856 TISSUE CULTURE.-SOCIAL SERVICE AND THE SANATORIUM.

25 eg. of amino-arseno-phenol with 10 eg. of tartro-bismuthate was administered every five days andeven twice a week. Patients received as many as25 injections without any special measures of pre-caution, and in not one of them was any stomatitisobserved even in subjects who for the most partneglected their dentition. MM. Sézary and Pomaretcontinued their researches with this product by intra-venous injections in animals. It is well known thatsalts of bismuth introduced into the general circula-tion are toxic. An intravenous injection of 15 to 20 eg.per kilo of tartro-bismuthate of potash and soda issufficient to cause death in a rabbit soon after, ifnot during, the injection. It was found, however,that the toxicity of the arseno-bismuth compoundwas less than that of the bismuth which enters intoits composition; the bismuth appears to lose itsgenera toxicity and its harmful action on the buccalmucous membrane. It appears that this new productmay be utilised with advantage in the treatmentof syphilis ;. it combines the active treponemicideaction of both components and acts with extremerapidity on secondary cutaneous lesions even wheninfiltrating and especially in arsenic-resisting cases.

TISSUE CULTURE.

THE success of Dr. A. H. Ebeling in maintain-ing in culture for a period of eight years a pieceof connective tissue isolated from the heart ofa chick embryo was the subject of comment inTHE LANCET. 1 There are now published on thesame subject the researches of Prof. Otto Busse,whose recent death has been a blow to the facultyof pathology at Zurich. Prof. Busse has demon-strated 2 the power of growth of animal tissueon a sterile medium of blood plasma, using piecesof rabbit’s heart or aorta. After an incubationperiod of one, two, or three days fine threads andspicules are seen growing out from the edges of thetissue. These threads and spicules soon developinto a dense network of spindle and stellate cells,which rapidly increase in number, until a fine halocan macroscopically be seen surrounding the tissue.Such cultures can be kept for months and even yearsprovided the medium is periodically changed. Ifthe culture becomes infected with bacteria in theearly stages of its growth, the surrounding layer isfound to contain only round cells ; but at a laterstage, when round cells are found mixed with spindleand stellate, or still later, when the network is welldeveloped, the whole layer undergoes dissolutionand is replaced by round cells only. Similar changescan be observed after chemical alteration in the plasmaculture medium, as, for example, after injection ofturpentine water into the animal some hours beforethe serum for the medium is withdrawn. That theround cells are a specific reaction against a foreignirritating substance can be well demonstrated byallowing bacteria access to one side only of the pieceof tissue. On this side the round cells are developed,while on the other side the usual spindle and stellatecells remain. Further, if a colony of bacteria isgrown at a little distance from the tissue, the roundcells are seen to stretch out in broad streams towardsthe colony and finally to collect in and around it,demonstrating the presence of chemiotaxis. Whencecome these cells, and what is their nature ? This iswhat Prof. Busse sets out to answer.One theory is that they were cells whicli had acci-

dentally wandered into the tissue from the blood andwere nothing more than migrating leucocytes. Thistheory may possibly be held when the round cellsare visible in fresh cultures, but it is more difficultto support when they are first seen in cultures thatare already 5-10 days old and in which the spindleand stellate cells are well developed ; and it is com-pletely untenable when the round cells are found in apure spindle and stellate cell culture, as in the follow-ing experiment. The central piece of tissue can be

1 THE LANCET, 1920, i., 335.2 Sitzung der Gesellschaft der Aerzte in Zurich, Jan. 12th, 1922.

removed with forceps from its halo of newly formedspindle and stellate cells, and these cells will go onreproducing themselves for weeks and months so

long as the culture is maintained in its sterile condi-tion. But as soon as contamination is allowed,round cells appear in the network, and their dailyincrease can be accurately noted. The number ofround cells increases at the expense of the highlydeveloped spindle and stellate cells, which draw intheir processes and degenerate into round cells, whileat the same time the fibrinous meshwork of the culturemedium undergoes solution and the whole culturebecomes fluid, simulating the process that takes placein the body when pus is formed. From these observa-tions there can be no doubt that the round cells comefrom the descendants of the tissue cells themselvesand not from any hypothetical leucocytes. What is,then, the nature of these cells ? They resemble inmany respects leucocytes, for one finds among themcells with U- and S-shaped nuclei. Some of them showgranulation in their protoplasm, which is more ofteneosinophile than basophile, and round cells have beenfound that in every morphological character resembleneutrophile leucocytes. For some time the objectionwas raised that in spite of their morphological re-semblance these cells were not true leucocytes, forthey failed to give the oxydase reaction, but recentlyProf. Busse has come to the conclusion that it is notsurprising that the chemical conditions in a smalldrop of plasma are not the same as those present inthe circulating blood in men and animals, for manyof the chemical auxiliaries of the body must neces-sarily be missing. Possibly through improvement inthe culture medium it may be possible to producethose conditions in which an oxydase reaction willbe positive.

Prof. Busse points out, further, that it is by nomeans true that tissue will only grow on plasma fromthe same animal. Embryonic tissue especially iseasy to cultivate in a foreign plasma-e.g., tissuefrom a young chicken was grown on dog’s plasma,and true mitosis was observed. Cultures of humanconnective tissue and of various tumours have beengrown with success on animal plasma, but greatdifficulty has been experienced in using human

plasma, because, even in the absence of infection,human plasma tends to liquefy and the firm mediumwhich is necessary for accurate observation of tissue-cultures is not obtained.

SOCIAL SERVICE AND THE SANATORIUM.

THE idea of combining social work with sanatoriumcare owed its origin in France to the AmericanRed Cross in 1917. It has gained official recognitionin that country, and is now to be introduced into,Belgium by Dr. Toussaint, who recently, on the eveof assuming the direction of Tournai Sanatorium,exposed his conception of a social department to theBelgian National Tuberculosis Society. He first laiddown the principle that a doctor’s responsibility tohis patient cannot be terminated automatically atthe end of six months’ treatment, but must continuethrough the duration of the disease. Such a respon-sibility is too serious to be discharged by a littleverbal advice, and a pamphlet when the patient isleaving the sanatorium. As a sanatorium physicianDr. Toussaint insists that only curable cases shall beadmitted, and that it is part of the superintendent’sresponsibility to be able to choose only those caseswhich have a reasonably good chance of ultimatecure. A workshop is to be attached to the sanatorium,.in which various trades will be taught to the patients(dress-making, sewing and embroidery, - cardboardwork, book-binding, typing, basket-making, artificialflowers, toys, &c.)—the patients learning these-trades under the closest medical supervision. Whena certain maximum working day has been fixed for agiven patient, it becomes the duty of the socialdepartment to place this patient in the conditions forwhich his health fits him, and either to secure for himwages which are sufficient for his maintenance or-

857VENEREAL DISEASE IN LONDON AND ENVIRONS.

else to find supplementary allowances making up hiswages to this amount. For the social department ofa sanatorium of 100 beds a single whole-time publichealth nurse is considered sufficient. Voluntaryworkers may help, but cannot replace her. No patientmay be discharged until his future has been assuredin advance. -

VENEREAL DISEASE IN LONDON ANDENVIRONS.

THE London County Council proposes to continuethe arrangement, which has worked well in the past,of joining with the County Councils of Buckingham,Essex, Hertford, Kent, Middlesex, and Surrey, andthe Croydon, East Ham and West Ham CountyBoroughCouncils, for the common utilisation of the facilitiesafforded by certain London hospitals for diagnosisand treatment of venereal diseases. During the year1921 the number of patients’ attendances at the variousclinicswas 496,209, as compared with 464,033 for 1920.The number of new cases was 25,418, representing areduction of 5628. Only four clinics showed an increaseof numbers.. The reduction is attributed mainly tothe disappearance of abnormal conditions associatedwith the war and demobilisation. " No doubt itwould be reasonable to assume," state the L.C.C.Public Health Committee, " that it is also due, to someextent, to the effects of the continuous anti-venerealcampaign." --

INTERNATIONAL CONGRESS OF OTOLOGY.

THE Tenth International Congress of Otology willtake place in the Ecole de Médecine, Paris, on July 19th,20th, and 21st, immediately following the two days’annual meeting of the Societe Francaise d’Oto-Bhino-Laryngologie. The date originally fixed forthe Congress was altered to prevent its clashing withthe meeting of the British Medical Association atGlasgow; the French organisers of the Congress areanxious to welcome a large number of English-speakingvisitors. The president of the British OrganisingCommittee is Dr. Urban Pritchard, the chairman, SirStClair Thomson, and the hon. secretaries are Dr.Lionel Colledge, 22, Queen Anne-street, London, W. 1,and Dr. J. S. Fraser, 50, Melville-street, Edinburgh,either of whom is prepared to give all informationconcerning present arrangements. The subscriptionto the Congress is Fr.100 ( £ 2 ), which should beforwarded to the treasurer, Dr. G. Laurens, 4, AvenueHoche, Paris, 8°. Those who intend to read papersor join in debates should write direct to Dr. Hautant,28, Rue Marboeuf, Paris, 8°. It has been decided tohold an exhibition of anatomical and pathologicalspecimens (macroscopic and microscopic) connectedwith diseases of the ear, nose, larynx, and pharynx.Those who desire to exhibit specimens should com-municate the number and description of the latter toDr. P. Truffert, 2, Rue Ambroise Paré, Paris, 10°.

CANINE REJUVENATION EXPERIMENT.

Dr. Knud Sand communicates 1 an interestingexample of Steinach’s methods, which as an isolatedcase he does not wish to overstress, but which seemswell attested and of a striking character. In May,1921, an acquaintance brought to him at a pathologicalinstitute in Copenhagen, a pedigree German pointer,12t years old, whose life the owner despaired of owingto senile changes; he contemplated having the dogkilled. Sand took the precaution of sending theanimal to Prof. Hansen, of the Royal Veterinary andAgricultural College of the same city, for a preliminaryreport. This affirmed that the dog suffered frompronounced senility, with the symptoms of dull eyes,thin coat, deafness, and thickened inelastic skin. Itcould move only with difficulty, was emaciated, andoften had incontinence of urine and faeces. Therewere no signs of organic disease except cirrhotickidney, which was almost universal in old dogs. A

1Zeitschrift für Sexualwissenschaft, March, 1922.

tuberculin test proved negative. In spite of misgivingas to whether an ana’sthetic would be borne, Sandperformed on May 23rd resection of the left epididymisand right-sided vasectomy. The effects of the opera-tion had been completely recovered from by June 15th.In a week s time from this both testicles were felt tobe distended, the right more so. However, very littleretrogression of senility occurred, and at the end of themonth the animal was returned to its owner, who,on Oct. 25th, wrote that three or four weeks afterdischarge the dog became brisker, its appetite better,and its coat thicker. By the end of August it couldrun behind a bicycle slowly ridden and the sexualappetite revived : sight and hearing improved and itno longer slept all day. In September great strideswere made, so that he again used it for sporting purposesand regarded it as equal in every way to a dog sevenyears old. The animal was again examined by theveterinarian already mentioned, who expressed greatsurprise at the change in it. The author concludes byrecommending such treatment to the attention of theveterinary profession. ____

COMPULSORY EVIDENCE AT INQUESTS.As many coroners are medical men it may be of

interest to note a point dealt with exhaustively by Mr.Justice Riddell recently in the Supreme Court ofOntario in an appeal in which the decision of a coronerwas questioned. The point at issue was whether aman already in custody upon a charge of manslaughterin respect of a death into which the coroner wasinquiring could he subpoenaed and compelled to giveevidence at the inquest. Mr. Justice Riddell, afterreviewing at length the cases decided in English courtson the subject, held that such a person had the right togive evidence and equally could be compelled to do so,and concluded by pointing out that the object withwhich the law is administered is to discover the actualfacts for the public safety, the duty being laid uponevery citizen to tell all he knows for the sake of thepublic at large. The question whether a person alreadycommitted for trial by magistrates, or in custody upona charge of murder or manslaughter, can legally becompelled to go into the witness-box in a coroner’scourt in the same matter, appears, however, at anyrate so far as this country is concerned, to be ofacademic rather than practical interest, because,although there may be questions which such a witnessmight properly be made to answer, they are necessarilyfew. This is because no such witness can be com-pelled to answer a question if the effect of his answermight be to criminate himself. Consequently, a

person charged with the death, the subject of theinquest, is usually allowed, but not obliged, to bepresent, and allowed, but not obliged, to go into thewitness-box.

____

TREATMENT OF GASTRIC CRISES.

Dr. Albert R. McFarland, assistant in the section ondermatology and syphilology of the Mayo Foundation,draws attention to the helplessness of the physicianand the abject misery of the patient during the gastriccrises of tabes, in which hitherto hypodermic injectionof morphia has been the only method which can controlthe pain and vomiting. The condition is oftenmistaken for gall-stone colic or some similar definitelyorganic cause, and the drug may have to be repeatedlyemployed before the true nature of the disease isdiscovered, by which time the habit of morphinism iswell established. After experiments with many drugsand different methods of administration, Dr. McFarlandhas found that the most satisfactory mode of treat-ment, palliative only it is true, is the administrationof chloral hydrate and sodium bromide in large dosesby rectum. The results have been at least as good asthose of morphia in the majority of the cases and therisk of establishing a drug habit has been avoided.A watery solution of chloral hydrate and sodiumbromide in which half an ounce (15 c.cm.) of the fluid

1 Journal of the American Medical Association, March 18th,1922.