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claims that perirenal injection is practically painless, Iand does not in any way interfere with the normalactivities of the patient, who can walk about imme-diately after the injection. It may be performedbilaterally at the same sitting, in the out-patientdepartment, or in the consulting room withoutcausing anxiety.A preliminary report on another method of radio-
logical examination of the renal pelvis has lately beenpublished by Dr. Samuel A. Thompson,3 who refersto the technique used by Dr. L. G. Cole in 1910. Dr.Cole described a method of inflating the kidneys withwarm filtered air, enumerating some of the advantagesof this procedure over pyelography with opaque media,but the method appears to have gained no furtheradherents. While the injection of an opaque solutioninto the ureter or pelvis causes a shadow which maybe of sufficient density to obscure the shadow of astone, and, in any case, throws into relief only thepelvis and calices and not the kidney tissue itself,the injection of oxygen-the medium selected by Dr.Thompson for his cases-causes no shadow, and,moreover, is found to show up the parenchyma of thekidney as well as pelvis and calices. Dr. Thompsonclaims that the size, shape, and position of any stonethat may be present can be determined with compara-tive ease. Among the conditions for which pneumo-pyelography is suggested as a useful help todiagnosis are hydronephrosis and pyonephrosis, inwhich the negative contrast method described aboveis not recommended without reserve. Accordingto Dr. Thompson, pneumopyelography is a simpleand painless procedure.
TRAUMATIC FAT-NECROSIS OF FEMALE
BREAST.
IN May, 1920, Dr. Burton J. Lee and Dr. FrankB. Adair 4 of New York, reported to the AmericanSurgical Association two examples of traumatic fat-necrosis of the female breast, pointing out the strikingresemblances of this condition to carcinoma. Sincethen they have met with three additional cases,though they have been unable to find any referencein the literature to this clinical entity. Duringthe period in which the patients presented themselvesat the breast clinic the writers met with 120 cases ofprimary operable and 163 of primary inoperablecarcinoma of the breast. Traumatic fat-necrosis hastherefore occurred in comparison with primary breastcarcinoma in the proportion of 5 to 283, or 1-8 per cent.Among benign breast tumours the proportion of fat-necrosis to other benign tumours was 5 to 72, orapproximately 7 per cent. Corpulency appeared to bean important factor, as there was not one single thinindividual in the series, and every patient had morethan the average amount of subcutaneous tissue. All ’,were heavy women, weighing from 152 to 211 pounds. IfIn every instance the breasts were large and full, the Imammary glands in one case reaching to the level ofthe umbilicus. One of the chief diagnostic points is adefinite history of trauma, which in two cases wasfollowed by ecchymosis. A characteristic symptom isthe extreme hardness of the tumour. Retraction ofthe nipple occurred in only one instance. Fixation ofthe skin strongly suggesting a diagnosis of carcinomawas found in all but one case. Attachment to thedeeper structures was observed in two instances andlacking in three, so that it could not be regarded as aconstant symptom. With one exception, in which theglands were exceedingly soft, no axillary or supra-clavicular glands could be felt. The absence of anyglandular involvement is therefore a differential pointbetween fat-necrosis and carcinoma. The writersconclude that traumatic fat-necrosis of the femalebreast is a not infrequent condition which must becarefully differentiated from carcinoma, and suggestthat some cases which may have been diagnosed by
3 Journal of Urology, April, 1922.4 Surgery, Gynecology and Obstetrics, April, 1922.
their gross appearances as carcinoma were not reallvcancerous at all, but were examples of traumatic tat.necrosis. ____
DYSENTERY IN THE BRITISH WEST
INDIES.
IN the course of a paper recently read before theSection of Tropical Diseases at the Royal Society ofMedicine, Dr. John Anderson showed that true
dysentery accounted for about 5 per cent., whilstother intestinal diseases, including enteric fever,diarrhoea, and enteritis, were responsible for over 20per cent., of the total deaths in the West Indies. Forwant of sufficient laboratory facilities the differentialdiagnosis of intestinal disorders is necessarily open tomuch inaccuracy, being based chiefly on clinicalgrounds or the degree of response to emetine treat-ment. Amoebic dysentery is apparently more preva-lent than the bacillary form, and, owing to inexactmethods of diagnosis and unsatisfactory treatment, isattended by a high death-rate. The usual method oftreatment consists of preliminary emetine injections,when a case failing to respond is presumed to be oneof bacillary dysentery and given sodium sulphate.Use is also made of native remedies of local repute.Amoebic abscess of the liver and intestinal perforationfrom amoebic ulceration appear to be rare complica-tions. The free pollution by coolies of the banks ofstreams, which may serve as water supplies, is a fertilesource of infection of all forms of intestinal disorder,and the inadequate methods of sewage disposal are aserious menace to the health of the population.Drastic measures of sanitary reform would indeed seemto be as necessary in the West Indies as in Mauritius.Dr. Anderson emphasised the need for encouragementand intelligent support by the Imperial Government,the importance of closer association between theinsular medical services and the schools of tropicalmedicine in England, and for an extension of facilitiesto educate the rising colonial generation in preventivemedicine.
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THE SEARCH FOR SPECIFIC REMEDIES.
THE search for specific remedies, according to Dr.H. H. Dale, is really a legacy from the days when ourideas on the relation of medicine to disease wereprimitive. Several cases of recovery after the exhibi-tion of a drug were at one time regarded as sufficientevidence that the drug alone had wrought the miracle.Our faith in pharmacy has now been weakened bymore precise experimental conditions and by theknowledge that the processes of disease and recoveryare immensely complex. The modern problem ininfective diseases is to find a drug which will do themaximum damage to the invading organism with theminimal damage to the host. But a superior attitudeeven towards those who have faith in the contents ofalmost any bottle is dangerous. Dr. Dale illustratedthis point at the Royal Institution last Friday bydetailing his own disappointing experiences with thealkaloids of ipecacuanha, one of the few of the oldspecific c remedies which have survived modernexperimental tests. These alkaloids have recentlybeen separated in the hope of finding one more toxicto protozoa than emetine while less toxic to the host.Success seemed to be imminent, for one of the isolatedalkaloids destroyed protozoa in vitro with muchgreater speed and sureness than any other, and at thesame time the toxic symptoms caused by its adminis-tration to the animal host were minimal. But,unfortunately, although almost ideal conditions appearto have been reached, this drug completely failed tocure the disease. Such disappointments are en-
countered almost daily by those engaged in medicalresearch, so complex are the still unknown factorsgoverning resistance. One important point emerges-we may regard it as almost certain that, stimulatingas were the side-chain theories of Ehrlich, the chemicalview of these processes must give way to the physio-logical one. Incidentally, as an illustration of the
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unexpected ends sometimes attained, Dr. Daleinstanced the attempt on somewhat slender theoreticalgrounds to enlist dyestuffs as remedies, leading tosuch different results as acriflavine as a disinfectant.and Bayer 205 as a specific for sleeping sickness. Thislatter, though not a dyestuff, is probably allied informula to trypan blue, and there appears to bemuch evidence of its value. A very advanced casewas recently sent from Liverpool to Hamburg fortreatment and returned apparently cured. Somerisk of damage to the kidneys appears to be entailed,but few patients would hesitate in the choice betweenliving with a damaged kidney and dying of trypanb-somiasis. In any case the results of the Germaninvestigations in Rhodesia will be awaited with keeninterest. The educational value to the public of suchan excellent interpretation of the ideals of scientificmedicine as that given by Dr. Dale cannot be toohighly assessed. Few people could contrive toenthral a lay audience and at the same time to sendaway the medical men present stimulated by a wealthof suggestive argument.
ADVANCED lectures in medicine, under the auspicesof the University of London, will be given at the houseof the Royal Society of Medicine, 1, Wimpole-street,London, W. 1, at 5 P.M., on May 22nd, 25th, and 31st,by the following professors in the Faculty of Medicineof the University of Paris, who will speak in French.On May 22nd, Prof. F. Widal will discuss Anti-anaphylaxie. Prof. H. Vaquez’s lecture on May 25this entitled De 1’Erythremie (Maladie de Vaquez-Osler),and Prof. J. Babinski on May 31st will speak on DesReflexes de Defense. The chair at these three lectureswill be taken by Lord Dawson, Sir WHmot Herringham,and Sir J. Purves Stewart respectively.
Dr. John Macpherson, C.B., who has lately retiredfrom the post of Commissioner of the Board of Controlfor Scotland, has accepted for a period of three yearsthe post of Professor of Psychiatry in the Universityof Sydney. This chair is the first of its kind in anyUniversity in Australia; the authorities have appointedto this post an experienced physician in Dr. Macpherson,a well-known administrator, who for some years haslectured on the subject of mental diseases at the
Royal Colleges’ School of Medicine in Edinburgh.There is already a clinic on mental diseases in connexionwith the hospital at Sydney.
DENT<1L BOARD OF THE UNITED KINGDOM.——Atthe close of the hearing of the disciplinary cases on
May llth the chairman of the Board, the Rt. Hon. F. DykeAcland, M.P., announced the Board’s findings in respect of17 of these cases. During the session three other cases werealso considered and dismissed, the facts alleged against thedental practitioners concerned not having been proved to thesatisfaction of the Board. With regard to the 17 cases wherethe regulations of the General Medical Council concerningcovering had clearly been infringed, the chairman made ageneral announcement to the following effect : Since 1897warning notices with reference to covering had several timesbeen issued by the Council, and the regulations had beenmade quite clear. Although the conduct of the practitionerswho had been summoned before the Board this session hadvaried very much in gravity, that conduct might in each casebe described as (1) fraudulent and dangerous to the publichealth. and (2’) grossly unfair to brother practitioners. Inaddition, some of the accused had jeopardised the chances oftheir assistants who applied for registration, in an endeavourto save themselves. Taking all the cases into account, andhaving especial regard to the fact that the practitionersconcerned had incriminated themselves (i.e., in writing tosupport the applications of their assistants for registration),the Board was prepared to give them. another chance. TheBoard therefore postponed judgment until the Novembersession, 1922, at which time the accused would be required tobring evidence of satisfactory behaviour in the interval. Infuture, when the facts of employment of unqualified assistantsfor other than mechanical work were proved, it must not beassumed that a similar course would be followed by the Board.The Board then adjourned, the chairman having announcedthat the session of Friday, May 12th, would be held inc am era.
THE PHYSIOLOGY AND PATHOLOGY OFRESPIRATION.
Profs. Leon Asher and R. Staehelin have respec-tively dealt with the physiology and pathology ofthe respiration in the Swiss 11’l edizinische Wochenschrift(Jan. 5th and 12th, 1022), summarising recentresearch work on this subject and giving a biblio-graphy. Prof. Asher first draws attention, in con-nexion with internal respiration, to Neuberg’s dis-covery of carboxylases-enzymes which, by splittingthe carboxyl group, e.g., of amino-acids, set freecarbon dioxide, amines thus arising. There are otherpossible reactions by which carbon dioxide can arisein the absence of oxygen-it can be expelled by acidfrom preformed carbonates, the end-stage of tissuerespiration, in the absence of oxygen, being organicacid. A. V. Hill finds that muscular contraction isan anoxybiotic process, lactic acid being formedwhich occasions the change of tension of the muscularfibres. Oxygen is used chiefly in the restitutionprocess after contraction. The oxygen part of therespiratory process in the tissues is comparable withfermentation-e.g., in respect of the influence of aco-ferment and of narcotics. In sugar fermentationintermediary substances arise, such as oxybutyricacid and acetic aldehyde, so too in tissue respiration.Protein and fat on oxidation yield similarly inter-mediary substances. The process is an acid-pro-ducing one, not only carbon dioxide but sulphuric,phosphoric, and organic acid arising.
The J1 easurement of Respiratory Exchunge.The consumption of oxygen in the body is ruled
by the needs of the cells ; uninfluenced by an over-supply, they cannot be forced into quicker burningas a fire can. The needs of the cells for oxygenstimulates the formation of haemoglobin in menexposed to the attenuated air of high altitudes andin cases of artificial pneumothorax. Aromatic nitro-compounds, harmless in themselves, become toxicbecause the tissues rob them of oxygen and reducethem to poisonous hydroxylamines. The tissue cellscan use then easily dissociable bound oxygen otherthan that in oxy-haemoglobin. There is no reserveof oxygen-supply in the body-a man can only holdhis breath for a minute or two, living meanwhile onthe oxygen in the lungs. Internal respiration ismeasured by the difference between the arterial andvenous blood. Barcroft has perfected the Haldaneferricyanide method, so that with his differentialapparatus the gaseous content of as little as 1/10th c.cm.of blood can be analysed. The respiratory exchangeof the heart and glands has been determined andfound to be considerable ; the use of oxygen inactively secreting glands is greater than the produc-tion of carbon dioxide. By means of the respiratoryquotient the proportion of protein, fat, and carbo-hydrate metabolised is measured and the energyoutput calculated. The thermodynamics of theheart has thus been studied.
The Gaseous Tension of the Blood.Warburg has put forward the view that oxygen is
used to maintain the concentration and potentialdifferences in living cells, which depend on thegranular structure of the bioplasm of the cells.When this is broken up oxygen respiration ceases.Great interest attaches to the gaseous tension of theblood. The dissociation tensions of oxygen andcarbon dioxide are plotted as curves, the gas pres-sures being given as abscissae, and the gas volumes.obtained from the blood after exposure to each gaspressure being given as ordinates. The oxygentension of arterial blood is found to be lower than ofthe alveolar air, and of carbon dioxide of the venousblood higher than that of the alveolar air. There isno proof of a respiratory secretory process, suggestedby Bohr and supported by Haldane. Haemoglobin is
