271RED CELL SEDIMENTATION IN HEART DISEASE

recorded simultaneously the effect of amyl nitriteon the electrocardiogram, arterial and venous bloodpressures, and heart-rate of normal persons. Altera-tions in the T wave of the electrocardiogram werebrought about which are interpreted as due to a

temporary relative cardiac ischsemia. It is believedthat this can be accounted for by the rise in theheart-rate which increases the work of the heart atthe same time as the coronary flow is reduced by thefall in blood pressure. Nagl suggests, therefore, thatamyl nitrite should not be used in cases of anginapectoris with a tendency to tachycardia. It isknown that its inhalation may rarely increase theseverity of anginal pain 6 or even induce an attack,2and changes such as Nagl describes may well be thecause. But in practice it is impossible to foretellwhich patients will respond well and which badly toamyl nitrite and actual trial in an attack is the onlytest. It is worth noting that patients who sufferfrom the relatively mild pain of angina of effort usuallyprefer to take nitroglycerin, while amyl nitrite isbest reserved for the long-lasting

"

spontaneous "attacks in which it gives the spectacular relief onwhich its reputation rests.

ETTORE MARCHIAFAVA

THE death of Prof. Marchiafava in Rome has beenovershadowed by war, but the passing of so great afigure in international medicine should not be for-gotten because he had outlived his contemporaries.Ettore Marchiafava was born in Rome on Jan. 3rd,1847, and he died there on Oct. 25th, 1935. He tookhis degree in medicine in 1871, was nominated next

year assistant in the

university departmentof pathological anatomy,and succeeded to thechair in 1883 whenTommasi - Crudeli was

transferred to the chairof hygiene. During his40 years as professor ofpathological anatomyMarchiafava made manyimportant contributionsto medical knowledge.This was a time ofrenaissance in Italianmedicine, in which hebore a distinguished part.He was a great teacher;his lectures on patho-His lectures on patno-

logical anatomy made the dead live again tohis hearers as he recalled the history, the symptomsand physical signs, and summed up their relationto post-mortem findings. But outside ItalyMarchiafava’s fame is based upon his observationson malaria. As early as 1879 he maintainedthat melanin was derived from the destruction ofthe haemoglobin of the red corpuscles, and hewent on to interpret correctly the early stages ofdevelopment of the malarial parasite. With Cellihe demonstrated the development of the parasitein the red corpuscle, the amoeboid movement, andthe production of melanin. In 1889 he and Bignamidiscovered the parasite of aestivo-autumnal or sub-tertian fever, and in 1892 they described the characterof the pernicious forms. He was also able to dif-ferentiate the quartan from the benign tertianparasite. Marchiafava’s interest in pathology never

6 Wood, F. C., and Wolferth, C. C. : Arch. Internal Med.,1931, xlvii., 339.

ceased, and in his ninth decade he was still to befound at work in the Institute of PathologicalAnatomy.RED CELL SEDIMENTATION IN HEART DISEASE

THE value of the erythrocyte sedimentation-rateas an indication of active disease has been demon-strated in rheumatic carditis, and also in syphiliticaortitis, thyrotoxicosis, and hypertensive heartdisease. In the January issue of the QuarterlyJournal of Medicine Paul Wood gives the results ofsedimentation tests done on 164 cases of all types ofheart disease and heart failure, excluding cases withany form of intercurrent infection or with a secondaryanaemia as shown by a red cell count of under 4 millionor a haemoglobin under 70 per cent. As controlshe has used 19 patients with cardiac neuroses. Hefinds that congestive heart failure retards thesedimentation-rate regardless of the cardiac patho-logy and therefore masks evidence of active disease.Increased sedimentation-rates are found in activerheumatic heart disease, myocardial infarction, andsyphilitic aortitis ; the result in this last condition

may help in the distinction between an aorticvalvular disease due to syphilis, rheumatism, or

athero-sclerosis. Again, the sedimentation-rate mayenable one to distinguish between coronary thrombosis,angina of rest, and angina of effort, since in cases ofcoronary thrombosis the rate is not immediatelyincreased, but after a day or two increases steadilyto a maximum, till about the end of the third week,after which it slowly returns to normal. Anginaof effort, on the other hand, shows a normalsedimentation-rate, and angina of rest, in theabsence of syphilitic aortitis, gives a slightly to

moderately increased rate which does not changematerially from week to week.

THE ENDOCRINE ORGANS AND INSANITY" We believe that it cannot be successfully denied that

the corpus of present day psychiatric literature conveys,and is intended to convey, the idea that the endocrine

pattern is a significant and important causal factor in theetiology of those abnormalities of behavior that are

collectively subsumed under the term insanity.’ Butwhere is there precise proof, in the truly scientific sense,that this is so ? "

HAVING put this question to themselves, and

finding no satisfactory answer, Raymond Pearl,Marjorie Gooch, and Walter Freeman set about thetask of seeing whether a statistical study of the weightsof the endocrine organs in a group of the insane wouldprovide any information from which conclusionscould be drawn. Their study,l most carefully andlaboriously carried out, deals with 1307 insane

persons dying in hospital and examined post mortemby Freeman. Each individual was placed, accordingto the preponderance of clinical evidence, into oneof four broad groups-namely, cycloids, paranoids,schizoids, and epileptoids. This material, as theauthors point out, has serious limitations ; itrelates wholly to a mentally diseased population,and standards of comparison from normal personscan be taken only from the very heterogeneousmaterials available in the literature. Secondly,the progress of the patient to death may well havechanged the biologicaHy normal weight relations ofthe parts. Imperfect as the data are, they should,however, be capable of revealing any pronounceddifferences between what the authors term theendocrine pattern of the psychiatric disease types.

1 Human Biology, 1935, vii., 350 and 555.