A HOSPITAL SWEEPSTAKE
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93 could spread to adjacent portions of the central nervous system with the production of a meningo- encephalomyelitis, the type of which would be determined by the distribution of the zoster infection. A meningeal reaction has long been recognised as a constant feature of zoster and occasionally the signs and symptoms of meningitis are present. In support of their conception of a zoster encephalitis Schiff and Brain point out that in the cases which they would put in this category, meningeal symptoms are a prominent feature and often show a local pre- dominance corresponding to the distribution of the zoster. The demonstration of the virus of zoster in the cerebro-spinal fluid of their case lends support to this view. ____ ABOUT DELIRIUM TREMENS. AT a meeting of the Society for the Study of Inebriety, held at the rooms of the Medical Society of London on Tuesday last, Dr. E. F. Wills, resident medical superintendent at Rendlesham Hall, described his personal experiences with sufferers from delirium tremens. The main question with which he dealt, as a clue to treatment, was whether the sudden withdrawal of alcohol is a factor in the onset of the delirium. Fairly admitting that this sequence of events has been flatly denied by certain authorities,. he detailed instances, which had come under his own observation, showing that delirium is more likely to manifest itself when alcohol has been abruptly discontinued. He further explained the occurrence of delirium tremens in association with shock or surgical interference as an example of the same phenomenon, believing that when such cases are closely investigated the real factor determining the symptom will be found to be the withholding of alcohol up to at least the amount which the patient had been previously imbibing. Therefore he holds the immediate bar to all alcohol to constitute incorrect treatment, advising that, together with the appropriate narcotics and purges, alcohol in ’’ tapering " doses should be exhibited. Dr. Wills’s paper concluded with the comforting statement that the number of cases of delirium tremens is on the decline in this country in response to the raised price of alcohol and the shorter hours during which its public purchase is sanctioned by law. This was a simple and practical communication. I MUCOUS MEMBRANE IN THE SKIAGRAM. RADIOGRAPHY of the stomach and duodenum is passing into a second stage of its development. In the first stage the stomach was filled with the opaque meal and the state of the lumen was thus made apparent. In the second stage, for which we are indebted to the pioneer work mainly of Akerlund, Forsell, Holzknecht, Schwarz, and Berg, interest may be said to have been transferred from the lumen to the wall itself, the investigation being directed to the contour of the mucous membrane. While the former method is of value in determining size, shape, tonus, and peristalsis, the latter is a considerable refinement where organic disease is concerned. A. Rohrbachl gives a full account of the technique he uses which closely resembles that recently described in our columns2 by V. J. Kinsella, and attributed by him to J. O’Sullivan. Only half a tablespoonful of the barium meal is given and it is important that this should be of 1 Med. Klin., 1930, xxvi., 469. 2 THE LANCET, 1929, i., 1130. maximal surface-tension and free from particles. This small amount is observed on the screen and by suitable manual compression it is made to fill the furrows of mucous membrane, leaving the intervening ridges bare. Films are taken with Berg’s well-known apparatus. Normally the mucous folds should appear as parallel lines of uniform width ; a radial arrangement indicates the present of an ulcer at the point of convergence. The main advantages of this over the earlier method are that by varying the degree of compression the presence of multiple ulcers can be determined, that ulcers can be seen on the anterior and posterior surfaces when their craters do not project in profile from the lesser curvature, and that information is given regarding the degree of inflammatory thickening of the mucous membrane surrounding the crater. The method is also of service in the investigation of carcinoma. Atrophy of the mucosa, as in pernicious anaemia, and the inflammatory changes of gastritis are also well brought out. A HOSPITAL SWEEPSTAKE. THE particulars of the first sweepstake to be organised in aid of the Dublin hospitals were published last week. Six hospitals are to share the profits- namely, Jervis-street, Sir Patrick Dun’s, National Dental, National Maternity, Children’s (Harcourt- street), and St. Ultan’s. A sum of E25,000 is guaran- teed for distribution in prizes, but the promoters hope that, as the result of the sale of tickets, they may have an amount at their disposal of at least four times that sum. Of the total receipts, 80 per cent. will be distributed in prizes, the other 20 per cent. covering the expenses as well as the profits for distribution to the charities. The sweepstake will be on the November Handicap, and the draw will take place on Nov. 17th, in the Mansion House, Dublin. It is clear that, unless the sale of tickets goes beyond expectation, the promoters must be content with a comparatively small sum for the benefit of the charities. CONSTITUTION OF HUMAN MILK. EXACT information about the constituents of human milk at all periods of lactation is important for the preparation of artificial foods for infants. Much attention has been paid to its composition during the first month, but after that there has been a gap. We therefore welcome new observations, just published by workers at the Royal Free Hospital and elsewhere, on the milk of 51 women attending welfare centres. It appears that the calcium content is lowest for the first two weeks of lactation, rising gradually to a maximum during the first four months ; it maintains a fair level after the fourth month, but slowly decreases. The rise in the proportion of calcium coincides with the time when the baby is increasing its intake of milk by the largest daily amount, while the subsequent decrease will be balanced by the supplementary foods that the child will take about the age of six months. The proportion of phosphorus runs parallel with calcium up to the end of the fourth month, but then remains almost constant. This, it is suggested, may be because growing soft tissues need more phosphorus than calcium. The ratio between the two elements is of great importance in the setiology of rickets, and this study indicates that during the first six months of life a ratio of CaO to 1 Widdows, S. T., Lowenfeld, M. F., Bond, M., and Taylor. E. I. : Biochem. Jour., 1930, xxiv., 327.
Transcript of A HOSPITAL SWEEPSTAKE
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could spread to adjacent portions of the centralnervous system with the production of a meningo-encephalomyelitis, the type of which would bedetermined by the distribution of the zoster infection.A meningeal reaction has long been recognised as aconstant feature of zoster and occasionally the signsand symptoms of meningitis are present. In supportof their conception of a zoster encephalitis Schiffand Brain point out that in the cases which theywould put in this category, meningeal symptoms area prominent feature and often show a local pre-dominance corresponding to the distribution of thezoster. The demonstration of the virus of zoster inthe cerebro-spinal fluid of their case lends supportto this view.
____
ABOUT DELIRIUM TREMENS.
AT a meeting of the Society for the Study ofInebriety, held at the rooms of the Medical Societyof London on Tuesday last, Dr. E. F. Wills, residentmedical superintendent at Rendlesham Hall, describedhis personal experiences with sufferers from deliriumtremens. The main question with which he dealt,as a clue to treatment, was whether the suddenwithdrawal of alcohol is a factor in the onset of thedelirium. Fairly admitting that this sequence ofevents has been flatly denied by certain authorities,.he detailed instances, which had come under his ownobservation, showing that delirium is more likely tomanifest itself when alcohol has been abruptlydiscontinued. He further explained the occurrenceof delirium tremens in association with shock or
surgical interference as an example of the same
phenomenon, believing that when such cases are
closely investigated the real factor determining thesymptom will be found to be the withholding ofalcohol up to at least the amount which the patienthad been previously imbibing. Therefore he holdsthe immediate bar to all alcohol to constitute incorrecttreatment, advising that, together with the appropriatenarcotics and purges, alcohol in ’’ tapering " dosesshould be exhibited.Dr. Wills’s paper concluded with the comforting
statement that the number of cases of deliriumtremens is on the decline in this country in responseto the raised price of alcohol and the shorter hoursduring which its public purchase is sanctioned by law.This was a simple and practical communication.
I
MUCOUS MEMBRANE IN THE SKIAGRAM.
RADIOGRAPHY of the stomach and duodenum is
passing into a second stage of its development. Inthe first stage the stomach was filled with the opaquemeal and the state of the lumen was thus made
apparent. In the second stage, for which we areindebted to the pioneer work mainly of Akerlund,Forsell, Holzknecht, Schwarz, and Berg, interest
may be said to have been transferred from the lumen tothe wall itself, the investigation being directed to thecontour of the mucous membrane. While the formermethod is of value in determining size, shape, tonus,and peristalsis, the latter is a considerable refinementwhere organic disease is concerned. A. Rohrbachlgives a full account of the technique he uses whichclosely resembles that recently described in our
columns2 by V. J. Kinsella, and attributed by him toJ. O’Sullivan. Only half a tablespoonful of the bariummeal is given and it is important that this should be of
1 Med. Klin., 1930, xxvi., 469.2 THE LANCET, 1929, i., 1130.
maximal surface-tension and free from particles. Thissmall amount is observed on the screen and by suitablemanual compression it is made to fill the furrows ofmucous membrane, leaving the intervening ridges bare.Films are taken with Berg’s well-known apparatus.Normally the mucous folds should appear as parallellines of uniform width ; a radial arrangement indicatesthe present of an ulcer at the point of convergence.The main advantages of this over the earlier methodare that by varying the degree of compression thepresence of multiple ulcers can be determined, thatulcers can be seen on the anterior and posteriorsurfaces when their craters do not project in profilefrom the lesser curvature, and that information is
given regarding the degree of inflammatory thickeningof the mucous membrane surrounding the crater.The method is also of service in the investigation ofcarcinoma. Atrophy of the mucosa, as in perniciousanaemia, and the inflammatory changes of gastritisare also well brought out.
A HOSPITAL SWEEPSTAKE.
THE particulars of the first sweepstake to be
organised in aid of the Dublin hospitals were publishedlast week. Six hospitals are to share the profits-namely, Jervis-street, Sir Patrick Dun’s, NationalDental, National Maternity, Children’s (Harcourt-street), and St. Ultan’s. A sum of E25,000 is guaran-teed for distribution in prizes, but the promotershope that, as the result of the sale of tickets, they mayhave an amount at their disposal of at least four timesthat sum. Of the total receipts, 80 per cent. will bedistributed in prizes, the other 20 per cent. coveringthe expenses as well as the profits for distribution tothe charities. The sweepstake will be on theNovember Handicap, and the draw will take place onNov. 17th, in the Mansion House, Dublin. It isclear that, unless the sale of tickets goes beyondexpectation, the promoters must be content with acomparatively small sum for the benefit of thecharities.
____
CONSTITUTION OF HUMAN MILK.
EXACT information about the constituents of humanmilk at all periods of lactation is important for thepreparation of artificial foods for infants. Muchattention has been paid to its composition during the
first month, but after that there has been a gap. Wetherefore welcome new observations, just publishedby workers at the Royal Free Hospital and elsewhere,on the milk of 51 women attending welfare centres. Itappears that the calcium content is lowest for thefirst two weeks of lactation, rising gradually to a
maximum during the first four months ; it maintainsa fair level after the fourth month, but slowlydecreases. The rise in the proportion of calciumcoincides with the time when the baby is increasingits intake of milk by the largest daily amount, whilethe subsequent decrease will be balanced by thesupplementary foods that the child will take aboutthe age of six months. The proportion of phosphorusruns parallel with calcium up to the end of the fourthmonth, but then remains almost constant. This, itis suggested, may be because growing soft tissuesneed more phosphorus than calcium. The ratiobetween the two elements is of great importance inthe setiology of rickets, and this study indicates thatduring the first six months of life a ratio of CaO to
1 Widdows, S. T., Lowenfeld, M. F., Bond, M., and Taylor.E. I. : Biochem. Jour., 1930, xxiv., 327.
