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® J )t
fitina DMial JtftrrnaL
VOL. XXXVIII.
DECEMBER, 1924.
NO. 12
A SURVEY OF HUMAN INTESTINAL PROTOZOA
IN PEKING, CHINA*
Jo h n
F.’ K e s s e l a n d R u t h S v e x s s o x , P ek in g.
I n t r o d u c t io n .
The examination of mobilized forces during and after the
recent Great W ar afforded opportunity to determine the protozoan
infestations of large groups of individuals. Interest was stimulated
in the clinical results of such infestations, and since the war surveys
have been carried on in different parts of the world to determine
the incidence of infestation in different regions. To date, only
prelim inary work has been done with the Protozoa in China, and
the present survey' involves the largest number of cases reported
from any one region m this c o u n ty .
The writers are glad to take this opportunitj^ to express their
appreciation to D r. R . G. M ills, Head of the Department of
Pathology, and D r. W. W . Cort, V isain g Professor of Parasitology, for their efforts in stimulating interest in the survey and
for their assistance in preliminar}’ arrangements, and to D r. D. L .
Sloan, Medical Superintendent of the Peking Union Medical College
Hospital and the Hospital staff for the¿¿ cooperation in procuring
specimens from the wards for exam inatiî, and to M iss Ida Pruitt,
Social Service Director, for m aking tk r arrangements to secure
.samples from the orphanage.
M a t e r i a l a n d M ^ ’. J o d s
The surve}’ was begun October 4, 19 2 3 , and was closed early
.the next A pril. It includes the following groups : 77 foreigners
treated in the hospital, 144 foreigners resident in Peking and in
*From the P a ra sito lo g y L aboratory, D epartm ent of P ath ology, P e k in g
•Union M edical College.
962
The China M edical Journal.
apparent health, examined for purposes of the survey or receiving
a physical examination without clinical diagnosis; 422 Chinese
treated in the
Hospital, and 394 Chinese in apparent health
examined for purposes of the survey or given a general
examination. T hus 1,0 3 7 individuals have been exam ined>
340 of whom have had six examinations, 39 five exam ina
tions, 50 four examinations, 62 three examinations, 80 two
examinations, and 466 one examination each. One hundred
of the Chinese and 70 of the foreigners were under fifteen years
of age. The 144 resident foreigners were for the most part from
residence compounds in Peking, and the 394 Chinese who were not
patients in the Hospital include, first, members of the Hospital
staff among whom were practitioners, technicians, stenographers,
and servan ts; second, a large group of servants sent by outside
emplo3'ers to the Hospital for physical examination, and third,
a group of fifty orphanage children. T he authors thus consider
that they have a very representative cross-section of the population
of Peking.
All examinations were made from fecal smears, first in iodineeosin stain. A ll positives were later stained with iron-hasmatoxylin
and then examined under an oil immersion objective. T he writers
believe this to be necessary for an accurate diagnosis, because cysts
of Endamoeba dysenteries and of Endolim ax nana are often con
fused when examined in the iodin-eosin alone, and races of Iodamoeba
butschlii, which m ay at times be spherical in shape, m ay also be
confused with E . dysenteries- when no permanent stains are made.
It is further impossible to make accurate differentiation between
Endamoeba coli and Councilmania lafleuri when examined only in
iodine-eosin stain.
S ix .examinations were made of as many of the cases as was
possible. W hile the authors recognize the fact, both from their own
experience and from that of others, that all positives are not detected
by six examinations, yet for practical purposes it is considered
sufficient for routine examinations. In this survey the findings of
six examinations are chosen arbitrarily as representing 10 0 ^ of
the positives, though an average of the estimates, for E . dysenteries
made by extensive surveys in England and by Fau st in China
(1924) indicate that in reality only about 9 0 ^ of all positives are
detected by six examinations.
A S u rv ey of H um an Intestinal Protozoa in P ekin g .
963
The survey has afforded material for training a number of
Chinese laboratory technicians and after prelim inary orientation
they have been relied upon, with occasional representative checks
b}’ the authors, to separate the positive cases from the negative.
Checking the work has shown that on the whole the technicians
employed overlooked about 1 0 ^ of the positives. Because of this
fact and because six examinations are chosen as a maximum
number of examinations, it is regarded that the results of this
survey present figures somewhat less than the actual maximum
percentages of positive infestations in this region.
T a b l e s an d D is c u s s io n s
The results of the survey are classified in the following tables,
the conclusions and discussions of which will be treated in turn.
D is c u s s io n
a n d C o n c l u s i o n s : T a b l e I.
Table I shows all positive findings of cases examined once,
twice, three times, four, five or six times, and gives the day on
which the infestations were first determined. Of greatest value is
the column for six examinations, which represents the positives of
340 cases, both foreigners and Chinese.
T he last column of the table, “ Percentages of Infestations
Detected by Different Exam in ations’ 5, is based entirely on the 340
cases examined six times each and the percentages are worked out
on the assumption that six examinations have revealed 1 0 0 ^ of the
positive infestations.
It is impossible to make exact comparisons between these
figures and the results of previous workers, because the data are
not presented in a uniform manner in the different surveys.
Generalizations have been made, however, and it is interesting to
note the relationships. A comparison of the conclusions of three
previous workers w’ith those of the present survey is presented in
Table II.
D i s c u s s i o n s a n d C o n c l u s i o n s : T a b l e II.
The figures of Dobell (19 17 ) and of Matthews and Smith
(19 17 ) are estimated from data collected in their surveys, while the
figures of Jepps (19 2 1) and of the present authors are based on
actual examination of six stools of the cases considered. Miss
T a b u -: I . — D a y s o n w h ic h I n f e s t a t io n s w e r e F i r s t D e t e r m in e d an d P er c e n t a g e s o f I n f e s t a t io n s
' on
D e tec te d b y D if f e r e n t E x a m i n a t io n s .
4
12
9
J
th lira ■2nd lsl
tli
tli
Councilmania
...............
coli
1
biiischhi
i n l c s i n a l i s ................
C hilom astix
Trichomonas
6
2
Inficiai
2
i
o
mcsniii
I
hominis
7
9
1
1
7
I
1
2
I
X
40
1
I
26
I
I
22
6
io
12
2
8
13
I
I
6
I
T
2
i
ij
i
1
I
I
rd 2nd
2
2
2
2
1
I
i
2
2
1
I
II
6
2
i
2
I
I
2
T
3
I
i
2
2
i
i
I
E m b a d o n i o n a s iutcstinaJisl
7
i p ti iii ni n p lìn f r n (> ; / c
...
i
b y differe n t
2nd 1st
1st
6
Ex.
5
3
2
1
4
Ex. Ex. Ex. Ex. Ex.
IO
I
2 0 I I I TOO
85
67
14
88
66
6
66 1 0 0
100
2
98
10 0
2 1 10 0
81
91
88
69
S
70
19 100
2
2
10 0
91
81
67
1
i
10 0
90
60
50
29
20
10
1
j
...
1
S
Ex.
exam in ation s
6
I
1^P 11 f n / 1*I/■* l /T111 /■>»»!~1 c
2
in fe s t a t io n s d ete cted
95 77 47
95 75 44
3 557
93
44
3 434 98 87 347
78 55 30
3
3
978774 63 42
58
3
5
3
11
I
I
2
3
53
3 5
rd 2nd 1st
»
I
i
i
I
Enicrom onas
h om m is
...i
...
i
1
1
Medical Journal.
Eudam ocba
Giardia
11
d y s c u t c r i a c ...
2
*
th
2 Exs.
China
R ndam ocba
lodamovba
...............
nana
43
7 3
4
rd 2nd 1st
!
E n dolim ax
Exa m in atio n s
3 Exam s.
The
543
13 2
35 3
7
19
57
14
3
3
5 4 3 17
34
32J
3 3
Oth flth
_
P e r c e n t a g e s of
4
5 E x a m in a tio n s
6 E x am in atio n s
A S u rv ey of Hum an Intestinal Protozoa in Peking.
965
T a b l e I I .— P e r c e n t a g e s o f I n f e s t a t i o n s D e t e c t e d b y D i f f e r e n t
E x a m in a t io n s a s C o m p ared w i t h o t h e r S u r v e y s .
Dobell
Je p p s
M atthew s
and Sm ith
K e sse l and
Sven sson
33 to 40
43 +
33-4
44
E . coli
33 i
—
40.5
47
G ia rd ia
22 -f
—
4S.7
42
73 +
64.6
75
7S
87
79-9
74
1 E . dysenter.,
°/0 + detected
by one
exam in ation
% + detected
b y three
exam in a
tions
\
E . dysenter.,
50 to 66f
E . coli
50 to 665
G ia rd ia
33-j to 50
—
Jepps doss not present her figures for E . coli and G iardia
intesIinalis but it seems to be more than a coincidence that our
percentagss for E . dysentcriae for a single examination and for
three examinations should correspond so closely with hers.
O ir percentages are higher than the maximum estimate made
by Dobell and also higher than those made by Matthews and
Sm ith. On the other hand, the figures of the present investigation
for E . coli and for Giardia come fairly near the estimates of
Matthews and Sm ith, E . coli being somewhat higher and G iardia
a few points lower than their estimate, though they are much
higher throughout than the estimate of Dobell. It should be
noted, however, that oar figures favor Dobell’ s conclusion that
G iardia is more sporadic in its occurrence than E . coli.
D is c u s s io n
a n d C o n c l u s i o n s : T a b l e I II.
Fo r the purpose of comparing the percentages of infestations
among the Chinese and the foreigners resident in Peking, the
results are tabulated separately in this and the following tables.
Table I I I represents the distribution of all infestations among
the Chinese, and shows the number of positives detected' in cases
examined once, twice, three, four, five or six times. The columns
under Totals give the number of cases positive, the number of
T a b le III.
(A v e ra g e 3 .1
I n f e s t a t io n s A m on g C h in e s e .
6 exam s.
5 exam s.
3 exam s.
1 exam .
+
+
—
+
—
% +
I
Totals.
% +
Cor
rected
40.1
9
M
12
19
i.S
32
23
40
99
2S5
271
545
33-2
E . d y s c n lc r ia c ................
79
1S9
5
18
5
26
XI
36
11
52
60
324
17 1
645
21
29-5
Coiai cilm an i a ..............................
50
21S
i
22
4
27
7
40
6
57
52
332 *120
696
14.7
19.2
E . coli
40
228
3
20
2
29
i
46
5
58
30
354 * 8l
735
9.9
11.7
3Ó
232
2
21
2
29
0
47
9
54
19
3fi5
68
748
8-3
13 -
G ia rd ia ...
31
237
4
19
4
27
4
43
3
60
18
366
64
752
7.8
10.
C iiilo m a s iix
17
251
3
20
i
30
2
45
2
fii
3
381
28
788
3-4
6.
Trichom onas
10
25S
2
21
2
29
i
46
i
62
2
382
iS
798
2.2
4-5
P cn iatrich o m o n a s
0
268
0
23
1
30
X
46
0
63
0
384
2
S14
.2
Etnbadom nnas ...
I
267
0
23
0
31
0
47
0
63
0
384
i
815
.1
—
D icnlam ocba
0
268
0
23
0
31
0
47
i
62
0
383
1
815
.1
—
...........................................
I. b iitsch lii
................
—
.
—
0
0 384
i 267
0
i 8 r5
■0
0
.1
................
—
23
31
47
63
* There w ere 18 cases of m ixed infection of E . coli and C oitncilm ania ¡ajjcu ri. In old er to compare w ith previous
survej'-s in which E . coli and C oim cih nania have not been differentiated, these eighteen were deducted from the total num ber
of cases of E . coli and C. laflcitri, g iv in g a percentage of 23.6, which can be com pared with infestations with E . coli reported by
previous w orkers.
E n icro m o n as
Medical Journal.
155
+
China
TI3
—
+
The
—
+
—
2 exam s.
+
E . nana ...
—
4 exam s.
vO
Ch
On
E x a m in a t i o n s ) .
A S u rv ey of H um an Intestinal Protozoa in P ekin g.
967
cases negative, the percentage positive for the whole series (an
average of 3 .1 examinations each) and the percentage positive
if corrected to six examinations according to the column in
T able I headed “ Percentages of Infestations Detected by Different
Exam inations’ 5.
It will be seen from Table I I I that the intestinal Protozoa
found in other parts of the world are present in Peking. E . nana
shows a higher percentage than in previous surveys and Iodamceba
biitschlii is also much higher than in any other surveys recorded
with the exception of B ru g ’s (19 2 0 ) in Java. Since I. biitschlii is
thought to be common in swine, the question at once arises whether
the close p r o x im o of the pig psn to the dwelling in China is not
an explanation of this fact.
Thè flagellates in general show re lativ e^ light infestations,
especially G iardia, 7.S% , when compared with the high percentages
found by the B ritish observers. D arin g the winter months of the
survey no Trichomonas were found. T h is indicates the possibility
•of its being as a rule a temporary parasite in man, and further
suggests, on account of no cysts having been found as yet, that
transmission is difficult to accomplish during cold weather. Both
motile and encysted forms of Giardia and Chilom astix were found,
though the encysted forms were most numerous.
Pentatichomonas was found twice during the surve}’ and
once soon after the survey was closed. One case was a mixed
infestation with Giardia and hookworm. T he second case was that
of a patient suffering from kala-azar, who was admitted to the
hospital in the last stages of the disease. It was impossible to take
a complete history of the case, although for the few days before the
patient died, five or six diarrhoeic stools were passed per day. T he
third case was also a mixed infestation with E . dysenteries, so here
again the complication of a mixed infestation prevents the acquire
ment of definite data as to the pathogenicitj- of Pentatrichomonas.
Form s answering to the description of Embadomonas intestinalis, Enteromonas' hominis and Dientamceba fragilis have been
found, once with certainty, and it is thought that two other cases of
Dientamceba were found. Since exact identification was uncertain
they have not been recorded.
Endamoeba dysenteries- has been found to be a common
parasite, and size races, corresponding to those recorded by Dobell
( 1 9 1 9 ) , have been encountered.
96 S
Councilmania lafleuri has been found in greater numbers thanE . coli. Budding forms of Councilmania have been seen both in
fresh and in stained specimens and the characteristic pseudopodial
differentiation of these two species has been apparent.
The distribution of total infestations among the 268 Chinese
examined six times each is as follows : 16 0 or 60% were positive
for protozoan infestation, while 108 or 40% were negative. Fo rtys ix harbored only one species of Protozoa, forty-five were infested
with two, thirty-three with three, twenty-two with four, ten with
five, and four were infested with six different species. We thus
see that of all the positive cases, 1 1 4 or j 2 °/o carried m ixed
infestations.
T a b le IV .— I n fe s t a t io n s A m o n g F o r e ig n e r s ,
(Average 3 .3 examinations.)
'À
X
■S:
•r.
vi
Si
a
MD
'A
v
to
*
O
'T
%
O
c;
0
c-t
Totals.
y,
0
-
(
+
-
+ — +
+
—
+
+
1
E . nana ............ Iß 42 6 10 6 IS 4
T
1
—
% +
% +
Cor
rected
i
7 1 20 ■12 * 7 / 4S
*73
21.7
26.5
i
6 ! s 3 27
194
12.2
16.5
C o u n c ilm a n ia .. 10 45 2 14 4 IS i
5 84 25* 196
H -3
14-5
E . coli
4
20* 201
9.0
11.6 *
E . dysenterioc..
............
1. b iitsch lii
...
II
44 i
9 46
I
15 3 l6
i
II
! 14
5 :2^
3 24
14
15 2 *7 3 12 i 20
3 52 O l6 0 *9 0 15
1
0 27
G i a r d i a ...............
3 52 O 16
C h ilo m a stix ...
6 49
T rich o m o n as...
2 53 0 1 6 0 19 0 15 0 27
I
I
i
18 0 15 0 27
IS 0 19 0 15
I
26
185
2 ! 87
5
216
3.3 !
3 -2-
I
5
21Ó
2.3
3-
0 §7 10
2 11
4-5
10.
88
218
1.4
I
188
3
2.8
* Th ere were 5 cases of m ixed infestation of E . coli and C o u ncilm ania
lafleuri. In order to com pare w ith p revio u s su rve y s in w hich E . coli and
C o uncilm ania have not been differentiated, these five w ere deducted from
the total num ber of cases of E . coli and C. la fleu ri, g iv in g a percentage of
18 .1, w hich can be com pared w ith in festations w ith E . coli reported by
previous w orkers.
T a b le V .— A
C o m p a r is o n o f G r o u p s o f C h i n e s e a n d F o r e i g n e r s .
FO REIG N ERS
C H IN E S E
S ix exam in ation s
each
S ix exam in ation s
each
200, 6 exam in ation s
5 16 , 1 to 5
„
S ix exam ination s
each
25, 6 exam in ation s
25, 1 to 5
„
75 , s ix exam in ation s
25 , i to 5
A d ults, H ospital
adm issions
A d u lts, servan ts
A ll adults
Children,
O rphanage
C hildren, H ospital
adm issions
A ll children
13
13-3%
7%
23
77
23
2%
2.4%
8
92
40
20 %
23-1%
24
i
49
2%
2.4%
0
50
0
0
30 %
15
35
30 %
9
41
15% 20.3%
7
43
14%
8
10%
20
30
40%
656
8 .4% 13-5%
7
43
40
676
5-6%
6-9%
24
6%
23
693
3 -2%
6%
0
17
699
2.4%
4-7%
no
26.6%
25
25
22
128
14-6%
19
E . co li....................
10
140
6 .6%
Iod a m oeb a ...........
8
142
...........
11
C h ilom a stix
T richom onas
Giardia
87
34 %
33 -3%
50%
147
569
20.5%
31
38%
107
609
8
42
16 %
58
658
8.1 %
5-3%
23
28
46%
6o
139
7 -3%
2
48
4%
10
140
6.6%
3
47
9
14 1
6%
0
50
...
13
33
4S0
Councilm an!a
26
17
236
40
25-3%
3 t>%
70%
E . d ysen terioe ...
24
32
J5
108
7&
18
55
42
cor
rected
A ll children
% + *
%+*
109
42 %
28%
............
E . nana
%+ *
42
% +
% +
cor
rected
37%
—
—
25, s ix exam in ation s
45 , i to 5
A ll ad ults
35
+
+
40, s ix exam in atio n s
h i , i to 5
+
% +
% +
% +
I
cor
rected
—
—
—
% + *
%+ *
+
+
+
I
cor
rected
cor
rected
■+
—
i 7-S%
32 %
6
64
S-6 % 10.7%
125
1 7 -2%
25 %
i
69
M%
i-7%
22
129
1 4 .6%
21%
3
67
4-3%
4-9%
2 3 .5 %
14
137
9-3%
1 2 .5 %
6
64
S.6%
9-8%
8
9%
4
147
2.6%
4-5%
i
ó9
M%
2%
76
24
25 %
2
149
i- 3 %
2-5%
3
67
5-7%
4-3%
5
95
5
5 -5%
11
140
7-3%
14 0,'.
1
99
i
3
148
2%
4 -5 %
+
—
% +
40 %
35
65
13%
20.5%
24
42
16%
17-2%
3
47
6%
14%
i
49
36
28%
10
4
46
s%
i
49
2%
* Corrected to s ix exam in ation s by reference to T able I, “ Percen tage of In festation s D etected b y D ifferent E x a m in a tio n s .”
% +
% +
A S u rv ey of Human Intestinal Protozoa in P eking.
969
D i s c u s s i o n a n d C o n c l u s i o n s : T a b l e IV .
Table IV represents the distribution of infestations among
foreigners of all ages in Peking. Seventy-seven of these were
admitted to hospital for various causes and the remaining 144 were
children and adults resident in Peking.
Some of these were
Peking Union Medical College staff members while others were
members of different missions.
Fo r all cases, the average number of examinations was 3 .3 .
The last column of the table shows the percentage of infestations
positive, corrected to the result procurable if six examinations had
been made of each case. These results compared with the
infestations among the Chinese recorded in the previous table show
that, on the whole, protozoan infestations among the foreigners are
lower than among the Chinese. Of special interest is Endamoeba
dysentericz, which shows .29.5% of infestation among the Chinese
and onh' 16.5^0 among the foreigners. Chilom astix is the
exception, and shows a higher percentage of infestation among the
foreigners than among the Chinese.
D is c u s s io n an d C o n c lu s io n s :
T a b le
V.
Fo r the benefit of comparisons of different important groups..
Table V is compiled. Where possible, the series representing,
actually six examinations of each case is recorded and where this
is not practicable, all examinations are recorded and corrections are
made to six examinations as previously described,.
The adults (hospital admissions) represent all adult hospital
patients who were examined six times each. The}- were taken in
about equal numbers from both medical and surgical wards, and
represent first, second and third class patients. When compared
with the adult servant group, it is noticed immediately that the
general percentages are higher among the servants than among the
hospital patients. Two reasons are offered for this particular
variation.
(1)
T he servants in Peking are chosen for the most part from
the coolie class, while Chinese who seek admission to hospitals
where Western medicine is practised are likely to be a group who
will use greater care about their food and who will be cleaner in
habit than the coolie classes.
9 /0
The China Medical Journal.
(2) E v ery case of the servant group was carefully checked by
thé authors, while only the usual checks on technicians were offered
for the group of patients.
The third column comprising examinations of 716 Chinese
adults, corrected to six examinations, is thought to give a very
fair representation of their protozoan infestations. In this group
E . nana shows the highest percentage of infestation, being 42°/o.
Next in order is E . dysenieriœ , giving an incidence of 3 0 ^ .
Councilmama lafleuri is approximately twice as high as E . coli
which is 1 0 % and Iodamoeba biitschlii gives an incidence of 1 3 . 5 ^ .
Giardia is low when_ compared with some other surveys, being
only 6.g% .
Patients who were fifteen years of age and under are classified
as children, and one hundred of this age were examined, fifty from
an orphanage and fifty from the children’ s ward in the hospital.
The orphanage children show on the whole a higher incidence of
infestation than the children in the hospital ward. T his is partly
owing to the fact that many of the children in the hospital ward
were infants and had thus not been exposed to infestation through
contaminated food, while all of the orphanage children were over
nine years of age. Another important factor is probably the care
of the children, for Chinese parents who would bring their children
to the Peking Union Medical College are probably more careful
than those who place their children in an orphanage. It is said
that the parents of a great many of the orphanage children are
living, having placed their children in the orphanage merely
because they are unable or unwilling to support them.
One noteworthy fact about the orphanage children is the high
incidence of infestation with E . coli, nearly three times as high as
Councilmania, while all other groups of Chinese show a higher
Councilmania infestation. It would seem that E . coli is endemic
in this special orphanage. Matthews and Smith (19 19 b ) have
also found E . coli to have a high incidence compared with other
Protozoa among certain asylum patients in England.
Another interesting feature about the orphanage group was a
particular race of E . dysenteriae which was present in about half
of the positive cases. It was very large, measuring 18 1> to 20^
in diameter, and was characterized by the scarcity of chromatoidal
bodies. Had it not been for the constancy with which four nuclei
A Su rvey of‘ Human Intestinal Protozoa in Peking.
9 71
appeared in the ripe cysts, this amoeba would certainly have been
confused with E . coli. T his peculiar race has been found in a few
other cases but was endemic in the orphanage. Iodamoeba has
about the same incidence of infestation among the orphanage
children that it has among the Chinese adults. T he other Chinese
children for some reason show a lower incidence of Iodamoeba.
In comparing the Chinese children and adults as a whole, it is
interesting to note that E . nana and E . dysentericu have a 5 %
higher incidence in the adults than in the children. Iodamoeba is
more prevalent in the adults, while Giardia has nearl\T four times
as high an infestation in the children as in the adults. Giardia is
commonly regarded as being an infestation of children and the
present survey supports this impression. Chilom astix has about the
same percentage of infestation in both children and adults, while
Trichomonas is noticeably higher in the adults.
A comparison of the adults and children among the foreigners
presents a ver}^ striking difference. W ith the exception of Giardia,
the adults have throughout a much higher percentage of infestation
than the children. T his is particularly true in the case of E .
dysenterice, which is almost negligible among the children while
the adults show a percentage of infestation only 5% lower than the
percentage of infestation among Chinese adults. It seems probable
that this low percentage of infestation in the children mav^ be
explained by : —
(1) The careful supervision of food given to foreign children.
(2) The tendency among children of foreign parents to drink a
great deal of milk. Hegner (1923) has shown that a m ilk diet
decreases the number of flagellates in rats, and Kessel (1924) has
shown that the amoebae of the rat react negatively to an exclusive
m ilk diet. It therefore seems likely that the great amount of milk
used in the diet of foreign children may partly account for this low
percentage of protozoan infestation. On the other hand, Chinese
children seldom take milk after they are weaned.
In other surveys, however, where the children have been
considered separately, they have not shown a lower degree of
infestation than adults, but rather a slightly higher degree [M at
thews and Smith, (18 19 c), and Maplestone, (19 2 1)]
972
In a comparison of the Chinese and foreign adult groups the
most important differences are :—
( 1 ) E . nana, E . dysenter'ice, lodamoeba bütschlii and G iardia
intestinalis are considerably higher among the Chinese than among
the foreigners.
(2). Chilom astix is decidedly higher among the foreigners
than among the Chinese.
(3) Councilmania lafleuri, E . coli and Trichomonas hominis
have about the same percentage of infestation in both foreigners and
Chinese.
T a b l e V I .— A g e
D is t r ib u tio n
Am ong
—
In fe s ta tio n s
16 - -5 0
i — 15
■+
of
C h in e s e .
+ % cor
rected
+
—
5 1 —■over
+ % cor
rected
+
—
+ % cor
rected
1
4 1.
13
24
41.2
li
26
34-4
35
65
37
223 •456
E . dysenteriac
24
76
25.3
13 7 542
29.2
Councilm ania
87
13
1
23 77
13-3
100 579
1 6.
7 ; 30
20.1
23-5
57 62 2
12.5
1 Í 36
3-
E . nana
E . coli
................
................
lo dam oeba...
G iardia
................
C h ilo m astix
Trichom onas
....
8
92
9-
58 621
13.6
2
35
7-3
24
76
25 -
38 641
7-
2
35
6.2
5
95
5-5
20 659
3-8
3
24
1
99
I.
16 663
4-
I
36
D is c u s s io n an d C o n c lu s io n s : T a b le
12 .
4-5
Vi.
A t first, age tables for both foreigners and Chinese were
compiled in which infestations were worked out in groups for each,
ten years of life. The numbers, however, are insufficient to make
such records of value and as among the foreigners only ten are
A S u rvey of Human Intestinal Protozoa in Peking.
973
recorded above 50 years of age, no age comparisons are presented
other than those of foreign children and adults in Table V . Among
the Chinese, however, where there are greater numbers concerned,
the similaritjr of all the middle groups was noticeable and a marked
-contrast to this group was seen immediately in the lowest group
and in the highest group. Consequently, those from 16 to 50 years
of age are placed in one group and are compared with the children
on the one hand and with the adults over 50 on the other. The
following generalizations are apparent :—
(1) Percentage of protozoan infestation, with the exception of
■G iardia, increases as age advances. Giardia is decidedly higher
in the children than in the other age groups.
From this Table it seems as if E . coli also is higher in children
than in adults. A comparison with Table 5 shows, however, that
the children in the hospital ward have even a slightly lighter
incidence of infestation with E. coli than the adults. It seems
•evident that the endemic occurrence of E. coli in the Orphanage is
responsible for the apparently high incidence in children, when
both groups are considered together.
(2) Of special interest is the increased infestation of E .
dysenterice, Councilmania lafleuri, and Chilomastix in the advanced
age group. Of this age group, comprising 37 in all, 1 1 were
admitted to hospital for intestinal disorder, 6 for malignant disease,
2 for cirrhosis of the liver and 5 for fractured femur. Of the
remainder, 6 were there for pli37sicai examination, without diagnosis,
1 for cardio-renai disease, 1 for carbuncle of neck, 1 for abscess of
foot, 1 for streptococcus infection of leg and 1 for diabetes. W hile
these figures in themselves are insufficient^ large to be conclusive,
yet they present forcibly to one’ s mind the possible importance of
the role of the intestinal protozoa in the chronic diseases of old age,
as is strongly suggested by K ly (1923) in his discussion of the
second great type of chronic arthritis. It should be noted that the
results of this survey do not agree with those of Maplestone (19 2 1)
in Queensland, Australia, where he found the lowest percentage of
infestation with E . dysenteries in his group from 41 to 80 years of
age.
97 4
D i s c u s s i o n a n d C o n c l u s i o n s : T a b l e V II.
For interest of comparison, some of the surveys that have
been carried on in different countries are presented in tabular form
in Table V II. Owing to the different conditions under which the
surveys have been made, the different personnel performing thè
examinations, and the various methods in compiling data, it is
obvious that the figures cannot all be compared at their face value.
It will be noticed that the series is divided into three groups, one for
six examinations, one for three and one for a single examination.
It is immediately evident that there is a difference in final results
between surveys recording the actual number of examinations and
those recording the average number of examinations. T h is can t e
illustrated by comparing our Chinese group of all ages, where the
actual percentages of three examinations is taken (Table V I I ) ,
with the Chinese in Table I II, who have an average of 3 .1
examinations. In our series the differences are not so marked as
they would be in surveys wiiere a number of the cases were examined
more than six times, some of them six times and some of them less
than six times, e.g., Matthews-Smith series of 2,355 convalescent
dysenteric troops with an average of six examinations. Cases
examined more than six times produce a higher percentage of
negative results than cases given from one to six examinations,
and would therefore reduce the percentage of infestation. It is
probable that Jepps (19 19 ) gives the most representative results of
the returned troop class, because the m ajority of her cases were
actually examined six times. As Jepps points out, it is interesting
to note that her actual results compare favorably with the the
oretical results of Carter, Mackinnon, Matthews and Smith (19 17 ).
B y the method of estimating used in the present survey, from
the single examinations and from the surveys of three examina
tions, the results of actual percentages can be approximately
reckoned and thus an idea be derived of the percentage of protozoan
infestation in different countries.
Another criticism on Table V II as a whole becomes apparent
from a consideration of the failure on the part of some investigators
to keep records of all the Protozoa found. W here no mention is made
in the text of forms missing in the tables, the question immediately
arises as to whether the authors have not confused some reported
organisms with forms not mentioned. Of special interest is
K essel and Svensson ...
P ekin g, China Fo reign all ages
K essel and Sven sson ...
K essel and Sven sson ...
Dobell, 19 17
................
Jepps, 1923
................
Brug, 1920
................
Brug, 1920
Faust & W assell, 19 2 1...
P ek in g, China
P ek in g, China
B ritain
M alay
Ja v a
Ja v a
W uchang,
Ch ina
P e k in g , China
P e k in g , China
Loudon,
E n g la n d
E n g la n d
................
M atthews and Sm ith,
19 19 (a)
Dobell, 19 2 1
................
Kofoid & Sw ezy, 1920...
Kessel and Sven sson ...
Kessel and Sven sson ...
W enyon, 19 17 ...
Dobell, 19 2 1
................
M atthews and Sm ith,
19 19 (b)
M atthews and Sm ith ,
19 19 (b)
Kofoid & Sw ezy, 1920...
Kofoid & vSwezy, 1920...
Kessel and Svensson ...
W enyon, 19 17 ...
Y o u n g ,1922
Y oung, 1922
................
M aplestone, 19 2 1
E n g la n d
Chinese adults
Chinese all ages
R eturned B ritish troops
N atives & Chinese
N a tiv e s ...
Europeans
C h in ese................
E n glan d
Fo reign all ages
Chinese all ages
H ealth y B ritish troops
in E g y p t
Su m m ary of all c ivilia n
reports
A sylu m patients
E n glan d
Children under 12
U. S. A .
U. S. A .
P ek in g, China
P e k in g, China
Egypt
A m azonas,
B razil
Am azonas,
B razil
Q ueensland
O verseas troops
Home Service troo p s...
Foreigners (all ag e s)...
Chinese (all ages)
N ative cooks ...
Federal troops................
221
200
275
2000
1034
150
100
143
105
368
1979
6
A verage
28.6 23-7
30.4
3-1 13.2
6-5
1.2
16.6
29-3
14.9
3-7
.5
13
6
Estim ated 9-13 7-10
to 6 ex.
6 64. 26.5
Corrected
to s ix
Corrected
to s ix
Ö
6
3
3
3
3
A ve ra g e
3
3
3
I
¡32
36-54l.5-.75 1S-27 6-9
29.
21
2.9
5-8
2.
12.5
4-5
2-5 14
4-5
(26.5 16.5 14.5 11.6
3-2
3-
10
2.8
25
38.5 32.5 20.5 9 - 15-5 6-5
10.
40.1 29-5 19.2 11 .7 13
16 .1
12.6
4°-5
2.2 14-5 . . .
7-7
•4 4.2
8.
23
12.
27.8
16.8
4.2 24-5
3--8
6-5
2.8
8.
4.8
5-6
4-3
-25 9-3
2.9
20.8 13-4 15-2 10.4
32. 20.7 12.8 10.8
20
•5 5-3
2.8
7-3
3-
6
.
4-5
4-5
2-5 11-5
10.7
1 .1
•9
2.1
1 .1
3146
I
4.6
3-4
18 .1
207
I
1 2 .1
9-7
45-9
54S
I
2.7
1.8
11.1
14 .1
1.8
2300
I
4.2
.1
I
221
816
I
20.5
29.3 12.8
27.8 4-3
15.9
15.8 10
5-5
7-3
22.4 14 .1 10.8 6.9
20.7
11-5
...
38.6
27-5
5-7
576
3-5
3-6
I -3
.8
87
I
I
251
I
School children
249
I
A ll ages
500
I
................
Trichom onas
Troops, m o stly in v a li
971
ded from w ar fronts,
m any w ith intestin al
disorders
Convalescent
dysen 2355
E n g la n d
teric troops
Sum m ary of all civilian 3146
E n g la n d
reports
Home Service troops
V. vS. A .
53
never abroad
P ek in g, China Foreign adults
15 1
Jepps, 19 2 1
Chilomasiix
E xam in ed
G iardia
!
Iodam oeba
L o c a lity
E. coli
or
C ouncilm ania
A uthors
Num ber
of
exam in a
tions
each case
.E. dysenteriae
In d ivid u als
E. nana
C ou ntry
Number or Cases
I
T able V I I . — C o m p a r is o n o f P r o t o z o a n S u r v e y s .
...
3-4 23.2
6.4
1.3 13
4-6 4.9
2.
7-
8-3
1 .1
4.4
22.5
36.9
14
2.8
4.6
26.4
11.Ö
2.2
...
•5
•7
1 .1
A S u rvey of Human Intestinal Protozoa in P eking.
975
Endamceba dysenteries, which in the iodine-eosin preparations may
be confused with either Endolim ax nana or Iodamceba butschlii.
Where the percentage of E . dysenteries is especially high and the
percentage of these other two amoebae low, or where they are not
mentioned at all, one immediately wonders if a confusion of
diagnosis has occurred. Among the flagellates also, there is
opportunity for error in confusion of species.
. Remembering these criticisms, the following generalizations
may be drawn : —
(1) W hile amcebiasis is by no means confined to tropical
countries, yet records taken in different parts of the world show
that infestations of E . dy sentence are higher in the tropics and
among crowded groups in temperate regions where sanitary
conditions are poor than among peoples in the more temperate
regions where approved methods of sanitation are employed. Ju st
what proportion of this decreased infestation is due to the temperate
climate and what portion to good sanitation is by no means definite
as yet. If the records from the more tropical regions given by
B rug (1920), Fau st and W assell (19 21) and Young (1922) in
Table V II are conclusive, it would seem that the hotter climate is
of- considerable importance, for these records show protozoan
infestation to be much higher in the tropics and sub-tropics where
sanitation is poor than around Peking, where sanitation is also
poor but where the climate is temperate. On the other hand,
Wenyon and O ’ Connor (19 17 ), examining native cooks in E g y p t,
and Jepps (1923) exam ining diarrhceic hospital patients in M alaya,
give percentages from the tropics that do not differ greatly from
our Peking records. Jepps however points out that she was dealing
with a special group of hospital patients, most of whose stools were
diarrhceic in nature and it would seem probable that her statistics
in this report are of greater value for the particular class of patients
in question than for the general population of M alaya.
(2) Comparing the reports of the Chinese in Peking in the
various groups for one, three, and six examinations with the reports
of Jepps (19 2 1), Kofoid and Swezy (1920), Dobell (19 17 ), and
Matthews and Smith (1919 a), it may be concluded that the Chinese
resident in Peking have a higher percentage of infestation with E .
dysenteries than the British and American troops who had returned
from the war fronts.
976
•
(3) Comparing our results of the foreign adults in Peking with
the groups of Kofoid and Swezy (1920) and Jepps (19 2 1) mentioned
.above, it will be seen that the foreigners in Peking carry about the
same percentage of infestation with E . dysenteries that was carried
by the troops returned from the war fronts.
(4) Comparing the civilian reports in England, (Dobell,
19 2 1), with the Chinese and foreigners in Peking, it is seen that
the percentage of E . dysentence infestation in Peking is at least
from three to four times as great as in England. A comparison
between Peking and America would show practically the same
ratio,, if we utilize the results of Kofoid and Sw ezy’ s examination
(1920) of 576 home service troops in U .S .A . given one examination,
according to which the percentage of infestation in Am erica is about
the same or only slightly higher than in England.*
(5) Matthews and Smith (1919b) report a 1 .8% incidence of
infestation with E . dy sent erica among children in Great B ritain —
given but. a single examination— while 1 . 7 ^ is the incidence of
infestation among foreign children in Peking— given six examinations
each. T he Chinese children in Peking; however, show an incidence
of infestation of about 2 5 ^ when examined six times. T h is
■difference must indicate the value of special dietary precautions for
the children on the part of the foreign parents in Peking.
D i s c u s s i o n a n d C o n c l u s i o n s : T a b l e V III.
T he distribution, of the intestinal protozoan infestations among
hospital patients would afford interesting. and; valuable comparison
providing data were kept of a sufficiently large gro,up to warrant
the tabulation of different diseases suspected of being caused or in
any wa}’ associated with intestinal protozoan- infestations. The
authors regard the present survey merely as a beginning of their
accumulation of such data and consider that various sub-groups
.are too small to warrant presentation in.this report. Accordingly,
two main groups are considered, Group I which includes those
suffering from chronic intestinal disorders including non-bacillarv
*Since w ritin g th is, an abstract in the “ T ro p ical D iseases B u lle tin ,”
Ju n e , 1924, of “ S tu d ie s on V ariou s In testin al P a ra sites (esp ecially Amoebae)
of M an ” b y Boeck, W. C., a n d 'S tile s, C. W., has been noted by the authors,
though th e y have not had access to the origin al paper. T h is abstract
ind icates that these w riters have found a h igh er incidence of infestation in
U. S . of A m erica than has been found in E n g la n d .
A S u rvey of Human Intestinal Protozoa in P ekin g.
T a b le
V I I I .— D i s t r i b u t i o n
A m o n g P a tie n ts
S u ffe r in g
P ro to z o a n
In fe s ta tio n s
fro m D is e a s e s o f t h e
C a n a l C o m p ared w it h T h o s e
T o g e th e r w ith
of
977
A lim e n t a r y
S u f f e r i n g fr o m o t h e r D is e a s e s ,
A p p a re n t H e a lt h y I n d iv id u a ls A d m itte d
fo r
G roup II . j
O th er diseases [
and p h ysical [ 185
•exam inations j
C hinese.
G roup I.
D ise a se of
a lim en ta ry
canal
G roup II.
O ther diseases
and p h y sic a l
e x am in a tio n s
i
T richo
m onas
% +
36 22.2
K>
CO
F o reign ers. \
Group I.
D iseases of L.
.alim entary
can al
/
E. nana
% +
E. dysenieriae
% +
Council- ;
mania
!
% +
1
E. coli
% +
Iodamocba
% +
G ia rd ia
Total No.
P h y s i c a l E x a m in a t io n .
2 £ +
13-9
8-3
0
3-6
4
1.1
0
6-3
4.4
i -7
2.2
1.1
i i -5 14-3
9.2
5-2
2.2
1.1
39
22.2
19.4
i i -3
10.6
0
0
8.8
3-4
15
1 1 .5
16.2
.i,
i
+
5 1 *
s j *
\
L
92 39 -i 30-5
J
599 42.3
23.2
dysentery, and Group I I which includes all others admitted to the
hospital together with persons in apparently normal health examined
for purposes of the survey or receiving physical examination
without any clinical diagnosis being made. The foreigners and
Chinese are considered separately because the percentages of
protozoan infestations among these groups differ so greatty. The
conclusions drawn below must be accepted with certain reservations
based upon the following possibilities of error :—
( T) Group II in each case includes many more individuals
than Group I.
(2)
One hundred and forty-four of the foreigners and two
hundred sixty-nine of the Chinese were tested for mere phj'sical
97S
T h e China M edical Journal.
examination or for purposes of the survey and no clinical histories
were taken. Though the majorit}^ of these were in apparent
health, it is not known what clinical symptoms would have been
detected upon careful examination. A group of twenty-five
hospital servants who were found positive for E . dysentence are
now being admitted in turn for careful examination and for
treatment with yatren and it is hoped that the clinical records
obtained will give added information as to the role of E . dysenteries
as a pathogen.
(3)
Foreigners suffering from chronic intestinal disorders
are possibly more likely to seek aid from W estern medicine than
Chinese with intestinal disturbances of a sim ilar character. The
thirty-eight foreigners of Group I represent 4 8 ^ of the foreign
hospital patients examined during the period considered, while the
ninet37-two Chinese of Group I represent only 22% of the Chinese
examined.
T he apparent conclusions to be drawn from Table V I I I are as
follows :—
(1)
Among the foreigners the percentage of positive infestation
from intestinal Protozoa in Group I is generally higher than in
Group II. The exceptions are E . nana, which gives a higher
percentage in Group I I, and Iodamesba and G iardia, the few
positives of which both fell into Group II.
Since the percentage of infestation with E . dysenteriac is
especially high in Group I (3 9 .2 ^ ), and since only two of the
cases positive for E . dysenteriae were suffering from acute
amcebiasis, the importance of paying due regard to the possible
protozoan origin of chronic intestinal disorders is clearly emphasized.
T he high percentage of E . coli, Councilm ania, Trichomonas
and Chilom astix in Group I m ay be explained in one of three
ways :—
(a)
Wenyon and O ’Connor (19 17 ) found a higher percentage
of E . coli among convalescents (“ mostly from dysentery or other
intestinal disord ers” ), than among healthy men. T h ey suggest
that the damaged intestine, for some unknown reason, is more
lik ely to become infested with this protozoon than is the normal
intestine.
A S u rvey of Hum an Intestinal Protozoa in P e k in g .
979
(b) Infestation with E . dysenteriae indicated fecal contamination
and the high incidence of mixed protozoan infestation in China
suggests that a class of individuals infested with one protozoon
m ay be infested with others and since emetin does not affect the
Protozoa, except E . dysenteriae, these other infestations m ay remain
even after emetin treatment.
(c) It seems possible that there m ay be times when the
presence of numerous protozoa in the digestive tract m ay produce
pathological effects, and the relation of Chilom astix and
Trichom onas to Group I causes one to stop and consider, at
least, the views of the group of investigators who regard the
intestinal flagellates as pathogenic.
(2) Among the Chinese, E . dysenteriae is the only protozoon
which has a higher incidence of infestation in Group I than in
Group I I, and this w7ith a difference of 7 ^ . It is thus apparent
that amDng the Chinese as well as among the foreigners there is a
higher incidence of infestation with E . dysenteriae among those
suffering from intestinal complaints than among those in Group I I.
(3) In comparing the foreigners and Chinese, one is
impressed with the fact that the ratio of Group I to Group I I of all.
Protozoa is on the whole higher throughout among the foreigners
than among the Chinese. T h is is especially noticeable with
E . dysenteriae, where the ratio of the foreigners in Group I to
Group I I is as 7 is to 2, while among the Chinese the ratio is as
2.7 to 2. T h is difference suggests that E . dysenteries is more
lik ely to cause chronic intestinal trouble among foreigners than
among Chinese, which brings to our minds the question of an active
racial im m unity to clinical symptoms resulting from infestation with
different races of intestinal Protozoa. The data here collected are
insufficient to warrant definite conclusions but bring to attention
the views held by a number of practitioners in China.
From the present investigation it seems that the Chinese,
owing to a higher percentage of infestation and thus greater pos
sib ility of exposure, have more opportunity to establish a balanced
relationship between host and parasite and consequently a tendency
toward clinical im m unity.
S u m m ary.
T h is survey records the intestinal protozoan infestations of 1,0 3 7
cases, 340 of which were examined six times, 39 five times, 50 four
980
times, 62 three times, 80 two times, and 466 one time.
following general sum m ary m ay be made : —
T he
1 . Forty-four p'er cent of the infestations of E . dysenteriae were
detected by the first examination, and 7596 by three examinations.
E . coli is less sporadic than E . dysenteriae, while G iardia is
slig h tly more sporadic.
2. The percentages of protozoan infestation among the Chinese
examined in Peking is as follows :— E n d o lim ix nana, 40.196,
En dim oeba dysenteriae, 29.596, Councihnania lafleuri, 19.296,
Endamoeba coli, 11.79 6 , lodamceba biitschlii, 1 3 %, Giardia
intestinalis, 1096, Chilom astix m esnili, 696, and Trichomonas
hom inis, 4.596.
3. Among the foreigners examined in Peking the percentages
of protozoan infestation are as follows :— E . nana, 26.596,
E . dysenteriae, 16.596, Councihnania, 14.596, E . coli, 11.6 9 6 ,
lodamceba, 3.296, G iardia, 396, Chilom astix, 1096, Trichom onas,
2.896.
4. T he percentage of E . dysenteriae among Chinese adults
examined is 32.596, among Chinese children 25.396, among foreign
adults 2596 and among foreign children 1.796.
5. Infestation with Giardia and E . coli is higher in children
than in adults.
6. Infestation with E . dysenteriae, Councihnania and C hilo
m astix is much higher in the age group above 50 years than in
the younger age groups.
7. Protozoan infestation among the Chinese examined in
Peking is about equal to that reported from some tropical countries
while it is lower than that reported from some other tropical regions.
8. Infestations among the foreign adults examined in Peking
are just about equal to the infestations of British and Am erican
troops returned from France and the Near E ast.
9. Infestation with E . dysenteriae among the Chinese
•examined in Peking is three to four times as great as among the
civilian population in England and the United States of Am erica.
10 .
foreigners
disorders,
foreigners
T he percentage of E . dysenteriae infestation among
examined in Peking, suffering from chronic intestinal
is 39.296, while it is only 1 1 . 3 # among the healthy
examined and among those suffering from other diseases.
A S u rv ey of Human Intestinal Protozoa in P ekin g .
981
1 1 . The percentage of E . d ysen teric infestation among
Chinese examined in Peking suffering from chronic intestinal
symptoms is 3 0 .4 ^ and 2 3 .2 ^ among the healthy Chinese examined,
and among those suffering from other clinical symptoms.
12 . T his difference points to a possible development of racial
im m unity to clinical amoebiasis on the part of the Chinese.
L it e r a t u r e
E
C it e d .
S. L .
1920. O nderzoek naar het voorkom en van d ie rlijk e d arm parasieten
b ij n ie tb u ik lijd e rs. G eneesk. T ijd sch r. v. N ed erl.-Ind ie,
l x : 626.
rug,
C a r t e r , H . F . , M a c k i n n o n , D o r i s L ., M a t t h e w s , J . R . ,
19 17 .
and
S m it h , A . M .
P r o t o z o o lo g ic a l i n v e s t i g a t i o n o f c a s e s o f d y s e n t e r y c o n d u c t e d
a t t h e L i v e r p o o l S c h o o l o f T r o p ic a l M e d ic in e .
A n n . T rop .
M e d . a n d P a r a s i t o l., x i : 2 7 . 1 2 t a b le s .
D
o bell,
C.
19 17 .
D
R ep o rts upon in v estigatio n in the U nited K in gd o m of
d ysen tery cases received from the E a ste rn M editerranean.
1. Am oebic d ysen tery and the protozoological in v estigatio n
of cases and carriers. B rit. Med. R es. Com., 4 (London, S ir
Jo sep h Caston and Sons), 85 pp.
C.
19 19 . The Amoebae liv in g in Man.
o bell,
(London, Joh n B ale, Sons and
D a n ie ls s o n ) , v i — 1 5 5 p p ., 5 p is .
D o b e l l , C.
19 2 1.
A report on the occurrence of in testin al Protozoa in the
in h ab itan ts of B ritain w ith special reference to E n ta m o eb a
h isto lytica . M ed. R es. Council, (O xford, F red e rick H a ll,
U n iv e rsity Press), 71 pp.
E l y , L . W.
19 23. Second grea t type of chronic arth ritis.
Jou rn . A m er. Med.
A s s o c ., l x x x i : 1 7 6 2 . 4 fig u r e s in t e x t .
E . C.
1924. O bservations 011 N orth C h ina in testin al
F a u st,
p arasites of M an.
( M a n u s c r ip t ) .
F a u s t , E . C., a n d W a s s e l l , C. M cA .
1920.
P re lim in a ry su rve y of the in testin al p arasites of m an in the
cen tral Y a n gtze V a lle y . C hina Med. Jou r., x x x v : 532.
H e g n e r , R- W.
19 23. T h e effects of changes in diet on the incidence, d istribu tion
and num ber of certain in testin al Protozoa of rats
Am.
Jo u r. H y g ., I l l : 180. pi. 4.
9B2
J
epps,
M
J
epps,
M
N otes on the in testin al Protozoa of 971 m en at the U n iv e rsity
W ar H osp ital, Southam pton. Jo u r. R o y. A rm y Med. Corps,
x x x v i i : 366. 3 tables.
essel,
o f o id ,
in
M alaya.
The d istin g u ish in g ch aracteristics of the p arasitic amoebae of
cultu re rats aud m ice. U niv. C alif. P ubl. Zoo!., x x i i i : 4S9.
p is. 43-4S, 3 figures in text.
C . A .,
1920.
K o fo id
O bservations on hum an in te stin a l Protozoa
P a ra sit., x v : 2 13 . pi. 7, 14 figures in te x t.
J. F.
1924.
K
W.
argaret
19 23.
K
W.
argaret
19 2 1.
C . A .,
19 23.
and
Sw
ezy,
O.
On the p revalen ce of carriers of E n d am o eb a d yscn teriae am ong
soldiers re tu rn in g from overseas service. N ew O rleans Med.
and S u rg. Jo u r., l x x i i i : 4
and
S w e z y , O.
On the m orp h ology and behavioi; of Pcntatrichom on as ardind c lte ili (D errieu and Ra}nuaud). U niv. C alif. Publ. Zool.,
x x : 3 7 3 ; pi. 37, 1 fig. in te x t.
M a p e e s t o n e , P. A .
1920.
M
a tth ew s,
H um an in testin al Protozoa in N orth Q ueensland. A n n . Trop.
M ed. and P arasito l., 283-292, 6 tables.
J . R .,
19 19 a .
and
S m it h , A . M .
The in te stin a l Protozoal infections am ong convalescen t d y sen
teries e xam in ed at the Liverpool, School of T ro p ical M edicine
(T h ird R epo rt). A n n . Trop. M ed. and P a rasito l., x ii i : 83 4
tables.
M a t t h e w s , J . R . , a n d S m i t h , A . M.
19 19 b . The spread and incidence of in testin al Protozoal infections in
the population of G reat B ritain . A nn. Trop. M ed. and
P arasito l., x ii i : 91
W e n y o n , C . M., a n d O ’ C o n n o r , F . W .
19 17 .
Y
o u n G,
H um an in testin al Protozoa in the N ear
E a st. (London,
W ellcom e B u reau of S cien tific R esearch ), pp. 1-2 18 , p is. 1-4-
C. J.
1922. H um an in testin al Protozoa in A m azonas.
and P arasitol., x v i : 93. 4 tables.
R eceived for publication, A u g u st, 1924.
A n « . T rop. Med.
Periarterial Sym pathectom y .
9 S3
PERIARTERIAL SYMPATHECTOMY (FOR TROPHIC
ULCERATIONS OF THE E XT R E M IT IE S.)*
H . B l a c k , f . r . c . s . (E n g.). S in gap o re.
The basis of the theory of periarterial S3?mpathectomy is
dependent on the experiments of Claude Bernard, who found that
in the rabbit, when the sympathetic nerve in the neck was divided,
the arterioles diiated and the ear became hyperaem ic; and when
the peripheral end of the cut nerve was stimulated, the ear became
blanched from constriction of its arterioles.
Attention was first drawn to the useful possibilities of this
operation by Leriche of L yon s, who published his original account
in 19 1 3 . He stated that the operation was first performed by his
old teacher, Jaboulay, in 1889, who, however, did not publish his
results. In 19 2 1 Leriche reported sixty-four cases in which he
had performed periarterial sympathectomy for various chronic
lesions, with only one complete failure.
The operation consists of removing the whole circumference
of the outer sheath of the main artery of a limb as high up as
possible for about one inch of its length. T h is causes an increase
in the vitalit}' of the limb below the operation, due to the
hyperaemia resulting from division of the sympathetic vaso
constrictor nerves which are believed to extend along the course
o f the arteries and arterioles in their outer sheaths.
It is not definitely proved that the sj^mpathetic vaso
constrictors do extend along the arteries in the manner suggested,
and in fact the contrary’ is asserted by some physiologists;
nevertheless, there is evidence that such, in man, is probably the
case. Leriche and others found that after periarterial sjmipathectomy of the femoral artery there was a temporary local
constriction of the femoral artery at the site of the operation,
and d istally there was an elevation of surface temperature
of from 2 °F . to 3 °F . which lasted about a couple of w eek s; also the
blood pressure in the limb was raised as much as 40 mm. of
m ercury. On the other hand, several surgeons who have performed
th is operation have failed to find any elevation of the temperature
*R e a d before the M alaya Branch of the B ritish M edical A sso ciatio n at
tlie annual m eetin g held in Singap ore, A p ril, 1924. R ep rin ted from the
B ritish M edical Jo u rn a l, A u g u st 2nd, 1924.
984
or blood pressure in the limb following the operation. A sim ilar
rise of temperature has been observed in a limb after excision of an
aneurysm of its trunk artery.
It seems probable that the continuity of the vaso-constrictor
S37mpathetic nerves is broken by the operation, and the distal
arterioles in consequence dilate. W hatever ultim ately proves to be
the real physiology of the operation, there is considerable evidence
that the vitality of the part below the site of the operation is
increased, as evidenced by the results that have been and constantly
are being reported.
A rterial decortication has been performed for various surgical
conditions, but its utility seems to be greatest and the results
obtained most encouraging in cases of trophic ulcerations of the
extrem ities; especially favourable results have been reported in
perforating ulcer of the foot. In ulcers of the legs or feet it gives
good results provided the ulcers are not very old or surrounded by
much scar tissue. It has been tried with no inconsiderable success
in R aynau d ’ s disease, in frost-bite gangrene, ischaemic paralysis of
the forearm, painful stumps, trophic contractions of muscles, and
in some chronic cases of pain in the hands and feet (erythrom elalgia).
I can find no report of the operation having been performed
for the ulcerations of leprosy. In two of m y cases (2 and 3) the
results were remarkable. In each the leper had lost several of his
toes and the stumps had remained ulcerated for six or more months ;
within two weeks or so after periarterial sympathectomy the stum ps
were healed, although the local treatment remained unchanged.
T h is result, I tliink, warrants further trial in leprous ulcerations;
it might prove, too, of value in D upuytren’s contraction of the
hand, but I have not been able to obtain suitable cases. Decortica
tion of the common carotid artery has been done for glaucoma and
for trophic ulcer of the cornea, but the results are not sufficiently
reported to be of value.
T he operation, it would appear, is contraindicated in diabetes*
in renal, hepatic, or cardiac disease, and in arterial degeneration.
Case 1.— C hinese, m ale, aged 32. T h ree p erfo ratin g u lcers of the
sole of the rig h t foot for five ye ars. V ariou s lines of treatm ent had been
tried w ithout success. T h ere w as a sm all patch of anaesthesia on the sole
of the foot and the W asserm ann reaction w as s lig h tly p o sitive. L e p ro sy
for lon g had been suspected, but repeated in v estig a tio n s fa ile d to-
Periarterial Sym pathectom y.
9S5
dem onstrate the le p ra bacillus. O peration w as done, and in tw elve d ays
the ulcers w ere healed and the p atien t soon after w ent out of h osp ital
back to h is w ork.
Case 2.—T a m il, m ale, aged 38. L ep er w ith two toes of the rig h t
foot destroyed b y lep ro sy and the ¡stumps ulcerated and raw for s ix
m onths. O peration, M arch iS th , 1924. T w o w eeks la te r the stu m ps were
healed over, the patien t w a lk in g a b o u t’a w eek later. A t present date the
ulcers are s till w ell healed.
Case 3.—C hinese, m ale, aged 2 1. In ner three toes of th e rig h t foot
sloughed aw ay, due to lepro sy, and stum ps ulcerated for seven months.
O peration, M arch i8 lh , 1924. Stum ps healed over in two and h alf w eeks.
P a tien t w a lk e d a w eek later and ulcers rem ain healed to date.
Case 4. —C hinese, m ale, aged 3 1. Fo r ten m onths he had a la rg e
sp read in g ulcer of the rig h t leg. O peration, M arch 20th, 1924. In a little
over two w eeks the ulcer w as clean and h ealth y-loo kin g and m uch sm aller
in s iz e ; in seven w eeks the ulcer was v e ry n e a rly healed and the healed
portion w as covered w ith ve ry th ick horn y epithelium .
Case 5.— Chinese, m ale, aged 52. H ad three chronic ulcers of the
left le g for » in e m onths. O peration, M arch 20th, 1924. R e su lt after seven
w eeks, v e ry great im provem ent. He had been in h osp ital for s ix m onths
w ith re st in bed and d ressin gs previous to operation, w ith little or no
app arent im provem ent.
Case 6.— C hinese, m ale, aged 33. S m all ulcer on dorsum of le ft foot
of the size of a five -sh illin g piece. H e had been in h osp ital w ith treatm ent
for seven w eeks and then w as operated on (March 27th, 1924) and three
w eeks la te r the ulcer was healed ; recen tly he was discharged cured.
Case 7.— C hinese, m ale, aged 35. S everal sm all ulcers at the back of
rig h t le g w hich he h ad had for five months. Operation on M arch 28th,
1924. H e w as d isch arged cured 011 A p ril iSth .
Case 8.— Chinese, m ale, aged 49.
U lcerated dorsum of the rig h t foot
a bru ise, of s ix m onths duration. Operation M arch 29th, 1 924;
e a rly in M ay the ulcer w as w ell healed over w ith th ick epithelium .
fo llo w in g
Case 9.— C hinese, m ale, aged 60. S everal ulcers of the toes of the
rig h t foot of one and a h alf years duration. Operation A p ril 3rd, 1924.
R e su lt, m iddle of M ay, grea t im provem ent.
Case 10.—Chinese, m ale, aged 45. Ulcer of left le g of eigh t m onths
duration. O peration on A p ril 4th, 1924. V e ry little im provem ent bj* the
m iddle of M ay.
T he operation is carried out as follows : The femoral artery
in its sheath at the apex of Scarpa’ s triangle is exposed by a
suitable incision. The femoral sheath is then opened and the
artery isolated and held up with two small blunt hooks. N ext the
outer coat or sheath of the artery is incised vertically along its
length carefully with a very sharp tenotomy knife for about one
986
inch, and this outer coat is then dissected from off the artery all
the way round and cut awaj-. It is thin, but thicker than might
be expected. Great care must be taken not to pull on the artery
or to tear the sheath away, as there is a risk of tearing through
the muscular coats of the artery, an accident that should not occur
with reasonable care. A n y tiny branch vessel should be secured
with mosquito forceps and tied with very fine silk. A ll remaining
cobweb-like tissue which is found still to be adherent to the artery
is dissected away. T h e artery is thus completely decorticated of
its outer sheath or adventitia. I have observed that as I dissected
aw ay the outer sheath the arten? contracted markedl3T at the point
of in ju ry. T h is, in a few of my cases, soon gave place to a slight
bulging of the arterj^, in fact the artery sometimes became
decidedly fusiform in shape. T he wound is then closed by
suturing the deep fascia and skin.
In none of my cases has any bad symptom occurred, and
whilst it is too early definitely to state whether aneuiysm as a late
result is iikehT to occur or not, m y impression is that this is
unlikeh’ provided the operator has been careful not to damage the
muscular coats. I have not seen any case of aneurysm resulting
from this operation reported. In none of my cases have I been
able to corroborate the suggested elevation of the temperature or
blood pressure in the limb below the site of the operation.
T he results so far encourage me to believe that this operation
m ay often be valuable, particularly in the classes of cases already
indicated, and where the more usual forms of treatment prove slow
or fail. It is, however, too early for me to speak with confidence
of the final results of this operation. It is onfy r e c e n t f y that
cases here have been subjected to this surgical method. In none
has any alteration of the local treatment been made, in order better
to be able to determine the direct effect of the operation.
Note.— R ecent reports show th at the operation is not w ith ou t ist
d an gers. R ie d er (Z e n tra lb l. ju r C h iru rg ., A u g u st 2, 1924) reports three
cases which, w ere attended b y g rav e consequences. N ecrop sy in one case
re ve a led throm bosis throughout the w hole exten t of the fem oral a rtery from
w hich the. p eria rte ria l tissu e had been rem oved a few d ays before in treat
m en t of arteriosclerotic gan gren e of the g re a t toe. In a second case, an old
fracture o f the le g th at refu sed to consolidate, the p eriarterial sym p ath ecto
m y had no effect on the h ealin g, and s ix w eeks la te r the le g had to be
am putated. In the th ird case, ulcus cru ris, edem a follow ed, but after
se v e ra l w eeks the p atien t recovered.— E d .
‘
i " ■ / 11
B eriberi in Chinese Women.
987
BERIBERI IN CHINESE WOMEN AND ITS
RELATION TO CHILDBEARING
J. A l l e n H o f m a n n , m .d ., H ack ett M edical C ollege, Canton.
Our experience with beriberi during the past few years has
led us to think the disease, or a disease very sim ilar to it, develops
more frequently in women during the childbearing period than at
other periods. Furth er, the impression is that this disease, when
it develops during pregnancy or the puerperium, is much more
severe than at other times. The condition here described may
possibly be some other disease entity, perhaps due to the disturbed
metabolism of these periods. If it is true beriberi, pregnancy or
the puerperium may be found to predispose to it, or at least to
aggravate the symptoms.
W ith this in mind the study of thirt\--eight cases was made.
T o be sure one cannot draw absolute conclusions from so few cases,
y et one can get a pretty good idea of what the possibilities are.
Parenthetically, I would like to state that the histories of these
patients were taken by our senior students and were written in
Chinese. T he diagnosis in all cases was made by m yself. T he
statistical stud\- was made by the medical assistant, D r. Y u n g,
and the medical intern.
E t io l o g y .
L iv in g conditions and occupations.— Of the thirty-eight cases
seen during the two 3'ears covered by this report, all were residents
o f Canton, except one which came from a village near to Canton.
T en patients were housewives. Three did farm work. One was a
boat woman. One was a weaver. Four were seamstresses. In
fourteen cases the occupation was not reported. Two were young
g irls from an orphan asylum . M any more orphan girls from the
same asylum were seen in the out-patient department. Twentyone patients were put down as belonging to the poor class, seven
•belonged to the middle class, three to the wealthy class, and of
seven the social position was not noted.
A ge Incidence.— Only one of our patients was less than ten
years old. Ten were between the ages of ten and twenty. Sixteen
were between twenty-one and thirty. Nine were between thirty-one
and forty. Only two were between forty-one and forty-five. Most
988
of the patients, viz., twenty-five (68.4. per cent), were thus between1
the ages of twenty-one and thirty-five. T h is corresponds to the
figures usually given.
Seasonal Incidence.— Four of our patients developed the disease
in the spring, sixteen in the summer, twelve in the fall, and five in
the winter. T he time of development in one case was not noted.
In experim entally induced beriberi, when persons are placed on a.
special diet which it is known will be followed by the appearance
of the disease, the period before the fa ll symptoms appear varies,
according to different observers, from forty to seventy-five days.
On an ordinary diet in which the vitam ins and other dietary
elements are not purposely reduced, it must take a longer period
before the sj^mptoms appear, probably three months at least. I f
this is correct then the period of development of the disease in them ajority of our patients corresponds to the wet period of the year.
T h u s the three drjr months of winter produced only four cases
in the spring. The three wet months of spring produced sixteen
cases in the summer. The three wet months of summer produced
twelve cases in the fall. The comparatively dry fall produced only
five cases in the winter.
Pregnancy and the pu erperium .— Twenty-seven of the patientswere married and eleven single. Of the twenty-seven who were
married six were pregnant and gave pregnancy as the cause of
their disease. In sixteen others the disease, usually in a very acute
and severe form, was precipitated, according to the patient, by the
birth of the child. T hus twenty-two of the twenty-seven married
women associated their illness with childbearing.
It must be
remembered that most patients date their illness from the beginning
of the more serious sym ptom s. It is more than likely that the
beginning in all married patients was during pregnancy, the
earlier symptoms being counted as discomforts belonging to the
later months of pregnancy. The three wealthy patients, mentioned
above, all belonged to this childbearing group.
Beriberi tends to recur with recurring
exam ple, one patient reports an attack while
first child, and again while pregnant with
Another patient had attacks while pregnant
third children, the present attack occurring
pregnancy. One .patient had attacks of the
pregnancies.
For
pregnant with her
her second child.
with her first and
during her fourth
disease during h er
989
■first and second pregnancy, the present one being her fourth. But
■there are also some cases in which childbearing seems to have
no influence. F o r example, one patient has beriberi every summer,
regardless of childbearing. One had an attack five years ago
before she began to have children. Syphilis was present in one
case and it was suspected in five others. One patient was an
alcoholic and one smoked opium.
S ym pto m ato lo gy.
T he onset was gradual in eighteen of our cases, sudden in
twelve, and not reported in eight. Of the twelve with sudden
onset, four died within ten days from cardiac failure. One of
these had edema of the lungs. In six patients the disease started
with chilly sensations and eight report having had a slight fever
for the first few days.
A ll the patients complained of numbness, beginning in the
legs.
In not a few the numbness began in the arms almost
■simultaneously. In one there was also numbness of the face.
T h ere was anesthesia in the anterior tibial region in most of the
■cases tested. In live there was anesthesia of the soles of the feet.
T h e heat and cold senses were not involved in the few cases where
these were tested. Hyperesthesia was not observed. Paresthesia
was observed in almost all cases; it was especially marked in the
.severe cases during their prolonged convalescence. Accompanying
the paresthesia there were also indefinite painful sensations in the
muscles, which were more or less relieved by massage. Fifteen
patients complained of aching legs, eight of pain in the arm s, two of
to n e pains, two of aching joints and two of back-ache. One com
plained of general discomfort all over the body. E igh t made special
mention of feeling very tired and heavy. Ten were completely
prostrated, unable to help themselves. Footdrop was marked in
a ll but one, and wrist-drop was present in man}7. T he knee-jerk
was absent in all but one, an incipient case. T he superficial
reflexes were .not tested in all cases, but where tested they were
found absent oftener than present. T he calf muscles in every case
were tender.
S ix patients complained of being d izzy; fourteen had headache;
seven could not sleep ; two complained of heaviness of the eyes and
seven of tinnitus aurium. There was deafness in two, and
abnormal sweating in two. One patient had lost the power o
990
speech owing to paralysis of the vocal cords. In one the voice was
much weakened, and in a third patient the speech was trem bling
in character, due to the weakness of the laryngeal muscles.
V ery early in the disease circulatory and respiratory
disturbances were manifested.
F iv e patients complained of
palpitation and eight others of shortness of breath.
T he pulse
was rapid, and also arhythmic in several.
In a few there was
marked arhythm ia. In one there was delirium cordis. Considerable
enlargement of the heart was noted in ten cases. Valve m urm urs,
indicating leaking valves, were common. Most of these symptoms
were undoubtedhT due to cardiac dilatation, for many disappeared
completely with the clearing up of the rest of the disease complex.
T h e following murmurs were noted : systolic murmurs, audible at
all four valves, in six cases; audible at the m itral and tricuspid
areas in five cases; audible at the tricuspid area in three cases. A
pulmonic accidental murmur was noted in eight cases. Cardiac
enlargement, especially marked toward the right, was very common.
T he spleen was enlarged in one case. Edem a was noted in twenty
patients, as follows : of the face in seven ; of the legs and feet in
tw elve; of the back in one; of the hands in three; of the la ry n x in
one; general anasarca in two. There was absence of edema in
eighteen. No marked emaciation occurred except in one patient
whose case was complicated by dysentery.
Among the earliest symptoms noted, as well as among those
most frequently met with, were loss of appetite and constipation.
Twenty-two complained of loss of appetite.
Thirteen were
abnormally thirsty. In three the tongue was heavily coated. One
had stomatitis. E ig h t were nauseated and four vomited their food.
One suffered from bitter eructations.
S ix had abdominal pain.
In six there was abdominal distention.
Tw enty-five were
constipated, some having great difficulty in defecation. Two were
said to have fhad incontinence of urine and involuntary bowel
movements.
It is' doubtful, however, whether this was due to
paresis of the sphincters, for both these patients were extrem ely
helpless. D iarrhea was present in two. T he liver was enlarged
in only one case. One patient complained of what seemed to be
girdle pain, but there were no other signs or symptoms of locomotor
ataxia present. Only one patient said she had claimed a normal
gastro-intestinal system.
991
Intestinal parasites were present in nineteen patients as follows :
A scaris lumbricoides in thirteen; Trichuris trichiura in s ix ;
Ankylostom a duodenale in two, and Clonorchis sinensis in four.
There was very little involvement of the excretor}^ system.
Eighteen patients showed no symptoms of this nature. Two patients
had to be catheterized several times. Two others complained of
difficult micturition and five of painful micturition.
A slight
albuminuria was reported in nine cases. It is difficult to say how
much of this was due to childbearing.
D ia g n o s is .
It is evident that in this disease there is a multiple peripheral
neuritis involving especially the nerves of the limbs. T hat the
affected nerves go on to W allerian degeneration, if proper treat
ment is not instituted earl}-, is suggested by the long delayed
improvement in cases coming for treatment late in the course of
their disease. T he vagus and the phrenic nerves are involved as is
shown by the tachycardia and respirator}7 distress. Furtherm ore,
the disease we are dealing with shows marked gastro-intestinal
disturbances, edema and even anasarca. It is a disease of either
gradual or rapid onset. It yields readil}T to beriberi treatment.
These facts meet all the limitations of the definition of beriberi
and we can confidently conclude that we are dealing with that
disease. Therefore the question is answered as to whether we are
dealing with true beriberi or some other disease.
C o m p l ic a t io n s .
T he following were noted : neurasthenia in tw o ; pernicious
vomiting (pregnancy) in one; secondary aniemia in th ree; uremia
in one; tuberculosis in one; rheumatism in one; and there were
the various helminth infestations mentioned above. No bed sores
developed in a single case, no matter how prostrate the patient
m ay have been. T h is argues for a good peripheral circulation.
On the whole most of the patients made fairh- rapid improve
ment. Nine had completely recovered within twenty days. One was
well at the end of two months and two were well at the end of three
months. Three left the hospital much improved in less than ten
days. Two left improved within one month, three within two
months. Four left unimproved after a few days’ stay. F iv e died ;
four of these within ten days and one in two months.
'9 9 2
T reatm en t.
The treatment was very simple. T he patient was put on
unpolished rice. L iq. strychnini was given in gradually increasing
doses, and after the acute symptoms had disappeared the patient
was cncouraged to use such strength as she had left. M assage
and electricity were also used. But nothing was found so effective
as getting the patients on their feet and helping them to walk.
However, great care must be taken not to do this too soon. It is
better to lose a few days than to put the slightest extra burden on
the already over irritable heart. Brew er’ s yeast was also used in
a number of the acute cases. No special benefit, can be ascribed to
its use.
C o n c l u s io n s .
1 . I have shown that these cases of polyneuritis occurring
during pregnancy and the puerperium are not instances of a new
•disease but are true beriberi.
2. T h is being so, the question naturally follow s; Is child
bearing a predisposing cause of beriberi ? Or, when the disease
occurs during pregnancy, are the two conditions related or merely
•coincident? Our limited number of cases seem to indicate that the
latter is the case.
Twenty-two of our twenty-seven married
patients associated their disease with childbearing. I f we assume
that the actual childbearing period of Cantonese women is from the
twentieth to the forty-fifth }'ear, then belonging to this period of
twenty-five j'-ears there were twenty-two cases of beriberi. Belong
ing to the pre-childbearing period of twelve years, (eight years to
twenty) there were eleven cases. In other words, there were propor
tionately less beriberi cases during the childbearing period than
during the earlier period. W e know also that beriberi is a disease
of the younger adult, which period corresponds largely with the
childbearing period of the Chinese women. Hence it is not likely
that childbearing is a predisposing cause.
3. Childbearing, however, does seem to make beriberi a much
more formidable disease. All our most serious cases belonged to
this group.
4. T he fact that beriberi is less common in women than in
men seems to depend upon the fact that beriberi is an institutional
disease.
Women are less commonly gathered into large groups
and in a large measure thejr manage their own kitchens. When
993
they are gathered into groups, however, -as in the orphan asylum
mentioned above, they seem to be as susceptible to beriberi as men.
It is a common observation that beriberi is most common in
institutions, or at least in places where the rice is cooked in large
■quantities, such as orphan asylum s, prisons, boarding schools,
shops where the workers are boarded, and in construction camps and
the Ijke. Manson suggests overcrowding as a possible contributing
cause of beriberi in these circumstances. I am inclined to think
that the storing of large quantities of over-milled rice, often of a
-pcor quality, in damp improper places is a more likely cause. The
receptacles of the rice are often not completely emptied, and the
new stock is poured on top of the old stock giving the latter plenty
of time to become sufficiently poisonous to produce beriberi in
.susceptible individuals. I am not unaware of the brilliant work
which has been done and which seems to prove beriberi to be due to
•the lack of certain water-soluble vitamins.
5. The wet seasons of the year were a definite causal factor
in the cases seen. It is well-known that beriberi is a disease
occurring in warm, damp countries where the population lives
principally upon rice. The disease may spread, however, to dry or
■even cold climates, if the population is obliged to live for a suffic
iently long time on over-milled rice from a warm, moist climate.
6. M any cases showed a very acute onset. I f beriberi is
purely and sim ply a deficiency disease then this is a peculiar
^characteristic, for all other deficiency7 diseases, at least so far as m y
knowledge goes, are insidious in tbeir origin and gradual in their
progress.
7. In his work on “ Tropical D iseases,” Manson makes the
statement that “ the onl}- lesion that might be considered specific
in beriberi is the duodenitis, which may- be present in acute cases
during the first three weeks of the disease, though this is not
invariable.” No /Ioubt the great frequency of gastro-intestinai
disturbances in our patients is, in a large measure, due to this. It
has been m y experience that almost all patients seen early, when
the reflexes are still exaggerated and the heart slowed, complain
most of all of gastro-intestinai distress together with slight chilly
sensations. Only incidentally do they mention numbness and
tingling in the legs and feet. A t this stage the calf muscles are
already sufficiently sensitive to suggest the diagnosis of beriberi.
994
THE
ETIOLOGY OF TETANY*
E . W . H . C r u ic k s h a n k ,
m .d
., D . S c ., ( L o u d ) . P e k i n g .
Three views have been put forward in an attempt to explain
the production of that complex of s3onptoms and signs which
follow so rapidly upon parathyroid extirpation and to which the
name tetany has been given ;
1.
T hat it is due to Ca deficiency of the blood.
2.
T hat it is due to a disturbance of the acid-base
balance of the body.
3.
That it is due to a toxin or toxins, the hj'pothetical
tetany poison being some derivative of the disintegra
tion products of muscle protein or of the nucleic acids.
1.
C a l c iu m D e f i c i e n c y .
Numerous estimations upon the total calcium of blood, of
plasma and serum have been carried out, and while a certain
divergence of results still exists, yet the general average of results
'arrived at by various workers is practically the same. In their
earlier work MacCallum and Voegtlin stated that the percentage of
calcium in whole normal blood was about 13 .3 mgs. while in
tetany blood it was about 5.4 mgs.
U sing the L^m an nephelometric method for the estimation of
small amounts I found the average result for the total calcium of
the blood of fourteen normal dogs to be 9 .12 mgs. per cent. The
average figure for the amount of calcium in plasma from 10 0 cc. of
blood was 8 . 1 1 mgs. while for the corpuscles from the same
amount of blood it was 1 .0 1 m gs., that is to say, in a hundred
parts by volume of blood we find a distribution of calcium between
the plasma and the cells in the proportion approximately of 8 to 1 .
In a series of some twelve rabbits in which sim ilar estimations
were made it was found that the figures were sligh tly higher,
being for whole blood, 1 0 .o mgs. per cent, for plasma from 100
cc. of blood, 8.6 mgs. and for the cells 1.4 mgs.
*F rom the D epartm ent of P h y sio lo g y , P e k in g Union M edical College,
P ek in g. R ead before the Section on C lin ical P h y sio lo g y , C. M. M. a !
Conference, S h an gh ai, F e b ru a ry , 1923.
E tiology of Tetany.
995
In seven tetany dogs, completel}- thyro-paratliyroidectomized,
the average figures gave a whole blood calcium content amounting
to 5.72 mgs. per cent, with a plasma and cell content per 100 cc. of
whole blood of 5.26 mgs. and 0.46 mgs. respectively. It is thus
seen that in experimental tetany the ratio of plasma calcium to cell
calcium is approxim ated 1 1 . 5 to 1.0 .
T a ^l e t . C o m p a r is o n o f a v e r a g e f i g u r e s f o r c a l c iu m
d is t r ib u t io n
in
norm al
d o g s and
tetan y
d o g s.
Plasm a Ca
Ca 100 cc.’s Plasm a Ca
Cell Ca
Cell Ca 100
per 100 ec. of per cent,
of in
per cent, of j R e m a rk s
ce.
blood
blood
w hole blood
of total Ca
total Ca
I
9.12
5-72
8 .1 1
5.26
37-4
55-2
88.9
91.9
l.OI
.46
54-4
11.1
8.1
norm al dogs
tetan j7 dogs
per cent, of
fa ll in Ca
The view that the nervous and muscular disturbances which
follow parathyroid extirpation are due to a deficiency of Ca in the
nervous system has been advocated mainly by MacCallum and his
co-workers.
With the loss of Ca from the blood and tissues there is a
disturbance of the cation balance i.e. the Ca and M g cations
diminish in amount while the Na and K cations increase. The
former are nerve sedatives, the latter nerve irritants.
Brown and Fletcher (Toronto, 19 15 ) are convinced that tetany
may be produced in children by high carbohydrate feeding especially
if the foods had been heated to boiling point or higher in their
preparation.
Infants fed over long periods on a too high
carbohydrate diet are prone to the development of water retention.
Such infants are spoken of as “ water babies’ ' and show a great
susceptibility to tetany, owing to the retention of N a and K ions
which are direct irritants of the nervous tissues.
In an important series of papers published between 1903-1906
J . B . MacCallum showed that hyperexcitability in the domain of
the visceral nervous system can be aroused by the injection of
certain salts which are antagonistic to or are précipitants of calcium
and that the symptoms can be suppressed by the addition of a
soluble calcium salt to the blood. In 1909 MacCalium and Voegtlin
996
expressed the opinion that tetany was due to the withdrawal of Ca
from the nerve cells which leave them in a state of hyperexcitability
and that this condition could be relieved by the injection of a
solution of Ca s a lts ; in fact b}- such injections they obtained
prompt relief from all the symptoms of tetany. T hey also
indicated that although the urine showed signs of acidosis, the
injection of Na salts had no ameliorating effect upon the condition.
MacCallum, Lam bert and Vogel (19 14 ), by the perfusion of blood
against an artificial fluid containing all the inorganic constituents
of blood except calcium, a method suggested by the vivi-diffusion
experiments of Abel, found that blood thus deprived of its Ca. (by
dialysis) when perfused through an isolated extrem ity produces
extreme excitability of the nerves sim ilar to that seen in tetany.
From this they concluded that hyperexcitability is due entirely
to loss of Ca. Experim ents in which the whole body was perfused
were not so successful.
Leopold and von Reuss (1908) found a marked diminution of
the total Ca in parathyroidectomised rats •with distinct hypoplasia
of the enamei of the teeth, and they also showed that in tetany
there was a greater loss of bone calcium as compared with that of
tissue calcium (this latter may even be increased above the normal).
It seems then that there is a loss of active calcium and from these
studies it has been surmised that the loss is occasioned by a
condition of acidosis. The loss of CaCos from bone by feeding
with H C 1has been corroborated as recently as 19 18 by Gotto.
It m ay be of interest here to refer briefly to a certain rela
tionship which has been found to exist between calcium and
bicarbonate. In acidosis there is a loss of bicarbonate and feeding
with acid will bring this about. Feeding with acid (H C 1) causes
an increase in Ca in the blood of rabbits. W e therefore have
this relationship, increased acid results in a lowered bicarbonate,
which further is associated with an increase in the Ca content.
Rona and T akakashi showed that in physico-chemical m ix
tures of Ca and bicarbonate, that the Ca varied directly with
the H ion concentration of the m ixture as in the equation
<Ca ) (HCO3) = K i.e. if the CH is constant then the Ca and
(H)
HCO3 will vary inversely or if the 0 H increases then Ca will
increase in proportion to the diminution of the bicarbonate.
Etiology of Tetany.
9 97
T hat acid radicles may liberate Ca from the tissues is
suggested by the reverse equation for the explanation offered for
the curative effect of Ca salts in tetany. The suggested explana
tion of the curative effect of the Ca salts in that phase of tetany
associated with a (prim ary) condition of alkalosis is that the Ca.
salts increase the formation of acid radicles according to the follow
ing equation :
2N a2 H P O , + 3 C aC l2 ^
N aH C 0 3 -f C aC l2
Ca3 ( P 0 4) 2 + 2H CI + 4N aC l
C aC 0 3 +
HC1 +
N aC l
T his would explain a loss of calcium due to the production of
acid bodies, and would also explain the almost total loss of combined
Ca in severe tetany. It would indicate that the degree of libera
tion of Ca from its protein combination is dependent upon the H .
ion concentration of the medium.
It must be remembered that in the early stages of tetany, e.g.
in tetany due to hyperpncea, there is very little loss, if any, of
calcium and it is onljTin the more severe condition that the calcium
loss is marked.
T his points I think to the fact that Ca. deficiency is a sign
and not the cause of tetany. I f marked Ca. loss were the cause
of tetany then why, it may be asked, do we never see tetany in our
diabetic patients ? W hy, in two dogs, should excessive excretion of
Ca produce tetany when there is so great a store in bone which is
not depleted in that time ? W hy should bleeding (100 cc. to 1 /3
of total blood) which removes Ca not make matters worse?
Alterations in the Ionic-Colloidal Content of the Blood in
Tetany. — In 19 16 a method for the estimation of diffusible calcium
was introduced by von M ysenbug and others. T h is method is one
of compensation dialysis, in which the diffusible salt in the dialyser
is balanced by the addition of an equal amount of the salt to the
dialyzing fluid.
T he separation by filtration of the diffusible salts of blood
serum can be effected by subjecting the filter to a pressure of 15 0
mm. of H g. T h is method was employed by Cushnj^ : but to deter
mine accurately the amounts of a salt in ionic and colloidal form, it
is essential not to alter the balance between them by removal from
the solvent of the diffusible salt. According to the law of mass
998
action the removal of the ionic calcium would result in a further
breakdown of calcium in combination in order to restore the normal
balance.
It has been found that very thin sacs made of parlodion are too
readily permeable to protein; while sacs which are too thick are
useless because of negative osmosis wliereb}' the volume of the
serum is increased. In such sacs the degree of permeability
to electrolytes is also considerably- reduced. In a very interesting
paper on the degrees of perm eability of collodion sacs, Eggerth has
shown that the speed of diffusion of electrolytes, ‘ ‘ non-dialvzable ”
colloids, like congo red, and proteins of serum and of blood cells,
depends upon the permeability of the membranes; and the relative
permeabilit}^ of the membranes depends upon the proportions in
which alcohol and ether are present in the alcohol ether solvent
used for dissolving the pyroxylin , or parlodion, to give it the name
.under which it is manufactured. Sacs made by dissolving collodion
in ether and alcohol in the proportion of 60 to 40 parts, were found
to be impermeable to protein after three hours dialysis. T h ey still
retained their m aximai perm eability to crystalloids, all of which
were found to pass through in 15 minutes. To obtain sacs which
will withstand dialysis of 24 hours at 15 -2 0 ° C. it is necessary
to employ a “ 30 to 40 alcohol” membrane. W ith such a mem
brane the diffusion of electrolytes is complete in 10 to 15 minutes
and it has been demonstrated that in the presence of protein the
diffusion of calcium salts is complete well within twenty-four hours.
W hile a considerable >drop in the total calcium of the blood and
of its cellular elements has been noted in parathyroid tetany, the
question as to whether or not this was due to a loss in free or
combined calcium has not been definitely settled. B y diatysis we
can determine the amounts of free and combined calcium in blood
plasma of serum, but no method has been perfected whereby
a sim ilar determination can be carried out with regard to the
cellular elements of the blood. In view of the fact that in para
thyroid tetany variations in.diffusible calcium may be great or small,
it was necessary to make up a series of dialyzing calcium solutions
in order to balance as nearly as possible the amount of free calcium
found in the serum. F o r this purpose, therefore, ten dialyzing
solutions were made up giving a percentage of normal serum calcium
varying from 40 to So-
Etiology of Tetany.
999
To 2.5 cc. of the calcium solution employed, 2.5 cc. of a double
strength dialyzing fluid were added, the composition of which was
such that it represented the inorganic constituents of the blood
serum in their respective molar concentration.
Since the balance between diffusible and colloidal calcium is in
some measure dependent upon the H . ion concentration of the
serum/ it is essential to bring the serum into equilibrium with an
atmosphere of C 0 2 of a tension approxim ating that of alveolar air.
T o do this a large spirometer was filled with COa and a ir; these
were thoroughly mixed, and the percentage of C 0 2 estimated before
and after each equilibration daily by the Henderson and Morriss
method.
The average results obtained in normal and totally thyroparathyroidectomized dogs were as follows. From a normal
average of n .3 0 mgs. per cent, the calcium fell in partially thyroparatlnToidectomized animals to an average of 7.04 mgs. per cent,
to be followed by a further fall upon complete thyro-parathj'roidectomy to an average figure of 4.95 mgs. per cent. It is thus
seen that the loss of calcium from the serum amounts to 56.20 per
cent of the whole.
The percentage of calcium which is diffusible calcium is
calculated as follows :
(Ca in dialyzate after dialysis x 2) minus Ca
Diffusible c a lc iu m ^ =
added.-------------------------------------------original calcium in serum.
W ith regard to diffusible calcium the figures obtained from a
■series of seven normal dogs were similar to those of Cushnj?- and
von M ysenbug, namely, that in normal animals the diffusible calcium
amounts to between 60 to 70 per cent, of the whole calcium content
o f the blood, taking 10 .5 mgs. as the percentage of calcium in
normal blood serum, while in the tetany animals the percentage of
the whole calcium which is diffusible varies between 80 and 100.
M acCallum suggested that the Ca. content of the tissues is
affected by the parathyroid secretion, which acts by governing the
conversion of a non-dialyzable or colloidal and ineffective combina
tion of calcium into a diatyzable form, which is essential for the
•control of the excitability of the nerves.
I f the; free calcium is
«essential, again one asks, why should bleeding help? From the
I OOO
results of the work on colloidal and ionic calcium it has been shown»
that the free calcium is reduced from the normal amount but not toan extent, namely, less than i mg. per 100 cc. of blood which would
account for the extreme condition of hyperexcitability of nerve and.
muscle.
In a word the results of the colloidal-ionic calcium
experiments sim ply show that we must regard calcium deficiency
as a sign and not as the cause of the tetany.
2.
A c id - B a s e
B alan ce.
It will be apparent from a consideration of the work done on:
this aspect of the problem that in so far as the alveolar C 0 2 tension
has been used as an indication of the alkaline reserve of the blood,,
it has always been postulated that the respiratory centre hasmaintained a constant irritability. In fact this must be so if the
alveolar CO a tension is to form any accurate index of changes in
the acid base balance.
It is generally taken for granted that tetany is a condition
with which is associated a liigh pH of the blood. T his idea is due
to the fact that in tetany produced by a loss of gastric H C 1,.
occasioned by pyloric or intestinal obstruction, the blood has
increased in alkalinity.
T h is is further suggested by the
experimental production of an uncompensated alkalosis, with
certain tetany symptoms, by overdosing with sodium bicarbonate.
B ut while a marked and characteristic clinical effect of
uncompensated alkali excess is the development of symptoms of
tetany, there is evidence pointing in the direction of a condition of
uncompensated C 0 2 deficit.
Uncompensated C 02 D e fic it:— In this condition the H 2 C 0 3
is decreased without a parallel fall in the N aH C 0 3. The result istherefore an increase in the ratio N aH C 0 3 and an increase in the
H 2C 0 3 ,
pH . It is the previous condition placed on a lower level
quantitatively. It is the exact opposite of what obtains in diabetes,
namely., an uncompensated alkali deficit. In this condition, as hasbeen pointed out by W ilson and Stearns, a retention of acid
metabolites is indicated, by a decreased excretion of ammonia and
titratabie acid in the urine, and there is also as when pH is raised
an increased excretion of bicarbonates.
Uncompensated C 0 2 deficit has been caused in man b y
hyperpnoea. W e have the classical experiments of Grant and.
Etiology of Tetany.
io o r
Goldman, carried out by them while they? were medical students in
Washington U niversity Medical School, St. Louis, (19 2 0 ), in
which both were able by voluntary deep breathing, at the rate of
14 to the minute continued for 15 to 60 minutes, to induce typical
carpo-pedal spasms and even one convulsion. T he condition is
also induced by breathing air with a diminished oxygen content,
such as is encountered at high altitudes (H aggard and Henderson,
19 2 0 ; Haldane, Kellas, Kennaway, 1 9 1 9 ) . T h is condition of C 0 2
deficit can be produced by immersion in warm water, in fact any
unusual demand on the lungs for oxygenation or cooling may
arouse respirator}!’ stimuli which to some extent rob the H . ion
stimulus of its usual control. The clinical symptoms are those of
tetany as have been shown by Grant and Goldman.)
In these conditions of uncompensated alkali excess or of C 0 2
deficit, the H . ion concentration of the blood m ay vary markedly
from the normal. One or two investigators have stated that they
find an increase in the pH of the blood in tetany up to 7.8 and of
C 0 2 as bicarbonate as high as 60-65 per cent.
In work which we have recently carried out and which,,
because of its failure to confirm these high figures, has been
repeated several times, we find that severe tetany is not necessarily
associated with a high pH or a high C 0 2 content. W ith regard tothe pH we have found that previous to the onset of acute tetanyr,
i.e. within 24-48 hours, during a period in which only slight but
very definite tremors are in evidence, there is a slight rise of pH
from 0 .10 to 0.20 and that after the acute attack and even during
it the pH returns to normal and tends to fall to 7.25. These are
results from parathyroid tetany in dogs, and it is noteworthy that
in the definite condition of transient tetany produced in the human
subject by Grant and Goldman, they found that the rise in pH
gave an average figure of 0 .15 , which is practically identical with
our average figure for the first 48 hours of tetany, namely, 0 .14 6 .
In' all our cases with this comparatively small average variation
to the alkaline side of pH by 0-146, in 48 hours, we had verydefinite calcium losses both in plasma and cells. T h is loss of
calcium must be due to a definite poison acting upon the tissues,
nerves, muscle, and bone, and it is increased when the acid phasesupervenes, because the acid tends to draw more and more calcium
out of colloidal combination.
1002
In one or two determinations of the H . ion concentration of
the blood in normal and tetany- dogs arrived at by the rather
laborious though very accurate method of first determining the
C 0 2 dissociation curve of the blood, it has been found that in blood
taken 36 hours after operation the pH was 7.39. (the normal was
pH 7 .3 1) and in a case of longer duration it has passed to the other
side of the normal line and was as low as pH 7.23.
Grant and Goldman’ s experiments, clear and well defined
though they be, do not indicate the whole blood picture. Had the\’
followed the H . ion concentration as far as they did the excretion
of N H 3 and the titratable acidit}' of the urine I am sure they would
have found it come down to normal and then pass to the acid of pH
7.4.
Acid-base variations will undoubtedly, with further study, give
us new conceptions and open up more profitable lines of study, yet
even there I feel they will be of the nature of an elucidation of the
mechanism of the abnormal event, rather than a direct attempt to
discover the essential causative factor in the production of t e t a n } \
3. Toxic
S u b sta n c e s o f P r o te in
O r ig in a s
a C au se o f T e ta n y .
There are three substances, derivatives of body protein, which
have been shown to produce a condition sim ilar to tetany : they
are histidin, arginin and creatin.
H i s t i d i n (Imidazol-alpha-amino-propionic acid) has been put
forward as a possible source because the phenomena of tetany are
sim ilar to those of chronic ergotism,
C r e a iin :— (Methjd-guanidine-acetic acid) also m ay be broken
down into its guanidine' group.
A r g in in :— (Guanidine-amino-valerianic acid).
A rgin in is
split into urea and ornithine (diamino valerianic acid) bj' arginase
a ferment found in the liver and the spleen by Kossel of H eidel
berg. T he urea could by combination with N H 3 form guanidine
-
•
■
-
^nh2
C—NH
- nh2
•
According to Koch a mother substance from which guanidine
m ay be formed is eyanamide (N H 2C H N ), a body which can be
E tio logy of Tetany.
1003
recovered from the urine of tetany dogs in methylated form.
C jTanamide plus ammonia forms guanidine as shown by the
■equation : —
^N H 2
N H a= C H N
+
NH3 =
C=N H
-N H 2
i f it is not so converted it is hydrated to urea.
The guanidine or methylguanidine toxin theory has been
stron gly emphasized by Noel Paton and Findlajr (Glasgow 19 12 ),
and by Koch (1918) and these observers are agreed that in all
particulars the symptoms produced by the administration of
methyl guanidine or guanidine are identical, .with those which
manifest themselves in tetany due to parathyroid extirpation.
T h e spasticity’, tremors, the electrical hj’perexcitability7 of the
neuromyon are all present; the same part of the nervous system
seems to be affected in the two conditions.
T he normal amount of guanidine in the blood of dogs equals
0 .10 mgs. per cent. W hile in tetany blood it is 0.87 mgs. per cent.
T h e amount of guanidine injected intraperitoneally or intram us
cularly to give definite symptoms is 0.066 grams or 0 .13 grams of
.guanidine hydrochloride per kilo of body weight.
The main facts in favour of the guanidine intoxication theory
are : 1. The sy^mptoms are identical with those produced by
parathyroidectomy.
2. Guanidine is greatly increased in the
■blood and the urine of animals suffering from parathyroid tetany.
.3. Nerve muscle preparations are affected alike by solutions of
guanidine and byT the serum of animals suffering from parathyroid
tetany. 4. Articles of diet rich in creatin such as meat, greatly
aggravate the symptoms.
T he following arrangement of equations will show the re
lationship of guanidine to arginin and cyanam ide;
Arginin -J- (arginase)
nh
I
2
nh
|
2+
h
2o
NH —C. NH. CH 2 .C H .,. OH, - CH. COOH
^NHa
N H 2.C H N
Cyanam ide
+
NHs =
C = NH
- nh2
Guanidine
Urea
+
|
2
+ N H „. CH.,. C H „. CH2. CH. COOH
■"NHa ‘
+
Ornithine,
nh
/XH„
0=0
.
The China M edicah Journal.
1004
Guanidine is thus urea in which the
by the N H (imino) group.
0 atom has been replaced
It would seem that guanidine transforming agents are absent
in tetany and it m ay be that a ferment or catalytic agent sim ilar to
or identical with arginase is produced by the parathyroid glands.
T h is idea that the parathyroid glands may be responsible for theproduction of an enzyme or enzymes— chemical agents or ferments
capable of producing a transformation of organic compounds— opens
up a new and difficult, but undoubtedly fruitful field of research.
DEMENTIA PARALYTICA*
S . D. S t u r t o n , m .a., m .b., m .r .c .s ., H angchow .
The members of our medical college who were privileged tohear Professor Kappers, of Amsterdam, lecture to us in Hangchow
last March, will recollect that he spoke of various strains of the
SpirochcBta pallida, which produce very varied clinical pictures.
He pointed out that the strains which may ultimately produce tabesdorsalis or dementia paralytica (G .P .I.) m ay have such scanty
symptoms in the prim ary stage, and even in the secondary, that
the disease may not be noticed by the patient, whereas the strains
which cause cerebro-spinal syphilis usualljTproduce marked prim ary
and secondary symptoms. A fter giving his evidence for believing
in various strains of SpirochcBta pallida,
which although,
morphologically identical are clinically different, Professor Kappers
concluded by urging the necessity of thorough treatment in the
early stages of syphilis and by pointing out that insufficient
treatment with the salvarsan group of drugs tends only to aggravate
the disease. M y own clinical observations have borne out this
statement, and experience in the pathological laboratory has.
shown that the Wassermann reaction is greatly increased in
intensity after one dose of salvarsan, usually becoming negative,
temporarily, after the third injection.
I have recently discussed the matter with one of the leading
French medical practitioners in China, and he is of the opinion
*From
H angchow .
the
D epartm ent
of
Path o lo gy,
C.M .S.
M edical
College*
Dementia Paralytica.
ioo 5
that in those cases which may be developing dementia paralytica,
m ercury, and not arsenic, is the most important drug, arsenic
-sometimes being even contraindicated.
T he differential diagnosis between dementia paralytica and
cerebro-spinal syphilis must depend chiefly on the clinical signs and
.symptoms of the two conditions. Pathological investigation is a
help in the diagnosis, but it must not be taken as the sole criterion.
It is a well-known statement in medical text-books that the two
conditions have three pathological signs in common, viz., a positive
Wassermann reaction of the blood, excess of globulin in the cerebro
spinal fluid, and lymphocytosis in the cerebro-spinal fluid. In
dementia paralytica the Wassermann reaction of the cerebro-spinal
fluid is also positive. It is commonly negative in cerebro-spinal
syphilis, but maj" also be positive in this condition, especially if
the spinal cord is serious^ involved.
Further differentiation can be made by means of the “ colloidal;gold” test, but this method is expensive, and requires very careful
manipulation.
B y the courtesy?- of Dr. Porak, lecturer at the Aurora
U niversity, Shanghai, I have been able to see the use of a water
manometer for measuring the intrathecal pressure of the cerebro
spinal fluid.
Increase in the intra-thecal pressure may be
indicative of dementia paralytica, provided thai other signs are also
in favour of this diagnosis.
Until recently it was believed that once dementia paralytica
had become established, it was bound to run a fatal course. A s a
.student at the Cambridgeshire Hospital for Mental Diseases, in
England, I was taught that the condition was almost invariably
fatal within two years, that a few cases were on record in which
patients had lived three or five years, and that the statistics for the
whole world showed one case which survived for iS years, but that
the diagnosis was doubted in this case.
To-day the outlook is brighter for sufferers from this condition,
and some complete cures, even of fairly advanced cases, have been
claimed. Articles have appeared in the “ British Medical Jo u rn a l”
and other medical papers, giving the full procedure adopted by
various physicians, but certain facts seem to be common to most of
the cases.
T he patients are greatly benefited by artificial
io o 6
production of fever.
Hypodermic injections of typhoid vaccine
and tuberculin have been tried with some success, but the
consensus of opinion is that inoculation with malaria parasites has
produced the best results. A m alarial patient is selected, prefer
ably one suffering from benign tertian m alaria, and about 5.C.C. of
blood are removed from one of his veins to be injected into a vein
of the patient with dementia paralytica. The latter patient m ay
be allowed to suffer from as many as twelve rigors, and the condition
is then cut short b3' a dose of quinine. Sim ultaneously with this
treatment the patient should be given a course of intrathecal
injections of autogenous salvarsanised serum. T his serum is
prepared b;/ giving an ordinary intravenous injection of salvarsan,
drawing off a suitable quantity of blood within half an hour, and
centrifuging until the clear serum can be decanted off. It is of
interest to note that autogenous salvarsanised serum was being
given with success in trypanosomiasis before the recent discovery of
“ B ayer 20 5 .”
T he difficulty in the treatment of dementia paralytica in the
past has been to bring arsenic or m ercury into contact with the
spirocliastes, as both these drugs are withheld from the cerebro
spinal fluid by the choroid plexus.
The advantage of the autogenous salvarsanised serum is that
it can be injected directly into the cerebro-spinal fluid. F o rty c.c.
of the fluid are removed by lumbar puncture and the corresponding
quantity of serum is injected by the force of gravity, or very slowly
from a syringe. If it is injected through a lumbar puncture the
patient should lie with the head at a lower level than the trunk and
lower limbs, so that the serum may pass as high up the cord as
possible.
Some phj'sicians prefer injection directly into the
cisterna magna, but this procedure, as one of its advocates has
said, requires a good knowledge of anatomy, also a steady heart
and hand.
T h is proceeding must be repeated at intervals until the patient
is well clinically, and the Wassermann reaction of the blood is
negative. Some cases are on record in which the W assermann
reaction of the cerebro-spinal fluid has also become negative, and
one is bound to think that these are the cases which are most lik ely
to be cured permanently.
Indications for Operation in Cataract.
1007
INDICATIONS FOR OPERATION IN CATARACT.
R . A . P e t e r s o n , m .d ., N a n k i n g .
The development of the operative treatment of cataract has
been one of the most brilliant accomplishments of ophthalmic
surgery. One cannot open a symposium summarising this subject
without paying tribute to men such as Daviel, Von Graefe and De
W ecker, through whose brilliant pioneer work cataract extraction
became a successful surgical procedure. In the period now drawing
to a close, Fuchs, the great master of ophthalmological surgery
and pathology, has through his clinical experience and his
laboratory study and research left us a rich heritage. One cannot
take time to enumerate the many other men, less famous, but
whose work was no less essential to the progress of modern
ophthalmology, and through whose experience and teaching count
less thousands have benefited.
T he cardinal operative indication for cataract is a positive
diagnosis that such a condition exists and is operable. In this day
of the universal use of the ophthalmoscope in the diagnosis of
cataract, such an observation seems almost trite. The possibility
of a mistaken diagnosis is small, yet there are certain cases,
especially those with a small, immobile pupil coupled with
intraocular pathology such as tumor, detachment of retina, or
cloudy vitreous, in which a most careful examination is needed to
prevent an incomplete, or even a wrong diagnosis. In the press of
a busy clinic hour at the dispensar}T, where scores of patients must
be seen in a limited period of time, there is an opportunity, in this
type of case, to form a wrong conception of the pathological
condition present. The examination should be thorough in order
to diminish the possibility of not recognising the presence of some
intraocular or extraocular condition that would tend to produce an
unfavorable result of .an operation that would otherwise be
successful.
Given a positive diagnosis of cataract, what are the indications
for operative intervention ? The first and the greatest indication
for operation is the impairment of the visual function to a degree
*R ead before the Section on O phthalm ology at the B ien n ial Conference
of the China M edical M issio n ary A ssociation held in S h an gh ai, F e b ru a ry
14 - 2 0 , 19 2 3 .
ôo8
which renders the patient no longer able to carry on his usual work.
'This degree varies somewhat for persons of different occupations,
and may necessitate operation at various stages of cataract
lnaturit}^. Fortunately, modern operative technique has developed
to such an extent that it is not necessary to wait until the cataract
is fu l'y developed before operating.
An increase of intraocular
tension, as found during the development of certain senile and
traumatic cataracts, is another indication for early operation. In
congenital cataract it is advisable to operate early in order that the
visual function may develop. In traumatic cataract the same rule
applies, so that the existent visual function can be conserved.
An increasing number of operators are advising early extraction
in unilateral cases even while the other eye has good vision. Unless
there is some weighty reason to the contrary, this procedure is
apparently sound. It seems good logic to operate in these cases
for the benefiL of the lateral vision and to avoid the possibility of
some local or general condition arising that would tend toward an
unfavorable result in the future. However, if one eye is already
blind, it would be advisable to defer operating as long as useful
vision persists.
A s to bilateral extraction of cataract at one sitting this is a
question that must be decided by the operator himself as he sees
the case in his clinic. In a certain number of cases such a course
is frequently contra-indicated because of the greater m argin of
safety given by single extraction. However, circumstances may
arise which indicate that a second operation would be out of the
-question. In such a contingency if the advantages gained by the
double operation balance the possibility of misbehavior of the patient,
■or undue physical reaction following the operation either of which
may jeopardize the safety of both eyes, one can in selected cases
proceed with the double extraction. There are many who routinely
favor a double extraction whenever possible. Such a course is
advantageous in that it embraces practically a single operation and
a single course of after treatment. If the first extraction reveals
any factor in the behavior or reaction of the patient that would
indicate the possibility of an unfavorable result, one would natur
ally postpone the second operation until a later date.
Cases with local or general conditions complicating cataract
also test the surgical judgment of the operator. S yp h ilis and
A Safe Pneumatic Tourniquet.
1009
diabetes demand appropriate treatment but are no contraindications
to operation. Tuberculosis patients with cataract, a condition not
often found, require careful preparation to avoid postoperative
coughing and delayed healing. Tendencies toward gastric distur
bances should be inquired into and precautions taken against
their occurrence. Previous attacks of iritis and iridocyclitis which
have left their traces may- give some concern ; 3ret such cases
.frequently give excellent results. High u to p ia , healed corneal
ulcer, and the various degenerations and low grade inflammations
of the retina and choroid are no barrier, but demand a guarded
prognosis. Increased intraocular tension and high blood pressure
should be relieved by appropriate measures before operation.
Virulent infectious processes an3rwhere in the body should naturally
postpone cataract extraction until they? are under control. However,
chronic focal infection, if apparently inactive, is, as Benedict has
pointed out, no barrier to a successful operation.
The indications for surgical intervention in cataract cases are
clearly defined. W here there is a reasonable expectation, after
careful examination, that useful vision can be restored, or, as in
certain complicated cases, conserved, it devolves upon the operator
to attempt that restoration or conservation. Cosmetic reasons may
indicate operation in some unilateral cases. The aim that over
shadows all others is the securing of a result that will give the best
■visual fuuction possible in each individual patient.
A SAFE PNEUMATIC TOURNIQUET.
Iv. O.' W i l k e r s o x , M.D., Chengchow, Honan.
The ideal tourniquet is one which combines the following
fe a tu re s; (1) ease of application; (2) ease of release and reapplication during an operation without disarranging the sterile field ; (3)
absolute knowledge of the amount of constricting force used, so as
to prevent tourniquet p a ra lysis; (4) arterial supply and venous
.return stopped at approximately the same time, so as to prevent
engorgement of the extrem ity distal to the tourniquet; and (5) a
sterilizable cuff, so that it may be placed in the operative field.
WTith these essentials in view, the following pneumatic
instrum ent has been devised. T he cuff (A) consists of an
IOIO
T h e China M edicai Journal.
inflatable rubber bag fifty-five centimeters long and five centimeters
wide, to be used for the adult tliigh ; and one thirty centimeters
long and five centimeters wide to be used for the arm or for
children. T h is bag is made of vulcanized rubber and may be
boiled. In order to bind the cuff to the extrem ity and to prevent
rolling when inflated, a fiat band (B) of the same material and
vulcanized to the end of the bag is used. T h is band is three
centimeters wider on either side than the cuff and about twice as
long. A towel is folded so as to be about ten centimeters wide
and wrapped loosely around the extrem ity, then the cuff is applied
firm ly over the towel and the flat band (B) comes immediately
over the cuff and is tucked under on either side and at the loose
end. T he edges of the towel are rolled up over the sides so as to
cover both the cuff and band. A small rubber tube (C) connects
the cuff at about its centre along one margin to the manometer and
safety valve unit (D). T h is tube is about one hundred and fifty
centimeters long and has on its end a small air-tight cock (E)
which is attached to the unit (D) by screwing into a threaded hole.
T he safety valve (F) and manometer (G) are soldered into a hollow
metal base having an inlet by means of a bicycle valve, and an
outlet to the cuff by means of the air-tight cock mentioned above.
The safety valve is sim ilar to a Record lij-podermic syringe except
that it has a small hole in the cylinder wall one centimeter from
the lower end equal in size to the airway hole in the bicycle valve.
A coiled spring is placed, inside thè cylinder so that it presses
against the piston head below and an adjustable screw cap on top of
the cylinder above. B y tightening or loosening this screw cap, the
tension of the spring can be varied and the amount of pressure
needed to lift the piston head above the hole in the cylinder
controlled. T he safety valve serves two purposes : (i) to prevent
excessive pressure in the cuff no matter how- fast or how much air
is pumped in ; and (2) as a release valve to let the air out when it i s .
desired to release the tourniquet. T h e necessary air for inflating
the cuff can be obtained either from a large bicycle pump or a
compressed air tank attached to the bicycle valve. A small pump
or hand bulb will not inflate the rubber bag quickly enough to
prevent venous congestion.
If the tourniquet is not to be in the sterile field, the cuff may
be applied by the operating room orderly before the patient is
- A Safe Pneumatic Tourniquet.
io n
anaesthetized. W hile the extrem ity is being draped it is elevated
so as to drain as much of the blood out as possible. The cock is
turned so as to connect the cuff and manometer and safety valve
unit (D) and the air is rapidly pumped in until air is heard
escaping from the hole in the safety valve. The safety valve has
previously been set so as to let all the air in excess of the desired
pressure escape, and there is no danger .of in ju ry to the soft parts.
The desired pressure is about fifty or sixty mm. H g above the
blood pressure taken with the same width cuff as that used on the
tourniquet. When the cuff is inflated, the cock is closed so as to
disconnect the cuff from the unit (D) and thus prevent any possible
leakage. When it is desired to release the pressure, the air is
turned back into the unit (D) and the piston head of the safety
valve elevated above the hole in the cylinder, allowing the air to
escape. I f desired to reinflate, simply pump up as before.
F ig . i . — A Safe Pneum atic Tourniquet. Cuff (A), scale i to 5.
S afety v a lv e u n it scale, 1 to 4. E n la rge d cross section
of sa fe ty v a lve scale, about 1 to 2. Pum p scale 1 to 8.
(W j x k e r s o n ).
(Ehina JHcbkal Journal.
V ol. X X X V I I I .
D E C E M B E R , 1924.
No. 12
THE HONGKONG CONFERENCE.
A s this issue of the Journal will be the last to reach our
members before the date of the Conference in Hongkong, I am
taking the opportunity that the editor has kindly given me lo write
a few last lines on the subject.
The Conference promises to be the best in the historj? of the
Association. A s regards the scientific work of the Conference we
have the advantage of working along with our medical confrères of
the British Medical Association, and we have the further unique
advantage of having the promise of assistance from some of the
leading medical workers of other lands. A s to our own members,
judging by present indications, this conference should be the best
attended in our history. We have already heard from over a
hundred who are hoping to come to the meeting, some from distant
parts of China, such as Manchuria and Shansi, and names are
still coming in.
We are quite sure that none who come to the Conference will
go away disappointed and so we make this last appeal to all who
can possibl}r manage it to come, even though they have not already
sent us in their names.
A party of seventy or eighty of our number, including in not a
few cases the wives of members, are likely to be travelling via
Shanghai. Fo r their information I should like to repeat what has
already been said, I hope, to them by letter. The boat conveying
the party to Hongkong will be the “ President L in coJn ” (Pacific
Mail) leaving the China Merchants’ W harf, Shanghai, on Saturday,
17 th January. The exact time of sailing is not yet settled but the
Com pany’ s agent assures me that it will not be before 2 p.m.
A n y members who have advised us of their going and have
asked for reservation of accommodation will find all arrangements
made for them on the boat ; there will be no need for them to go to
the shipping offices.
Information about accommodation in Hongkong will, we hope,
be available before the date of sailing. But in any case the boat
■will be met in Hongkong and arrangements confirmed there.
The Hongkong Conference.
10 13
W ith regard* to the details of'the'Conference meetings, we hope
to be able to print a fairly complete programme in this number of
the Journal. T hat of our own Association meetings is already
complete and we hope to have the details of the Scientific Sections
in hand before this issue goes to press.
A booklet containing abstracts of the scientific papers to be
presented to the Conference is being prepared. W e hope that this
will be as complete as possible, but so far about half the writers of
papers have failed to send us the abstracts asked 'for, and if these
are to appear the matter must be put into the printer’ s hands
without much further delay.
T he reports of officers of the Association and of Councils and
Standing Committees will be printed and distributed before the
meetings begin. This will obviate the reading of long reports and
allow what time there is to be devoted to discussion of the subject
matter.
Owing to the distance of Hongkong from Shanghai, the trade
centre of China, it is possible that the trade exhibit will be slightly
smaller than at previous conferences. What it m ay lack in size,
however, will be more than made up in the interest of the material
that is to be exhibited. It has more than once been complained,
both by our own members and the exhibitors themselves, that
sufficient opportunity was not given for detailed inspection of the
exhibits. T his will be obviated on this occasion by leaving the
Saturday morning of the Conference free for such purposes. It is
likely that a summary of the material shown will be given by the
separate exhibiting firms at the end of the booklet containing the
abstracts of the scientific papers.
The Hongkong friends are hoping to prepare a short guide to
Hongkong for Conference use, which will contain, besides much
useful information for visitors, maps, etc., giving the location of
the Universit}' buildings, and plans showing where the different
sections are to gather.
F in ally, we rel}T on you all to make the Conference a real
thoroughgoing success both by coming yourselves, if by any
possibility you can manage it, and by taking full part in the
discussions in Hongkong.
J
am es
L-
M
axw ell,
1014
PUBLIC HEALTH IN THE ORIENT.
The conditions affecting public health are so sim ilar in India
and China that the census and other reports of one country cannot
fail to be of interest to physicians in the other. Therefore
attention is drawn to an interesting review which appeared recently
in the “ Indian Medical G azette’ 1 (September, 1924), of the report
of the census of India, taken in 19 2 1 . The total population as
shown by the census was 318,9 42,480, an increase of 1.2 per cent
upon the figures for 1 9 1 1 .
A v e r a g e I n d ia n F a m i l y .
T he ordinary fam ily in India usually consists of four persons,
except in Bengal where it is generally five. T he rate of
m asculinity is definitely higher for first-born than for subsequent
children; as a rule, the total number of children born is from five
to seven, of whom tw7o to four die in infancy.
I n fa n t M o r t a l it y .
The figures for all India are 274 per mille for male births, and
260 per mille for female births. Some idea of the appalling infant
m ortality in Indian cities m ay be gathered from the recorded infant
m ortality per 1,000 live, births in the following cities :— Bombay,
55 6 ; Calcutta, 386; Rangoon, 3 0 3 ; Madras, 282. About one-fifth
of the total deaths per annum in India are deaths of infants under
one year of age. Over 40 per cent of this mortality occurs during
the first week of life, and over 60 per cent of it during the first
month of life ; probably at least 50 per cent of it is preventable.
Between one-third and two-fifths of all children born in India die
before reaching puberty.
S e x R a t io .
In every province of India females are fewer in number, from
9 14 females per mille of males in the United Provinces to 955 per
mille in M adras. T h is is directly? opposite to the figures for Great
Britain with 1,068 females per mille of males, and for France with
1,0 3 4 . The decline in the number of females in India has been
progressive during the decade, indeed since 19 0 1. To some slight
extent epidemic influenza, plague, malaria and relapsing fever m ay
be responsible for the discrepancy; but the cardinal factor is that
male children are desired, are more cared for, and have a better
expectation of life. T o this may be added early child-marriage and
“ dirty m idwifery ” as a factor in the extra female m ortality.
Public Health in the Orient.
F
em ale
10 15
I n f a n t ic id e .
There can be no doubt whatever that this practice is still in
vogue in several parts of India. The figures speak for themselves.
In a table showing the ratio of living females per mille of males
in (a) castes and races where there is a tradition of infanticide, as
compared with sim ilar figures for (b) castes and races where there
is no such tradition, the figures for group (a) run from 778 to 8 1 1
females per mille of males at all ages to (b) S20 to 936, with quite as
big a disproportion for femaie children of ages from birth to the fifth
year. T he same difference is to be found in the census returns in
19 0 1, 19 10 , and 19 2 1. Female infanticide is one of the factors
accounting for the preponderance of males.
T h e I n f l u e n z a E p id e m ic
The influenza epidemic lasted from M ay, 19 18 , well into the
year 19 19 , with subsequent local outbreaks until 19 22 . The total
m ortality which the epidemic caused it is difficult to assess correctly.
D uring 19 18 - 19 19 the number of recorded deaths from influenza
totalled S x/2 millions. If deaths in independent state territories be
added, the total is even higher— between 12 and 13 million deaths
in the two years. A s the case mortality in general was about 10
per cent, it is probable that not less than 125 million persons in
India contracted influenza during the period. It is this feature of
the report which dominates and overshadows every o th er; the
epidemic was of tremendous importance from ever}- aspect
of national life. It was far more effective for evil than war,
famine, plague or any other adverse cause duriug the decade.
T h e E f f e c t of t h e G r e a t W a r on I n d ia .
Among the 480,000 Indians who served in the war the total
casualties amounted to 58,238. Yet the war probably saved far
more lives to India than it cost. D uring the great influenza
•epidemic, the troops and followers collected together in cantonments
under strict medical supervision were better looked after, and
showed a much smaller mortalit}7 rate than they would have done
i f left at home; further, remittances from men serving in the field
to their fam ilies in India m aterially aided the latter, and raised the
standard of living and comfort, especially in the Punjab. T hus in
place of devastation, the war, in all probability, improved health
conditions in some parts of India.
io i6
E c o n o m ic C o n d it io n s a n d P u b l i c H e a l t h .
It is usually held that mortalit}? and economic distress run
parallel. To a great extent this is true of India, but there are
many modifying factors. Thus economic simplicity of living,
among the vast majority of the population and the custom of early
m arriage, give India a very high birth rate. On the other hand,
the heavj? m ortality from the epidemic and endemic diseases
associated with a tropical climate, the non-hygienic modes of life
and ignorance of the laws of health, make for a ver5r high death
rate. It is a common opinion that with an increase in the standard
of comfort of living the birth rate tends to decrease slightly?. In
India the evidence hardly- supports this view. During the past
thirty years there has been an undoubted improvement in the
standard of living yet there is little evidence of decrease in the
birth rate; on the contrary, there is a steady-, if slight, increase.
T he probability seems to be that the births will go on steadier
increasing, but that the naturai rate of increase of the population
will be held in check for decades to come by epidemics of disease.
HDefcical TRcports.
P E K IN G , C H IH L I.
P eking U n ion M edical College H osp ital Report for 1924.
S ta ff: 66 foreign and Chinese plrvsicians; 4 visitin g
professors; 22 hospital internes; 55 nurses, Chinese and foreign;
and 17 other members of the staff.
In the report of the Medical Superintendent it is stated that
substantial progress has been made throughout the organization.
The bed capacity has been increased from 197 to 2 13 . The
Physiotherapy Division, which has been in operation since October,
19 2 3 , has proved to be a valuable adjunct, especially to the work
of the surgical and neurological division. Total number of
in-patients treated during the year, 3,797. T he average duration
of stay of patients in hospital was sixteen days. There were
8 1,8 14 visits to the Out-patient Department. Radium treatments
numbered 1 2 1 . Among other departments of work are the College
Health and Private Consultation Service, Supplemental Clinics,
Medical Reports.
1017-
Follow-up W ork, and a'monthly-magazine,in the Chinese language..
Each Department of the Hospital makes a full report of the work
done during the year. In the- report 6f the Department of
Pathology is the statement that free diagnosis of any pathological
tissue is offered practitioners in the Orient in exchange for gross
material accompanied by clinical data. During the past year this
offer has been accepted by 94 different physicians, who have sent
in 486 specimens for examination.
One doctor w rote: “ I
appreciate this service, and believe that nothing could be done by
the Peking Union Medical College that would be of so much value
to small hospitals.” The Medical Social Service is doing very
good work in helping the poor, diseased, and unhappy outside
the hospital. General information is given concerning the rates
and regulations of the hospital, and the report closes with an
admirable classification of diseases and of the surgical operations
performed.
K W AN G JU , KOREA.
E llen L a v in e Graham H ospital and K w an gju Leper H om e.
Report for 1 9 2 3 -1 9 2 4 .
Hospital staff : Drs. R . M. Wilson and Rowe.
Levie, Nurse, M iss Georgia Hewson, R . N.
Dentist, Dr.
During D r. W ilson’s absence on furlough the hospital work
was carried on by Dr. Rowe, a Korean physician; “ only a few years
ago he was a little boy running wild in a heathen village.” Number
of m-patients, 5 3 4 ; out-patients, 13,7 2 9 .
Operations under a
general anaesthestic, 170 . In the Leper Home there are 565 pa
tients. In M ay last, seventy-five of the patients were discharged as
probably cured. “ Alan never is, but always to be blest.’ ’ Instead
of being happy- there was much weeping because they had to leave
the Home. A t the Foosung Leper College, of which D r. Wilson
is also superintendent, forty cases vyere paroled last spring as
apparently cured. Dr. Levie and his dental department render
valuble service to the hospital. Building difficulties are the same
everywhere in the East. During D r. W ilson’ s absence his home
was burned down. When he returned and started to erect a new
building, the Chinese contractors absconded. Other workmen had
to be employed and a heavy financial loss was sustained. Great
stress is laid upon the evangelistic work.
io i8
CANTON, K W AN G TU N G .
H ack ett M edical College for W o m en . Turner T rain ing School
For Nurses. D avid Gregg H osp ital F or W o m e n and
Children. Report for 1924.
Hackett M edical College for Women.— Stall : 18 medical
teachers. Total number of students, 63, of whom 44 (70%), are
Christians. The demand for interns is greater than the supply.
T he students come from eight different provinces.
D avid G regg Hospital fo r Women and C hildren.— Staff : F iv e
foreign physicians, 6 interns. Nursing s t a ff: T hree foreign
nurses, 3 Chinese nurses, and 38 student nurses. Number of
in-patients during the year, 2,348 ; out-patients, 14,644.
Each hospital department presents a report with an analysis
of the cases attended. In the Obstetrical Department there were
4S5 labors, 349 being normal, 13 6 abnormal. In the record
of the Surgical Department it may be noted there were only two
appendectomies. Total receipts, $ 7 0 ,8 12 .4 5 ; total expenditure,
$52,76 6 .8 8 . Of the surplus $ 14 ,4 8 5 has been set aside for building
purposes.
Turner T raining School for N u rses.— Facu lty : E igh t
physicians and six trained nurses. T hirty-eigh t student nurses
have given faithful service in the care of the sick, and are gradually
doing more evangelistic work in the hospital and in the homes of
the patients.
There is an increasing demand for graduate
registered nurses in south China and man}? are desirous of taking
the training. It is hoped the time will soon come when conditions
will permit Chinese nurses to go into the country districts.
A m erica n H osp ital, Meshed, P ersia. R eport for 1 9 2 3 .
H ospital Staff : D r. Hoffman and D r. Eichtwardt.
M iss Mabel F\ Nelson.
Nurse :
The physicians connected with this hospital are members of
the C. M. M . A . and therefore the report of their work, as of all
medical mission work, should be interesting to us. T he year was
^ne of special rejoicing because of two events : the first medical
trip of the doctors into Afghanistan, and the building of a new
hospital. Num ber of in-patients during the year 3,406. Out
patients, 14,000. M ajor operations performed, 13 0 . The prim itive
•conceptions of disease and methods of treatment are much the sarde
in Persia as in China. But the Chinese are free from one bad
1019
Current Medical Literature.
custom. In the Meshed Hospital some of the patients were little
.girl-wives, 10 -12 years of age, and the doctors are righteously
indignant. There is still much prejudice against Persian women
receiving obstetrical treatment in foreign hospitals. Hundreds of
minor operations were performed. T he most common was for
«ntropiuin following trachoma, which is very prevalent. More
-doctors and nurses are needed for the hospital. “ Our field is large,
our opportunities unlimited ; the responsibility for the direct and
indirect preaching of the Word while healing the sick is ours,
because direct aggressive evangelistic work in this f Sacred Shrine
•C ity ’ cannot be done as in other places. But slowly yet surely
C hrist is being made known; the seed is being sown, and where
H is word is preached there is promise of a harvest.”
C u rre n t flDeMcal ^Literature.
P IC R IC A C ID A S A S K IN D IS IN F E C T A N T .
T crsch m id ,
Z cn tra lbl.
j.
C h vr.,
M ay
24th,
1924.
Tiirschm id states that Mitchell in 1 9 1 1 first drew attention to
the germicidal action of picric acid, and was followed by Gibson in
19 19 , who found that a five per cent alcoholic solution was superior
to tincture of iodine because it did not cause any irritation of the
operation field and was also decidedly cheaper. H ewitt’s experim
ents in 19 22 showed that the skin was no longer sterile at the end of
three-quarters of an hour after it had been painted with ether,
alcohol, and 3 per cent tincture of iodine, but remained sterile
after it had been painted with iodine in benzine, 7 per cent tincture
•of iodine, and picric acid. Gibson had very successful results in
.437 cases. Slek and T urkel, who used a 5 per cent alcoholic
solution of picric acid, came to the following conclusions : (1) Picric
acid hardens the upper layers of the skin and thus prevents the
organisms in the deeper layers invading the site of operation. (2)
Picric acid does not irritate the exposed peritoneum or cause perit
oneal adhesions. (3) It does not have any injurious efi’ect on instrum
ents. (4) It does not produce eczema or inflammation of the skin
■even of the most sensitive parts, such as the scrotum. (5) It is three
times cheaper than tincture of iodine. Tiirschmid states that a 5
per cent alcoholic solution of picric acid has been used on 17 0 cases
in the General Hospital at Nowy T a rg in Poland, and has proved
to be an excellent skin disinfectant. The skin is washed once or
twice with benzine, according to its state of cleanliness, and the
1020
T h e China M edicai Journal.
operation area is then painted with the picric acid solution for ten
to twenty seconds. The cases, included 52 hernias, 33 thyroidec
tomies, 20 appendicectomies, and 37 other aseptic operations. In
onl}? six did suppuration occur, which was of a slight and superficial
character. The discoloration of the skin caused by picric acid is
readily removed by a 25 per cent alcoholic solution of ammonia,
T H E B LO O D IN M O R P H IN H A B I T U A T I O N .
P e l l t n i a n d G r e e n f i e l d , Aic-h. In t. M ed., M ay, 1924.
T his paper deals with the question of whether any specific
toxic substance is produced by morphin habituation. The authors
state that since the results of the work of Valenti, who in 19 1 4
reported a series of experiments which tended to answer the
question in the affirmative, his results has never been tested by
other investigators, aud they have therefore made the study of this
question the subject of the present paper. T heir work consisted of
duplication of the most significant feature of Valenti’ s work and of
additional tests of their own, a detailed account of which is given.
The authors criticize Valenti’ s faulty technic and question the
methods of arriving at his conclusions, and stress the negative
findings of other investigators along similar lines as well as their
own. The}? conclude that (r) no toxic substance is formed in the
blood of dogs habituated to morphin which is capable of producing
circulator}? disturbances in normal animals into which the serum is
injected; (2) they find no evidence that any toxic substance ispresent in the blood as a result of morphin habituation.
T H E T R E A T M E N T OF H IG H B LO O D P R E S S U R E B Y
S U L P H U R IN J E C T IO N S .
Is t v a n , The L an cet, A u gu st, 23, 1924.
The author has found by experience that the irreg u lar
occurrence of high blood pressure can be treated with lasting effect
by exhibiting sulphur solutions by the intra-muscular route. T he
procedure is as follows. The first injection of i.e.cm . of sulphur
solution, containing 0.001 g. sulphur, is made in the gluteal region,
followed by a second after two or three d a y s ; thereafter, at longer
intervals, the subsequent doses are gradually increased to 5 or as
much as 10 c. cm. of the solution. The injections are admittedly
painful, and are generally accompanied by pyrexia, which is
apparently beneficial. It has been observed that other artificially
produced conditions of fever do not have a lasting effect in reducing,
high blood pressure. In the majority of cases four to five injections
are sufficient for the course of treatment, even if the blood pressure
were not completely reduced to the normal level. I f necessary, the
10 2 1
-course can be repeated after several weeks. It was noticed as a
strikin g fact that when the necessary course had been completed,
and the concomitant reaction had developed, the blood pressure
remained at a considerably lower level with a marked degree of
permanence. A t the same time, the symptoms of headache,
vertigo, and pseudo-uraemic manifestations were mitigated, if not,
as in some cases, completely abolished. The effect of the sulphur
seems to be to check spasms of the arteries, and to inhibit the
development of such angio-spasms.
D I S E A S E IN A N N A M E S E , CO CH IN C H IN A
M ontel,
B u ll. Societe de P athologic E x o tiq u c,
Ju n e
u ,
1924.
A studj? is here presented of the geographical distribution
■of infectious diseases in Cochin China in connection with the
influence of race and climate. Pathology in general and the evolution
of disease are profoundly different to what is observed in Europe.
The majority of Annamese patients are in a state of hypo-nutrition,
and a great number are starving when the}- enter hospital. The
clim ate of Cochin China is very depressing and most favourable
to the development and pullulation of morbid germs. The waters
are very deficient in mineral salts and calcium. The commonest
food is rice, very poor in prolems and mineral salts. Chemical
an alysis has shown that the vegetables of Cochin China are much
poorer in mineral matter than those of Europe. V ery little meat
and fish is consumed. Annamites are sensible to all infectious
diseases, but no case of scarlet fever has been observed either in
natives or Europeans. Annamites are more sensible to pulmonary
tuberculosis than Europeans, in fact, the affection is very common,
«specially laryngeal tuberculosis, but peritoneal tuberculosis is
rare. Pott’ s disease is often observed, and asthma is prevalent in
a ll its forms, also beriberi. Syphilis presents itself under almost
the same aspects as in Europe, but the prim ary and secondary
accidents are greater.
Cerebral syphilis (tabes and general
paralysis) is very rare.
N E W D I E T FO R P E P T IC U L C E R .
C olem an,
Jo u r. A v ie r. M ed. Assoc., Septem ber
2 0,
1924.
In the new diet recommended for the treatment of peptic ulcer,
.glucose salt enemas are given throughout, and, for the first three
to five days, only w’ater is allowed by mouth. Feeding by mouth
is started on the fourth to the sixth day. The only foods per
mitted are olive oil or butter fat and white of egg. L ater in the
treatment, yolk of egg and cream may be added to the diet in
replacement of a portion of the other fats. T h is diet has been in
continuous use for twelve years by this author and the results have
proved satisfactory.
1022
L E U K O C Y T E S D U R IN G T H E G E S T A T IO N P E R IO D .
H e y n , Z eit sehr, fü r G eb. u nd G y n ä k o lo g ie , Ju n e, 11924.
The author examined 44 healthy pregnant women before theyhad risen or eaten in the morning. The leukocytes ranged from
6,950 to 23,500 in the 23 primíparas and from 7,050 to 16 ,55 0 in
the multiparas during the last two months of the pregnancy. In
another group of 25 primíparas and 33 multiparas who had been
out of bed for two hours doing light housework, the averages were
1 2 ,2 1 0 and 11,4 6 0 . The eosinophils and h-mphocytes scarcety
reached the lowest range of normal figures, but the shifting to the
left of the Arneth formula was. pronounced in every? month of the
pregnane}?. It can be relied on, the author says, as a sign of probable
pregnancy. When the shifting to the left is especially notable the
woman should be spared over-exertion. He presents these physio
logic hemograms to serve as a basis for diagnosis and prognosis in
pathologic conditions.
R E S E C T IO N
OF
YAS
DEFERENS
S t e i n d l , A r c h iv jiir k lin . C liiru rg., A u g u st 7, 1924.
T h is communication from Hochenegg’ s service confirms that
the Steinach operation has an’ unmistakable effect in a general
stimulating and tonic action on the entire organism. But this
effect is transient, and the complications which are liable to follow,
such as rapid loss of strength and an unfavourable influence on the
central nervous sj?stem, impose extreme caution in its application.
vSteindl performed the operation in several cases of inoperable
cancer, hoping thus to arouse the defensive forces. The results
were so good that he since has applied it to supplement the
extirpation of cancers in the rectum, to help the.organism in its
task of recuperation, but was unable to detect an}? special influence
from it. No benefit was apparent in a case of Parkinson’ s disease,
nor in one of Parkinsonian symptoms after encephalitis, nor in
prostatic retention of urine. A permanent action was not obtained
in any instance.
D E C L IN E
IN
T U B E R C U L O S IS
IN C ID E N C E .
R o b e r t s o n , M innesota M edicin e, A u g u st, 1924.
Among 250 complete postmortem • examinations made by
Robertson or under his direction during 19 0 3 -19 19 inclusive there
was no evidence of tuberculosis in 30 per cent, and evidence of
active tuberculosis in 27.6 per cent, with 16 per cent of healed
cases and 26.4 per cent adhesions. Among 250 cases sim ilarly
observed by another pathologist during 19 2 3 -19 2 4 , the findings
were 39.2, 6.4, 10 .4 . and 44 per cent respectively. In 1,000
necropsies performed by Robertson or supervised by him in 19 23-
3023
1924 at the Mayo clinic, the findings were 2 0 .1, 4 .5, 63.0 and 12 .4
per cent respectively. A n alysis of these cases as to age shows that
the younger generations are acquiring a total immunity in far
greater degree than the older generations. In fact, if healed
lesions are found in a parent, there is some ground for assuring
the son or daughter of a relatively increased immunity in them
selves.
E T IO L O G Y
OF
PUERPERAL
IN S A N IT Y
B o u r n e , Jo u r. L a ry n . and Otol., Ju ly , 1924.
Sixty-one cases of puerperal insanity were analyzed b y Bourne.
Uterine infection, with or without blood infection, accounted for
eighteen (27 per cent), and of these eighteen, thirteen were serious,
some of them proving fatal. Of the sixtyi'-one confinements there
were nine cases of eclampsia (13 .5 per cent). There were eight
cases of difficult labor with various conditions, including severe
hemorrhage, manual dilatation of the cervix, and extraction with
the forceps. A s to the influence of an unstable mental equilibrium
and a bad fam ily history, there were eighteen cases. T hus of all
the cases more than one-quarter gave signs of a predisposition to
mental disease. Four of the eighteen patients were epileptic. In
four there was a history of previous sojourns in an asylum , while
five had suffered puerperal insanity after previous confinements,
and five came of a stock in which insanity had appeared in former
years.
E X P E R I M E N T A L A S C E N D IN G R E N A L IN F E C T IO N .
D y k e a n d M a y b u r y , Brit. Jo u r. S ta g ., Ju ly , 1924.
A series of experiments is reported on by the authors, designed,
if possible, to bring about an “ ascending’ 5 infection of the kidne}?,
using the term “ ascending” in the sense of an infection passing
into th e kidney via the lumina of the urinar}? passages.
Attempts
directed to bring about infection of the ureter from the bladder
showed that the uretero-vesical junction offered, under the experi
mental conditions, an insuperable bar to the passage of infection
from the bladder upward. B y direct infection of the lumen of the
ureter it was found to be possible to bring about a subsequent
infection of the kid n ey; but this infection was due, not to
regurgitation of the infected pelvic contents into the renal tubules,
but to direct spread through the epithelium renal sinus into the
interstitial substance of the kidney, and under certain conditions,
into the space between the kidney and its true capsule. Carmine
injected into the pelvis did not pass through the renal papilla, which
appeared to offer an impassable barrier to a reversal of the urinary
flow.
No evidence could be obtained of the possibility of the
occurrence of an “ ascending” renal infection.
Thè 'China Medical Journal.
1024
PUERPERAL
S c h a an n in g ,
T H R O M B O S IS
N o rsk Mctgcizin fo r L a e g e v id .,
Ju ly , 1924.
Thrombosis developed in 0 .6 1 per cent of the 9,367 childbirths
-in the last six years at the Christiania M aternity Hospital. It
appeared the fifteenth or sixteenth day alter delivery in all but two
in which the intervals were three and fifty-one days. Embolism
developed in thirteen cases, none fatal. The women who had lost
more than 1,000 c.c. of blood presented thrombosis in 2.92 per
cent, and puerperal fever in 10 per cer/ vhile the corresponding
figures for women who had not lost so m u.h blood were 0.44 and
4 .1 per cent. It is now the routine pr° ' ce to arrest excessive
hemorrhage at all costs as the lesser e>
not waiting until the
patient is too weak. When the loss of
reaches 1,000 c.c.
Brandt clears out the uterus with his ha
after delivery of the
placenta. T his always arrested the hemorrhage, and none died
from infection afterward. A s soon as thrombosis is £‘u.c.pected, the
foot of the bed is raised with blocks 15 cm. high, but m. bolster is
placed under the knees.
Superficial massage is begui after the
temperature has been normal for a w?eek, and the joints are
-exercised both passively- and actively. Embolism never developed
from this. Two of the fifty-seven thrombosis patients died from
pyemia about fort}? days after spontaneous delivery, and one fr*
pneumonia after forceps delivery. The others recovered. Ther.
were only two instances of thrombosis among the 1 1 9 placenta
prasvia cases.
T Y P H O ID
C ruz,
FEYER
IN
F IL IP IN O S
P h ilip . Islan ds M ed. Assoc. Jo u r.,
Ju ne,
1924.
Out of 10 ,18 5 consecutive necropsies performed in the city
morgue of M anila during a period of more th
sixteen } ears, 36 1
were typhoid cases, an average of one tyj
r every twenty-eight necropsies. The yearly and seasonal
.oidence shows a
tendency to increase every year and a liô1’ lity for typhoid
m ortality to occur every month. Although males are more
susceptible to typhoid infection than females, yet the disease is as
severe and as fatal to women as to men. The greatest suscep
tibility as well as the greatest mortality of typhoid can be said to
occur between the ages of 15 and 25 years. The triad of the
specific lesions of the disease is almost the same as that found in
temperate climates except that the average enlargement of the
.spleen in this country is less. The involvement of the cecum
occurred in one-third of these cases, and of the colon in only onefourth, which indicates that the extent of the intestinal lesion has
no direct relation to the m ortality of the disease. T h is series
show's an extraordinarily high percentage of intestinal perforation
<(15.6) and intestinal haemorrhage (11.9 ), about five times the
1025
incidence in temperate climates. The presence of adult ascarides
in 47 per cent of the perforated cases should be considered a
possible responsible factor.
U R IC A C ID P R O B L E M
Fo lin ,
B eiigi/un d
and
D srick ,
Jo u r. B iol.
C h e m .,
Ju ne,
1924.
The authors report at length the results of their experimental
study on uric acid. These investigations were begun on the basis
of the conviction that they could determine uric acid in blood with
a precision unattainabl' ip earlier work. When uric acid is inject
ed into the blood-strea.-A of animals, the kidneys immediately' take
up very much uric acijCL The kidneys at the same time become
edematous and great']' ' enlarged. Up to fully 0.2 per cent of uric
acid may be teinj:-,
y stored in the kidneys. The uric acid
which cannot find 1.
(.ent in the kidneys remains to a large extent
in the circulating b,ood until it is destroyed ; in other words, all
the other tîsûes seem to be more or less completely' impermeable
to solubl^ urates. The destruction of uric acid in the dog, and
presumably in all other animals, seems to take place within the
circulating blood, though it is possible that some is destroyed in
the kidneys. The destruction of uric acid within the circulating
i.blQod proceeds with extreme velocity during and immediately after
injection (100 mg. per kilogram), but soon slows down to a
^measurable speed, and the speed continues to diminish as the
concentration of the circulating uric acid continues to sink. The
uric acid destruction stops the instant the blood is removed from
the living animal. Intravenous injections of uric acid (20 mg.
per kilogram in the form of lithium urate) into normal men are
followed by excretions of from 30 to 99 per cent. The destruction
in man, therefore, amounts to from 10 to 70 per cent, the average
being about - 50 per cent. The losses (destructions) in man are
variable because t1 1. ■ wo factors involved— speed of destruction and
speed of excr b?*? *<are subject to independent variations. The
excretion in :na. ' jasts from one to four days. The duration is
main!}- determi-?i|5ti by the speed of destruction. The unique and
characteristic high levels of uric acid in normalhuman blood are
due to a lack of responsiveness on the part of the human kidney.
H igh protein diets increase the responsiveness of the kidneys and
thus lower the level of circulating uric acid.
T h e c h a r a c t e r is t ic la c k o f re s p o n s iv e n e s s on th e p a r t o f th e
h u m a n k id n e y is e x a g g e r a te d in g o u t an d th is is th e m a m o r o n ly
r e a s o n w h y th e g o u t}7 c a r r y a b n o rm a lly h ig h le v e ls o f c ir c u la t in g
u r ic a c id .
T h e u r ic a cid d e s t r o y in g p ro c e ss in th e g o u t y is in
t r in s ic a lly a b o u t th e sa m e a s in n o rm a l p e rso n s b u t is s u b je c t to
yvider v a r ia t io n s .
T h e d is tr ib u t io n o f in je c te d u r ic a c id is s u b s t a n
t i a lly th e s a m e in g o u t y s u b je c ts a s in n o rm a l p e rso n s .
In tr a v e n o u s
u r ic a c id in je c t io n s (20 m g . p e r k ilo g ra m ) do not p ro d u c e a tt a c k s
1020
in the gouty, but may produce enough temporary injury to the
kidneys to result in a transient retention of other nitrogenous
waste products than uric acid (increased nonprotein nitrogen and
urea of blood). In normal persons no such retentions have been
encountered.
M O R T A L IT Y I N S U R G IC A L D I S E A S E S O F C H IL D R E N
C u t l e r , Boston M ed. and Su rg . Jo u rn a l, A u g u st 14, 1924.
Among the 4,989 cases admitted to four services on which
Cutler bases his paper there were 13 S deaths, a mortality of 2.7
per cent. Infection caused nearly one-half the deaths. Em pyem a
was the cause of the greatest number of deaths in this group, but
there were 462 patients who admitted suffering from this disease, a
number exceeded only by admissions for cervical adenitis (522) and
the m ortality is only 16.66 per cent. Acute appendicitis caused
fortj^-one deaths, the second greatest number among the infections;
yet the mortality figures only 1 1 .4 5 Per cent because the disease
was third in order of admissions (358). These figures included
appendicitis with abscess and appendicitis with peritonitis, so that
although the percentage is high there is some justification for it.
Acute peritonitis, due to streptococcus and pneumococcus infection,
produced a very high m ortality : 23 cases, 13 deaths, a m ortality
of 56 .52 per cent. Septicemia proved uniform ly fatal in 12 cases.
Tuberculosis is responsible for a large number of the cases included
in this series. There were in all 52 patients with only 8 deaths,
m ortality of 1.5 3 per cent.
Congenital malformations constituted the second .group of
conditions in which mortality occurred (23 per cent). Cleft palates
were most numerous (402 cases) ; harelip was next (284 cases) ;
then congenital pyloric stenosis ( 1 17 cases); spina bifida (110
cases) ; hypospadias (90 cases) ; harelip and cleft palate (74 cases) ;
hydrocephalus (44 cases) ; atresia of anus (31 cases) ; megacolon
(16 cases); malformation of intestines (15 cases); exstrophy of
bladder (T5 cases, some réadmissions) ; obliteration of bile ducts (3
cases); patent urachus (2 cases). Malformation of intestines gave
a m ortality of 66.66 per cent; patent urachus, 50 per cent;
obliteration of bile ducts and exstrophy of bladder, 3 3 .3 3 per cent;
atresia of anus, 32-25 per cent; hydrocephalus, 29.54 per cent;
spina bifida, 29.09 per cent; megacolon, 25 per cent; harelip and
cleft palate, 1 2 .1 6 per cent; pyloric stenosis, H . 1 1 per cent;
harelip, 3 .16 per cent; hypospadias, 2.22 per cent; cleft palate,
0.24 per cent.
There were 56 deaths from intestinal obstruction, 10 .83
per cent of the total mortality. Intussusception was responsible
lor 39 of these deaths and during this seven-year period 13 3
patients with this type of obstruction wrere admitted, giving a
mortality for this condition of 29.32 per cent.
Pasteur, the Christian and the Scientist.
1027
PASTEUR, THE CHRISTIAN AND THE SCIENTIST.*
W. W. C a d b u r y , m .d ., Canton C h ristian C ollege, Canton.
Western science has entered the schools and colleges of China
to stay. It Should be studied property, in due proportion and
harmony with all other truth. But some students pursue it with
little interest, as a matter of course ; some, with the sole object of
making scientific knowledge the stepping-stone to material wealth ;
and some are so influenced by it as to fling religion and all ideas
of philanthropy to the winds, declaring that science and religion
are incompatible and that truth is to be found in science alone. It
behooves everj? young scientist, and especially every phj^sician, to
consider the life and work of Louis Pasteur, wrho stands forth
pre-eminently as the greatest scientist of all time and yet who
combined with his scientific knowledge a profound love for
humanity and reverence for God.
Louis Pasteur was born of humble parents in the town ot Dole,
December 27, 18 22. In this home be grew up watching his
parents at their daily toil, and inspired by their high moral and
religious lives.
As a schoolboy he did not distinguish him self.
He was considered slow ; he never affirmed anything of which he
was not sure, and yet he had a vivid imagination. H e was sent to
school at Paris but homesickness overcame him and in a few weeks
his father took him home again, and he resumed his studies at
Arbois and later at Besançon. A t the age of twenty we find him once
more in Paris attending lectures on chemistry at the Sorbonne.
The lecturer was no other than J . B . Dumas, the celebrated
chemist, who remained a great inspiration to Pasteur as long as he
lived .
✓
D uring these days of study at the Ecole Normale, and at the
Sorbonne, Pasteur maintained himself by teaching. H e had
alread}7 begun his study? of tartaric acid, the first of those
monumental contributions to science to which his later life was so
completely devoted.
T h is active life was first interrupted when he was only
fortv-six years of age by a cerebral hemorrhage which threatened
*A paper read to the students of the Canton C h ristian C ollege at a
m eetin g of tlie A rts and Science Club.
I02S
his life.
Fortunately, he entirely recovered except for slight
stiffness of one hand, and it was after this attack that his greatest
achievements were made. In spite of bitter opposition on al! sides
he persevered, proving to the world the truth of one great discovery
after another. To few men has come such complete recognition by
the world of the value of their life work. He was elected a member
of the Academy of Sciences, the Academy of Medicine, and in 1882
was admitted to membership in the Académie Française.
The
French Government in 1874 voted him a pension of 12,00 0 francs,
which was later increased to 25,000 francs. On November 14 ,
18S8, the Pasteur Institute was formally opened. T he funds
for this had been raised by popular subscription and it was dedi
cated prim arily to the treatment of rabies and to carrying forward
research in microbic diseases.
In celebration of his 70th birthday, a great gathering met in
the theatre of the Sorbonne. Representatives of scientific societies
of many different lands vied with one another in extolling the
achievements of this greatest scientist of the century. Pasteur
entered the assembly on the arm of the President of the Republic.
Lord L ister, who represented the Royal Societies of London and
Edinburgh, brought to him the homage of medicine and s u r g e s .
“ You have,” said Lister, “ raised the veii which for centuries had
covered infectious diseases.” When Pasteur rose to embrace L ister
the sight of these two men gave the impression of a brotherhood of
science laboring to diminish the sorrows of humanity*.
Pasteur’ s interest in the scientific pursuits of his colleagues at
the Pasteur Institute continued as keen as ever, though he
.gradually failed physically until the end came. Finall}*, on
September 28, 1895, with one hand resting in that of Mine.
Pasteur and the other holding a crucifix, he very peacefully passed
away.
John D. Rockefeller recently purchased the cottage at Dole in
which Pasteur was born 100 years ago. The French Government
has appropriated 20,000 francs with which to re-model the house
and make it into a public museum. It will be presented to the
people of the Commune of Dole.
W hen one comes to summarise the achievements of Pasteur,
their scope is found to cover such a vast range that Chem istry,
Physics, Biolog}", and Medicine all claim him.
The practical
1029
value of his discoveries to certain industries is expressed byH u xley, the E n glish physiologist, in the w ords: “ Pasteur’ s
discoveries alone would suffice to cover the war indemnity of five
m illiards paid by France to Germ any in 1S 7 0 .” To a foreigner
who took Pasteur to be a doctor, Edmund About replied : “ He
does not cure individuals, he only tries to cure hum anity.”
The students of science of the present day require a most
elaborate equipment and special laboratories- T he most humble
college, in the smallest provincial town, would not now accept such
dens as the wState offered, if it offered any at all, to the great
French scientist. Pasteur was onty too glad to have a small attic
room set aside for his use.
To sum up the achievements which he accomplished is indeed
difficult. Paul Bert in presenting to the government the claims of
Pasteur for a pension said :
“ H is w o ik s m ay be classed in three series, con stitu tin g three great
discoveries.
“ The first one m ay be form ulated thus : Each ferm entation is
produced by the developm ent of a special microbe.
“ The second one m ay be given this form ula : Each infectious disease
is produced b y the developm ent w ithin the organism of a special microbe.
“ The third one m ay be expressed in this w a y : The m icrobe of an
infectious disease, cu ltivated under certain detrim ental conditions, is
attenuated in its pathogenic a c tiv ity ; from a virus it has become a vaccine.
“ As
a
practical
consequence
of
th e
f ir s t
d is co ve ry - ,
M.
Pasteur has
g i v e n r u l e s f or t h e m a n u f a c t u r e of b e e r a n d of v i n e g a r , a n d s h o w n h o w b e e r
and
turn
and
w ine
th em
m ay
be
sour,
preserved
bitter,
again st
or s l im y ,
secon dary ferm en tatio n s w h ic h w o u ld
and w h i c h r e n d e r difficult th e ir tr a n s p o r t
e v e n t h e i r p r e s e r v a t i o n on t h e sp ot.
“ A s a p ractical consequence of the second d iscovery, M. P asteu r has
given rules to be followed to preserve cattle from splenic fever contam ina
tion, and silk w orm s from the diseases which decimated them. Surgeons,
on the other hand, have succeeded, by m eans of the guidance it afforded, in
effecting alm ost com pletely the disappearance of erysip elas and of the
purulent infections which fo rm eiiy brought about the death of so m an y
p atients alter operations.
“ A s a practical consequence of the th ird discovery, M. P asteu r has
given rules for, and indeed has effected the preservation of horses, oxen,
and sheep from the an th rax disease which every year k ills in Fran ce about
20,000,000 francs worth. Swine w ill also be preserved from the rouget d is
ease w hich decim ates them, and p ou ltry from the cholera which m akes such
terrible havoc am ong them. E v e ry th in g leads us to hope that rabies w ill
also soon be conquered.”
10 3 0
On the walls of the Chapel of the Pasteur Institute are
inscribed the scientific triumphs of the master, whose ashes repose
there. How different from the m ilitary achievements of that other
great Frenchman, Napoleon, whose remains lie in the Hotel des
Invalides !
Each heading m arks a great step forward in the history of
science :
1848.
1857.
1862.
1863.
1865.
18 7 1.
1877.
1880.
1885.
M olecular D issym m etry.
Ferm en tations.
So-called spontaneous Generation.
Stu d ies on W ines.
D iseases of Silkw o rm s.
Stu d ies on Beer.
V iru len t M ierobic D iseases.
V accin atin g V iru ses.
P ro p h y la x is of R abies.
Adequatel}* to discuss these various discoveries is quite
impossible in the time allowed for this lecture, yet every student
of the great M aster should have some conception of what his
contributions to science signified.
On M o lecu lar D is s y m m e t r y .
Pasteur was primarily^ a chemist and his first original research
was in the line of chemistry. M itscherlich, one of the greatest
chemists of the time, had just announced that the tartrates and
paratartrates of soda and ammonia had the same chemical
composition, the same crystalline form, the same angles in the
crystalline condition, the same specific weight, the same double
refraction, and consequently the same inclination of the optic axes.
Notwithstanding all these points of sim ilarity, if the tartrate is
dissolved in water, it causes the plane of polarized light to rotate,
while the paratartrates exert no such action.
A fter considering these phenomena for several years, Pasteur
concluded that there might be two different groups of crystals in
the paratartrates, the members of one group turning the plane of
polarised light to the right and the other to the left. W hen mixed
together these two groups neutralized each other so that paratartrates
apparently had no influence on the polarized beam of light.
Pasteur found that the paratartrates were composed of crystals
that were dissymmetrical, that is, when their image is reflected in
a mirror it cannot be superposed on the crystal itself. T h is idea
10 31
Pasteur makes cleâr by reference to the mirrored image of a hand.
The image of the right hand as seen in the mirror is a left hand. It
cannot be superposed on the hand of which it is the reflection any
more than the left hand can be superposed on the right hand, and
have corresponding parts occupy corresponding places. Pasteur
found that the paratartrates were not only dissymmetrical but that
they possessed two forms of dissymmetry. The mirrored image of
some of the crystals could be superposed on certain of the other
crystals just as the mirror image of the right hand can be superposed
on the actual left hand. He concluded that if he separated these
two groups from each other he would have two very different
substances, and so the m ystery propounded by Mitscherlich would
be solved.
W ith Pasteur to conceive an idea was to think out its
experimental demonstration. He manufactured the paratartrates
according to the directions given by Mitscherlich, and then
proceeded to sort the two varieties of crystals by hand. It was
slow, patient work, and for hours Pasteur strove feverishly on
alone in the laboratory. A t length the crystals were ready for
solution and examination as to their effect upon the polarized
light. If Pasteur’s idea as to the dissymm etry of crystals were
confirmed, a great scientific advance was assured. T rem blingly
the young enthusiast adjusted his polariscope. He tells the story
him self of his first hesitant glance. But hesitation was changed
to triumph. H is prevision was correct. There were two forms of
crystals with different effects on polarized light in M itscherlich’s
supposed simple substance. Pasteur could not stay to put his
instrument away. The air of the laboratory had become oppressive
to him. Drunk with the wine of discover}^ as a French biographer
rem arks, he rushed into the open air and almost staggered into the
arms of a friend who was passing. “ A h ,” he said, “ I have just
made a great discovery. Come to the Luxem bourg garden and I
will tell you all about i t .” Pasteur pursued these studies with
rare enthusiasm. T he newspaper, “ L a V é rité ” , describing his
long journeys to obtain the chemicals he needed, declared : “ Never
was treasure sought, never adored beauty pursued over hill and
vale with greater ardor.”
Fin ally, Pasteur showed that there were four different tartaric
acids :
1.— The rig h t or d extro-tartaric acid.
1032
2 .— The left or laevo-tartaric acid.
3.— The com bination of rig h t and left, or racem ic acid.
4-— The m eso-tartaric acid, optically, inactive.
O n F e r m e n t a t io n .
T h is study of crystals led Pasteur to meditate on the distinc
tion between material derived from living and non-living sources.
In the summer of 1856 a L ille manufacturer had met with great
disappointments in the manufacture of beetroot alcohol and he
sought advice of Pasteur, who consented to make some experiments.
He noted that the globules in the fermentation juice were round
w^hen fermentation was healthy, and lengthened out when alterations
began and became ver}" long when fermentation became lactic.
M ilk, meat solutions, butter, etc., also undergo changes quite
sim ilar to alcoholic fermentation. These changes he proved to be
due to the presence of minute living things that grow in the
solutions. V\'h\- does wine then change to vinegar? Because of
the microscopic fungus, Mycoderma aceti. If the wine is exposed
to the air this germ grows rapidly and change takes place. In a
full, closed bottle this does not occur, because the mycoderma
cannot grow in the absence of air. It was sufficient to keep the
wine for a few moments at a temperature of 50 C. to 60. C. T his
does not alter the wine, but prevents the further growth of the
germ. He had demonstrated to the world the great principle of
“ Pasteurization” , which is now extensively applied to the
preservation of m ilk.
S po n t a n eo u s G e n e r a t io n .
These studies of the cause of fermentation led to a prolonged
discussion of the whole question of the origin of life. Philosoph
ers, poets, naturalists, all believed in spontaneous generation. It
was indeed an heroic task that Pasteur set himself in order to disprove
this common belief. The devout attitude that he assumed in
entering upon this problem is well illustrated by this quotation
from a letter to his father : “ God grant that by my persevering
labors I may bring a little stone to the frail and ill-assured edifice
of our knowledge of those deep mysteries of life and death, where
ail our intellects have so lamentably failed.”
Pasteur began by the microscopic study of atmospheric air.
“ If germs exist in the atmosphere,” he said, “ could they not be
arrested on their w a y ?” It then occurred to him to draw— through
I P33 -
an aspirator— a current of outside air through a tube containing a
little' plug of cotton wool. The current as it passed deposited on
this sort of filter some of the solid corpuscles contained in the air
the cotton wool often became black with these various kinds of
dust. In this dust were germs. B y experiment he proved that the
most readily decomposed liquid remained pure indefinitely if placed
out of reach of atmospheric dust. But if a bit of the cotton filter
were placed in contact with the liquid there was an immediate
change. W hile he thus proved that the germs of living matter arefound in the dust of atmospheric air, he also proved that this air
varies from the comparatively- germ-free air of the Mer de Glace, to
the germ-laden air of a Paris street. H is study is well summed
up in a popular lecture given at the Sorbonne in 1864, as follows :
“ H ere is an infusion of organic m atter, as lim pid as d istilled w ater
and extre m ely alterable. It has been prepared to-day. To-m orrow it w ill
contain a n im a lcu le , little infusories, or flakes of m ouldiness.
“ I place a portion of that infusion into a flask w ith a lon g neck, lik e
this one. Suppose I boil the liq u id and leave it to cool. A fter a few d ays,
m ouldiness or anim alculas w ill develop in the liquid.
B y boiling, I
desti-03-ed any germ s contained in the liquid or again st the g la ss ; but that
infusion being again in contact w ith air it becomes altered, as all infusions
do. N ow suppose I repeat this experim ent, but that, before b o ilin g the
liquid, I draw (by m eans of an enam eller's lamp) the neck of the flask into
a point, leavin g, however, its extrem ity open. T h is being done, 1 boil the
liq u id in the flask, and leave it to cool. Now the liq uid of this second flask
w ill rem ain pure not on ly two days, a month, a year, but three or four
ye a rs— for the experim en t I am te llin g you about is alread y four years old
and the liq u id rem ains as lim pid as distilled water.
W hat difference
is there, then, between those two vases ? T h ey contain the sam e liqu id ,
they both contain air, both are o p e n ! W hy does one deca3' and the
other rem ain p u re ? The only difference between them is t h i s : in the
first case, the dusts suspended in air and their germ s can fa ll into the
neck of the flask and arrive into contact w ith the liquid, where they- find
appropriate food and d ev e lo p ; thence m icroscopic beings. In the second
flask, on the contrary, it is im possible, or at least extrem ely difficult, unless
air is vio le n tly shaken, that dusts suspended in air should enter the
v a s e ; th ey fa ll 011 its curved neck. When a ir goes in and out of the vase
through diffusions or variations of tem perature, the latter never beingsudden, the air comes in slow ly enough to drop the dusts and germ s that it
carries at the opening of the neck or in the first curves.
“ T h is experim ent is fu ll of in stru c tio n ; for this m ust be noted, that
e ve ryth in g in air save its dusts can e asily enter the vase and come into
contact w ith the liquid. Im agine what you choose in the air— e lectricity ,
I 0 34
m agn etism , ozone, un know n forces even— all can reach the in fu sion. O nly
one th in g cannot enter e a sily , and that is dust, suspended in air. A n d the
proof of th is is th at if I sh ak e the vase v io le n tly two or three tim es, in a
few day^s it contains anim alculse or m ouldiness. W h y ? because air has
com e in vio le n tly enough to c a rry dust w ith it.
“ A nd, therefore, gentlem en, I could point to th at liq u id and sa y to
yo u , I have tak en m y drop of w ater from the im m en sity of creation
and I have taken it fu ll of the elem ents appropriated to the developm ent
of inferior beings. A n d I w ait, I w atch, I question it, b e g g in g it to re
com m ence for me the beau tifu l spectacle of the first creation. B u t it is
dumb, dumb since these experim en ts w ere begun several y e ars a g o ; it is
dumb because I have kep t it from the on ly th in g m an cannot produce, from
th e germ s w hich float in the air, from L ife, for L ife is a gen n and a germ is
L ife . N ever w ill the doctrine of spontaneous generation recover from the
m o rtal blow of this sim ple experim en t. ”
But people said, “ If all comes from a germ, whence came the
first germ ? ■” “ We must bow before that m y s te ry / ’ said Pasteur,
■“ It is the question of the origin of all things, and absolutely
outside the domain of scientific research.”
S il k w o r m D i s e a s e .
B ut these theoretical studies were to give way to the investiga
tion of a most practical economic problem. In 1845 a disease
known as pebrine was noted among the silkworms in France. In
1849 it became a disaster, and in 18 5 3 seed had to be procured
from Lom bardy. Pasteur was persuaded to go and investigate
this veritable plague. He applied him self indefatigabty to the
problem. In 1865 he announced that it was a mistake to look for
the bodies exclusively in the eggs or the worms. T he evil
developed itself chiefly in the chrysalides and the m oths; it was in
them that it should chiefly be sought. There should be an
infallible means of procuring healthy seed by having recourse to
moths free from corpuscles. In order to avoid pebrine, the
■disease caused by the corpuscles so clearly visible through the
microscope, no seed should be used that came from infested moths.
B y following this simple rule the silk industry was restored to
Prance and an immense financial sum was saved to the country
annually.
On D
is e a s e
I n f e c t io n .
The genius of Pasteur manifested itself in his ability to see
into the future and to deduce from one discovery after another
truths which he was afterwards able to demonstrate fu lly.
P asteur, the Christian and the Scientist.
i o 35
A s a result of his studies on fermentation he wrote : “ When
we see beer and wine subjected to deep alterations» because they"
have given refuge to micro-organisms, invisibly introduced and now
swarming within them, it is impossible not to be pursued by the
thought that sim ilar facts may, must, take place in animals and
m an.” Another great mind had been set to working as a result
of Pasteur's investigations in fermentation and in 1S 74 the
following letter was written to him by Lord L ister, who initiated
what is recognised to-day as antisepsis in surgery :
“ A llo w me to tender 3rou m y m ost cordial th an k s, for h a v in g — by your
b r illia n t research es— dem onstrated to me the truth of the germ theory
o f putrefaction, and thus furnished me w ith the p rin cip le upon w hich
a lo n e the an tisep tic system can be carried out. Should you at an}- tim e
v is it E d in b u rgh , it w ould, I believe, give you sincere gratificatio n to see at
o u r hospital how la rg e !3' m an kin d is being- benefited b y 3ôur la b o rs.”
One of the most appalling facts of the time was the high
death-rate in the Paris Maternity Hospital, in 18 56 , between
A p ril 1s t and M ay 10th, 64 deaths occurred among 347 confine
ments. T he hospital had to be closed. Women of the lower class
looked upon the “ M atern ity” as the vestibule of death. Some
years later, Pasteur, having found in certain puerperal infections a
germ , in the shape of a chain, came to the Academy of Medicine.
One of his colleagues was eloquently enlarging on the causes of
epidemics in lying-in hospitals. Pasteur interrupted him. “ None
of those things cause the epidemic, it is the nursing and medical
staff, who carry the microbe from an infected woman to a healthyo n e .” The orator replied he feared the microbe would never be
found. Pasteur went to the blackboard and drew a diagram of the
chain-like organism sa y in g : “ There, that is what it is lik e .”
As a result of the discovery of the infective nature of puerperal
fever the death-rate from this disease in the best tying-in hospitals
has fallen from 200 per 1,000 to 1 per 1,000.
V a c c in a t io n A g a i n s t D i s e a s e .
No discovery of Pasteur’s was more striking than the principle
o f vaccination against microbic disease. H e found that the germ
o f chicken cholera when grown on artificial media alwaj^s caused the
-disease in the fowls that had been inoculated. In the midst of these
studies he was called away for several months. WThen he returned
he repeated his experiments with the cultures of chicken cholera.
1036
To his surprise the inoculations no longer produced the disease^
A fter njuch trouble he prepared fresh cultures of the microbe*
When this fresh and virulent material was injected into fowls which
had been previously treated with the old cultures, they failed to
take the disease. .Other, fowls promptly died. Those that had
been treated by the old attenuated cultures were rendered immune
to the virulent fresh cultures. A great secret of preventive
medicine had been revealed and Pasteur was prepared to follow the
trail to its source.
Davaine, having heard of Pasteur’ s work on butyric ferment,
compared the ferment with the action of certain microscopic parasites
which he had observed in the blood of animals who had died of
anthrax o r ’ charbon disease. These rod-shaped bodies he called
“ bacteria” .
T h is disease had assumed the proportions of a great national
disaster, destroying whole herds of sheep. Pasteur set about the
study of this problem with his characteristic zeal. A fter a series
of experiments he found that in neutralized chicken-broth the
bacteria can no longer be cultivated at a temperature of 4 5 0 C. It
can still be grown at 4 20 C. or 440 C. But spores do not develop.
T hus a method of attenuating the virus was obtained. A fter eight
days of growth under these conditions a culture which originally
killed ten sheep out of ten, only killed four or five out of the same
number, and after ten or twelve day's it did not kill a n y ; it merely
gave the animals a mild attack of the disease which preserved them
from the deadly form. That is, a genuine method of vaccination
against this dread disease had been demonstrated. But veterin
arians were very slow to accept this discovery and the most bitter
attacks were made against it.
In March 18 8 1, M. Rossignol, an editor of the Veterinary
P ress, being incredulous, started a campaign to make an experiment
011 a grand scale by which the truth or otherwise of Pasteur’s
discovery might be demonstrated to the world. The program was
as follows. The Melun A gricultural Society put sixty sheep at his
disposal. Twenty-five were to be vaccinated by two inoculations a
twelve or fifteen d ays’ interval, with attenuated anthrax virus.,
Some days later those twenty-five and also twenty-five others were
to be inoculated with a very virulent culture of the germs. “ The:
twenty-five unvaccinated sheep, will all perish,” wrote Pasteur,.
I 0 37
" t h e twenty-five vaccinated ones will survive.”
T h e surviving
-Tsheep were afterwards to be compared with the ten sheep which had
undergone no treatment at all, to prove that vaccination did not
prevent sheep from returning to their normal state of health after
a certain time.
On June 2 ,18 8 1, Pasteur, before starting for Melun, wrote as
iollow s to his children :
“ It is on ly T h u rsd a}’’, and I am alread y w ritin g to y o u ; it is because a
g re a t resu lt is now acquired. A w ire from M elun has ju st announced it.
On T u esd ay last, 3 1 s t M ay, we inoculated all the sheep, vaccinated and
non-vaccinated, w ith very viru len t splenic fever. It is not forty-eigh t
hours ago. W ell, the telegram tells me that, when we arrive at tw o o'clock
th is afternoon, a ll the non-vaccinated subjects w ill be d ea d ; eighteen were
a lre a d y dead this m orning, and the others d yin g . A s to the vaccinated
ones th ey are all w ell. The telegram ends with, the w ords, ‘ stu n n in g
su c c e ss.’ It is from the veterin ary surgeon, M. R o ssig n o l.”
No success had ever been greater than Pasteur’ s. T h e whole
of France burst out in an explosion of enthusiasm. When a few
months later Pasteur attended the International Medical Congress
in London, he concluded his address with the following statement :
“ A llow me not to conclude without te llin g yo u of the great jo y th at I
ie e l in th in k in g th at it is as a mem ber of the In tern ation al M edical
C ongress sittin g in London that 1 have m ade know n to you the vaccination
•of a disease more terrible perhaps for dom estic anim als than is sm allp ox
fo r m an. I have given to the word “ vaccination ” an extension w hich I
hope Science w ill consecrate as a hom age to the m erit and im m ense services
rendered b y your Jenner, one of E n g la n d ’s greatest men. It is a great
happ iness to me to g lo rify that im m ortal nam e 011 the ve ry soil of the noble
an d hospitable c ity of L on don.”
I n o c u l a t io n A g a i n s t R a b i e s .
The last great scientific attainment of this full life was the
•development of a method of preventive inoculation against that
dread disease hydrophobia. B y grasping at successive ln*potheses
and proving their truth, Pasteur ultimately succeeded here as in
his previous triumphs. The rabic virus had always been supposed
to be in the saliva only- of the mad dog. He proved that it was also
contained in the brain. He showed that infection occurred with
•certainty’ when the brain substance of a rabic animal was injected
into the brain of a dog or rabbit. Then by taking the medulla of
the brain oi this infected animal and suspending it for two weeks
in a phial its virulence was destroyed. W ith this substance
1038
animals could be inoculated, and by gradually increasing the
virulence of the matter injected complete protection from the disease
could be assured.
On Ju ly 6, 18 8 5 , a little boy, named Joseph Meister, entered
P asteur's laboratory. He had been bitten two days before by a
mad dog, which had inflicted fourteen severe wounds on the body.
T h e preventive treatment had proved invariably successful on dogs.
Should he risk it on this boy? He consulted with Dr. Vulpian
who advised him to proceed. W hy not try this experim ent?
There was no other treatment likely to succeed.
The inoculations were commenced, each more virulent than
the previous one. Pasteur became nervous and excited ; he had
feverish visions of the lad dying of hydrophobia. Twelve inocula
tions were given. T h e last one was strong enough to give the
disease to rabbits after only seven days. Joseph M eister recovered.
T he long period of incubation of the disease makes it possible to
give the preventive treatment before the symptoms develop.
One of the most dreaded aud intractable of diseases known to
mankind had been conquered, and a death-rate of at least sixteen
per cent had been reduced to less than one per cent.
D e v o t io n t o S c i e n c e .
Pasteur's great achievements were the result of his infinite
patience, hard work, a brilliant genius, and his admiration for
science. H is worship of science was real and nothing short of the
pursuit of the truth would satisfy him. Science should be the
hand-maid of industry and he had proved its value in his studies
of wine, beer, and silk.
A t a farew ell banquet P asteu r addressed those presen t as follow s :
“ G entlem en, I propose a toast : ‘ To the p eacefu l strife of S cien c e .’
I find m yse lf d eep ly im pressed b y tw o propositions. F irs t, th at science
is of no n a tio n a lity ; and secondly, in apparent, but o n ly in app aren t,
contradiction, th at science is the h ig h e st p ersonification of n a tio n a lity .
Science has no n a tio n a lity because kn ow led ge is the p atrim o n y of
h u m an ity, the torch w hich g iv e s lig h t to the world. Science should be the
h igh est personification of n a tio n a lity because, of all the n ation s, th at one
w ill a lw a y s be forem ost w hich sh all be first to p rogress b y the labou rs of
th ough t and of in telligen ce.
“ L e t us therefore strive in the pacific field of science for the p re
em inence of our several countries. L e t us strive , for strife is effort, strife
is life when p rogress is the g o a l.”
Pasteur, the Christian and the Scien tist.
i °3 9
A t the opening of the Pasteur Institute, overcome by his
emotions, Pasteur asked his sDn to read his speech. Addressing
his fellow-workers and pupils he said :
“ K eep yo u r e a rly enthusiasm , dear collaborators, but let it ever be
regu lated b y rigorou s exam ination s and tests. N ever advance any’th in g
w hich cannot be proved in a sim ple and d ecisive fashion.
“ W orship the sp irit of criticism . I f reduced to itself, it is not an
aw akener of ideas or a stim u lan t to great th in gs, but, w ith ou t it, everj-th in g
is f a llib le ; it a lw a y s has the last word. WhaL I am now a s k in g you, and
yo u w ill a sk of yo u r p u p ils later on, is w hat is m ost difficult to an inventor.
“ It is indeed a hard task , when you believe yo u have found an im portant
scientific fact and are fe v e rish ly an xio u s to p u blish it, to constrain
yo u rself for d ays, w eeks, years som etim es, to figh t w ith y o u rself, to tr y
and ruin yo ur own experim ents, and on ly to proclaim yo u r d iscovery after
h a v in g exh austed a ll contrarj’ hypotheses.
“ B u t when after so m an y efforts, yo u have at la st arrived at a cer
ta in ty , yo u r jo y is one of the greatest which can be felt b y a hum an soul,
and the thought th at you w ill have contributed to the honour of you r
coun try renders th at jo y s till deeper.
“ I f science has no country, the scien tist should have one, and ascribe
to it the influence w hich his w orks m ay have in th is world. If I m ig h t be
allow ed, M. le President, to conclude by a p hilosophical rem ark in sp ired b y
yo u r presence in th is Home of W ork, I should sa y th at two con trary law s
seem to be w re stlin g w ith each other n o w a d a y s; the one, a law of blood and
of death, ever im a g in in g new m eans of destruction and forcin g nations to be
co n stan tly read y for the b a ttle fie ld ; the other, a law of peace, w ork and
h ealth, ever e v o lv in g new m eans of d eliverin g m an from the scourges w hich
beset him .
“ The one seeks violen t conquests, the other the re lie f of h u m an ity.
The latter places one hum an life above anjr victory ; w h ile the form er w ould
sacrifice hundreds and thousands of liv e s to the am bition of one. The law
of w h ich w e are the instrum ents seeks, even in the m idst of carnage, to cure
the sanguinarj'- ills of the la w of w a r ; the treatm ent in sp ired b y our
an tisep tic m ethods m ay preserve thousands of soldiers. W hich of those tw o
la w s w ill u ltim a te ly p revail, God alone knows. B u t we m a}' assert th at
Fren ch science w ill have tried, by ob eying the law of H u m an ity, to extend
the fron tiers of L if e .”
On the occasion of the celebration of his seventieth birthday,
Pasteur again refers to science as the harbinger of better things.
Addressing the delegates from foreign nations he said :
“ Y o u n g m en, have confidencc in those pow erful and safe m ethods, of
which we do uot 3*et know all the secrets. A nd , w hatever your career m ay be,
do not iet y o u rselv es become tainted by a deprecatin g and barren sceptic-
1040
is m ; do not let yo u rselves be d iscouraged .by the sadness of certain hours
■which p ass over nations. L iv e in the serene peace of laboratories and
lib ra rie s.
S c i e n c e a n d P a t r i o t i s m .,
T h is devotion to science was always associated with a deep
feeling of patriotism for his country. When he was smitten with
the serious illness that threatened his life in its very prime he said
to his friend, Henri Sainte-Claire Deville : I am sorry to die ; I
want to do much more for m y country. ”
A t the In tern ation al M edical C ongress at Copenhagen he said :
“ B y our presence in th is C ongress, we affirm the n e u trality of science.
: ......Science is of 110 c o u n try ..
but if science h asn o country, the scien tist
m u st keep in m ind a ll th at m ay w o rk tow ards the g lo ry of h is coun try. In
e v e ry great scien tist w ill be found a great patriot. T h e th ough t of ad ding
to the greatn ess of his cou n try su stain s him in his lon g efforts, and throw s
him into the d ifficult but glorious scientific enterp rises w hich b rin g about
real and durable conquests. H u m a n ity then profits by those labors com ing
from variou s d irection s
...”
T he Senate of the French Government has recently well
described Pasteur as the “ Symbol of French Science” . Ambassador
Jusserand, in a Pasteur Centenary address delivered in the United
States, referred to a plebiscite taken some years ago by a French
newspaper.
The question was.; “ Wrho, was the greatest
Frenchman that ever lived ? ” Answers to the number of 2,300,000
came in, 'and Pasteur was acclaimed the greatest, while Napoleon
ranked but seventh in the list. Y et a recent writer has well said :
“ Pasteur belongs not to the biographers, not to the bacteriologists,
not even to adoring France, he belongs to H um anity for all tim e.”
P a s t e u r ’ s P e r s o n a l it y .
Behind the, scientist there was the man, the personalit}7. He
is described as a grave looking man, his face full of quiet energy
and reflective force. W hen Pasteur’ s name came up for election to
the Académie Française, Alexandre Dumas, one of the members,
refused to let Pasteur call on him. “ I will not allow him to come
and see m e,” he said.
“ I will m yself go and thank him for
consenting to become one of u s.”
Pasteur’s pupil, M. R oux,
expressed the attitude of his colleagues when he said : “ T he work
of Pasteur is admirable, it shows his genius, but one must have
lived on terms of intimacy with him to know all the goodness of his
heart.”
10 4 1
Pasteur’ s affection for his wife and children was deep and
abiding. H is was an ideal home, and in his wife he ever found
an ardent and devoted helpmeet in every problem which he
-undertook.
A few quotations from the sayings of Pasteur will best reveal
"the idealism and the high religious motives of the man. W hen he
was attacked on all sides by his opponents he said : “ A man of
science should think of what will be said of him in the following
century, not of the insults or compliments of one d a y .”
W^hen
people spoke of the constant risk of infection which he incurred in
his study of microbic disease, Pasteur’ s answer was : “ L ife in the
midst of danger is the life, the real life, the life of sacrifice, of
•example, of fruitfulness.” H is first words to a student when
.meeting him were always somewhat as follows : “ W ork persever
in g !^ work can be made into a pleasure and alone is profitable to
man, to his city*, to his country.”
H is was no m aterialistic
philosophy. “ T he more I study nature,” he said, “ the more I
stand amazed at the work of the Creator. I pray, while I am
-engaged in m y work in the laboratory.”
And yet he was not afraid to approach the greatest m ysteries
of the universe. It would scarcely be possible to indicate a more
profound distinction between the respective products of living and
of mineral nature than the existence of the dissym m etry among
living beings and its absence in all merely dead matter. It is
strange that not one of the thousands of artificial products of the
laboratory, the number of which is each day growing greater and
greater, should manifest either the power of turning the plane of
polarization or non-superposable dissymmetry. N atural dissym m e
trical substances such as gum, sugar, tartaric and malic acids,
quinine, strychnine, essence of turpentine, and the like, may be
and are employed in forming new compounds which remain
dissymmetrical though they are artificially prepared. It is evident,
however, that all these new products only inherit the original
dissym m etry of the substances from which they are derived. When
chemical action becomes more profound, that is, becomes absolute!}'
analytic or loosening of the original bonds imposed by nature,
all dissym m etry disappears. It never afterward reappears in any
of these successive ulterior products.
“ W hat can be the causes of so grea t a difference? ” W e quote from
P a s te u r’s life b y his son-in-law : “ P asteur often expressed to me the
1042
con viction ,” sa y s M. R adot, “ th at it m u st be attrib u ted to the circum
stances that the m olecu lar forces which operate in the m in eral k in gd o m and
w hich are brough t into p la y eve ry day* in our lab oratory, are forces of the
sym m etrical o rd er; w h ile the forces which are present and activ e at the
m om ent when the grain sprouts, w h en the e g g develops, and w hen under
the influence of the sun the green m atter of the leaves decom poses the
carbonic acid of the air and u tilizes in d iverse way’ s the carbon of th is acid,
the hydrogen of the w ater and the o x y g e n of these two products are of the
d issj'm m etrical order, p ro b ab ly d epending on some of the gran d d is
sym m etrical cosm ic phenom ena of our u n iverse.”
In the mind of Pasteur there was no conflict of science and
religion.
“ There are two men in each one of us : the scien tist, he who starts
w ith a clear field and desires to rise to the k n ow led ge.o f N atu re through
observation, experim en tation and re a s o n in g ; and the m an of sentim ent, the
m an of belief, the m an who m ourns his dead children, and who cannot, alas,
prove th at he w ill see them again , but who believes th at he w ill, and liv e s
in th at hope, the m an who w ill not die lik e a vibrio, but who feels th at
the force that is w ith in him cannot die. T h e two dom ains are d istin ct, and
woe to him who tries to let them tresp ass on each other in the so im perfect
state of hum an know ledge.
“ Th e m ore I know , the m ore n e a rly does m y faith approach th at of
the B reton peasant. Could I but know it a ll m y faith w ould d oubtless
equal even th at of the Breton p easan t w o m an .”
The Infinite was to him everywhere manifest in the laws of
the creation of the universe.
“ H e who proclaim s the existence of the In fin ite, and none can avoid
it, accum ulates in that affirm ation more of the su p ern atu ral than is to be
found in a ll the m iracles of all the re lig io n s ; for the notion of the In fin ite
presents th at double ch aracter th at it forces itself upon us and 3ret is
incom prehensible. W hen th is notion seizes upon our u n d erstan d ing, we
can but k neel. I see everyw h ere the in evitab le exp ression of the In fin ite
in the w o r ld ; th rou gh it, the supern atu ral is at the bottom of ever}" heart.
T h e idea of God is a form of the idea of the In finite. A s lo n g as the
m y ste ry of the In fin ite w eigh s on hum an thought, tem ples w ilj be erected
for the w orship of the In fin ite, w hether God is called B rah m a, A lla h ,
Je h o va h , or J e s u s ; and on the p avem en t of those tem ples, men w ill be seen
k n eelin g , prostrated, ann ih ilated , in the th ough t of the In fin ite .”
And modern Pantheism has never had a greater disciple,
whose life and work set forth the devotion to an ideal— that service
to hum anity is service to God : “ Blessed is he who carries within
himself a God, an ideal, and who obeys it ; ideal of art, ideal of
science, ideal of gospel virtues, therein lie the springs of great
thoughts and great action s; they all reflect light from the
Infinite.”
I043
Hongkong Conference.
3 oin t C o n fe ren ce o f tb e C b in a HDebical
HIMssionarp a s s o c ia t io n anb tbe B r it is h
HDefcical a s s o c ia tio n , Ibongfum g.
PROVISIONAL SCIENTIFIC PROGRAMME.
W ed n esd a y M orning, Jan uary 2 1 st., 1925.
9 .3 0 -10 a.m.
O p e n in g
A d d r e s s : — “ Relation
ships in Medicine between China
the W estern World ” ...
...
and
... Hume.
10 a.m .— 12 .3 0 p.m.
S e c t io n s
on
M e d ic in e ,
P a r a s it o l o g y
and
P u b l i c H e a l t h ..............
Contributors.
Sym p o siu m on H ookw orm :
T h e w ork of the Ch ina H ookworm Com m ission.
G rant.
E p id em io lo g y of hookworm infection in the Soochow
area.
Sto ll, Cort,
Svensson.
E p id em io lo g y of hookw orm in South C h in a ................
Cort, Oldt,
Cadbury.
L e n g th of life experim ents on hookworm larvae. ... Svensson.
H ookw orm th erap y based on the treatm ent of 5,000
........................................... Bercovitz.
cases in H ainan.
...
The p ractical aspects of hookworm , ascaris, and
trieh iu ru s infection as checked b y egg counts. ... Cadbury.
S e c t io n in A n t h r o p o l o g y .
Sym p osiu m on racial characters :
R ep o rt on anthropom etric data of R esearch
Com m ittee of C.M .M .A.
...........................................
A p re lim in a ry a n a ly sis of selected Chinese an
thropom etric data
........................................................
R elatio n of dentition and dental caries to age am ong
the Chinese.
M ethod of cran io m etry.............................................
On the incidence of m enstruation and m enopause....
M easurem ents of the Chinese p e l v i s .............................
S e c t io n i n
Stevenson.
Stevenson.
B lack .
Sh ellsh ear.
Yang.
M iles
Surgery.
In te stin a l obstru ction .............................................................
Treatm en t of g a lls to n e s ........................................................
T h ro m b o -an giitis obliterans
...........................................
T aylor.
D ig b y.
Lud low .
J 04 4
W ed n esd a y A ftern oon
2 — 4 .3 0 p .m .
Contributors
S e c t io n o n M e d i c i n e
C lin ical observations on tu berculosis am ong the
Chinese ...
L im Boon K e n g.
The incidence of tu bercular infection in China
K o rn s.
K n ow led ge of sy p h ilis, e sp e cia lly visce ra l sy p h ilis,
in general m edicine ...
L e a v e ll.
Cerebro-spinal s\Tp h ilis, its p revalen ce'in China and
treatm ent b y cysterne and sp in al route. ...
Pfister.
B rie f summary’ of m ethods of treatm ent of venereal
d isease in the arm}*- w ith a dem onstration of the
app aratus now used. ...
L ew is.
L aboratory dem onstration : controlled W asserm ann
Reaction.
M inett.
U nusual m an ifestations of m alaria
Dobson.
..............................
S e c t io n o n A n t h r o p o l o g y .
Sym p osium on racial characters :
N ew methods of m easu rin g h eigh ts and w eigh ts
...
M cC loy.
A n age-h eigh t-w eigh t stu d y of Cantonese school
boys.
K e y s, C adbury.
P h ysica l exam in ation of students at C hengtu. •
K ilb o rn .
P h ysica l m easurem ents
S h an gh ai and H aw aii.
A ppleton .
of
Chinese children in
...........................................
T h e occipital lobe in the brain of the Chinese.
Sh ellsh ear.
P h ysio lo gical anthropom etry. ....
E arle.
S e c t io n o n E a r , N o s e a n d T h r o a t
B acteriolo gical studies of ear infections
................
D unlap.
T h e problem of tracheo-bronchoscopy and oesopliagoscopy.
M atsui.
R ecent developm ents in bronchoscopy and oesophagoscopy.
.....................................................................
H u a L iu .
M a x illa r y s in u sitis...................................................................
T h ack er-N eville
Presentation of an o to laryn golo gy card (O.P.D.)
T h ack er-N eville
C yto lo gy of m astoid itis w ith dem onstration of slides.
T s ’en
N aso -p h aryn geal grow ths.
Chia.
S e c t io n o n R a d i o l o g y
D em onstration...........................................................................
H arvey.
*Hongkong Conference.
I045
T hursday M orning, Jan u ary 22nd, 1925.
9 * 3 °— io
a .m .
O p e n in g
A d d ress :
Beri-beri.
S ta n to n
i o — 1 2 . 3 0 p .m .
S
e c t io n s
P
on
h y s io l o g y ,
P
h arm aco lo gy
and
Contributors.
M e d ic in e .
.
Recent advance in the p h ysio lo g y of gastric secretion. L im , R .K .S .
The com position of some Chinese d elicacies.............. L iu .
Notes on the a n a ly sis of food of Central China coolies. Pow ell.
Th e pharm acology of M a H u an g .......................................Chen.
Fu rth er experim en ts on the pharm acology and
..............................
... Chen.
clinical uses of ephedrine
E x p e rim e n ts dem onstrating the action of certain
drugs 011 the heart.............................................................. Chu.
C en trifu gal m ethod for the qu an titative determ ina
tion of album in in urine.
...
...
W ong.
Basal m etabolism
...
...
...
...
... E a rle .
S
e c t io n
on
G yn aeco lo gy
and
O b s t e t r ic s .
The new m id w ifery.
...
...
................
K irk .
Prolapse in p regn an cy........................................................... J . P. M axw ell.
Ectopic p regn an cy : the presentation of a recent
series and a stu d y of one case delivered at fu ll term. K w an .
R eport of a case p resenting in terestin g and unusual
indications for C aesarian section. ...
Jam es.
Sm ith.
Caesarian section.
...
...
................
Som e rem arks on the tra in in g of Chinese m idw ives
Jam es.
in our hospitals.
In travenous injection of m ercurochrome in puerperal
sep sis........................................................................................ Branch.
S
e c t io n
on
P
a r a s i t o l o g y ".
Recent aspects of the Clonorchis problem w ith
................
dem onstrations.
...
...
L ife cycle of two new heterophyid flukes occurring
in the Sino-Japanese areas with dem onstrations.
A stu d y of antim ony therapy in schistosom iasis
jap ónica.
................
................
Fau st.
F a u st, Y o k ogaw a.
M eleney, F au st,
W assell.
On two cases of incipien t schistosom iasis japónica
treated in the P.U.M .C.
........................................... Lee.
A n epidem ic of schistosom iasis japónica in the
A n k in g area.......................................................................... T aylor.
C le a rin g of amoebic infections in m am m als b y an
e x clu siv e m ilk diet ' ...
...
...
...
K essel.
S e c t io n o n P u b l i c H e a l t h
School h ygiene. ...
; School h y g ie n e .....................
...........................................
School h ygiene and baby clinic.
School h ygiene and infant w elfare in the W est Indies.
Control of scarlet feve r..........................................................
M ental hygien e. ...
...
...
...
................
Contributors.
Woo.
M iller.
Yen, A tw ater.
M inett, (Mrs.)
L im , C .E .
Ross.
S e c t io n o n O p h th a lm o lo g y
Sym posium on Cataract.
S e c t io n o n R a d i o l o g y
Bronchial spirochetosis in Canton w ith X -ra y
fin d in g s ...................................................................................
Report of tw o y e a r s ’ experience with the C.M .M .A.
X -ra y Unit.
D em onstration. ...
S e c t io n o n S u r g e r y
D em onstration in School of Anatom}-.
Je u , C adbury,
H arve y
B ryan .
Harve\*.
D ig b y.
Thursday A ftern oon .
2 — 4 .3 0 p .m .
S e c t io n o n A n t h r o p o l o g y .
Recent-w ork in the field of prehistoric anth ropology
in China
B lack
H on gk on g and the sea. ...
W illiam s
The origin of the peripheral nervous system
S h ellsh ear
S tu d y of the causes contributing to the d evelop
m ent of the left aortic arch in m am m als and the
rig h t aortic arch in birds
Congdon
S e c t io n s o n M e d ic in e a n d P a t h o l o g y
M elioidosis, a disease of rodents, com m unicable to
m an.
T h e occurrence of beri-beri in p artu rien t women ...
B eri-beri. ...
Q uantities of fluid present in the pleura, pericardium ,
and peritoneum in cases of beri-beri
The p ath o lo g y of filariasis
Case of spleno-m edullary le u k a e m ia ..............................
Blood sedim entation test
S e c t io n o n G y n a e c o l o g y a n d O b s t e t r i c s .
G yn aecological ou t-patient re view
R e v ie w of the w ork of the gyn aecolo gical clinic in
the Canton H o spital for 3 ye ars
..............................
V a g in a l hernia ...
...
s.-:
Stanton
hayney
Pom fret
M inett
Anderson
M orrison
Branch
H eath
W righ t
M iles
S
e c t io n
P
on
Contributors.
a r a s it o l o g y .
Cysticerctis cellu losae in o r b it ...........................................
On a case of trirad iate Taenia solium from North
C h ina.........................................................................................
Tw o new cases of hum an creeping disease (Gnathostom iasis) in China, w ith a note on the presence
of the p arasite Gnathostom a sp in ig eru m in
reservoir hosts
S an d flies and sandfl}- fever in N orth China ...
A p relim in ary check list of the mosqxiitoes of the
Sino-Japanese areas ...
D istin g u ish in g characteristics of the in testin al
protozoa of m an
A p relim in ary report on the incidence of human
intestinal protozoan infections in Seoul ...
A n tirabic treatm ent, dem onstration of N egri bodies.
S
e c t io n o n
P
u b l ic
H
F a u st
M orishita, F a u st
B olt
F a u st
K e ssel
K e ssel
M inett.
A ddison.
In d u strial hygiene.
M aitland.
H ealth and modern in d u stry in China.
M aitland.
D isinfection and disinfestation of troops in the field.
H ingston,
On outline of the h isto ry of Plagu e in H o n g k o n g ....
S eve rn .
D estruction of flies.
M cCloy.
D em onstration of water chlorination....
M inett.
N igh t-soil disposal in C h in a.....................
Pan.
e c t io n o n
S
urgery
S p in al anaesthesia.
S
H ow ard
ealth
A general review of the public health problem s in
H ongkong.
S
10 4 7
...
................
Lee.
Some experiences w ith local anaesthesia.
W righ t.
G unshot wounds—
Thomson.
A stu d y of railw aj* and w ar wounds. ...
R eisell.
Litholopax3*................................................................................
D ig b y.
e c t io n o n
O ph th alm o lo gy
L i.
E x te n s iv e tuberculosis of eye in a baby.
The finding of m ilia ry tubercles in the choroid in
autopsy specim ens.
Lee.
Spontaneous trep h in in g in glaucom a.
H ow ard.
...
T h e value of m ilk injections in the treatm ent of
gonorrheal ophthalm ia......................................................
Sm ith.
1048
Friday M orning, Jan uary 23rd, 1925.
9.30— 10 a.m .
O p e n in g A d d r e s s :
Leprosy
M uir.
10 a.m .— 12 .3 0 p.m.
S
e c t io n s
M
on
e d ic in e ,
P
h arm aco lo gy
and
Contributors.
P u b lic H e a lt h .
L a te st phases of m odern treatm ent of leprosy.
... H eiser.
........................................... Fow ler.
The C h ina L ep er S u rve y .
Some observations on the m odern treatm eut of
le p ro sy .......................................................................................F o w ler.
F u rth e r experim ents w ith the eth yl-esters prepared
from h ydnocarpus oil.
...
...
...
... Read.
The nature of the leueoeytosis caused by the
adm in istration of chaulm oogra oil and its de
riv a tiv e s.
...................................................................... Read.
S
e c t io n
on
A
n th ro po lo gy.
D iscussion on ra cia l standards.
D iscussion on the teach in g
P h ysio lo g y ,
................
S
e c t io n
on
of
A n ato m y
and
O ph th alm o lo gy.
T h e treatm ent of sym blepharon and recurrent
p terygiu m b y H a y 's operation............................................ T h a ck e r-X ev ille.
F u n d u s changes in kala-azar p atients.
................ L in g
A cute retrobu lb ar n eu ritis and a report of four
aty p ic a l cases......................................................................... L a i
Plasm om a of the con ju n ctiva (a p relim in ary report) Soudakoff
A n anom alous duct from the lacrim al glan d
... L in g
A refraction card for the E y e D epartm ent in a
teaching i n s t i t u t i o n ........................................................ T h a ck e r-N e ville
S
e c t io n
on
S
u rgery
.
The incidence of app endicitis am ongst the Chinese. Gibson
R e su lts of the R o ck e y in cisio n ........................................... Thom as
T h e f a lx in g u in a lis am ongst the C hinese
... Osman
S
e c t io n
on
R
a d io l o g y .
D em onstration
...........................................
H arve y
F rid ay A ftern oon , J an u ary 23rd, 1 925 .
2— 3 p.m.
S e c tio n
on
O p h th a lm o lo g y .
Demonstrations
:
(a) Trachom a bodies, (lantern, and m icroscopic
slides) ...................................................................................
(b) E p ith e lia l cells and p arasitic bacteria (lantern,
and m icroscopic slides)
...
...
...
... H ow ard
(c) A n instru m ent of precision for m easu rin g
stereopsis
......................................................................J^ igb y
io 4£
S e c tio n
on
Contributors.
S u rg ery.
D em onstrations in the w ards of the Governm ent
C iv il H o s p i t a l ....................................................... .
... D ig b y
S
e c t io n
on
E
ar
, N
o se
and
T
hroat.
D em onstration : Tem poral bone (slides).
...
...
D unlop
N .B.— A t 3.30 p.m. The conference w ill be thrown open to the:
public who w ill then have an opportunity of in sp ectin g the variou s
e x h ib its and of w itn essin g short dem onstrations of pop u lar interest.
C.iQ .iD .iH . Program m e for IJongkong Conference.
M onday, January 26th , 1925 .
9-9.25. a.m.
9.30-10. a.m.
10 a.m .-12. m.
2-2.30. p.m.
D evotional exercises.
P resid en t’s address.
E v a n g e listic w ork as related to :
(a) H ospitals. Paper b y Dr. J. H . M ontgom ery (Chinchow)
(b) M edical Schools. Paper b y Dr. R . T. Sh ield s (Tsinan).The follow ing lines are suggested for discussion :
1. M ethods in hospitals and schools.
2. Conservation of resu lts obtained.
3. M edico-evangelistic tours.
4. H ow assistance can be got from local churches.
5. Use of literature.
R eports of E x ecu tive , Councils and Stan d in g Com m ittees
(except Council on H ospital Standardization).
Note : R eports w ill all be printed and distributed before
the m eeting and w ill be m erely presented.
D isc u ssio n .
3.30-4. p.m.
5-7 p.m .
R esolutions.
Conference on Leper A dm inistration.
Tuesday, January 27th , 1925.
9 9.25. a.m.
9.30-11.30. a.m.
11.3 0 -12 m.
2-3 p. m.
R eport of Council on H osp ital’ A dm inistration.
The follow ing questions w ill’ be esp ecially dealt w ith :
S alaries of H ospital A ssista n ts. Opened b y Dr. P. J . Todd
Use of hostels as adjuncts to hospitals. Opened by
D r. F . F . Tucker.
In stitu te of H ospital Technology. D iscussion opened b y
D r. G. Hadden.
R esolutions.
H ealth program m e for m ission schools and colleges.
Opened by Dr. E . W. W allace, Secretary, C h ristian
E ducation al A ssociation.
1050
. T h e China M edical Journal.
3-3.30. p. m.
3.30-4. p. in.
9.15. p. in.
H ealth and in d u strial conditions in China. Opened
by
D r. C. T. M aitland.
R esolution s.
Pu blic m eetin g in C ity H all.
“ S id e lig h ts on a cen tu ry of m edical m issions in China,
w ith cinem atograph film s.” Dr. Jam es L . M axw ell.
W edn esday, Jan uary 28th , 1925.
9-9.25 a. m.
9.30-10.30. a. m. C om m unity and C hild H ygien e.
Opened b y Dr.
F. J.
W am pler.
C om m unity and C hild H ygien e. Opened b y Dr. Iv a
M iller.
10 .30 -11.30 a.m. D iscussion on proposed changes in the Constitution.
11.3 0 - 12 . m.
R esolu tions.
2-3. p .m .
'
Continued d isciission on Constitution.
3-4. p. m.
R esolu tion s an d nom inations. . .
5-6. p. 111.
V aled icto ry m eeting.
INSTITUTE OF HOSPITAL TECHNOLOGY
A commencement of the work of this Institute is to be made
with the approval of the Executive Committee at St. James
Hospital, Anking, and in such other sub-centres as it is possible to
begin work in without delaj7. Applications for the training of
hospital Assistants in such branches as laborator}T technique,
pharmacy, and anaesthetics m ay be sent to D r. George Hadden, St.
Jam es Hospital, Anking. D r. Hadden will supply particulars as to
the range of these courses. Communications should be accompanied
b y a stamped envelope for reply.
Note.— T his is merely a prelim inary announcement and fuller
particulars will be issued as soon as possible.
C.M.M.A. PUBLICATION COMMITTEE
The F ifth Edition of the M edical L exicon is. nearly read}'.
It is quite essential that all users of this work possess themselves
of a copy as there are many additions and changes in this edition.
T he first half of Rose and Carless S u rg ery is issued as a
separate volume to meet present needs. The second volume should
be ready this spring.
New editions of T he R o ller Bandage, F irst A id and
Laboratory Experim ents in Physiology have also been issued.
The incorporation of much new matter has delayed the
publication of this volume and of the Lexicon.
Book Review s.
1 051
ÜBooft IReview s.
Facial Surgery.— B y H. P. P ickerill,
c. b. e. , m .d ., m.s., W ith an introduction
by S ir W. A rbuthnot Lane, Bart., c.B., m .s . Price 2 1 / - net. Postage gd.
Publish ers : E . & S. L ivin gsto n e, 17 , T evio t Place, E d in b u rgh , 1924.
D u rin g the great w ar the author w as surgeon-in-charge of the New
Zealand Section, Queen’s H ospital, Sidcu p. To this hospital w ere sent all
th e facial cases w ith loss of tissue from all the B ritish arm ies in the field,
excep t the cases of through and through wounds and fractures of m axillae
which were sent elsewhere. In evitab ly there were ver}' m any severe cases
in which after p rim a ry h ealin g had occurred there were presented consider
ab le difficulties in m ak in g good the lost tissues.
Before the w ar, patients with such destructive injuries, would have
been provided w ith m asks made of m etal to hide the disfigurem ent. These
m ask s were u su a lly s k illfu ll}' constructed and were attached to the face by
Tneans of spectacles, in the case of large loss, or by the use of gum for sm all
m a sk s. T h is method of treatm ent, however, w as not satisfactory. The
p atie n ts were never ve ry h appy w earing w h a t.th e y termed " t i n fa c e s ” ,
.and it was very difficult to preserve the artistic appearance for an y length
o f time. vSurgery more resourceful and ingenious was needed. “ N ecessity
being the m other of invention ” the author and his colleagues w ith so
m an y patients requ irin g treatm ent devised new methods of plastic su rgery
which have proved ve ry successful. There are few cases now, however
exten sive, which are beyond restoration b y pu rely su rgical m easures and
irom the p atien ts’ ow n 'tissu es. In a foreword, the w ell-know n surgeon, S ir
W. A rbuthnot Lane, who had every opportunity d u rin g the w ar of
o b se rv in g the excellen t w ork of the author, states that the new methods
devised and the im provem ents made in the operative procedures for the
rem oval of disfigurem ents of the face and head produced by bullets or h igh
■explosives, were m ost strik in g . The valu e of this su rgical advance is not
■Confined to m ilita ry su rgery. Fresh p ossibilities and new fields are opened
u p for the treatm ent of innocent and m align ant grow ths of the face, lupus,
iicevi, burns, traum atic losses, and congenital and acquired deform ities.
T h e operations for harelip and cleft palate w ill perhaps have to be en tirely
revolutionised. T he principles adopted are also e q u ally suitable for p lastic
operations in v a g in a l, urethral, and vesical surgery.
The num erous illu stratio n s are origin al and m ost of them ve ry im
p re ssiv e. The coloured frontispiece shows four exam ples of grea t loss of
fa c ia l tis s u e ; in each case the loss was satisfacto rily restored subsequently
b}1- su rgical m eans. The book can be cordially commended to a ll surgeons
in China as there are few who are not constan tly called upon to perform
p lastic operations, and the au th or’s work is not on ly a good gu id e but also
a stim u lu s to fu rth er inventiveness.
Methods and Problems of Medical Education.— F irs t series. D iv isio n
of M edical Education.
N ew Y o rk , U .S.A . 1924.
The R o ckefeller Foundation, 6 1 B roadw ay,
Th e p rogress in a ll departm ents of m edicine is so rapid , and the
p ap ers d escribing th is p rogress are so num erous and w id e ly scattered, that
it is difficult to obtain com prehensive know ledge of a n y p articu lar subject.
T h is is esp ecially, true of all that relates to . m edical education. P lan s of
new bu ild in gs, methods of instruction, and experim ents in teach in g are
u s u a lly published in local jou rn als or .in com m em orative volum es so tha
1052
the m aterial is not w id ely dissem inated. To avoid some of these difficultiesthe R o ckefeller Foundation intends to collect and p ublish from tim e to tim e
b rief descriptions of clinics, laboratories and m ethods of teach in g in
different p arts of the world in order that the inform ation in convenient
form m ay be brought to the attention of those m ost interested. The present
w ork constitutes the in itia l effort. There are eigh t articles on m ethods of
teaching anatom y w ith descriptions of laboratories and appar-atus, b y
teachers of anatom y in the U nited States, E n glan d , China, B elgiu m ,
G erm any, Sw itzerland. One article describes the departm ent of p harm a
cology and to xico lo gy in Y a le U n iversity, U .S.A ., another the T h orn d yke
M em orial Lab oratory of the R esearch D epartm ent of the Boston C ity
H o spital ; and there are two articles on the teachin g of obstetrics and
gyn eco lo gy, one b y F.. S . E w e ll of the Boston L y in g -in H o sp ital, and the
other b y J. Preston M axw ell of the P e k in g Union M edical C ollege. T h e
illu stratio n s, co n sistin g of num erous p lans and figures of laboratories, are
excellen t. A ll p h y sician s in C hina engaged in teach in g m edical students,
and those who are p lan n in g to construct m edical educational bu ild in gs or
h ospitals in connection w ith m edical schools, w ill find th is volum e,
e x tre m ely useful.
Ultra-Violet Rays in the Treatment and Cure of Disease.—B y P.
H all, M .R .C .S . (E n g.), l . R . c . p . (Lond.), w ith introductions b y S ir H en ry
G au vain . m .a ., m . d ., m .c . (Camb.) and Leonard E . H ill, m .b . (Lond.)
f .r .s . Price 7 /6 net.
Publishers : W illiam H einem ann (M edical
Books) L td . 1924.
The power of u ltra-violet ra y s, w hether of su n lig h t or artificial ligh t,,
to cure su rg ical tu berculosis and rickets, to hasten the cure of wounds and
to im prove the general health of w e a k ly children has been ab u n d an tly
established. T h e author goes further and describes his successful use of
these ra y s in other m orbid conditions such as rheum atic disorders,
neurasthenia, pulm onary tu berculosis, catarrhal conditions of the re sp ira to ry
tract and various skin diseases. The electric incandescent and arc lig h ts
and other form s of apparatus used, and the technique of ad m inistration,
are c a re fu lly described w ith helpful illustratio n s. The introductions b y
S ir H en ry G au vain and D r. L . E . H ill are interesting. U ndoubtedly in
u ltra-violet radiation there is a valu ab le rem edial power that h elp s to cure
diseases often resistan t to other m ethods of treatm ent, p a rtic u la rly certain
diseases w hich are caused or m ade worse b y dirt and darkn ess. The volum e
is commended to p h ysician s w illin g to try e very scientific m eans for th e
alleviatio n or cure of disease.
Errors o f Accommodation and Refraction of the Eye and their
Treatment. —A H andbook for Students.
Bjr E . C larke, m .d ., f . r . c . s . ,
Price S /6 net. F ifth edition. Pu blish ers : B ailliere, T in d a ll & Cox,,
S, H enrietta Street, Covent G arden, London. 1924.
The first edition of the w ork, based on lectures delivered at tlie Central
London O phthalm ic H ospital and the M edical G raduates College, w as
publish ed tw en ty y e ars ago. F o r th is edition, the fifth, the whole w o rk has
been th o ro u gh ly revised and brought up-to-date. M edical students and
others who w ish to obtain an accurate and thorough know ledge of the errors
of accommodation and refraction and th eir treatm ent w ill find th is volum e
an excellen t guide.
The sériés of illu stra tiv e cases is ve ry in stru ctive.
The subject of E y e stra in still occupies the prom inent place th at is its due.
The g r a v ity of th is condition, and the im portance of correcting it, have been
abundantly shown d u rin g the late w ar in the num ber of soldiers s u ffe rin g
from shell-shock and neurasthenia follow in g head in ju ries. In th e
Book Reviews.
1053
•concluding chapters the vision tests ior the various governm ent services
■are given . The illu stratio n s throughout are num erous and v e ry good. The
■work is e sse n tia lly practical, a ll m atter u nnecessary for the bu sy practitioner
-or over-burdened student being omitted.
A System for Case-taking.—B y C. W. Service, b.a., m.d., c.m.
W est
C hina Union U n iversity, Chengtu, Szechwan. Price : P aper cover,
60 c e n ts ; Cloth cover, $1.0 0. Issu ed b y the U n iversitj" L ib raria n .
P rinters : C. M. M. Press. 1924.
In the w ork of the m edical school with which the author is connected
li-e felt there was great need for a guide in case-taking, convenient and
en su rin g u n ifo rm ity of method. H ence the w ritin g of the present book
w hich it is hoped w ill meet this need and also serve for the instruction of
the students in the use of E n g lish m edical term s. Th e first p art opens
w ith the usual directions for ta k in g the anam nesis. T h is is followed by
interrogations and in vestigation s relatin g to the special system s. The
second p art g ives instructions for the plvysical exam ination of su rgical
cases, and m ethods of case-taking in the various specialties. The author
m u st have spent much tim e and care in com piling this w ork. T yp ograph ical
errors m ay be found here and there, but these w ill be re a d ily pardoned by
a ll w riters who have been at the m ercy of Chinese p rinters. A few
suggestion s are offered for consideration in the preparation of the n e x t
-edition. On page 3 1 the word “ osculation ” should be corrected. Cross
references should be more numerous, and when given the p age should be
stated. A n occasional comment on the frequency or otherw ise of p articu lar
diseases in C hina would perhaps strengthen the stud en ts’ interest and
m em ory. A n in d ex w ould be useful. But as the price of the book is
ex tra o rd in a rily low, perhaps we are ask in g too m uch. The author has
com piled a m ost useful book for m edical students, and we hope it w ill be
w id e ly used and that it w ill soon pass into a second edition.
Lang’s German-English Dictionary of Terms used in Medicine
and the Allied Sciences.—E dited and R evised bj* M ilton K . M eyers,
m.d. T h ird edition enlarged. Price G .$7.00. P u b lish ers: P. B la k isto n ’ s
Son & Co., 10 12 W alnut St. Philadelphia, U. S. A .
T h is well-know n d ictionary is intended to be a com plete g lo ssa ry of
'Germ an m edical words in common use. It contains also a large num ber of
term s em ployed in the an c illa ry sciences, p articu la rly chem istry, biology
and p athology. Special care has been taken in the rendering of those
diseases, sjanptom s etc., to which in the Germ an lan gu age personal nam es
are applied. In the present edition, 4,000 new term s have been incorporated,
so that the volum e now contains app ro xim ately 53,000 definitions. P h y s i
c ian s and m edical students w ith a w o rkin g know ledge of Germ an, those
w ho are learn in g the lan gu age, and readers who w ish for a translation of
th e Germ an term s frequ en tly met w ith in E n g lish m edical literatu re, w ill
a ll find th is dictionary v e ry helpful. The definitions are accurate, and
adequate for all practical purposes.
The Theory and Practice of the Steinach Operation.— W ith a R eport
on one H undred Cases. B y Dr. Peter Schm idt (Berlin), and an
introduction to the E n g lish edition by J. J . A braham , c.b.e., d .s.o .,
m.d., (Dub.), F.R .c.s., (Eng.), Price 7/6 net. Publish ers : W illiam
H einem ann (Medical Books) Ltd. 20, Bedford Street, London.
In the Steinach operation of vasectom y the vas deferens is ligated in
tw o plnces from one-lialf to three-quarters of iin inch apart, r-nd the portion
between is then excised. It is claimed that by d im m in g back the
1054
The China M edical journal.
sperm atic fluid, w hich is the object of the operation, the in te rstitia l o r
L e y d ig ’s cells are increased, and there is a greater production of th e ir
p articu lar hormone w hich affects beneficially the secretions of other
endocrine glan d s, w ith the resu lt th at in selected cases the im provem ent
in the p atie n t’s condition is so m arked as ju s t ify ca llin g it phj^sical and
m ental rejuven ation.
There has been m uch acrim onious controversy over the procedure, the
objections to it being theoretical, sociological, religio u s and p sych ological.
The purpose of the author is to e xp lain the theory and p ractice of the
operation and in defence to describe some of the resu lts achieved. The
clin ical records of cases subm itted to operation w ill be, to m any, the ch ief
interest of the book, w hich la y s down c learly the indications and contra-'
indications for intervention in conditions not hitherto considered am enable
to th is treatm ent. It has a w ide range, but the operation seem s to be m ost
successful in cases of prem ature old age associated w ith s lig h t m ental
depression. P h ysician s and surgeons interested in the m an y questions
raised b y experim en tal and operative w ork of th is k in d w ill find th is
volum e ver}^ useful. T h e subject is dealt w ith scien tifically and in a m anner
above adverse professional criticism .
JOURNALS AND PAMPHLETS.
The Prevention, Diagnosis and Modern Treatment of Leprosy.—
B y H en ry Fow ler, m .d ., l . r . c . p . and s. etc. P u blish ed b y the Council
on H ealth Education , 23, Y u en M in g Y uen Road, Sh an gh ai.
A clear, concise description in the Chinese la n gu age of the im portan t
facts re la tin g to lep ro sy and of the m odern treatm ent of the disease b y
m eans of chaulm oogra oil, hydnocarpus oil, and th eir eth yl esters. A ll
Chinese doctors w ill find this m onograph in its convenient form v e ry
useful, and it m ay be safety put into the hands of in te llig e n t sufferers from
the disease to induce them to place them selves under the care of p h y sic ian s
who are u sin g this treatm ent w ith such successful results.
The Radiological Review.—A B i-m on thly Jo u rn a l D evoted to the P ro
gress of X -ra y and R ad iu m as it relates to the p ra ctisin g P h y sic ia n
and D entist. Subscription, $ 1.5 0 per annum . Pu blish ed by the
R ad iolo gical R e v ie w P u b lish in g Co., Q uincy, 111., U. S. A.
T h is is a new journal devoted e n tirely to the progress of rad io lo gy
and edited esp ecially fo r,th e general p ractitioner and variou s sp ecialists,
other than rad io logists, who are interested in k ee p in g up w ith the progress
of this im portant science. E ach num ber w ill consist of one or two o rigin a l
articles together w ith excerp ts and e x tra cts from a ll im portant articles on
rad io lo gy in the lead in g m edical jou rnals.
The Siam Outlook.—Publish ed q u arterly in the interests of M issio n ary
En d eavor in the K in gd om of Siam .
Th e October num ber contains an in terestin g description of the m edical
and evan gelistic w ork am ong the lepers in S iam . It has several good
illustratio n s.
Tsinan Medical Review.—V ol. 4, No. 4, October, 1924.
P u b lish ed b y the
M edical D epartm ent of the Sh an tu n g C h ristian U n iversity, T sinanfu .
The present issu e of th is excellen t p eriodical for Chinese doctors,
published in th eir own lan gu age, contains the u su al num ber of h elp fu l
articles m ain ly concerned w ith the practical treatm ent of disease. A ll
Chinese doctors should certain ly subscribe to th is R eview .
Correspondence,
Gorresponfcence.
Correspondents are requested to w rite on one side of the paper only,
and alw ays to send their real nam es and addresses. The J o u r n a l does
not hold its e lf respon sible for the opinions or assertions of correspondents.
Lacquer D erm a titis
In the B ritish Mcdical Journal,
June 2 1 st, 19 24 , there is the
following letter from Caroline
L ittle, m . b ., B . c h . of the W esle
yan Mission, L io Y an g Hsien,
Hunan.
S i r , — L iv in g as I do in one of
the centres of the Chinese lacquer
in d u stry, your note on M ali Jo n g g
(March 15th , 1924, p.506) is of con
siderable interest.
The famous
N ingpo varn ish — the sap of R h u s
vern icifera, used in lacquerin g
boxes, tea-poys, and variou s orna
m ents is a potent source of trouble to
foreigners here. It is also frequently
used as an ex tra fine varnish for
the floors, w indow s, and woodwork
of our houses, and as a ru le we view
it w ith considerable disfavour in its
damp condition, as even a sm all
sm ear of the varn ish 011 the skin
causes w ithin tw en ty four hours an
intense erythem a, itching, and final
l y oedema and vesiculation. U ntil a
considerable tim e has elapsed after
its application it is unsafe to use it,
or to come into close contact with
the varn ished object. M y latest
p atien t—a foreigner— is a good e x
am ple of this. H is desk had been
re varnished, and after some days,
when the surface w as app aren tly
d ry, he began to use it again. It
w as not lon g before h is righ t w rist,
where it rested a gain st the surface
of the desk, became red and itching.
T h e erythem a spread and the affected
area became in ten sely oedematous,
and then v e s ic u la r; fin a lly bullae
appeared. There w as intense itch
in g and some pain. Of all the
various rem edies sodium hypophosphate (1 in 8) and black-w ash seemed
to g iv e m ost relief. The bullae
g ra d u a lly dried up, the erythem a
and oedema lessened, and itch in g
sto p p ed ; and now, about three w eeks
later, there is on ly a large patch of
desquam ation to rem ind the sufferer
of his discom fort.
Im m unity' is acquired. The ap
prentices when first introduced to
the varnish p ra ctic a lly a ll react in
a fashion sim ila r to th at above de
scribed, though u su a l!}’ to a lesser
degree ; as the d ays p ass the irrita
tion d im inishes. If, how ever, th ey
cease to w ork w ith it for, say, a
month, and then resum e w ork, there
is a sligh t reaction of the sk in , p ass
in g off in a few days. A few people
are n a tu ra lly im m une, but I rather
th in k it is a question of liv in g in an
atm osphere of varn ish , for the w ife
of one of our chief lacquer w orkers
tells me that the lacquer varn ish
has no effect on her or her children.
To appreciate the degree of im
m un ity acquired one has on ly to
watch the varn ishers at w ork. The
lacquer is applied w ith a s ilk ra g
rolled up in the hand after being
squeezed out of the s tic k y m ass.
The local treatm ent here for lacquer
d erm atitis is “ tea o i l ” — the oil
expressed from the seed of Thea
sa sa n q u a ; it certain ly relieves the
irritation. The lacquer w orkers also
use it e very even in g w hen th eir
w ork is done to rem ove e very trace
of the varn ish from their hands and
arm s.
E x c ep t to those ve ry h ig h ly
susceptible, exposure of the lacquer
boxes to the air for a w eek or two
rem oves danger of derm atitis. The
exported boxes have p rob ab ly been
packed as soon as the su rface was
dry and had not been su fficiently
exposed to the a ir to allow of the
slow absorption of o x y g en to tak e
place, which, by the best authorities,
is attributed to an obscure chem ical
reaction depending on the presence
of a compound of m anganese w ith a
p rotein-like substance.
C aro lin e
L i t t l e , m . b ., b . c h .
** *In the Transactions of the F ift h
B ie n n ia l C ongress (1923), of the
1056
F a r E astern A ssociation of T ro p ical
M edicine, there is a paper by Pro
fessor T oyam a on “ L acqu er D er
m atitis ” , w hich g iv e s the resu lts
of his in vestigatio n s of the lacquers
used in the F a r E ast. Jap an ese
lacquer, the best, is obtained from the
sap of R h u s ■vernicifera. In its fresh
state the sap is m ilk y w hite,but turns
b lack if exposed to the air ow in g to
spontaneous oxidatio n b y the action
of an oxyd ase called laccase. T h is
laccase is not poisonous, but the sap
contains another substance, know n
a s “ u rish io l” ,which seem s to produce
a poisonous action as the resu lt of
oxidation when acted upon either
b y laccase or by other oxyd ases
contained in the sk in .
A s so
m inute a q u an tity as 0.0000015 gr. of
u rishiol d issolved in one drop of
oil can produce a distinct in flammation of the sk in , persons m ay be
affected w ithout direct contact w ith
the lacquer tree or lacquer, as the
lacquer sap can be scattered b y the
w ind, or more lik e ly b y dust or
insects. U rishiol has been isolated
from the lacquer tree of China,
which is closely related to, if not
identical w ith, R h u s vern icifera .
A s lon g ago as the seventh century,
A . D. lacquer d erm atitis w as de
scribed in the m edical books of
China.— Ed.
3 n flßem ortam .
A t G lendale, C alifornia, on Su n d ay, Septem ber, 14th , 1924, D r. H en ry
T . W hitney, after a short illn ess passed into the eternal and fu ller life.
In 1877, Dr. W h itney came to China w ith his w ife for w ork in
connection with the A m erican Board M ission, and w ent as the first m edical
m ission ary to the Shaow u field. A fter the death of Dr. Osgood in 1S80,
D r. W h itn ey saw through the press a translation m ade b y him of G r a y ’s
A natom y. H e continued his w ork in the Foochow H ospital at Ponasang,
and for tw elve years d ivided his tim e between Foochow and Shaow u. I11
1893 he went to Pagoda A nch orage to live, and w h ile sh arin g the evan ge
lis tic w ork of the station, m ade a new translation of G r a y ’s A natom y,
publish ed a p h ysio lo g y in Chinese, Foochow dialect, for the use of the d ay
schools, also a m edical vo cab u lary in Chinese and E n g lish , and had a d a ily
clin ic. D u rin g the years 1897-1898 he w as President of the C h ina M edical
M issio n ary A ssociation. In 1908 he m oved to Y u n g-fu h , a station in need
•of a m edical m ission ary, where he b u ilt a residence and refitted a Chinese
house for a hospital. H e rem ained there u n til his return to the U .S .A . in
19 19 , after 42 years of faith fu l service in China. N ear the close of th is
period his e yesig h t failed, and his w ife and friends read aloud to him.
On his return to C alifornia successful operations on both eyes restored his
e yesig h t and com fort in reading, a rem inder of the glad and sacred prom ise,
“ A t even in g tim e it shall be lig h t .”
M rs. W h itn ey passed a w a y two years earlier than her husband to the
h eaven ly home. T h eir children, Joh n, M ary, and H enry, w ith th eir
fam ilies, are a ll liv in g in C aliforn ia. W h ile we mourn w ith them we can
also rejoice for the departed, th at he could sa y w ith the A postle P aul, “ I
h ave fough t a good fight, I have finished m y course, I have k ep t the faith .
H enceforth there is laid up for me a crown of righ teousn ess w hich the Lord,
the righteous ju dge, sh all g iv e me in that d a y .”
(R ev.) G . H . H u b b a r d .
News and Comment.
NEWS
S o u th
H o s p ita l,
AND
COMMENT.
S h an gh ai. Several la rg e g ifts have
j alread y been prom ised to the fund.
M a n c h u r ia
R a ilw a y
D a i r e n . — R ecogn isin g
{
the need for a new and modern
p lant, • su fficien tly large to accom
m odate the service of the com
m u n ity for some tim e to come, and
sufficien tly equipped for the most
e x a c tin g scientist, the S. M. R a ilw a y
officials h ave decided to erect a new
hospital. The two m ain bu ild ings
of this project are now risin g 011
a beautiful site not fa r from the
geograph ical center of the city.
The m ain structure w ill house 400
beds, and the isolation unit, 150.
The bu ild in g costs alone
are
estim ated at seven m illion yen, and
the equipm ent at Yen 450,000.— 1
P. U. M. C. B u lle tin .
\
_
_
“ B y -P ro d u c ts”
of
M is s io n a r y W o r k .— A t
T°57
j
M e d ic a l j
J apanese
H o spital :
E arthquake
The
decision
hospital
in
app roxim ately
in
to
Yen
r e lie f
A m erica
for
F u n d .—
b u ild
H on jo,
earth quake
A m er ic a n
R elief
la r g e
Tokyo,
fro m
7,000,000
of t h e
fun d
th e
a
subscribed
A m erican
Red
C r o s s w o r k a y e a r ago , w a s re a ch e d
r e c e n t l y b y t h e c o m m i t t e e in c h a r g e
of
th e fu n d ,
c o n s tru c tio n
w ould
be
petuating
Am ericans
w hich
a g r e e d th a t the
of s u c h
th e
the
best
spirit
came
to
be a
institution
way
in
per
the
T h e bu ild in g
th re e -s to re }'
rein fo rce d
concre te stru ctu re , the site
a pp roxim ately
of
w hich
to t h e r e l i e f of t h e
e a r th q u a k e suffere rs.
is
an
four
coverin g
acre s.
The
a public j e s t i m a t e d c o s t of t h e b u i l d i n g i s
m eeting held recen tly in London, j
Y e n 3,000,000.
T h e m e m b e r s of th e
Dr. P. Cochrane, for tw enty-five j c o m m i t t e e d e s i r e to m a k e i t t h e
vears a m edical m ission ary in j b i g g e s t a n d t h e m o s t p e r f e c t l y
C h ina and form erly Principal of j e q u i p p e d in t h e F a r E a s t . T h e
e x p e n s e of m a i n t a i n i n g t h e h o s p
Union M edical College, P ekin g,
w as the princip al speaker, his
i t a l is to be m e t b y t h e i n t e r e s t on
subject being, “ Products and B y
t h e Y e n 4,000,000 r e m a i n i n g of t h e
fu n d , w h ic h , it is p la n n e d w ill be
products of M ission ary W o rk .”
l e n t to t h e c i t y o f T o k y o .
Accord
Dr. Cochrane showed that m ak in g
i n g to t h e
a u th o r itie s
concerned,
C h ristian s of the heathen was a
the
hospital w ill
have
beds
for
product of the bj-p rod u cts. M ainly,
the
w ork of m edical m issions j m o r e t h a n 250 p a t i e n t s , a n d m o r e
t h a n 500 o t h e r s c a n b e t r e a t e d a
included the producing of a national
day.
Indigent
patients
w ill
be
h ealth conscience, and the hum an
g i v e n free tr e atm e n t.
T h e tem por
isin g of scientific work, besides
a r y b u i l d i n g fo r th e h o s p i ta l w o r k
creatin g a native m edical profession.
w ill be c o m p le te d b y M a r c h , 1 9 2 5 .
T hese w orks had opened the door
T h e p e r m a n e n t s t r u c t u r e c a n n o t be
in China, and it w as now ready for
f i n i s h e d b e f o r e 1 9 2 6 . — Ja p a n M edical
a great evan gelistic
cam paign,
World, O c t o b e r , 1 9 2 4 .
w hich, he contended, was the real
w o rk of the m ission ary societies at
th is juncture. T h e y m ust convert
O b lite r a tio n o f T a tt o o M a r k s .
the people, found churches, and leave
— In the Out Patient D epartm ent
the natives to run them.
we have seen the effects of the w ar
in the num bers of men who came
in w ith terrible burns on th eir arm s
T h e N ational M edical Association
caused by the strong n itric acid or
of China is celebrating its tenth
w ash in g soda solution w ith w hich
an n iversary. The occasion is being
th ey had tried to take tattoo m ark s
em phasized b y a cam paign to raise
off, th in k in g that the police would
$100,000 for a perm anent head
arrest all tattooed m en. W e had
quarters of the A ssociation in
tw en ty or th irt}’ such cases in a day,
and as m ost of them had tried their
own treatm ent first, there were some
v e ry bad infections.— St. L u k e ’s
H osp ital, Sh an gh ai.
W hat H appened ?
F o r the false
practice of m edicine, a Chinese w as
fined $50 or g iven the altern ative
of three w e e k s’ im prisonm ent in 'the
M ixed Court, S h an gh ai. T h é defen
dant w as p ra ctisin g h is bogus
su rg e ry on the arm of a m an who
w ished to lose his tattoo m arks.
S urgery
for
tw o
c e n t s .—
C iv ilia n s a s-w e ll as soldiers w ere
am ong the p atients the w ar sent us.
One poor farm er had been ru n n in g
a w a y from the press g a n g when he
fell and cut his knee. H e got avv'ay
from the soldiers, but fell into the
hands of a C hinese doctor who
sewed his knee up far two cents.
W hen the m an reached the hospital
a few d ays later infection had set in
w hich caused his death sh ortly
afterw ard s.— S t. L u k e ’s H ospital,
S hangh ai.
M e d i c a l W o r k i n ' C s in a .— Old
M rs. C h ’en w as an ardent B uddh ist
and v e ry anti-foreign.
But a
ch an ge came over her. “ Y e s ,” she
said , c ra c k in g a Water-melon seed
s k ilfu ll}’ , " I w ent to P e k in g to
h ave m y sick n ess cut out. Y ou had
heard I had a sickn ess ? ” I shook
to y head. “ Oh y e s, a terrible
sickn ess. I t g re w in me as big as
th a t.” She m easured off about a
foot of space. “ M y husband b ein g
d ead ,” she w ent on. “ I asked his
n e x t brother, who is the head of the
fa m ily now, if I m ig h t go to P e k in g
to have it cut out. Y o u see, I had
taken m edicine from e v e ry doctor
in town, oh, the v e ry best m edicine ;
centipede heads even, and the m ilk
of a yo u n g m other w ith her first
child, and all to no a va il. M y sou
came home from P e k in g U n iv ersity
then, and he said the foreign ers
could cut it out so that I should be
quite w ell. Y o u can im agine how
a fia id I w as. I would not even hear
of it, u ntil 1 began to see that it
w ould be either m y sickn ess or m y
life, and m y son said he w ould
stand beside me and prom ised that
he w ould let them take noth ing from
me except the sickn ess. F o r you
know , it is said the foreigners w ish
for our hearts to m ake m e d ic in e ;
althou gh 1 no lon ger w h o lly believe
that now. W ell, the head of the
fa m ily refused to let m e go. H e
said it w as better to die respect
a b ly than go to a foreign devil. I
ju st w aited un til he w as ill one
tim e With his opium , and 1 w ent
w ith m3’ son secretly. Such a
w hite, w hite place, the h o s p ita l!
A n d I slept p eacefu lly throughout
the cu ttin g, and kn ew no th in g m ore
u n til I found m yself in a bed lik e
snow for w hiteness, with the sic k
ness beside me on the table in a
bottle. I brought it home and here
it is .” A n d there it tr u ly w as, in
the place of honour between the
jad e urn and the can d lestick s, a
large bottle of alcohol with a
g h a stly , red-veined tum our w ith in .
B u t m eanw hile, old M rs C h ’en is
quite reconciled to foreign ers. T h e
operation w as evid e n tly the event
of her life and people come from
far and near to see the m arvel of a
sickn ess sa fe ly im prisoned in a
bottle. S h e has become fam ou s,
and reign s in conscious d istinction
am ong her tow nspeople.— Pearl S .
B u ck ,
In te rn a l.
R e v . M issions,
October, 1924.
M e d ic a l
E d ucation
in
U n it ed
D u rin g the la st tw entyfour y e ars, m edical education in
the U nited States has been e x te n
s iv e ly im proved, so th at grad u ates
now obtain a m edical tra in in g in
accordance w ith the g re a tly e n larg
ed present-day know ledge of m edi
cine. A la rg e o v ersu p p ly of m edical
schools, in clu d in g m an y w hich w ere
of low ty p e, has been rep laced b y
h a lf as m an y g re a tly im proved,
W ell-equipped
in stitu tio n s.
The
num ber of m edical students was
reduced from 28,142 in 1904 to1
12,930 in 19 19 , but the num ber in
th e better equipped colleges Was'
S t a t e s .—
News and Comment.
increased from 4 pel cent to 88 per
cent. Since 19x9, also, these better
trained students have been increas
in g at the rate of more than a
thousand each year, the total enrol
m ent th is year being 17,728, of
whom 95 per cent are in C lass A
m edical schools. D u rin g the twentyfour 5-ears, the num ber of graduates
from m edical schools has decreased
from 5,747 in 1904, of whom only
369 were from the better colleges,
to 2,656 in 19 19 , of whom 94 per
cent were from the better equipped
in stitu tio n s. Since 19 19 , w ith the
excep tion of the w ar class wThich
grad uated in 1922, the num bers
g ra d u a tin g each year have been
ra p id ly in creasin g. T h is year there
were 3,562 grad uates, of whom 94
per cent were from the better
equipped colleges.
A bio grap h y of the late R ev. Dr.
W enyon, the first W esleyan m edical
m issio n a ry to China, is being pre
pared by his fam ily . Dr. C. M oriey
W enyon,
C.M .G., 1 1 ,
ChandosStreet, Cavendish-square, London,
w ill be glad to receive personal
in ciden ts or letters.
A m ural tablet to the m em ory of
Dr. G. D uncan W h yte w as unveiled
and dedicated on N ovem ber 23 1924,
a t R egent-square 'Ch,ureh, London
(Rev. Ivo r J. Roberton, D.D .). In
the church m agazine for November.
D r. Roberton w rites : “ T h is stirs
m an y thoughts and feelin gs, and
not least it prepares w ith a deep
significance for our w eek of prajêr,
th a n k sg iv in g and self-denial for
foreign m issio n s.'1
C h in g ta o
M e d ic a l
S c h o o l.—
T h e M edical School of the Chingtao
H ospital, Ch ingtao, g ave an opening
ceremoii3r recen tly, attended by
m a n y prom inent Japan ese and
C h inese officials. The School has
been erected b y the Japan ese
governm ent as one of Ja p a n ’s
■enterprises for the education of
C h in ese students. The s ch o o l offers
a four y e a r s ’ course of medicine
a n d adm its h igh school graduates.
1059
The ord inary expen ses for the
m aintenance of the school are to be
covered p a rtly by the profit of the
hospital above m entioned,
and
parti}7 by the subsid}- given b y
the Japan ese governm ent, which
am ounts
to
Yen
140,000
per
M edical
W orld.
annum .— Ja p a n
October, 1924.
D eath
R ate F rom T u b er cu lo sis
Th e death-rate from
tuberculosis in Ja p a n is greater
than from a n y other disease, b eing
16 per 10,000 population. The rate
am ong Jap an ese residents in M an
churia is three tim es as large, being
48 per 10,000. T h is is due to the
peculiar clim atic conditions in the
territory. On the m ain islan d ,
T o kyo heads the list, the rate being30 per 10,000. N ex t comes O saka
w ith 2 3 ; and K y o to w ith 28 per
10,000. In the country, deaths from
tuberculosis are far less than in the
cities, the prefecture of Iw ate
h a vin g the low est record in Ja p a n ,
with only 7 per to,000.— Ja p a n
M edical W orld, October 24, 1924.
in
J apan.
Ja p a n e se M e d ic a l I n s t i t u t e in
C h i n a . — A s a cultural w ork to be
carried out in China, the D ep art
m ents for F o reign A ffa irs and for
Education have alread y decided to
establish an In stitu te for N atu ral
Science in S h an gh ai, China, at an
approxim ate cost of Y en 2,000,000.
The research w ork in the in stitu te
w ill cover several branches of (1)
pathology, anatom y, bacteriology,
parasitolog}’ , serology, and Chinese
ph arm aco lo gy; and (2) p h ysics,
ch em istry, geology, zoology and
botany. The design of the bu ild
in g s has been m ade by Prof.
Uchida, of the E n g in ee rin g D epart
m ent 111 the T o kyo
Im p erial
U n iv ersity, and the construction
w ill be com pleted in three years.
A s ord in ary expend itu re,
Yen
500,000 is allow ed y e a r ly to the
institu te. It is expected th at some
considerable m edical w ork and
special research in C hina w ill be
carried out in the near future.—
Ja p a n M edical W orld, October 15,
1924,
1 060
Ube Cbina flDefctcal Jou rn al
Published by
The China M edical M issionary Association.
E D IT O R — Edward M. Merrins, M.D.
St. John’s University. Office address,
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Medical papers and
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Shanghai.
TREA SU RER
AND
E X E C U T IV E
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