be able to giverise to a well-defined humoral property--namely.hypercoagulability. Its realisation, however, seemeddifficult. To obtain such an immediate effect as isnecessary in h2emorrhages, it is not a question of thedirect development in the patients of an anaphylacticstate by excessive injection of serum, since it is wellknown that anaphylactic sensitisation requires acertain period of incubation for its production. Butthe patients can profit by the advantage that can beobtained from passive anaphylaxis by the injectionof serum from a sensitised animal. Anthema isthe serum of rabbits which have had, at intervalswhich have been regulated by experience, several verysmall successive intravenous injections of horse serum.The animals are bled 21 days after the first injection,

1178 INTESTINAL OBSTRUCTION DUE TO MECKEL’S DIVERTICULUM.

being the time necessary for an effective sensitisation.Their serum injected into a guinea-pig immediatelycaused a marked hypercoagulability in the blood ofthis animal and produced the same property in man.This property renders the serum applicable to everykind of haemorrhage, including that due to various blooddyscrasiae and as a preventive in surgical interventionin parts liable to bleed or in hsemophilic patients ;it may be used in doses of 10-20 c.cm. subcutaneously.There are no special contra-indications, and serumdisease is exceptional and never severe. In healthysubjects in whom the blood coagulability was previouslyestimated by MM. Dufour and Le Hello, it was foundthat this was markedly increased after injection ;and they are furthermore of opinion that the factorof increased blood coagulability may enter into theexplanation of some of the hitherto unexplainedphenomena of shock. In conclusion, 11 cases are citedby the authors of haemorrhage after abortion, fromuterine and vesical cancer, at the menopause, inhaemophilia, melaena and haematemesis in which theinjection of this ’serum was followed by marked andimmediate benefit.

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INTESTINAL OBSTRUCTION DUE TO MECKEL’SDIVERTICULUM.

Two cases of this unusual condition were reportedin October. Surg.-Captain M. L. B. Rodd, R,.N.,details a case of intestinal obstruction in a boyof 17 whose appendix had been removed six monthsbefore. A large intussusception, starting 2 inchesfrom the ileo-caecal junction, was found at the opera-tion ; and when this was unravelled a diverticulitiswas found, about 18 inches higher up, and this alsowas intussuscepted. The diverticulum was removed,recovery being uninterrupted. Another case ismentioned in which the condition, diagnosed as

appendicitis, proved at operation to be a diver-ticulitis.-Major Dean F. Winn, Medical Corps,U.S. Army, gives an account2 of a still more curious ’,,example of this condition. A soldier of 19 was I,being operated upon for appendicitis on Nov. 9th, ’I1920, and it was found difficult to bring the inflamed I,appendix up into the wound owing to a denseperitoneal band which held down the ileum. Withdifficulty the band was traced upwards and wasfound attached to the blind end of a Meckel’s diver-ticulum 8 inches long. As the patient now began tosuffer from shock, the diverticulum was not removed.The patient subsequently refused further operation,though warned of his risk, and he was discharged toduty on Nov. 26th. He was readmitted at 3 A.M.on the next day, Nov. 27th, again suffering fromintestinal obstruction, and at the second operation,that evening, a band of omentum was found attachedto the tip and side of the diverticulum, incarceratingseveral loops of dusky and distended bowel. Thistime the diverticulum was removed. Convalescencewas normal. Each of these authors quotes a paperin the Annal8 of Surgery for May, 1921, by Coley andFortune, who had only been able to find in the litera-ture since 1917 16 cases of intestinal obstruction byMeckel’s diverticulum.

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POST-GRADUATE COURSES ROUND BRISTOL.

THE committee in charge of post-graduate studyin medicine in the University of Bristol, encouragedby the success achieved in courses of demonstrationsheld recently in several country centres, is proposingto extend its activities by arranging for similarcourses in other towns in the south-west of England.In rural areas with cottage hospitals, Universitylecturers undertake all these demonstrations, a courseconsisting, as a rule, of six. For towns of largersize, with hospitals of 100 beds, the University offersseveral alternative plans: (1) To conduct a coursesimilar to those arranged for smaller centres, in whichall the demonstrations are given by the University

1 Journal of the Royal Naval Medical Service, October, 1921,p. 314.2 Military Surgeon, October, 1921, p. 464.

" team " ; (2) to undertake nothing but the organisa-tion and the advertisement, the course itself beinggiven by members of the local hospital staff ; (3) tocombine the two schemes by making the Universityteam responsible for some demonstrations, theremainder of the course being undertaken by thelocal hospital staff. Prospective centres are invited

. to appoint a local secretary to whom, or to thedirector of post-graduate studies, each practitionerattending the course pays a fee of two guineas, tocover the cost of postage, advertisement, and travel-ling ; should there be any balance, an honorariumwill be handed to the lecturer. A list of subjectsis offered to the group who select a series of six. Inthe courses already held one demonstration has beengiven per week, the subjects being the treatment offractures, the uses and preparation of vaccines, andrecent work in cardiac disease. To each of thesetwo demonstrations have been devoted. For thecourses which it is hoped may be held next spring,a much wider choice is offered, including variousaspects of surgery, medicine, gynaecology, ophthal-mology, and so on. A synopsis of each demonstra-tion that is offered for selection is given, and thegroup is thus able to find what is most likely tosatisfy its needs. The advantage of such courses tothe country doctor, who finds it difficult to leave hispractice for more than a day at a time, is obvious.It is to be hoped that this kind of work will be widelyundertaken, not only in the south-west of England,but also throughout Britain by the appropriateuniversities. To this end inquiries as to procedurewill be welcomed ; they should be addressed to theDirector of Post-graduate Studies, Department ofPathology, University of Bristol.

TREATMENT OF SCARLET FEVER WITH

IMMUNE HUMAN SERUM.

TREATMENT of patients suffering from an acuteinfectious disease with the serum of convalescentshas been widely used in the United States and inGermany, particularly in the cases of scarlet feverand measles, but has not to our knowledge beenemployed in this country. The present extensiveepidemic of scarlet fever in London should affordplenty of opportunities of testing the value of thisnew method. In a recent paper read before theChicago Society of Internal Medicine, Dr. G. H.Weaver, of the Durand Hospital of the JohnMcCormick Institute for Infectious Diseases, reportshis observations on 54 cases of scarlet fever treatedby convalescent serum. All the cases were severe,38 being of the toxic type, 6 being characterised byseptic complications, and 10 showing a combinationof toxic symptoms and septic complications. Onlytwo deaths occurred, one in the toxic and the otherin the septic group. In neither case was any appre-ciable benefit derived from the serum. The bloodwas taken during the fourth or early in the fifthweek of the disease, only those being chosen as

donors who were free from any suspicion of tuber-culosis, whose blood gave a negative Wassermannreaction, and who had had a typical attack of scarletfever without complications; 200-300 c.cm. were

taken from adults, and proportionately less frombigger children. After the serum had separatedfrom the clot it was drawn off, mixed with serumfrom two or three other patients, and 0’3 per cent. oftricresol added. Cultures were then made from themixture which, if sterile, was placed in small bottlesof 30 c.cm. capacity and kept in a refrigerator tillit was used. The serum was injected intramuscu-larly in doses of 60-90 c.cm., half the amount oftenbeing injected into each thigh. Intravenous injec-tions were sometimes used, but did not present anyadvantages over the other route. If no obviousimprovement occurred a second injection was givenafter 24 hours. Beneficial effects, however, following

1 Journal of the American Med. Assoc., Oct. 29th, 1921.