1
755 statistics now in vogue. Though his own conclusions are based on a statistical analysis of hundreds of cases, he is critical of the analysis, mostly from American sources, of cases terminating in recovery after the removal of alleged foci of disease. These figures are, he remarks, based on the erroneous a,ssumption that no patient can recover unless foci are removed. Study of insured persons suffering in Sweden from chronic progressive polyarthritis has satisfied Dr. Kahlmeter that about 60 per cent. of them recovered their capacity for work under ordinary institutional treatment ; long before the doctrine of focal infection was successfully launched, his patients were muddling their way through to recovery. No doubt recovery may hinge on the removal of an infectious focus. When, as happens in many cases, its removal has no noticeable effect on the disease, it may be that it has extended so far that the original peccant focus no longer plays an important part, or that constitutional and other factors prevent recovery. Dr. Kahlmeter’s conclusions are based on blood sedimentation-rate, percentage of hfemoglobin, numbers of erythrocytes, and absolute and comparative numbers of leucocytes. The blood, taken from the capillaries in the fasting state, was examined by one and the same person. With these figures before him,Dr. Eahlmeteris doubtful if infection alone can be held responsible for the disease. An infectious factor is, however, demonstrable in so high proportion of cases that it is impossible not to hold it responsible for playing a dominant role in many cases. He compares the genesis of polyarthritis with that of asthma, remarking how in both many different influences or exciting factors may produce one and the same clinical picture. The clinical uniformity of chronic progressive polyarthritis may conceal the interplay of multiform causes. POST-VACCINAL ENCEPHALITIS THE February issue of the Bulletin of the Inter- national Office of Public Health contains a survey of the incidence and fatality of post-vaccinal encephalitis in certain countries during the last two years. In England from September, 1933, to October, 1934, four cases with three deaths after primary vaccination were reported in persons aged 4, 6, 7, and 18 years. The symptoms in each case developed on the thirteenth or fourteenth day after vaccination. There was one mild case in a lad aged 19 following revaccination. In Germany in 1933 there were fourteen cases with one death following primary vaccination and five cases with two deaths after revaccination. In the first six months of 1934 there were three cases with one death after primary vaccination and two cases with one death after revaccination. In the United States in 1933, in addition to five cases in children aged from 3 to 9 years which occurred from eleven to nineteen days after primary vaccination, there were three cases about which there were no details. In Holland eight cases were notified in 1933 ; three of these were rejected after examination by the official neurologists, who also regarded some of the remaining five as doubtful. As the number of vaccinations performed during the year was 26,000, the average proportion of one case to every 5000 vaccinations remained the same. In the first six months of 1934, when 10,000 vaccinations were performed, two cases were reported. In Norway twenty-eight cases with eleven deaths were reported during the period 1930-33. Of eighteen children who had been vaccinated before or after 1930 and had survived the complication, seventeen had com- pletely recovered and only one still had paralysis. In Sweden no fatal cases had occurred since 1932, and there were only three mild cases in 1934. The number of annual vaccinations remains about the same in this country. In Belgium, where about 100,000 vaccinations are performed yearly, there was only one case-in a girl aged 12 years, who developed the first symptoms on the twelfth day after vaccination and died after a few days’ illness. There were no cases in British India. THE NEW UNIVERSITY HOSPITAL IN JERUSALEM Dr. J. J. Golub, who has been invited to select a site in Jerusalem for the Rothschild-Hadassah University Hospital, is making some stay iri London en route for Palestine. Dr. Golub is director of the Hospital for Joint Diseases in New York City, and is serving as consultant in the planning of the new hospital and of the attached Nathan Ratnoff medical school. They will be built on Mount Scopus adjoin- ing the Hebrew University to which the hospital is affiliated for post-graduate teaching and research in hygiene, bacteriology, biochemistry, parasitology, general pathology, and cancer. The hospital is to have 250 beds and an out-patient department capable of dealing with 144 patients an hour. There will be a visiting staff of at least 36 specialists, and quarters are being arranged for 20 residents. A special emergency service will provide ambulances to work over the whole of Jerusalem and bring patients to the nearest available hospital. A special feature of the Rothschild-Hadassah Hospital will be a private and semi-private floor of 14 beds serving the growing needs of foreign visitors to Jerusalem. This section of the hospital will be referred to as the American Hospital in Palestine. At present Palestine has only about three hospital beds per thousand of population, including those provided by the Government and various missionary bodies. NEUROGRAMS AN extension of the method of radiological definition by the injection of substances opaque to X rays has recently been described by Dr. Makoto Saito,lof Xagoya, Japan. He and his co-workers have proceeded from the successful use of lipiodol in the visualisation of blood-vessels, and of thorotrast in that of lymph-vessels to experiments in neurography. The ulnar nerve, being the only one that is readily reached by subcutaneous injection without exposure, was used for injection experiments on the intact nerve. Thorotrast was found more suitable than lipiodol, mainly because it flowed further along the nerves. By subcutaneous injection of 0’5 c.cm. of thorotrast into the ulnar nerve, where it lies in its groove behind the elbow, clearly defined shadows of 7 em. to 39 cm. of the length of the nerve were obtained. The neurograms were taken twenty-four hours, two days, and three days from the time of injection, and the central spread of the solution was clearly demonstrated. In one case, three days after the injection, 24 em. of the nerve were visible on the film, stretching from the point of injection to the axillary fossa ; towards the periphery the shadow stretched for 4 em. only. The form of the shadow may be linear, wavy, or denticulate ; in some cases the nerve-fibres show up distinct from the neurolemma and in one film it is even possible to recognise the internal leaf of the neurolemma, consisting of fibres running parallel with the nerve, from the obliquely running fibres of the external leaf. Saito describes the neurograms obtained in nerve lesions, and in a case of multiple neuromata, where the nerve is 1 Amer. Jour. Surg., 1934, xxvi., 300.

THE NEW UNIVERSITY HOSPITAL IN JERUSALEM

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Page 1: THE NEW UNIVERSITY HOSPITAL IN JERUSALEM

755

statistics now in vogue. Though his own conclusionsare based on a statistical analysis of hundreds of cases,he is critical of the analysis, mostly from Americansources, of cases terminating in recovery after theremoval of alleged foci of disease. These figures are,he remarks, based on the erroneous a,ssumption thatno patient can recover unless foci are removed.

Study of insured persons suffering in Sweden fromchronic progressive polyarthritis has satisfied Dr.Kahlmeter that about 60 per cent. of them recoveredtheir capacity for work under ordinary institutionaltreatment ; long before the doctrine of focal infectionwas successfully launched, his patients were muddlingtheir way through to recovery. No doubt recoverymay hinge on the removal of an infectious focus.When, as happens in many cases, its removal has nonoticeable effect on the disease, it may be that it hasextended so far that the original peccant focus nolonger plays an important part, or that constitutionaland other factors prevent recovery. Dr. Kahlmeter’sconclusions are based on blood sedimentation-rate,percentage of hfemoglobin, numbers of erythrocytes,and absolute and comparative numbers of leucocytes.The blood, taken from the capillaries in the fastingstate, was examined by one and the same person.With these figures before him,Dr. Eahlmeteris doubtfulif infection alone can be held responsible for thedisease. An infectious factor is, however, demonstrablein so high proportion of cases that it is impossible notto hold it responsible for playing a dominant role inmany cases. He compares the genesis of polyarthritiswith that of asthma, remarking how in both manydifferent influences or exciting factors may produceone and the same clinical picture. The clinicaluniformity of chronic progressive polyarthritis mayconceal the interplay of multiform causes.

POST-VACCINAL ENCEPHALITIS

THE February issue of the Bulletin of the Inter-national Office of Public Health contains a surveyof the incidence and fatality of post-vaccinalencephalitis in certain countries during the last twoyears. In England from September, 1933, to October,1934, four cases with three deaths after primaryvaccination were reported in persons aged 4, 6, 7, and18 years. The symptoms in each case developed onthe thirteenth or fourteenth day after vaccination.There was one mild case in a lad aged 19 followingrevaccination. In Germany in 1933 there were

fourteen cases with one death following primaryvaccination and five cases with two deaths afterrevaccination. In the first six months of 1934 therewere three cases with one death after primaryvaccination and two cases with one death afterrevaccination. In the United States in 1933, inaddition to five cases in children aged from 3 to 9 yearswhich occurred from eleven to nineteen days afterprimary vaccination, there were three cases aboutwhich there were no details. In Holland eight caseswere notified in 1933 ; three of these were rejectedafter examination by the official neurologists, whoalso regarded some of the remaining five as doubtful.As the number of vaccinations performed during theyear was 26,000, the average proportion of one caseto every 5000 vaccinations remained the same. Inthe first six months of 1934, when 10,000 vaccinationswere performed, two cases were reported. In Norwaytwenty-eight cases with eleven deaths were reportedduring the period 1930-33. Of eighteen childrenwho had been vaccinated before or after 1930 andhad survived the complication, seventeen had com-pletely recovered and only one still had paralysis.In Sweden no fatal cases had occurred since 1932,

and there were only three mild cases in 1934. Thenumber of annual vaccinations remains about thesame in this country. In Belgium, where about100,000 vaccinations are performed yearly, therewas only one case-in a girl aged 12 years, who

developed the first symptoms on the twelfth dayafter vaccination and died after a few days’ illness.There were no cases in British India.

THE NEW UNIVERSITY HOSPITAL IN JERUSALEM

Dr. J. J. Golub, who has been invited to select asite in Jerusalem for the Rothschild-HadassahUniversity Hospital, is making some stay iri Londonen route for Palestine. Dr. Golub is director of the

Hospital for Joint Diseases in New York City, andis serving as consultant in the planning of the newhospital and of the attached Nathan Ratnoff medicalschool. They will be built on Mount Scopus adjoin-ing the Hebrew University to which the hospital isaffiliated for post-graduate teaching and research inhygiene, bacteriology, biochemistry, parasitology,general pathology, and cancer. The hospital is tohave 250 beds and an out-patient department capableof dealing with 144 patients an hour. There will bea visiting staff of at least 36 specialists, and quartersare being arranged for 20 residents. A specialemergency service will provide ambulances to workover the whole of Jerusalem and bring patients tothe nearest available hospital. A special feature ofthe Rothschild-Hadassah Hospital will be a privateand semi-private floor of 14 beds serving the growingneeds of foreign visitors to Jerusalem. This sectionof the hospital will be referred to as the AmericanHospital in Palestine. At present Palestine has onlyabout three hospital beds per thousand of population,including those provided by the Government andvarious missionary bodies.

NEUROGRAMS

AN extension of the method of radiologicaldefinition by the injection of substances opaque toX rays has recently been described by Dr. MakotoSaito,lof Xagoya, Japan. He and his co-workershave proceeded from the successful use of lipiodolin the visualisation of blood-vessels, and of thorotrastin that of lymph-vessels to experiments in neurography.The ulnar nerve, being the only one that is readilyreached by subcutaneous injection without exposure,was used for injection experiments on the intactnerve. Thorotrast was found more suitable than

lipiodol, mainly because it flowed further along thenerves. By subcutaneous injection of 0’5 c.cm. ofthorotrast into the ulnar nerve, where it lies in its

groove behind the elbow, clearly defined shadows of7 em. to 39 cm. of the length of the nerve wereobtained. The neurograms were taken twenty-fourhours, two days, and three days from the time ofinjection, and the central spread of the solution wasclearly demonstrated. In one case, three days afterthe injection, 24 em. of the nerve were visible onthe film, stretching from the point of injection to theaxillary fossa ; towards the periphery the shadowstretched for 4 em. only. The form of the shadowmay be linear, wavy, or denticulate ; in some casesthe nerve-fibres show up distinct from the neurolemmaand in one film it is even possible to recognise theinternal leaf of the neurolemma, consisting of fibresrunning parallel with the nerve, from the obliquelyrunning fibres of the external leaf. Saito describesthe neurograms obtained in nerve lesions, and in acase of multiple neuromata, where the nerve is

1 Amer. Jour. Surg., 1934, xxvi., 300.