C. E. van Rooyen

OBSERVATIONS ON INFECTION BY PLASMODIUM KNOWLESI (APE MALARIA) IN THE TREATMENT OF GENERAL PARALYSIS OF THE INSANE.

This investigation was directed towards overcoming certain well-known difficulties associated with the induction of benign tertian malaria for the treatment of general paralysis of the insane. The principal disadvantages of the existing method may be summarized as follows. The average clinician resident in cool climates is frequently unable to obtain a specimen of infected blood at very short notice, and much valuable time may thereby be lost in commencing the treatment of an early case. Yet again, when blood has been obtained there is a temptation to seize the opportunity of treating several other cases resident in the district by the transference of blood from one patient to another, a procedure which is only three human volunteers in India. We have investigated the practical applicability of substituting this type of parasite for Plasmbdium vivax in the treatment of G.P.I., and the following cases illustrate the application of this form of infection in the treatment of the disease. Clinical notes concerning the course of ape malaria occurring in man, the action of certain antimalarial remedies on this type of infection, and various experimental data are also incorporated. The work has been carried out with a strain of parasite originally obtained from the Malaria Survey of India, and which was supplied to us by the courtesy of Sir Rickard Christophers of London, to whom we owe our thanks.

A Laboratory Test for Diagnosis of Smallpox.

Experience of over 100 cases of smallpox studied in the Middle East has convinced us that a diagnofiAs of variola on the first and second day of the rash is often extremely difficult and that the differentiation of mild smallpox from varicella may be impossible throughout its course. The purpose of this paper is to describe the clinical application of a laboratory test which has helped us greatly in establishing the identity of variola in the first day or two. The test is based on certain points of distinction between the elementary bodies of variola and varicella found in the skin lesions of these diseases.

A BIOLOGICAL TEST IN THE DIAGNOSIS OF HODGKIN'S DISEASE

became far more definite and constant this was adopted as the standard procedure. In the case of mice the dose was 0.05 c.cm., as more than that cannot safely be injected. The result of these observations is summarized in the preceding table. It will be observed that none of the broth suspensions of the six control glands gave evidence of any pathogenic action when administered by the cerebral route except No. 6-the tuberculous gland which killed both of two guinea-pigs from tuberculous meningitis, with generalization evident post mortem in the cervical lymph glands and spleen. On the other hand, the broth suspensions of all the six lymphadenoma glands gave typical positive results in the rabbits, and five of them produced as well a fatal disease in the guinea-pig, chiefly characterized by pareses, occasional rigidity of the muscles of the back, and by progressive weakness and loss of weight. The clinical picture of the disease thus produced in guineapigs by intracerebral injection of suspensions of lymphadenoma glands, however, is far less striking and obvious than in the rabbits. Post mortem, several of these guinea-pigs showed some congestion of their subcutaneous tissues and slight but definite congestion and enlargement of their lymphatic glands in the axillae and groin. Bacteria were absent from their meningeal fluid and from their blood. Sections of the brains, however, of some of these guinea-pigs have shown the presence of lymphocytic exudate and some thickening of the meninges; and a few of the vessels in the cortex occasionally show a cuff of lymphocytes. There would seem to be little doubt, therefore, that suspensions in broth of lymphadenoma gland where injected intracerebrally can give rise to meningoencephalitis in the guinea-p.g as well as in the rabbit. With one exception, the broth suspensions of the glands used in these experiments had been allowed to macerate in the refrigerator for one to two weeks before injection. The exception was Case No. 9, in which the only broth suspension of gland available was a hundred days old. It is interesting to note that, while this old suspension was still active for the rabbit, it failed to affect the guineapig. Throughout these experiments the mice, of which four to six were injected with each of the suspensions, remained unaffected.

RELATIONSHIP OF JOCHMANN’S AND OTHER ENZYMES TO THE ENCEPHALITOGENIC AGENT IN LYMPHADENOMATOUS LYMPHATIC GLANDS

There are cases both of the inflammatory and of the degenerative types in which a spasmodic element may be so definite as to lead to difficulty in an accurate diagnosis, and in eventualities of this kind the tests which. I have mentioned are of such value that I think it is obligatory to employ one or other of them before assuming that we can afford these cases some measure of relief by procedures designed to secure vaso-dilatation. Treatment, apart from amputation, is frankly discouraging. Vaso-dilators of a chemical nature, such as muscle extract, peptone,. and acetylcholine, have but a temporary value, and that only when the spasmodic clement exists. The alternate suction and pressure treatment of Landis and Gibbon has not been employed in this country to any extent so far as I am aware, but promising results have been claimed by these authors in cases of thrombo-angiitis. Sympathectomy, which at one time appeared to offer a solutioin, has failed to yield the results which were hoped for. I do not say that it is valueless-by no means; it increases the degree of comfort, it lessens the pain, and it probably delays the onset of skin ulceration and gangrene-but it cannot be said to have any permanent effect upon the progress of the disease. And when we consider the pathology which underlies these lesions it could not very well be otherwise, for the vasospasm which sympathectomy relieves is but an incidental and often a minor part of the pathological picture.

RECENT EXPERIMENTAL WORK ON THE AETIOLOGY OF HODGKIN'S DISEASE.

BIBLIOGRAPHY Adams, B.: The Medical Officer, 1928, xxxix, 185 Begbie, R. S., and Gibson, H. J.: British Medical Journal, 1930, ii, 55. Fleming, G. W. T. H.: Ibid., 1933, i, 412. Gray, J. D. A.: Ibid., 1929, i, 142. Houston, A. C.: Metropolitan WNrater Board, Twenty-third Annual Report, 1928; Twenty-fourth Annual Report, 1929 ; Twentyfifth Annual Report, 1930; Twenty-sixth Annual Report, 1931. Stewart, A. D., and Ghosal, S. C.: Indian joburnz. Med. Research, 1932-3, xx, 34 1. Wilson, W. J., and Blair, E. M. ,cV.: Joltrn. of Hyg., 1927, xxvi, 374; ibid., 1931, xxxi, 139. Wilson, W. J.: Britishi Medical journal, 1928, i, 1061. Annual Report of the Chief MIedical Officer, iinistry of Health, 1930 and 1931.