713THE THERAPEUTICS OF INTESTINAL AMCHB1AS1S.

ended April 30th last, on which a report has just beenissued, 44 patients of a " type and quality " com-mended in the report, were assisted, all of whom wouldhave been unable to enjoy the benefit of Alpine treat-ment without this help. The report, however,laments the large proportion in this last year of short-time patients. The possible number of days that apatient can be under Alpine treatment in accordancewith the scheme is 198, but this figure was only reachedby seven patients, and there were only 18 who spentover 180 days in Davos. Patients who come out lateand go away early do not get the benefit of the fullwinter’s treatment which it is the object of the Fundto give, and the promoters take the opportunity ofbringing this fact once more before the notice of thepractitioners in this country on whom the onus rests.For the information of those who may still wish tomake recommendations this year it may be added thatgrants are made at the rate of £2 (50 Swiss francs) aweek to selected cases, the grant being given for aperiod covering the late autumn, winter, and earlyspring, and being conditional on the recipient stayingat an approved sanatorium or pension at Davos.Applications should include a statement of financialmeans, a report from the family doctor, and a

certificate of medical suitability from one of thehonorary examining physicians to the Fund. Successfulcandidates are required to go out to Switzerlandwithout delay and to stay there for the whole of thewinter unless prevented by some urgent and unforeseencause. If the patient does not elect to stay at asanatorium where there is a resident medical man, hemust place himself under one of the Fund’s visitingphysicians at Davos. The question, how much doesit cost for a patient to live at Davos through thewinter, is answered in the report by the statementthat a British patient of the class for whom the Fundis intended will probably require not less than £5 aweek-that is to say, £3 a week in addition to thegrant of £2—which would cover everything exceptthe journeys to and fro, and guarantee the degree ofcomfort desirable to give the venture its fair chanceof success. Once again it should be remarked thatgrants are only made to persons in an early stage ofthe disease. The hon. secretary of the Fund, to whomapplications should be addressed, is Mr. David Vesey,97, Warwick-road, London, S.W. 5.

EPIDIDYMITIS.

EPIDIDYMITIS attributable neither to the gonococcusnor to the tubercle bacillus is not infrequent, and itsdiagnosis and treatment occasion considerable diffi-culties to the practitioner. The organisms usuallyresponsible are staphylococci, streptococci, and thecolon bacilli. More rarely the B. mucosus capsulatusof Friedlander and the Micrococcus catarrhal,is havebeen found. Clinically the epididymitis may resemblethe gonorrhceal and tuberculous varieties in that itmay be either acute or chronic in its commencement.The fact that there is no urethral discharge makes thedifferential diagnosis from tuberculous epididymitisdifficult, and it is not surprising that in manycases mistakes occur. Dr. Meredith F. Campbell 1quotes with approval the conclusions arrived at byA. R. Stevens-that if the epididymitis is of less thanone month’s duration bilateral involvement favourstuberculosis ; if it is associated with a sinus of overone month’s duration the infection is probably tuber-culous. This probability is increased if there existsclinical tubercle elsewhere in the body or markedlesions of the prostate and seminal vesicles. As anaid to diagnosis Dr. Campbell recommends the use ofsmall doses of tuberculin which will cause a reactiononly in a tuberculous case. Treatment consists of restand careful immobilisation of the scrotal contents bymeans of the special suspensory bandage in use at theBellevue Hospital. About one in four cases requiresoperation, which may be either epididymotomy orepididymectomy. The method of epididymotomy

1 Amer. Jour. Med. Sci., September, 1928.

used by Dr. Campbell is that advocated by F. R,Hagner—namely, exposure of the testicle and multiplepuncture of the epididymis with the blunt end of aHagedorn needle. That early and thorough surgicalelimination is indicated is proved by the fact thatof the 79 cases of non-tuberculous non-gonococcalepididymitis collected by Dr. Campbell a third eventu-ally lost the testicle by suppuration. To the samenumber of the journal Dr. Ernest Rupel contributesan article on the use of calcium chloride in the treat-ment of epididymitis. It is based on clinical observa-tions made while treating cases of non-tuberculousepididymitis (both gonococcal and due to pyogenicorganisms), 50 being treated by ordinary methods and28 by these methods supplemented by intravenousinjections of calcium chloride. The calcium chloridewas given in doses of 0-5 g. to 1 g. in dilute solution.In most of the cases receiving intravenous injectionsprompt relief from pain was noted. Sometimes therelief was only temporary, but when pain recurred itgenerally yielded to a second injection. In 8 of the22 patients treated one injection was sufficient. In theremaining 14 an average of 3-5 injections was required.Without being able to explain the reasons for theclinical results obtained the author expresses convic-tion that the injections not only relieved the patient’ssymptoms, but actually cut short the duration of hisattack. The fact that the calcium injected waseliminated rapidly from the blood stream makes itquite likely that the determining agent will be foundto be the calcium within the tissues or perhaps somenew body produced through a tissue change. As noharmful effects have been noted from this form oftreatment it is certainly worthy of wider trial.

THE THERAPEUTICS OF INTESTINAL

AMŒBIASIS.

IN therapeutics a periodic stocktaking may be achastening experience. After probing the literatureon the therapeutics of amoebic dysentery publishedduring the last 30 years R. Knowles and threecolleagues have constructed a graph to illustrate therise and fall in popularity of various specifics duringthe first quarter of the twentieth century. The earlyyears witnessed the era of ipecacuanha which wasfollowed by a minor, but ill-directed, wave ofenthusiasm for ipecac sine emetine ; hard on its heels(1912) came the work of Leonard Rogers and theintroduction of emetine, which still remains inpopular favour. In succeeding years emetine-bismuth-iodide, yatren, and stovarsol have to someextent replaced the older remedies. To determine theclaims to serious consideration of the various methodsthe workers proceed to analyse the results of treat-ment of 154 patients. These patients, who wereunder the care of different professors and researchworkers at the Calcutta School of Tropical Medicine,received in all 220 treatments, and the results afforda basis of comparison with those obtained in otherinstitutes. The decision as to when a real andpermanent cure of such a chronic, latent, and insidious.disease has been obtained is not easy to make. To-follow up native patients is very difficult and even fromEuropeans it is almost impossible to obtain speci-mens of faeces for microscopical examination weekby week, after the cessation of treatment. Occasion-ally a careful patient, interested in his own case, canbe induced to send a specimen once a week for eightweeks, but such patients are rare. Moreover, even a.negative parasitological test is not an absolute indica-tion of a permanent cure. In our view the onlyreal test is to follow up the clinical history of the-patient for at least a year after treatment has beendiscontinued.

Of the various specifics the authors discuss firstalcresta ipecac (Lilly and Co.). Of the seven patientstreated with this drug three were possibly successfuland four were failures-an unsatisfactory result.Thirty-two patients were treated by injections of

1 Indian Medical Gazette, August, 1928.