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323 of other rabbits gave 2 positive results in those treated with arsphenamine and 2 positive in those treated with fever. There were no positive transfers from those animals in which the combined treatment was used. Serological tests had proved valueless in treating rabbit syphilis since a high proportion of paradoxical and misleading results were found. The discussion was opened by Dr. A. BECK, who described some results obtained from heating syphilitic mice in a hot-air chamber. Because the mice tolerated this treatment badly the successful experi- ments were few in number but seemed to indicate that Treponema pallidum in the brains and lymphatic tissue of mice is more resistant than the same organism in the external lesions of rabbits and of man. Other speakers discussed the clinical application of Prof. Bessemans’s experiments and referred to the increasing importance of artificially induced fever as an additional method of treatment in various stages of human syphilis. SOCIETY OF MEDICAL OFFICERS OF HEALTH A MEETING of the fever hospital medical service group of this society held on Jan. 28th, with Dr. J. A. H. BRINCKER in the chair, was given to a discussion on the Prevention and Treatment of the Enteric Diseases Dr. ANDREW TOPPING, in opening, said that the aetiology of these diseases did not seem to be under- stood by the public or even by the medical profession, to judge from the recent happenings at Croydon. He wished to emphasise that typhoid fever always arises by the direct or indirect contamination of the proximal end of one person’s alimentary canal from the distal end of another’s. He agreed with Prof. Greenwood that water must be presumed to be guilty until proved innocent, but too great a con- centration on water might allow the real criminal to repeat his offence. Infection by milk and milk products could be prevented by efficient compulsory pasteurisation. Secondary infection of the staffs of fever hospitals was not uncommon in spite of their training. He quoted a case of a nurse who had become infected by eating a grape belonging to a patient. In non-epidemic times three things were par- ticularly required. First, the public must be educated; they should be told, for example, that diphtheria and scarlet fever are far more important causes of death than enteric. Secondly, cooperation with the local doctors should be continuous and not reserved for an emergency ; they should be accus- tomed to use the laboratory facilities provided and to call the medical officer of health or his specialists into consultation in cases of fever of doubtful origin. Thirdly, the Croydon outbreak had shown that the medical officer of health must make himself respon- sible for the sanitary control of the water-supplies and the sewage. It seemed clear also that more legal powers were required for the control of food- handlers. When an epidemic had actually broken out publicity was often a two-edged weapon. On the question of immunisation Dr. Topping did not propose to rush in where eminent bacteriologists had -if not feared to tread-at least failed to keep in step ; but his personal opinion was that active immunisation of the community was unjustified in the face of a water-borne epidemic. Dr. E. W. GOODALL, who was prevented by illness from taking a personal part in the discussion, sub- mitted a paper embodying his experience of the treatment of enteric fevers. How long that experience has been was shown by the fact that he studied the cold water treatment at the London Fever Hospital in 1887-89. He had given up the more drastic versions of this treatment and now preferred tepid water baths. He thought that the greatest advance in the treatment of typhoid in his lifetime was the alteration from a starvation milk diet to a diet con- taining about 4000 calories a day. It was important to watch the stools to make sure that this increased diet was being digested. Dr. Goodall also discussed the recognition and treatment of perforation, which accounts for a third of the deaths from typhoid. He had previously described the signs and symptoms of 96 cases of perforation and he emphasised the dangerous stage of euphoria during which all signs of perforation except a rising pulse-rate may pass off. He had never satisfied himself that it was possible to detect a pre-perforative stage. Mr. A. FELIx, D.Sc., described the advances made during the last two years in the serum introduced by him for purposes of treatment. He claimed that it was definitely specific, which Dr. Goodall doubted, and suggested that it might prove to be better given to all cases and not to selected cases only. It must be given early and was probably of little use in the third or fourth weeks. He suggested one-third of the prophylactic dose as the best dosage for treatment- e.g., a single dose of 30 c.cm. with the titre-strength at present in use. He greatly regretted the neglect of blood cultures as a routine means of diagnosis. The blood culture was often positive before fever appeared and the clot from the blood taken for a Widal might be used instead of more complicated methods which were not easy for the general prac- titioner. Dr. Felix also mentioned a new method for diagnosing carriers by an examination of the serum ; he would be glad to be put in touch with any carriers in order to try this new test. One advantage of it would be that the results would be constant and repeated examinations would not be necessary as in the case of examination of faeces and urine. Subsequent discussion largely turned on the diffi- culty in controlling carriers and made it clear that in typhoid, unlike diphtheria for example, there was no such thing as the non-virulent carrier. LIVERPOOL MEDICAL INSTITUTION A MEETING of this society was held on Jan. 20th, with Prof. R. E. KELLY, the president, in the chair. Dr. DONALD OwEN described shortly the signs and symptoms in a case of Hyperostosis Frontalis Interna together with the post-mortem findings. In the discussion that followed, Prof. HENRY COHEN said that although in recent years there had been renewed interest in the condition, it had been described by Morgagni, and was still referred to in Italy as Morgagni’s endocraniosis. Its dominance in the female had been noted by Rokitansky, who sought to relate it with pregnancy and a curious deposit of flakes of bone that is occasionally found lining the skulls of pregnant women. But Greig had con- clusively shown that this latter differed in nature and intensity from true hyperostosis frontalis interna. Stewart in 1928 had called attention to the association with obesity and advanced mental diseases though his cases were found in asylums. Greig in the same year had strenuously denied that there was any

SOCIETY OF MEDICAL OFFICERS OF HEALTH

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of other rabbits gave 2 positive results in those treatedwith arsphenamine and 2 positive in those treatedwith fever. There were no positive transfers fromthose animals in which the combined treatment wasused. Serological tests had proved valueless in

treating rabbit syphilis since a high proportion of

paradoxical and misleading results were found.The discussion was opened by Dr. A. BECK, who

described some results obtained from heating syphiliticmice in a hot-air chamber. Because the micetolerated this treatment badly the successful experi-ments were few in number but seemed to indicatethat Treponema pallidum in the brains and lymphatictissue of mice is more resistant than the same organismin the external lesions of rabbits and of man.

Other speakers discussed the clinical applicationof Prof. Bessemans’s experiments and referred to theincreasing importance of artificially induced fever asan additional method of treatment in various stagesof human syphilis.

SOCIETY OF MEDICAL OFFICERS OFHEALTH

A MEETING of the fever hospital medical servicegroup of this society held on Jan. 28th, with Dr.J. A. H. BRINCKER in the chair, was given to adiscussion on the

Prevention and Treatment of the EntericDiseases

Dr. ANDREW TOPPING, in opening, said that theaetiology of these diseases did not seem to be under-stood by the public or even by the medical profession,to judge from the recent happenings at Croydon.He wished to emphasise that typhoid fever alwaysarises by the direct or indirect contamination of theproximal end of one person’s alimentary canal fromthe distal end of another’s. He agreed with Prof.Greenwood that water must be presumed to be

guilty until proved innocent, but too great a con-centration on water might allow the real criminal torepeat his offence. Infection by milk and milkproducts could be prevented by efficient compulsorypasteurisation. Secondary infection of the staffs offever hospitals was not uncommon in spite of theirtraining. He quoted a case of a nurse who had becomeinfected by eating a grape belonging to a patient.

In non-epidemic times three things were par-ticularly required. First, the public must beeducated; they should be told, for example, thatdiphtheria and scarlet fever are far more importantcauses of death than enteric. Secondly, cooperationwith the local doctors should be continuous and notreserved for an emergency ; they should be accus-tomed to use the laboratory facilities provided andto call the medical officer of health or his specialistsinto consultation in cases of fever of doubtful origin.Thirdly, the Croydon outbreak had shown that themedical officer of health must make himself respon-sible for the sanitary control of the water-suppliesand the sewage. It seemed clear also that morelegal powers were required for the control of food-handlers. When an epidemic had actually brokenout publicity was often a two-edged weapon. On thequestion of immunisation Dr. Topping did notpropose to rush in where eminent bacteriologists had-if not feared to tread-at least failed to keep instep ; but his personal opinion was that activeimmunisation of the community was unjustified inthe face of a water-borne epidemic.

Dr. E. W. GOODALL, who was prevented by illnessfrom taking a personal part in the discussion, sub-

mitted a paper embodying his experience of thetreatment of enteric fevers. How long that experiencehas been was shown by the fact that he studied thecold water treatment at the London Fever Hospitalin 1887-89. He had given up the more drasticversions of this treatment and now preferred tepidwater baths. He thought that the greatest advancein the treatment of typhoid in his lifetime was thealteration from a starvation milk diet to a diet con-taining about 4000 calories a day. It was importantto watch the stools to make sure that this increaseddiet was being digested. Dr. Goodall also discussedthe recognition and treatment of perforation, whichaccounts for a third of the deaths from typhoid. Hehad previously described the signs and symptoms of96 cases of perforation and he emphasised the

dangerous stage of euphoria during which all signsof perforation except a rising pulse-rate may pass off.He had never satisfied himself that it was possible todetect a pre-perforative stage.

Mr. A. FELIx, D.Sc., described the advances madeduring the last two years in the serum introduced byhim for purposes of treatment. He claimed that itwas definitely specific, which Dr. Goodall doubted,and suggested that it might prove to be better givento all cases and not to selected cases only. It must be

given early and was probably of little use in thethird or fourth weeks. He suggested one-third of theprophylactic dose as the best dosage for treatment-e.g., a single dose of 30 c.cm. with the titre-strengthat present in use. He greatly regretted the neglectof blood cultures as a routine means of diagnosis.The blood culture was often positive before feverappeared and the clot from the blood taken for aWidal might be used instead of more complicatedmethods which were not easy for the general prac-titioner. Dr. Felix also mentioned a new methodfor diagnosing carriers by an examination of theserum ; he would be glad to be put in touch withany carriers in order to try this new test. Oneadvantage of it would be that the results wouldbe constant and repeated examinations would notbe necessary as in the case of examination of faecesand urine.

Subsequent discussion largely turned on the diffi-culty in controlling carriers and made it clear that intyphoid, unlike diphtheria for example, there was nosuch thing as the non-virulent carrier.

LIVERPOOL MEDICAL INSTITUTION

A MEETING of this society was held on Jan. 20th,with Prof. R. E. KELLY, the president, in the chair.Dr. DONALD OwEN described shortly the signs andsymptoms in a case of

Hyperostosis Frontalis Internatogether with the post-mortem findings. In thediscussion that followed, Prof. HENRY COHEN saidthat although in recent years there had been renewedinterest in the condition, it had been described byMorgagni, and was still referred to in Italy as

Morgagni’s endocraniosis. Its dominance in thefemale had been noted by Rokitansky, who sought torelate it with pregnancy and a curious deposit offlakes of bone that is occasionally found lining theskulls of pregnant women. But Greig had con-

clusively shown that this latter differed in nature andintensity from true hyperostosis frontalis interna.Stewart in 1928 had called attention to the associationwith obesity and advanced mental diseases thoughhis cases were found in asylums. Greig in the sameyear had strenuously denied that there was any