218 SEQUELS TO CHILDBIRTH

Wiseman emphasises the importance of controllingall irradiation therapy by frequent blood counts.It is essential that irradiation should be withheld,whatever the clinical condition of the patient, if thetotal red cell count and white cell count show rapiddeterioration.

SEQUELS TO CHILDBIRTH

IN our first issue of the New Year Dr. Meave

Kenny described the state of 100 women who hadbeen treated for puerperal sepsis at the QueenCharlotte’s Maternity Hospital isolation block atHammersmith. Examining them four or five yearsafter their illness she found that no less than 87 werefree from any gross lesion of the pelvic organs, suchas tubal masses, uterine displacements, or vaginitis.Cervicitis was noted in 5 patients only, and a tubo-ovarian mass in 2, both of whom had previouslysuffered from pelvic peritonitis. The pelvic findingswere indeed so far negative that as the investigationproceeded its interest narrowed upon what was emerg-ing as the most appreciable residuum of the originalpuerperal infection-namely, sterility. Among the100 women during four to five years of the activechild-bearing period there had been only 5 pregnancies.No contraceptive measures had been used by 26women, and of the 69 who attempted contraception,only 22 employed methods likely to influence thecoming of another pregnancy.We recall these findings of Dr. Kenny’s in order

that they may be compared with those recordedin another illuminating article entitled Some Gynaeco-logical Sequelae of Natural Delivery.l Here theauthor, Dr. Wilfred Shaw, states specifically that heis dealing with natural confinements, not those

complicated by puerperal infection, and the basisof his paper is menstrual irregularities, vaginaldischarges, and uterine displacements. With greatfairness he assesses the importance of these annoying,if not serious, disturbances, and the treatment heoutlines is both practical and clear. What is mostremarkable in looking at the two papers is thata woman seems less likely to suffer from gynaeco-logical sequelae after a severe bout of puerperalsepsis than if her delivery and puerperium are

uncomplicated. That this may sometimes be true issuggested by Dr. Kenny’s observations. The patientwith puerperal infection has a long period of enforcedrest and good food, whereas the woman who has a" natural delivery " is soon sent home to addedcares and restrictions.

HISTOLOGY OF THE DISORDERED BRAIN

HISTOLOGICAL methods of psychiatric researchhave not been much employed or esteemed in Englandsince sanguine notions about the anatomy of the

biogenic psychoses raised hopes that were not fulfilled.This neglect of morbid anatomy, now fortunatelybeing made good, did not obtain elsewhere, as may berecognised from the monograph recently publishedby Schaffer and Miskolczy from Hungary.2 2 Schaffer’sviews on the common structural features of theheredo-degenerative diseases of the central nervoussystem have been energetically put forward for adecade, and began with his valuable earlier studyof amaurotic familial idiocy. In spite of the strongobjections offered by Spielmeyer and others tohis assertion that exogenous affections can be

1 Practitioner, January, 1937, p. 24.2 Anatomische Wesensbestimmung der hereditär-organischen

Nerven-Geisteskrankheiten. By Karl Schaffer and DesideriusMiskolczy. Acta med. scand., suppl. lxxv. 1936. Pp. 171.

differentiated histologically from endogenous ones,he has not flagged and now offers a further expositionof his findings. An elective and exclusive changein the ganglion cells is for him the criterion of ahereditary cerebral anomaly, with its substratein the neuro-ectodermal hyaloplasm. In detailed

reports on schizophrenia, senile dementia, andPick’s and Alzheimer’s diseases, his pupil Miskolczygives a well-documented review of the data thatconfirm Schaffer’s view. What he says of his ownobservations on schizophrenia is not open to theusual criticism that only the brains of long-standingcases with late secondary changes have beenexamined ; on the contrary, he was able to enjoy thegloomy (but, for histologists, enviable) fruits of an

apparently high death-rate among acute schizo-phrenics within a few months after their admissionto hospital. But he is unconvincing in his effortsto rebut the accepted view that the cellular loss inthe cortex is an outcome of varied processes, and notitself the primary histological change. The technicaldiscussion of the plaques and other features of senileor presenile dementia which he describes is relatedto schizophrenia by a final survey of the allegedevidence for a hereditary connexion between seniledementia and dementia praecog ; Dr. Miskolczydecides against such a connexion.

A VERSATILE SCHOOL

MEETING on Tuesday last to receive the latestannual report, the governors of the London School ofHygiene and Tropical Medicine found good reason to’be pleased. Within a dozen years of its establishmentthe school has attained a vital position in the medicallife of this country, and wields great influence outsideEngland and outside Europe. It is a post-graduatecentre for hygiene and tropical medicine ; it setsitself to give helpful answers to the innumerablequestions that come from investigators, would-beinvestigators, administrators, and practitioners allover the world ; and it ranks high among our insti-tutes of research. The dean’s report tells of inquiriesof so many kinds that the year’s total would seemrespectable for a small country rather than a singleschool. Mostly their subjects are of more immediateimportance to the expert than to the profession as awhole-though it is of interest to know, for example,that Mr. A. E. Oxford has isolated a derivative of

tyramine (ergot) " which may be of very consider-able pharmacological importance " ; that Dr. LucyWills has shown that the haemopoietic factor inMarmite is not identical with any of the constituentsof the vitamin-B complex (except possibly B,) ;that Dr. G. P. Crowden’s use of reflecting surfacesto secure comfort in the tropics now extends to theprovision of face-masks for furnace-workers and sheetslined with aluminium foil to prevent the chilling ofaccident victims ; and that Dr. Marion Watson hasdiscovered a diet that produces a definite increase inthe resistance of mice to infection by Bacterium

aertrycke. But of all the work described the moststriking is certainly the joint researches of thedivisions of bacteriology and biochemistry on theisolation of immunologically active chemical sub-stances. We hope to be able to publish some of thiswork in the near future.

WE regret to learn of the death on Jan. 18th, atBembridge, Isle of Wight, of Dr. Harold WaterlowWiltshire, consulting physician to King’s CollegeHospital, at the age of 58.