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.