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COLLOIDAL MANGANESE IN HODGKIN’SDISEASE.

BY ROBERT SAMUT, M.B., C.M. EDIN.,PROFESSOR OF PATHOLOGY. MALTA UNIVERSITY.

I PLACE these two cases on record as I do not thinkthat hypodermic injections of colloidal manganesehave been tried before in this disease, and in thehope that the preparation may be given a wider trialby others.CASE 1.—J. M., aged 27 years, a clerk, reported sick some

months ago, complaining of progressingly increasing weak-ness and inability to perform his duties. He was the subjectof profound anaemia, and presented two large swellings,one on each side of the neck, so large that they interferedwith the wearing of any kind of collar except a low. soft" Shakespeare." Similar swellings, though not so marked,existed in the groin on either side. These swellings provedto be masses of lymphatic glands, so crowded together as toappear one mass ; but on palpation it was found that theyretained their individuality and were slightly movable,though movement was hampered by their reciprocal com-pression. All the glands were firm, and nowhere did theyshow any tendency to softening. The spleen was slightlyenlarged, and the patient complained of a slight, dull, achingpain over the left hypochondrium and of tenderness over theepigastric region. The erythrocytes were diminished to3,200,000 per c.cm. at the first examination, and thehaemoglobin was reduced to 68 per cent. (colour index 1-06).Microscopically there was a slight increase in the smalllymphocytes (30 per cent.). Otherwise the blood picturewas normal.

I diagnosed Hodgkin’s disease, and started cacodylate ofsodium (0-10 g.) injections at once. After 24 injections,there being no apparent diminution in the size of the tumours,or any improvement in the patient’s general condition, Idetermined to change the treatment, and substitutedinjections of colloidal manganese for those of sodiumcacodylate. Improvement followed after the first eight orten injections, and was so steady that, after three months’treatment, the glands had practically disappeared. One ofthe left cervical glands remained slightly swollen when thepatient had a slight attack of appendicitis. The attack wasnot such as to call for immediate operative interference, and,in about a fortnight, the patient returned to his work. Afew days after I heard that he had had an extremely severeattack of appendicitis during the night. He had been seenby the D.M.O. and transferred to the Central Hospital forimmediate operation. A large appendicular abscess was ievacuated that same night ; there were signs of acuteperitonitis. The patient sank gradually, and died four daysafter the operation.CASE 2.-About four months ago another case of

Hodgkin’s disease came under my care. The patient wasa female, aged 22 years. The clinical and blood pictureswere exactly the same as in the previous case. The patienthad been treated in Italy for several months with no apparentimprovement. The cervical glands were very large and firm.The spleen was not appreciably enlarged. I had been soimpressed with the result obtained by the use of colloidalmanganese in the first case, that I determined to start thesame line of treatment in this case also. A marked improve-ment appeared after the first few injections. I saw thepatient at long intervals, and each time was struck by thediminution in size of the glands. It is now some weekssince I last saw the patient ; there was absolutely no traceof the swollen glands. The patient’s colour has improvedenormously, and her general condition is what she describesas

" normal."

Three weekly injections were given in both cases.They were given intramuscularly in the gluteal region,and were absolutely painless.

A CASE OF

CONGENITAL TUMOUR IN A BABY.

BY R. HANDFIELD-JONES, M.D. DURH., M.R.C.S.

THE following case is of sufficient interest to meritrecord :-Baby X, aged 14 momtls, was admitted to the Children’s

Hospital, Shanklin, from Cowes.History.—The mother had noticed ft swelling in the left

axilla for some months, which had lately begun to growrapidly, but was not painful and did not appear to worrythe child in any way.

Condition on admission.—The growth was about the s:zeof a cocoanut, lobulatcd, not adherent to the skin ; it had a

tense feeling and felt harder in some parts than others ; itextended from the clavicle downwards for about 3 to 4 in.,passed backward into the axilla, reaching almost to theanterior border of the scapula. The growth appeared tocome from under the clavicle just between the coracoidprocess and the acromion. The child was in perfect healthand condition; indeed he was one of the bonniest babies Ihave ever seen, and he did not mind prolonged examinationof the growth. As it was growing rapidly we decided toremove it. On Nov. 30th, 1919, my partner, Dr. J. Cowper,operated, and I gave the anaesthetic.

Operalion.—Duration, 1 hours. The growth, whichturned out to be a multilocular cystic one with haemorrhageinto two of the largest cavities, required very careful dis-section to separate it from the important structures around ;part of the pectoralis major was spread out over it andadherent. The growth appeared to originate from the bursaunder the coraco-acromial ligament. One or two large veinshad to be ligatured, otherwise the bleeding was not severe,which was fortunate in so young a subject.

’ The patient made an uneventful recovery, healingpractically by first intention, and was discharged onDec. 23rd, 1919.

Shanklin, I.W.

Medical Societies.LIVERPOOL MEDICAL INSTITUTION.

THE fifth ordinary meeting ot the session washeld on Dec. 22nd last, Dr. R. W. MACKENNA, theVice-President, being in the chair, when Dr. C. J.MACALISTER read a paper on

Some Relationships between Disease and ReversionaryCharacteristics.

He pointed out that man’s present stage of develop-ment had probably been acquired owing to conditionsof environment and opportunity by which his ancestorswere surrounded. This had led to his having struc-tural and physiological complexities presenting con-siderable variation and sometimes involving deviationfrom perfection. His habits as to food had undergoneextraordinary changes, and it was probable that theconditions which had rendered him capable of meta-bolising any type of food, animal or vegetable, musthave resulted in great developmental changes. Havingdefined what was meant by reversion to type,Dr. Macalister spoke of anatomical and physiologicalimperfections which represented reversion to typescharacteristic of some of those ancestries from whichhe was originally evolved, limiting his observationsto the metabolic side of the question. Variationsoccurred sometimes towards the carnivorous type ofmetabolism, sometimes towards the vegetarian, andhe suggested that the stock from which man originatedwhen on the carnivorous side might be regarded ashaving a latent vegetarian metabolism, whereas onthe vegetarian side it would be a latent carnivorousone. This hypothesis might be used to explain theadaptability to new dietetic conditions in early stagesof evolution. Dealing with the functional capacityof the organs of metabolism, he suggested that whereasthe majority of people were furnished with organsadequate in size for dealing with a variety of food,some had too small a liver or pancreas, or kidneysunable to eliminate certain materials, or in whichgeneral eliminative functions were apt to be slow.Such people probably represented variations toancestral types of metabolism, and disease might beavoided by adherence to diets corresponding to thetype to which they belonged. If personal idio-syncrasy were met, there was no reason why variantsshould be regarded as abnormal, or should sufferill-health if taught to diet themselves in accordancewith their physiological requirements. Dr. Macalisterconcluded with a reference to racial reversions.

Dr. E. CRONIN LOWE read a paper upon the

Rationale of Vaccine Therapy,illustrated by diagrammatic lantern-slides showingthe part played in the maintenance of a naturalimmunity by endocrine glandular functions. Vaccine

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therapy was not an alternative mode of treatment, butan accessory one. Dr. Lowe attempted to differentiatethe comparative usefulness of detoxicated and sensi-tised vaccines in various conditions, and to assess theimportance of bacterial findings by blood-countpictures and serological tests. Stress was laid uponfocal reactions as an essential guide to dosage andinterval in vaccine treatment.

DEVON AND EXETER MEDICO-CHIRURGICALSOCIETY.

A MEETING of this Society was held at the RoyaDevon and Exeter Hospital on Dec. 15th last, DrP. H. STIRK, the President, being in the chair.The PRESIDENT read a paper on the

Cooperatioyt of the General Practitioner inPreventive Medicine

in which he traced the advances made in this brandof medical science from early Victorian days up tcthe present time, narrating the transition from thEold Poor Law Board through the Local GovernmentBoard to the present Health Ministry. He paidtribute to the work of Sir John Simon, Sir GeorgeBuchanan, Sir R. Thorne Thorne, Sir W. H. Power, andSir Arthur Newsholme, and others who had done muchto establish the medical officers of the Board in afitting position. Dr. Stirk went on to make a surveyof the various health services. The death-rate wassteadily declining, but the birth-rate remaineddangerously low. Infant mortality was the lowest onrecord, but loss of life should be still further reduced.Epidemic diseases had fallen on the whole and therewas evidence of victory over certain infectiousdiseases. Tuberculosis, measles, acute rheumatism,and influenza were still prevalent, and with venerealdiseases leading to much disablement and mortality.Sanitation had improved, but housing accommodationwas still deficient. The findings of the school medicalofficers in respect of physical and mental impairmenthad been confirmed by the examination of recruits.Returns showed that one half of the insured peopleclaimed or received treatment and that time lost fromunemployment exceeded 270,000 years per annum,largely through preventable disease. Dr. Stirk thenspoke of the wider view now taken by State medicinein the work of the maternity and child welfare centresand tuberculosis and V.D. clinics. He pleaded for aspirit of cooperation in the general practitioner whomight be apt to consider the public health authorityas an opponent. He advocated education of the publicin the early signs and symptoms of disease by thefamily doctor, whose opportunities and special know-ledge qualified him to undertake such duties. Dr.Stirk approved the employment of part-time medicalofficers in clinical work, but he considered it necessaryfor administrative work to be on a whole-time basis.All medical work done in connexion with schoolchildren should be, he concluded, under the directcontrol and administration of the Ministry of Health.

Discussion.In the discussion which followed, Dr. G. G. GIDLEY

spoke of the educative work now being done by thewomen’s institutes, several of which had been estab-lished in Devon.-Mr. A. L. CANDLER regretted thelack of physiological teaching in public schools andpaid a tribute to the work of the boy scouts and girlguides. He envied the powers possessed by themilitary arm in the control of infection.-Dr. R. M.BARROW thought much tact and skill in argumentwould be required in explaining to the public how tobenefit by the teaching suggested in Dr. Stirk’s paper.- Dr. PERIERA GRAY was of opinion that the curativeside of medicine should be relegated to the practitionerand the preventive to the public health official.-Dr.R. V. SOLLY inquired at what age-limit medical super-vision should terminate and to what extent incomeshould be a qualifying factor in the case of children sosupervised.-Dr. DELPRATT HARRIS advocated the

principles of eugenics.-Dr. F. A. ROPER discussedpublic health from the wider point of view of nationalhealth.-Dr. H. JoNAS said that while the publichealth service must increase either in whole-time orpart-time officials, in his opinion efficient administra-tion was impossible on a part-time basis. There mustbe unity of control.-Dr. G. ADKINS (M.O.H., Devon)considered that it was impossible for a man to cureand prevent disease. The whole-time official shouldcooperate with the curative man, as for example, inthe diagnosis and treatment of ringworm, adenoidswhere they met on common ground ; without coöpera-tion disputes would inevitably arise.-Dr. L. P. BLACK,as a part-time M.O.H., had observed the lack ofprecautions as to isolation taken subsequent to a

notification. He discussed the series of inspectionsnow in vogue from the pre-natal period to adolescence.- Dr. W. HORTON DATE (deputy M.O.H., Devon),said that the circular returned by the school inspectorwas so worded as to give no reason for the practitionerto take exception when investigations of the throatand nose were suggested in a given case. There wasmuch yet to be done in the way of educating both thepublic and the teachers in our schools also.The PRESIDENT in his reply quoted Sir G. Newman,

who had stated that the care of the family should notbe intermittent at times of illness, but an educativeinterest should be taken by the general practitionerat all times. He advocated the school nurse takingthe position of school attendance officer where thiswas possible.

ABERDEEN MEDICO-CHIRURGICAL SOCIETY

AT the December meeting of this Society, Mr. J.SCOTT RIDDELL, the President, in the chair, Prof. C. R.MARSHALL gave an address on the subject of

Convulsions.He said that convulsive movements, considered asinvoluntary contractions of volitional muscles ofcentral origin, were of the same order whether they weretrue tremors, as in paralysis agitans, or typical con-vulsive seizures, as in epilepsy. Prof. Marshall dealtonly with movements of cerebral origin and stated thatthe motor area possessed no automatism. He spokebriefly of the causes of convulsions and illustrated theeffects of a slowly acting, cerebral, convulsant poisonas an example of a uniformly diffuse stimulus. He

regarded the flaccidity of the muscles in chorea asan important factor in the characteristic movements.Of the difficulty of explaining the commencement ofepileptic attacks, he said that powerful psychicalstimuli did not necessarily cause them, but he suggestedthat they might possibly be initiated by psychicalstimuli which were associated with altered vagotonus.In nocturnal epilepsy such psychical stimuli mightoccur in dreams.On Dec. 16th the annual dinner of the Society was

held in the Society’s rooms, when 68 members andguests assembled.

LIGUE NATIONALE CONTRE LE PERIL VÉNÉRIEN.—A society for combating venereal disease has recently beenstarted in Belgium under this title. Its objects are statedas follows : To unite, coordinate, and set in action all themoral and social forces which may avail in the fight againstvenereal disease ; to encourage, maintain, and, if necessary,create and develop societies and institutions for the preven-tion and treatment of these diseases : to inform, throughintensive propaganda, all classes of the population of thedangers consequent upon these diseases, the methods oftreatment, and the means of preventing their spread, and ofthe rules of moral conduct which ensure protection from them ;to develop medical instruction both within and without theuniversities ; to assure the foundation of societies for aidingthe victims of venereal disease ; to combat charlatanismand, in general, all those causes which make for the extensionof the venereal endemic. The organisation of the leaguecomprises three sections (1) medical, (2) moral propaganda,(3) social welfare. One of the leading features of its activitieswill be the attention paid to popular instruction.