ROYAL MEDICAL BENEVOLENT FUND: THE CHRISTMAS GIFTS
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1230 for those who use sanocrysin, but for all who treat tuberculosis. Dr. Secher follows the classification of tuberculosis into the anatomical forms of exudative, degenerative or necrotic, and productive or prolifera- tive, which has now passed into common use on the continent, admitting that in practice it rarely gives a true picture of the clinical condition. The choice of case for sanocrysin treatment is probably best made on purely clinical grounds of history, signs, and symptoms, with a good radiogram as a backing, and without reference to a supposed pathological picture which may or may not exist. To the actual admini’3tra- tion of the drug Dr. Secher finds three useful guides- temperature reaction (four types are recognised), erythema, and albuminuria, and he devotes a chapter to an analysis of all the untoward symptoms met with by various investigators. He agrees that it is not always easy to differentiate between toxic symptoms due to the gold-ion and those due to the liberation of tubercle endotoxin. Possibly the former may be more easily detected now that minute quantities of gold can be estimated in the urine and faeces by colorimetric, electrolytic, or iodometric titration. Although most English workers appear to have discontinued its use, Dr. Secher is a firm believer in the value of antiserum combined with sanocrysin, as originally advocated by Mollgaard. The interest in tuberculosis antiserum revived by sanocrysin investi- gation may itself lead to useful results. Dr. Secher adheres also to the large-dose method of administra- tion, never using less than 0-5 g. as a start, and aiming at a high concentration of sanocrysin, being guided subsequently by the patients’ reactions. Sanocrysin is a powerful drug, and cannot be used without facilities for careful observation of patients at rest in bed and without expert nursing. There is no question .of ambulant treatment as in the case of tuberculin. All the necessary precautions have been taken by Dr. Secher, and his records, given in full detail in the book, are a monument of painstaking research. Of the ultimate results he is evidently convinced, for writing of pulmonary tuberculosis he says: "Sano- crysin treatment (when employed in accordance with ,right indications and carried through with sufficient energy) will in all patients cause an improvement of their condition and will cure a large number...." Dr. Secher has had an extensive experience of sano- crysin and writes with conviction, but his readers may be more reserved in their conclusions. SPIDER BITES. IT is well established that some tropical spiders are big enough and poisonous enough to catch and kill animals as large as small birds. But modern observation has wiped out the tarantula myth, nor are there now found in Gascony " spiders of that virulency that, if a man tread upon them, to crush them, their poison will pass through the very soles of his shoes " as was once affirmed, Indeed, the pendulum has swung so far the other way that arachnologists have come to doubt whether spiders’ bites ever cause ill- ness in man. However, Dr. Emil Bogen, of Los Angeles, 1 has seen 15 cases in recent years where a characteristic chain of symptoms has followed the bite of Latrodectus mactans, a big black spider which has an unfortunate habit of lurking under the seats of privies. The chief ,symptom is pain, which may occur in any or every part of the body, irrespective of the site of the bite, and is accompanied with restlessness, nausea, dizziness, and other general signs. It is obvious from his description that the patient’s complaints might easily be put down to fright if only an odd case was seen ; they are, however, repeated with considerable regu- larity.in all the examples which have come to the Los Angeles General Hospital. The pain is often very severe, and requires large doses of opiates to control it. Dr. Bogen has had good results by injecting the serum of convalescent cases. After a few days the patient recovers without any ill-effects. 1 Jour. Amer. Med. Assoc., 1926, lxxxvi., 1894; Archiv. Int. Med., 1926, xxxviii., 623. The bibliography is, unfortunately, not printed in the Archivess " on account of lack of space," so that it is difficult for anyone who is interested to follow the matter up; but in his summary of the literature Dr. Bogen points out that similar poisonings, often from other species of Latrodectus, have been repeatedly described in Southern Europe, Russia, Australia, New Zealand, Madagascar, and South America, and there is evidently no reason to doubt that human arachnidism is a reality.____ ROYAL MEDICAL BENEVOLENT FUND: THE CHRISTMAS GIFTS. IT has been the practice of the Royal Medical Benevolent Fund for many years to present to the annuitants and some of the most necessitous grantees a Christmas gift. The Treasurer now makes an appeal for f370 to keep up this practice. The committee has not in hand any special fund to draw upon to meet this Christmas gift. The individual sum given, 25s., is small, but the recipients are many ; in former years they have received this little augmentation of their narrow means and are no doubt looking forward to its receipt this year. It is a friendly act on the part of the managers of the Fund which should not be allowed to cease, and we trust that our readers will make the continuance possible by finding the small sum necessary. Subscriptions may be sent to the Ron. Treasurer, Sir Charters Symonds, at the Offices of the Fund, 11, Chandos-street, Cavendish- square, London, W. 1. MEDICAL SUPPLIES IN WAR. TilE military authorities of the United States of America are clearly determined not to be caught napping by another war. All officers of the Medical Reserve are told precisely what will be their appoint- ments on mobilisation, whether to hospitals, field ambulances, or as specialists. The question of medical supplies and their replacement is being carefully considered, and so far as surgical instruments are concerned, is discussed by Major R. C. Heflebower, Medical Corps, U.S. Army, in an address to the American Surgical Trade, reported in the Military Stirneon for November. The arrangements for pro- viding instruments in war-time are in the hands of a special section of the Surgeon-General’s Office, a section which has nothing to do with the present supply. First the section has to decide what instru- . ments will be wanted, and what specifications shall be put forward ; it is advised by certain Reserve officers, who are surgical instrument-makers, so that buying shall be done commercially in the best way. Then the quantity of stores wanted must be defined. Ultimately that will be settled by the scale of mobilisation, but at present tentative contracts are put out, and the tenders are advised upon by the Reserve officers, who discuss whether they can be better assigned - whether, for instance, similar contracts for forceps should be given to each contractor, or whether all large forceps should be made by one and all small forceps by another. The third question is, whence shall the instruments be obtained ? At first some can be purchased; this will be the work of the Reserve officers, who (having regard to the needs of the civil population) will buy what is immediately available. The rest must be made. The industry, however, may not itself be able to cope with the demand, and it may be necessary to call on workers in associated trades. Thus surgical needles or scissors might be roughed out by other workers and finished by the surgical instrument- makers provided that there were enough skilled mechanics. So as to avoid a shortage the trades can get a lien on the services of mechanics engaged else- where, and these men will be scheduled as indis- pensable. Moreover, the raw material, power, and transport required for this work must all be arranged for in advance by the Assistant-Secretary for War, in the light of the needs of other essential services. It is hoped that working along thse lines there will be little industrial confusion in the change from peace
Transcript of ROYAL MEDICAL BENEVOLENT FUND: THE CHRISTMAS GIFTS
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for those who use sanocrysin, but for all who treattuberculosis. Dr. Secher follows the classificationof tuberculosis into the anatomical forms of exudative,degenerative or necrotic, and productive or prolifera-tive, which has now passed into common use on thecontinent, admitting that in practice it rarely givesa true picture of the clinical condition. The choiceof case for sanocrysin treatment is probably best madeon purely clinical grounds of history, signs, andsymptoms, with a good radiogram as a backing, andwithout reference to a supposed pathological picturewhich may or may not exist. To the actual admini’3tra-tion of the drug Dr. Secher finds three useful guides-temperature reaction (four types are recognised),erythema, and albuminuria, and he devotes a chapterto an analysis of all the untoward symptoms met withby various investigators. He agrees that it is notalways easy to differentiate between toxic symptomsdue to the gold-ion and those due to the liberation oftubercle endotoxin. Possibly the former may bemore easily detected now that minute quantities ofgold can be estimated in the urine and faeces bycolorimetric, electrolytic, or iodometric titration.Although most English workers appear to havediscontinued its use, Dr. Secher is a firm believer inthe value of antiserum combined with sanocrysin,as originally advocated by Mollgaard. The interest intuberculosis antiserum revived by sanocrysin investi-gation may itself lead to useful results. Dr. Secheradheres also to the large-dose method of administra-tion, never using less than 0-5 g. as a start, and aimingat a high concentration of sanocrysin, being guidedsubsequently by the patients’ reactions. Sanocrysinis a powerful drug, and cannot be used withoutfacilities for careful observation of patients at rest inbed and without expert nursing. There is no question.of ambulant treatment as in the case of tuberculin.All the necessary precautions have been taken byDr. Secher, and his records, given in full detail in thebook, are a monument of painstaking research. Ofthe ultimate results he is evidently convinced, forwriting of pulmonary tuberculosis he says: "Sano-crysin treatment (when employed in accordance with,right indications and carried through with sufficientenergy) will in all patients cause an improvement oftheir condition and will cure a large number...."Dr. Secher has had an extensive experience of sano-crysin and writes with conviction, but his readers maybe more reserved in their conclusions.
SPIDER BITES.IT is well established that some tropical spiders
are big enough and poisonous enough to catch andkill animals as large as small birds. But modernobservation has wiped out the tarantula myth, norare there now found in Gascony " spiders of thatvirulency that, if a man tread upon them, to crushthem, their poison will pass through the very soles ofhis shoes " as was once affirmed, Indeed, the pendulumhas swung so far the other way that arachnologistshave come to doubt whether spiders’ bites ever cause ill-ness in man. However, Dr. Emil Bogen, of Los Angeles, 1has seen 15 cases in recent years where a characteristicchain of symptoms has followed the bite of Latrodectusmactans, a big black spider which has an unfortunatehabit of lurking under the seats of privies. The chief,symptom is pain, which may occur in any or everypart of the body, irrespective of the site of the bite,and is accompanied with restlessness, nausea, dizziness,and other general signs. It is obvious from hisdescription that the patient’s complaints might easilybe put down to fright if only an odd case was seen ;they are, however, repeated with considerable regu-larity.in all the examples which have come to theLos Angeles General Hospital. The pain is oftenvery severe, and requires large doses of opiates tocontrol it. Dr. Bogen has had good results byinjecting the serum of convalescent cases. After afew days the patient recovers without any ill-effects.
1 Jour. Amer. Med. Assoc., 1926, lxxxvi., 1894; Archiv.Int. Med., 1926, xxxviii., 623.
The bibliography is, unfortunately, not printed in theArchivess " on account of lack of space," so that it isdifficult for anyone who is interested to follow thematter up; but in his summary of the literatureDr. Bogen points out that similar poisonings, often fromother species of Latrodectus, have been repeatedlydescribed in Southern Europe, Russia, Australia,New Zealand, Madagascar, and South America, andthere is evidently no reason to doubt that humanarachnidism is a reality.____
ROYAL MEDICAL BENEVOLENT FUND: THECHRISTMAS GIFTS.
IT has been the practice of the Royal MedicalBenevolent Fund for many years to present to theannuitants and some of the most necessitous granteesa Christmas gift. The Treasurer now makes an appealfor f370 to keep up this practice. The committeehas not in hand any special fund to draw upon tomeet this Christmas gift. The individual sum given,25s., is small, but the recipients are many ; in formeryears they have received this little augmentation oftheir narrow means and are no doubt looking forwardto its receipt this year. It is a friendly act on thepart of the managers of the Fund which should not beallowed to cease, and we trust that our readers willmake the continuance possible by finding the smallsum necessary. Subscriptions may be sent to theRon. Treasurer, Sir Charters Symonds, at theOffices of the Fund, 11, Chandos-street, Cavendish-square, London, W. 1.
MEDICAL SUPPLIES IN WAR.
TilE military authorities of the United States ofAmerica are clearly determined not to be caughtnapping by another war. All officers of the MedicalReserve are told precisely what will be their appoint-ments on mobilisation, whether to hospitals, fieldambulances, or as specialists. The question of medicalsupplies and their replacement is being carefullyconsidered, and so far as surgical instruments are
concerned, is discussed by Major R. C. Heflebower,Medical Corps, U.S. Army, in an address to theAmerican Surgical Trade, reported in the MilitaryStirneon for November. The arrangements for pro-viding instruments in war-time are in the hands of aspecial section of the Surgeon-General’s Office, a
section which has nothing to do with the presentsupply. First the section has to decide what instru-
.
ments will be wanted, and what specifications shall beput forward ; it is advised by certain Reserve officers,who are surgical instrument-makers, so that buyingshall be done commercially in the best way. Thenthe quantity of stores wanted must be defined.Ultimately that will be settled by the scale ofmobilisation, but at present tentative contracts areput out, and the tenders are advised upon by theReserve officers, who discuss whether they can bebetter assigned - whether, for instance, similarcontracts for forceps should be given to eachcontractor, or whether all large forceps should bemade by one and all small forceps by another. Thethird question is, whence shall the instruments beobtained ? At first some can be purchased; thiswill be the work of the Reserve officers, who (havingregard to the needs of the civil population) will buywhat is immediately available. The rest must bemade. The industry, however, may not itself be ableto cope with the demand, and it may be necessaryto call on workers in associated trades. Thus surgicalneedles or scissors might be roughed out by otherworkers and finished by the surgical instrument-makers provided that there were enough skilledmechanics. So as to avoid a shortage the trades canget a lien on the services of mechanics engaged else-where, and these men will be scheduled as indis-pensable. Moreover, the raw material, power, andtransport required for this work must all be arrangedfor in advance by the Assistant-Secretary for War,in the light of the needs of other essential services.It is hoped that working along thse lines there willbe little industrial confusion in the change from peace
