534 T

that described is not an incident of frequent occurrence evenin large establishments, and the mistress referred to will

probably have ample time to consider a course of procedure.to meet the next occasion before it arises. Let us hope thatthe footman was duly grateful for the consideration accordedto him and that his mistress will have no reason to regret..her kind treatment of him.

__

ARTERIAL LESIONS IN ANCIENT MAN ANDTHEIR LESSONS.

FEW pathological conditions have given rise, perhaps, to more diverse views as to their etiology and significance-

.a,nd, as a consequence, to more conflicting rules of conduct-than arterio-sclerosis and allied arterial degenerations. This

condition has been held up as the pathological "horrible, example " by antitobacconists, total abstainers, diet faddistsof all kinds, contemners of athletics and of the wear and tearof modern life. Apart, therefore, from its antiquarian interest,a paper by Dr. Marc Armand Ruffer describing his examina-tions of the Arterial Lesions found in Egyptian Mummies 1deserves thoughtful consideration for the sidelight it throwson ultra-dogmatism in support of preconceived -centro-

versial theories. Dr. Ruffer first describes the procedure of,dissection and the preparation of the specimens for the

microscope- It appears that the embalmers of the twenty-first.Dynasty removed not only the viscera but the aorta and

most of the muscles of the body, packing the spaces thuscreated with mud, sand, or rags. Sometimes sawdust mixedwith a resinous material of unknown nature (but certainlynot bitumen) was used. It was only rarely that a portionof the aorta or one of the large arteries was left

behind, but fortunately the posterior peroneal artery,owing to its deep situation, often escaped the embalmer.The isolating of the arteries is a very disagreeable process,for the hard black material lining the walls of the cavitiesafter removal of the packing is not removable by water, buthas to be taken away mechanically, thus creating an

irritating dust. The packing does not appear to contain

pathogenic microbes, for no inflammation ever followed thenumerous cuts and scratches. The arteries, when dissectedout, are placed for’24 hours in a solution containing carbonateof soda 1 per cent. and formol 0’ 5 to 1 per cent. They arethen immersed for some weeks in glycerine, to which a fewdrops of formol have been added. Calcified artery is decalcifiedin Marchi’s solution for 24 hours and cut in the usual

manner. Dr. Ruffer gives a description of specimens from24 subjects, consisting of aorta, brachial, anterior and pos-terior tibials, posterior peroneal, femoral, profunda, radial,ulnar, and palmar arch. The results of the examinationare given and points of interest noted as follows : (1) thatthe muscular coat may be changed almost wholly by calci-fication, following on degeneration of the muscle fibre, intoa magma of no particular structure; (2) that the diseasevery often seems to pick out the point of origin of the

- smaller arteries. Dr. Ruffer considers that there can be nodoubt that the condition is exactly the same as is seen at thepresent day-namely, calcification following on atheroma,and that, in spite of the 3000 years that have elapsed sincedeath, the lesions are still recognisable by their positionand microscopical structure. "The earliest signs," he says,"of the disease are always seen in or close below thefenestrated membrane-that is, just in the position where

- early lesions are seen at the present time. ’The disease is,.characterised by a marked degeneration of the muscularcoat and of the endothelium. These diseased patches,discrete at first, fuse together later, and finally form

1 Arterial Lesions found in Egyptian Mummies (1580 B.C.-525 A.D.),by Marc Armand Ruffer, Journal of Pathology and Bacteriology,vol. xv., 1911.

comparatively large areas of degenerated tissue, which

may reach the surface and open out into the lumen

of the tube." The correspondence of the disease

to that recognised at the present time is obvious. In

Dr. Ruffer’s opinion, therefore, "the old Egyptians sufferedas much as we do now from arterial lesions identical

with those found in the present time. Moreover, when weconsider that few of the arteries were quite healthy, it

would appear that such lesions were as frequent 3000 yearsago as they are to-day." As to causation, Dr. Ruffer

considers that tobacco can certainly be eliminated, as thisdrug was not used in ancient Egypt. While alcoholic

beverages played a part in Egyptian social life, Dr.

Ruffer holds that it is clear that the Egyptians, as a

race, are not, and never have been, habitual drunkards.

Moreover, Dr. Ruffer has found the disease just as commonin over 800 post mortems of Mussulmans who had certainlynever touched alcohol in their lives. This fact has led him

to call in question the importance of alcohol as a cause ofarterial disease. As to the "increased wear-and-tear" "

theory of modern life, there is no evidence that old Egyptiansworked too hard, either mentally or physically; the time

tables of workmen which have been discovered show thatthe Egyptian navvies of ancient times toiled practicallythe same hours as the Egyptians do now. In Dr.Ruffer’s opinion, too, the theory that the wear and tear

of human life has increased is a myth, the fact being, hesays, that our life is easier and that we work less thanour ancestors did. Meat, too, is something of a luxury inEgypt, and Dr. Ruffer’s experience in Egypt and the Easthas not strengthened the opinion that meat eating is a causeof arterial disease. Finally, he holds that strenuous muscularexercise can also be excluded as a cause, for there is noevidence that ancient Egyptians were greatly addicted to

athletic sports, though they liked watching professionalacrobats and dancers. In the case of the priests and

priestesses of Dair-el-Bahari, which formed the greater pro-portion of those whose mummies were examined, it is highlyimprobable that they were addicted to much muscular

exercise. ____

THE CONDITIONING OF WINE.

ONE of the most delicate wines is claret, and it is its

delicacy which, justly we think, has brought it the sobraqwetof a temperance wine. It contains least alcohol, acidity, andsugar amongst wines, but it easily spoils, and according torecent researches the element which spoils it is oxygen. Thequicker it spoils by this agency the more delicate as a rule isthe wine, and a good claret is not a wine to be left more thanmany minutes exposed to the air before it is consumed. Thereare some people who do not understand this, or do not

appreciate the horrid result of their action, for they willre-cork an unfinished bottle. If this were done under an

atmosphere of nitrogen there would be no complaint, for ifoxygen is carefully excluded the wine remains sound andpalatable. When wine, in fact, is left in an inert atmo-

sphere, and for choice nitrogen appears to be the best

atmosphere for the purpose, clarification rapidly takes

place and the wine soon begins to assume a characterwith which good bottling and long keeping endow it.Fermentation ceases, the organisms die and retire to thebottom with a sediment which is desirably eliminated. Itis not improbable that the maturing process of a wine inbottle is due to the small quantity of oxygen in the air firstbeing absorbed, leaving only inert nitrogen which fails tosupport the vitalities of the organisms normally present inthe wine. When the activities of the organisms thus ceasethe wine assumes in a quite short time all the qualities of amatured sound article. This view is expressed with such

535

confidence that the proposal has seriously been made to pumpan atmosphere of nitrogen over wine stored in bulk.

EPIDEMIC DROPSY IN CALCUTTA.

IN the latter part of 1909 and during 1910 a considerableoutbreak of epidemic dropsy, or beri-beri, occurred in

Calcutta. Major E. D. W. Greig, of the Indian MedicalService, was deputed to inquire into its causation, and hasnow furnished a first report. 1 The main conclusions arrived

at are that no specific cause is to be found in the blood or

œdematous fluid in cases of epidemic dropsy, which diseaseclosely resembles" ship beri-beri," that it is not infectious,and that it is a disease of nutrition, being induced by a "one-sided dietary." During the investigation of the distributionof cases in Calcutta it was found that the better-class

European quarter escaped altogether ; it was also found that

two populous wards inhabited by Hindus were but slightlyaffected in comparison with those around them. On farther

inquiry it appeared that these two wards were very largely in-habited by a community of Hindu merchants, known as Marwaris. These people consume much less rice than the Ber galipopulation generally, taking wheat (áta) and pulse instead.On further inquiry it was found that the few cases of epidt miodropsy that did occur in these wards were among Bengalis(rice eaters), not among Marwaris. This was a verysignificant fact, as the sanitary conditions of both sets ofpeople in these wards were similar, and were no better thanin the native quarters of Calcutta generally. Chemical

analysis and histological examination showed that in the

process of "polishing carried out in the mills at Calcuttaand elsewhere certain constituents essential to nutrition areremoved from the rice, and that the áta habitually eatenby Bengalis is also so finely sifted that it is deprivedof these ingredients even more than rice itself.

Pigeons were fed on 11 polished " rice, such as is

consumed by the people affected, and were found

to lose weight and to suffer from characteristic poly-neuritis, while control pigeons fed on a mixture of wheatand pulses kept up their weight and remained in good health.Analyses have shown that the amount of phosphoricanhydride in unpolished rice is about twice as much as is

present in polished samples. Further, the two severe out-breaks of epidemic dropsy in Calcutta that have occurred in1877-79 and 1907-09 have synchronised with a high price offood grains, and with a fall in prices they have come to anend. It has to be remembered that the two prominentfeatures of epidemic dropsy-viz., swelling of the feet andbreathlessness-may be produced by ankylostomiasis and byover-indulgence in alcohol ; to sustain the diagnosis of beri-beri, therefore, each case must be carefully examined. Also,the treatment of food grains by 11 polishing," and theremoval thereby of portions containing physiologicallyimportant constituents of food, only forms part of a generalproblem, the "one-sidedness" " of a dietary ; this may be

brought about in other ways-e.g., by an exclusive con-

sumption of fine, starchy, wheat flour, such as fine áta. This

inquiry substantiates the conclusion arrived at by Fraser andStanton in their investigation of beri-beri causation in theFederated Malay States (1909), that the polishing of rice insteam mills removes substances essential for the nutrition ofnervous tissue-viz., phosphorus compounds. Chemical

analyses by Mr. D. Hooper, who was associated with MajorGreig, showed that unpolished rice contained 0.6 6 to 0.8 percent. phosphorus pentoxide, while the polished grains con-tained only 0 40 to 0-45 per cent., and the polishings

1 Scientific Memoirs of Officers of the Medical and Sanitary Depart-ments of the Government of India. New Series. No. 45. EpidemicDropsy in Calcutta. First Report. By Major E. D. W. Greig, M.D.,D.Sc., I.M.S. Calcutta, 1911. Price 2s.

(koorah) contained over 3 per cent. The phosphorus and thefat are concentrated, in the outer layers, while the nitrogenis distributed throughout the grain ; the same holds good inthe case of wheat. This inquiry is still progressing, but thatthe phosphorus content of the dietary is the predominant.factor in causation appears to be proved. Prevention would

consist in improving the dietary value, either by usingunpolished food grains, or by adding rice and wheat brare

removed in the cleaning process, or by substituting for part.of the rice consumed some other grain rich in phosphates,such as mung dal (Phaseoius radiatus) ; the addition of freshmeat would also be of value. Major Greig concludes byobserving that the present mode of estimating diet values by,determination of the quantities of protein, fat, and carbo--hydrate requires further investigation.

BRUIT SYNCHRONOUS WITH THE HEARTSOUNDS HEARD OVER A PULMONARY

CAVITY.

AT a meeting of the Société Medicale des H6pitaux of -

Paris on April 7th M. G. Variot and M. Henri Dumontshowed a woman, aged 22 years, who had a very rare bruit.She was admitted into hospital for pulmonary tuberculosis.There was marked depression of the chest on the left side.below the clavicle. In the first, second, and third intercostalspaces was a slight undulation corresponding to the pulsa-tions of the heart. On percussion there was in front on the-left side slight dulness at the apex, and below this moremarked dulness which extended from the median line across -the chest to merge into dulness -at the base. On the left sidebehind there was slight dulness at the apex and dulness atthe base below the inferior angle of the scapula. On the

right side percussion was normal in front, but there wasslight dulness at the apex behind. The apex beat was in the -fourth intercostal space and above it a faint systolic murmurof variable intensity was heard. At the apex of the right,lung, in front and behind, fine and crackling râles wereheard. On the left side respiration was harsh and slightlyblowing and there were some splashing sounds. A bruit...of a metallic character, with its maximum at the inner

border of the scapula behind and in the third inter-

costal space in front, was distinctly heard. It was

also heard at a distance of three metres from the-

patient, but with a different timbre. It sounded like the"tic-tac" of a large watch or of a clock, and was-

synchronous with the pulsations- of the heart. It was-heard at night by the other patients in the ward. Thebruit was very variable the patient said that it was absent.on certain days, but it rarely disappeared for an entire day -usually it reappeared after some moments. The patient sa’idthat it disappeared when she had palpitations of the heartand when she stopped- breathing. On compressing thethorax with the hand at the level of the third intercostal

space the bruit was- modified and its rhythm was changed ;.on increasing the pressure it disappeared entirely. Its.

intensity varied from moment to moment ; it was more--

distinct when the mouth was opened than when it was shut,as a result of resonance in the upper air passages. Finally. -it varied in rhythm; sometimes it was simple "tic," butusually it was double—a "tic-tac"; several times it was.

observed to take the form of a long and two short sounds-°° tic tac-tac "). There was abundant thick, greenish-yellow ’expectoration containing numerous tubercle bacilli, but therewas no pyrexia. Radioscopy showed that the diaphragm was.two or three centimetres higher and moved much less on

inspiration on the left than on the right side. The greater part)f the left lung, especially at the apex, was opaque ; there was..a clear zone only opposite the third intercostal space. The-

capacity was such that it was impossible- to distinguish the: