of 1 /1
1436 supple scar which assumed the colour and characters of normal skin. Old glandular sinuses, which resisted all previous treatment, rapidly closed. Of 63 children suffering from Pott’s disease 27 were cured, 26 were improved, and 6 remained stationary. Four died-three from an intercurrent disease and one from exhaustion the result of prolonged suppuration complicated by amyloid kidneys. Of 94 children suffering from hip disease and white swellings 38 were cured and 50 were improved. Professor d’Espine found that a certain number of children suffering from hip disease were com- pletely cured after treatment for eight months at Cannes-a result exceptional at other latitudes. The results were not less brilliant for " white swellings," in the treatment of which immobilisation was avoided. Dr. Revillet considers that rest treatment is much abused and is the cause of anky- losis and muscular atrophy. In a number of cases " spina ventosa " was rapidly cured by exposure to the sun. In tuberculous peritonitis effusion and meteorism rapidly dis- appeared ; in 7 cases 3 patients were cured, 3 were improved, and 1 died from perforation. In 11 cases of lupus, 8 patients were cured and 3 were improved. The diseased surface was gradually exposed to the sun until a stage was reached when the treatment could be con- tinued for the greater part of the day. Progress was rapid ; nodules were effaced, crusts fell, slight desquama- tion was produced, and islets of white skin were formed. Finally, a smooth supple scar, never keloidal, was produced. To sum up, in 888 cases of tuberculosis positive results were obtained in 93 per cent., and cures in 52 per cent. It is to be noted that these results are not merely the statement of Dr. Revillet about his own methods, but are vouched for by Professor d’Espine. What lesson do they teach ? 2 In this country the open-air treatment of tuberculosis has become a commonplace, but we think that the value of heliotherapy, particularly of exposure of the diseased part to the sun, is not sufficiently appreciated. Though for this purpose England is inferior to the Mediterranean littoral, it should not be for- gotten-and our frequent meteorological notes prove it-that we have many places on our southern shores where the daily aggregate of sunshine is considerable. THE HISTOLOGY OF THE SCARLET FEVER RASH. THE histological characters of the exanthem of scarlet fever form the subject of an interesting paper contributed to Medicinische Bldtttr of Oct. 22nd by Professor J. Hlava of the Bohemian Pathological Institute of Prague. He states that the most important previous observations on this subject are those of Neumann and Unna. Neumann described swelling of the cells of the rete and the formation of gaps and networks in which wandering cells were enclosed. Unna maintained that the swelling of the skin resulted from the hyperæmia of the vessels of the corium, and that the changes in the epithelial layer were but slight. Professor Hlava’s observations were made upon the skin of 18 fatal cases, and also on small pieces removed ex vivo in seven other cases. He concludes that the chief changes occur not in the horny or granular layers of the epidermis, but in the cylindrical and prickle layers and in the corium. There is a hyperasmia associated with oedema. The cedema extends into the epithelium and may penetrate through the granular layer to form small vesicles in the horny stratum. In the epithelium small areas of softening may result from imbibition or from necrosis. These areas may involve groups of piickle cells, the disorganisation starting at the periphery of the cells and extending in towards the nuclei, which become disintegrated. The central cells of these areas of softening may show the changes to a lesser degree, the pro- toplasm being simply homogeneous and the nuclei pyknotic. A few polymorphonuclear leucocytes may occur, in and around these softened areas, but this leucocytic invasion is at most slight. Some dilatation of the lymph channels of the papillary layer with enlargement of the endothelial cells can be seen even before the appearance of the rash, and they may contain some debris of red blood corpuscles. On the first day of the eruption mononuclear cells with a few polymorpho- nuclears occur around all the blood-vessels of the corium, but even by the fourth day there is very little proliferation around these vessels. No changes of any kind are dis- cernible in the sweat or sebaceous glands. The appearances in fatal cases are somewhat different. The epithelial cells contain more pigment; haemorrhages and connective tissue cells containing pigment are much more common in the corium, and the cell proliferation around the blood-vessels is more marked. These differences are probably referable to the hsemorrhagic character of most of the fatal cases. Pro- fessor Hlava concludes that the hypersmia, the serous effusion, the leucocytic changes, and the later cell prolifera. tion about the blood-vessels are in favour of the inflammatory nature of the process rather than of the view that it is a simple toxic oedema. -- THE Lord Mayor has become chairman of a Mansion House committee formed to promote the raising of a fund for the erection of a new building for the Royal Society of Medicine, which already possesses a splendid site. A POWEUFUL claim has been made by the Society of Tropical Medicine and Hygiene for the endowment of the study and prevention of tropical disease as a memorial to his late Majesty King Edward VII. THERE has been praiseworthy activity during the week in the districts where plague-infected rats have been found, but evidence of a spread of the infection has been forth. coming. - WE regret to announce the death of Professor Lancereau, which has just occurred at the age of 80. ROYAL MICROSCOPICAL SOCIETY.—The next meet. ing of this society will be held on Nov. 16th at 8 P.M., when there will be an exhibition of specimens of British mycetozoa by Mr. A. E. Hilton. THE NOTIFICATION OF OPHTHALMIA NEONATORUM. -The Midwives Act Committee on Nov. 8th asked the London County Council to take action with a view to the more effectual prevention of blindness or impairment of vision caused by the want of prompt and efficient medical treatment among newly born infants, and recommended the compulsory notification of all cases of ophthalmia neonatorum. So far as the practice of certified midwives was concerned, the com- mittee stated, a method of notification already existed, as one of the rules of the Central Midwives Board required every certified midwife to advise that medical assistance should be obtained in every case of inflammation of the eyes, however slight. If the Council made the order the information obtained would enable the medical officers of the sanitary districts to make known to those con- cerned the opportunities available in necessitous cases. It would be found of value where the infant was taken to a hospital, where the medical practitioner perhaps would not have an opportunity of keeping the infant under treatment, and it would serve a useful purpose incidentally in bringing to light cases attended by midwives concerning which they had omitted to advise that medical aid was necessary, and to inform the Council accordingly. Notification would render more complete the arrangements for securing continuous and efficient treatment of the child. The order would be ad- vertised and a copy sent, as directed by the Public Health Act, to each qualified medical practitioner residing or practising in the county. The Council decided to make the compulsory notification order.

THE HISTOLOGY OF THE SCARLET FEVER RASH

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1436

supple scar which assumed the colour and characters of

normal skin. Old glandular sinuses, which resisted all

previous treatment, rapidly closed. Of 63 children sufferingfrom Pott’s disease 27 were cured, 26 were improved, and 6remained stationary. Four died-three from an intercurrent

disease and one from exhaustion the result of prolongedsuppuration complicated by amyloid kidneys. Of 94 children

suffering from hip disease and white swellings 38 were curedand 50 were improved. Professor d’Espine found that a certainnumber of children suffering from hip disease were com-

pletely cured after treatment for eight months at Cannes-aresult exceptional at other latitudes. The results were not

less brilliant for " white swellings," in the treatment ofwhich immobilisation was avoided. Dr. Revillet considers

that rest treatment is much abused and is the cause of anky-losis and muscular atrophy. In a number of cases " spinaventosa " was rapidly cured by exposure to the sun. In

tuberculous peritonitis effusion and meteorism rapidly dis-appeared ; in 7 cases 3 patients were cured, 3 were

improved, and 1 died from perforation. In 11 cases of

lupus, 8 patients were cured and 3 were improved. The

diseased surface was gradually exposed to the sun until astage was reached when the treatment could be con-

tinued for the greater part of the day. Progress was

rapid ; nodules were effaced, crusts fell, slight desquama-tion was produced, and islets of white skin were formed.Finally, a smooth supple scar, never keloidal, was produced.To sum up, in 888 cases of tuberculosis positive results wereobtained in 93 per cent., and cures in 52 per cent. It is to

be noted that these results are not merely the statement ofDr. Revillet about his own methods, but are vouched for byProfessor d’Espine. What lesson do they teach ? 2 In this

country the open-air treatment of tuberculosis has become acommonplace, but we think that the value of heliotherapy,particularly of exposure of the diseased part to the sun, isnot sufficiently appreciated. Though for this purpose Englandis inferior to the Mediterranean littoral, it should not be for-

gotten-and our frequent meteorological notes prove it-thatwe have many places on our southern shores where the dailyaggregate of sunshine is considerable.

THE HISTOLOGY OF THE SCARLETFEVER RASH.

THE histological characters of the exanthem of scarletfever form the subject of an interesting paper contributed toMedicinische Bldtttr of Oct. 22nd by Professor J. Hlava ofthe Bohemian Pathological Institute of Prague. He states

that the most important previous observations on this subjectare those of Neumann and Unna. Neumann described

swelling of the cells of the rete and the formation of gapsand networks in which wandering cells were enclosed. Unnamaintained that the swelling of the skin resulted from thehyperæmia of the vessels of the corium, and that the changesin the epithelial layer were but slight. Professor Hlava’s

observations were made upon the skin of 18 fatal cases, andalso on small pieces removed ex vivo in seven other cases.He concludes that the chief changes occur not in the hornyor granular layers of the epidermis, but in the cylindricaland prickle layers and in the corium. There is a

hyperasmia associated with oedema. The cedema extendsinto the epithelium and may penetrate through the

granular layer to form small vesicles in the horny stratum.In the epithelium small areas of softening may result fromimbibition or from necrosis. These areas may involve groupsof piickle cells, the disorganisation starting at the peripheryof the cells and extending in towards the nuclei, whichbecome disintegrated. The central cells of these areas of

softening may show the changes to a lesser degree, the pro-toplasm being simply homogeneous and the nuclei pyknotic.

A few polymorphonuclear leucocytes may occur, in andaround these softened areas, but this leucocytic invasion isat most slight. Some dilatation of the lymph channels of thepapillary layer with enlargement of the endothelial cells canbe seen even before the appearance of the rash, and they maycontain some debris of red blood corpuscles. On the first

day of the eruption mononuclear cells with a few polymorpho-nuclears occur around all the blood-vessels of the corium, buteven by the fourth day there is very little proliferationaround these vessels. No changes of any kind are dis-

cernible in the sweat or sebaceous glands. The appearancesin fatal cases are somewhat different. The epithelial cellscontain more pigment; haemorrhages and connective tissuecells containing pigment are much more common in the

corium, and the cell proliferation around the blood-vesselsis more marked. These differences are probably referable tothe hsemorrhagic character of most of the fatal cases. Pro-

fessor Hlava concludes that the hypersmia, the serous

effusion, the leucocytic changes, and the later cell prolifera.tion about the blood-vessels are in favour of the inflammatorynature of the process rather than of the view that it is a

simple toxic oedema. --

THE Lord Mayor has become chairman of a Mansion Housecommittee formed to promote the raising of a fund for theerection of a new building for the Royal Society of Medicine,which already possesses a splendid site.

A POWEUFUL claim has been made by the Society of

Tropical Medicine and Hygiene for the endowment of thestudy and prevention of tropical disease as a memorial to hislate Majesty King Edward VII.

THERE has been praiseworthy activity during the week inthe districts where plague-infected rats have been found, butevidence of a spread of the infection has been forth.

coming. -

WE regret to announce the death of Professor Lancereau,which has just occurred at the age of 80.

ROYAL MICROSCOPICAL SOCIETY.—The next meet.ing of this society will be held on Nov. 16th at 8 P.M.,when there will be an exhibition of specimens of Britishmycetozoa by Mr. A. E. Hilton.

THE NOTIFICATION OF OPHTHALMIA NEONATORUM.-The Midwives Act Committee on Nov. 8th asked theLondon County Council to take action with a view to themore effectual prevention of blindness or impairment of visioncaused by the want of prompt and efficient medical treatmentamong newly born infants, and recommended the compulsorynotification of all cases of ophthalmia neonatorum. So far asthe practice of certified midwives was concerned, the com-mittee stated, a method of notification already existed, asone of the rules of the Central Midwives Board requiredevery certified midwife to advise that medical assistanceshould be obtained in every case of inflammation ofthe eyes, however slight. If the Council made theorder the information obtained would enable the medicalofficers of the sanitary districts to make known to those con-cerned the opportunities available in necessitous cases. Itwould be found of value where the infant was taken to ahospital, where the medical practitioner perhaps would nothave an opportunity of keeping the infant under treatment,and it would serve a useful purpose incidentally in bringingto light cases attended by midwives concerning which theyhad omitted to advise that medical aid was necessary, and toinform the Council accordingly. Notification would rendermore complete the arrangements for securing continuous andefficient treatment of the child. The order would be ad-vertised and a copy sent, as directed by the Public HealthAct, to each qualified medical practitioner residing or

practising in the county. The Council decided to make thecompulsory notification order.