Showing papers in "The Medical Journal of Australia in 1948"

Toxaemias of pregnancy.

Abstract: MODERN TRENDS IN DISEASES OF THE EAR, NOSE AND THROAT Edited by MAXWELL P. ELLIS, M.D., M.S., F.R.C.S. Pp. ix + 471, with i40 illustrations. London: Butterworth & Co., Ltd. 1954. 65s. This is a first-class book. It should prove valuable to post-graduates and specialists both for examination purposes and for everyday practice. Each section has been written by a man whose main interest is in that particular subject, and all chapters make very interesting reading. It is a book which should be recommended both for the individual and for the reference library. The volume has been well produced and the price is reasonable for the contents.

The regulation of body temperature.

Abstract: S FROM セ i e d i c a l LITERATURERadiology 240 Physical Therapy 241 MEDICO-LEGALHocking versusBell 242 BRITISH MEDICAL ASSOCIATION NEWSScientific 244 NAVAL, セ i Q l i t a r y AND AIR FORCEAppointments 245 THE REGULATION OF BODY TEMPERATURE.'

Immunity in tuberculosis.

Abstract: In this review various aspects of tuberculo-immunity and of the pathogenesis and diagnosis of tuberculosis (TB) are examined in the light of current immunological knowledge. Successful resistance in TB is not easily predicted by the presence or absence of an immune response but it is a balance between the various types of immune responses of the host and the strength of the infecting bacterial strain for that individual host. Primary infection is usually acquired through the inhalation of infected droplets; the probability of the development of disease among TB-positive individuals varies from 30/100000 in Denmark to 600/100000 in some Eskimo populations. Even if TB were eradicated however sporadic cases would continue to occur since for TB acquired from the environment control would necessitate lowering the rate of infection in bird and animal groups. 4 groups of TB patients include: 1) those in which cell-mediated activity is fully active 2) those in which cell-mediated immunity is not detected 3) an intermediate group leaning more towards group 1 and 4) an intermediate group leaning towards group 2. The cells involved in the outcome of a TB infection macrophages and lymphocytes are discussed individually. The thick cell wall of the Mycobacterium tuberculosis resists destruction by enzymes antibodies and other factors and requires a mechanism that will activate macrophages and histocytes to breach this cell wall and lead to cell death. A vaccine against TB should be long lasting such as BCG although BCG has not been found to be effective in all populations. The degree of immune response to TB will depend on: 1) the degree of sensitivity the mycobacterial species is capable of inducing and 2) how much of this sensitivity is cross-reactive with M. tuberculosis. High effectiveness of BCG immunization has been related to a low endemicity of non-TB mycobacteria; it should be administered early in life in countries with a high prevalence of TB. The pathogenesis and pathology of TB is discussed as are immunological tests such as the tuberculin tests which indicates TB sensitivity in vitro tests for cellular hypersensitivity and dual skin tests. Future research should focus on the BCG vaccine better in vitro tests and standardization of reagents.

Non-suppurative hepatitis; a study of acute and chronic forms with special reference to biochemical and histological changes.

Abstract: IT is the purposeof this paper to record some observations which have been made on thirty-two patients suffering from non-suppurativehepatitis, most probably causedby a virus infection. The diseasewas encountered in both its acute and its chronic forms. The study has been made by means of clinical observation,biochemical tests for liver function and material obtained either by the aspiration biopsy technique or at operation. The virus disease which is now called \"infectious hepatitis\" has come into prominence as a result of its prevalence during the two world wars. The term \"catarrhal jaundice\" has until recent times been applied to this condition. The description by Virchow\") in 1864 of a catarrhal inflammation in the duodenumand larger biliary passagesas the causeof the jaundice was responsible for this conception. In 1920 Eppinger,(S) examining material from cases' in the first world war, found evidence of degenerationin the liver cells, but no sign of catarrhal obstruction. Finally biopsy studies during the acute phaseof the diseaseby Iversenand Roholm'\" in 1939 and by Dible et alii(4) in 1943 have produced direct evidence againstthe catarrhalconceptionof the disease. The acute form of infectious hepatitis is well known in Australia, and often minor outbreaks occur, especially

Histoplasmosis; report of an Australian case.

Abstract: tone of the stomach was good and the outline of that organ as far as the pylorus was sharp and regular. The food left immediately and rapidly. The duodenal cap was distorted; it did not distend or contract. The appearance was similar in all the films, which also showed some slight irregularity at the greater curvature side of the pyloric segment (Figure I). In five and a half hours' time a small residue was present in the stomach, the rest of the opaque food being in the small coils in the pelvis and in the colon, from the caecum to the splenic fiexure. The caecum was normally movable and no abnormality was visible in the colon. From this examination, which revealed absence of distension of the duodenum together with gross Irregularttv and half shadows, I concluded that the patient had a carcinoma of the duodenum. Infiltration at the extreme prepyloric area was also present; this evidently caused the pylorus to gape, and accounted for the rapid initial passage of the food from the stomach. The duodenal lesion was the more extensive and was evidently the primary focus, the carcinoma extending proximally through the pylorus. Great difficulty was encountered in persuading the patient to undergo operation, and this did not take place till two months after the opaque meal examination. The operation was performed by Dr. Kenneth Hadley; he found around the pyloric area a carcinoma, two-thirds of which extended into the stomach and one-third into the duodenum. There was evidently some perigastric and periduodenal infiltration, as the pyloric area had to be dissected from the pancreas, when partial gastrectomy and gastro-jejunostomy were later performed. Microscopic examination of the specimen showed an infiltrating type of carcinoma extending deeply through the walls. Its tumour cells were closely packed in cords and strands and contained well-stained nuclei.

Goitre Studies. I. The Incidence of Endemic Goitre in Three Areas in Australia.

Abstract: S FROM MEDICAL LITERATUREPhysiology Biochemistry BRITISH MEDICAL ASSOCIATION NEWS652 652

Listeria meningitis, a description of a strain of Listeria monocytogenes and a report of a case.

Abstract: As no classification of the pathological histology of the testis has attained universal acceptance, and as there is considerable variation in the enthusiasm devoted to the preparation and examination of serial sections of each tumour, it is not surprising that Twomby, Temple and Dean'\" were unable to confirm these results. However, they considered the test of great value in prognosis, and gave the following figures: of patients passing 1000 mouse units per litre of urine, 77% survtved: of patients passing 1000 to 2000 mouse units per litre of urine, 43% survived; of patients passing 2500 mouse units per litre of urine, 18% survived; of patients passing 10,000 or more mouse units per litre of urine, all are dead. It is presumed that these figures cover a five-year period. We must therefore accept the performance of repeated Aschheim-Zondek tests as routine procedure in the management of malignant disease of the testis. The hormonal relationship of various testicular lesions has been briefiy summarized by Wyndham. (0)

Report of a Survey of Children Born in 1941, with reference to Congenital Abnormalities arising from Maternal Rubella.

Abstract: ORIGINAL ARTICLESPage. Report of a Survey of Children Born in 1941 with Reference to Congenital Abnormalities Arising from Maternal Rubella, by P. R. Patrick .. .. 421 Observations on the Use of Mixtures of Protamine Zinc and Regular Insulins In the Management of Diabetes Mellitus, by Ewen Downie, M.D .• F.R.C.P., F.R.A.C.P. ., . . . . . . . . . . .. 425 The Syndrome of Chronic Hypertension, Fibrositis and Tonsillitis, by V. :T. Kinsella .. . . . . .. 429 An Investigation of the Inorganic Iodine Content of the Saliva in Hyperthyreoldlsm following the Administration of Potassium Iodide, and the Effect of 2-Thiouracll and 4-Methyl Thiouracil Thereon, by L. E. A. Wright, M.Sc. .. .. 431 A Simple Abdominal Retractor, by Keith :T. B. Davis 436

Urinary tract tuberculosis.

Abstract: A 76-year-old man with diabetes and a 2-year history of mediastinal lymphadenopathy of unknown cause presented with fever and fatigue. Pyuria was seen on urinalysis. Contrast-enhanced computed tomography (CT) of the abdomen showed mild dilatation of the left renal pelvis and thickening of the ipsilateral ureteral wall (Panels A and B, arrows); the excretory phase on CT showed mild narrowing of the left ureter (Panel C, arrows). He was treated with a beta-lactam antibiotic, but pyuria and fever persisted. The results of a urine culture were negative. Urinary acid-fast staining revealed the presence of acid-fast bacilli (Panel D). A polymerasechain-reaction assay for Mycobacterium tuberculosis was positive. Patients with urinary tract tuberculosis can present with dysuria and hematuria, though many patients are asymptomatic, with only sterile pyuria, with or without microscopic hematuria. Urogenital tuberculosis may cause complications, such as ureteral strictures, oligospermia in men, and vaginal bleeding in women. The patient was treated with multiple-drug therapy for tuberculosis, and his symptoms abated.

The physiological activation of prothrombin.

Abstract: children, owing to their upsetting experiences,are liable to become the troublesomepeople of tomorrow, and the community owes it to itself and to them to see that they get the best considerationpossible, from the moment the suit is instituted. I am awarethat any effective measures for better securing the welfare of these children might involve heavy public expense. However, as the public spendsfreely upon horsesand greyhoundsand the excitements which those animals provide, I regard with contemptany objection basedon expense. There is anothermatter to which I would like to refer. Every year there is an increasing tendency in the professionsto specializemore and more at the expenseof general knowledge. It is no longer considerednecessary, or even desirable, for a professional man to have broadened his general outlook or to have fortified his mind to withstand the narrowing tendency of having oBly one intellectual interest, by building the professional superstructure upon a sound and lastmg general education. I may be expressingan outmodedidea when I tell you that it is my clear conviction that an advancedbasiceducation, either in the classics or in modern languagesand comparativephilology, or in mathematics,or in history, or in psychology, makes the brain a better machine,and the mind more receptive over a wide field, and the judgementbetter balancedthan they are without the aid of an early 'comprehensivetraining. Let me take two instances to illustrate what I am stressing. One of the greatestand most Ilberal-minded Australian lawyers of all time was Leverrier. His legal knowledge was immense, his judgement perfectly balanced. But he was, as many of you may remember,not only a lawyer, but also a scientistof great attainments,a mathematician and a man possessedof wide general learning. All these contributed to his greatnessas a lawyer. Another great Australian, whom many of you will remember, was Edgeworth David. As a geologist he combined a great knowledge of detail of Australian geology with a remarkable capacity for evolving from detail a clear and comprehensivepicture of the geological structure and history of the continent as a whole. Edgeworth David before he became a geologist was a classical scholar of considerablelearning. Each one of you, no doubt, will readily call to mind from your own experienceprofessional men graced with the imprint of general learning; men who can leave the highroad of some specialized pursuit, and enjoy, with delight to themselvesand their friends, the broad and lovely fields and bushlandsof knowledge. I suggest,therefore,that the greatquestionof education, as it affects our two professions,is one which a society such as this might well examine. Let it be understood,however, that I am not attacking specialization; it is both desirableand inevitable. What I am suggestingis that there should be a proper foundation beneathit. At the risk of detaining you a little longer than I should, I pass to the last matter to which I invite your attention. We of the British race have developedover the centuries a form of constitutional government which particularly suits our character, our love of freedom and our deep dislike of anything savouring of autocracy. And we have developedconceptsof law, and of the rule of Jaw, which are admirably designed to secure us from invasion of our liberties, and to protect us from the dictatorship either of an individual or of any group of individuals claiming to exercise executive authority without responsibility either to the law or to the people. As a result of the last two world wars, those precious things which we have inherited, which are the envy of less fortunate peoples,are in grave danger of being lost. That danger exists because the people, having enjoyed liberty for so long, do not notice its existence,and tend to neglect their duty of understandingand preserving it for themselvesand for their children. The continuance of parliamentary government as we have known it, of the responsibilityof parliamentand the executive governmentto the people, and of the rule of law, dependsentirely upon a strong and articulate desire for their continuanceon the part of a substantialsection of the community. You may ask what this has to do with a medico-legal society. Just this: without leadershipno community can be anything but a decadent rabble. I use the word \"leadership\" in a large sense,as comprising not merely the active leaders of a State, but also the many who have a guiding or enlightening influence upon others. So far democracy has succeededin our land, because leadership, loyal to its principles, has not been lacking. This has happenedbecausea substantial portion of the people-andnote that I say \"portion' and not \"class\"has qualified itself for leadershipeither by a broad and liberal education gained scholastically, or by balanced wisdom acquired by wide experienceor wide reading. That is where we enter the picture. There is no longer any leisured class to provide part of the necessary leadership; because,say what you like about the leisured groups of the past, they provided many men who devoted their lives to the service of the community. More and more, the generalmassof the people will come to respect a man for his learning, be it learning in science, art, music, literature, or in one of the professions, or in anything else. These are the men upon whom depends the survival of democracy,of civil liberty, of the rule of law, of the responsibility of those who govern to those who are governed. Therefore do I stress the first and paramount duty of all professional men-particularly of the lawyers because of their understanding of constitutional principles-to hold their education and their knowledge of humanity in trust for the benefit of the people, just as much as they hold their professional skill in trust for thosewho seekit. In conclusion, I hope that such thoughtsas I have been tempted to utter in the course of this address, if not acceptable to Minerva, might possibly be provocative enough to stimulate useful ideas in others. As I said, humanity is only just beginning to understanditself and to study itself scientifically. This society has sprung into life at one of the greatest and most anxious periods of all history; at a time when it was never more necessary for all men of special learning to accept their responsibilities towards the community. Let us, therefore, following the example of other learned associationsin our land, proceed to fulflll our aims and ambitions of useful achievement.

Investigation of carbohydrate metabolism in normal pregnancy.

Abstract: film of his nasal accessory sinuses revealed dulness of both maxillary sinuses, and the so-called fluid level was clearly defined. Proof puncture was not performed, nor were antral irrigations given. Treatment consisted of daily applications of short-wave therapy with the rotating electrode, at first with electrodes of low capacity with increasing dosage as treatment progressed. Complete recovery had taken place at the end of six weeks' treatment. X-ray examination showed the disappearance of pus from both antra. Sulphonamide therapy was also instituted, and bacterial suspensions were given on alternate days (Figures XVI, XVII and XVIII).

The diameter of cardiac muscle fibres: a study of the diameter of muscle fibres in the left ventricle in normal hearts and in the left ventricular enlargement of simple hypertension

Abstract: in normal or abnormal subjects of these low period potential changes; but we do suggest that more attention to their occurrence and interpretation is needed. This will necessitate the use of recording systems capable of much better frequency responses than the commonly used penwriters, and of amplifiers with wide band pass characteristics. A more accurate terminology than the hitherto used \"waves\" and \"rhythms\" would seem to be indicated if this quantitative approach to electroencephalography should prove useful. Our own observations have led us to hope that this type of recording may be of assistance in the psychiatric and psychological spheres. Figure XIII is a recording from the unexposed brain of a rat under light \"Nembutal\" anlEsthesia (the calibration is a 50 cycle per second wave). This shows that, in the field of neurophysiology, .appreciation of the possibilities of more accurate recordings of brain potentials may have a wide application. Study along the general lines indicated above is proceeding in Tbilin, Georgia, Union of Socialist Soviet Republics, under Professor Beritoff. (1)

Spontaneous rupture of a pancreatic pseudocyst.

Abstract: Dr. MacFarlane arranged a visit for me to Harwell, where the Atomic Energy Research Unit is situated in a disused aerodrome. A small pile was working here with a larger unit under construction. It was very pleasing to see the huge amount of constructional work that was in progress at this site. The conclusion was quickly forced upon me that the British were not sleeping upon their atomic research plans. I had a pleasant and instructive day with Dr. J. D. Loutit and Mr. Neary, the physicist. These scientists are working under the Medical Research Council. Discussions centred upon the handling of isotopes for medical and research purposes and the requisite safety precautions to be employed. These workers were most interested in the therapeutic possibilities of radioactive potassium which is readily absorbed from body fluids into body cells, but of its selective absorption little yet is known.

Iso-agglutinins in cord blood.

Abstract: (1) P. H. J. Turton: \"The Distribution of Simple Goitre in DerbYshire\", Proceedings Of the Royal Society Of Medicine, Volume XXVI, 1932-1933, page 1223. (2) F. W. Clements: \"Goitre Studies: I. The Incidence of Endemic Goitre in Three Areas in Australia\", THE MEDICAL JOURNAL OF AUSTRALIA, Volume I, 1948, page 637. (\") R. Olesen and N. E. Taylor: \"Endemic Goitre and Physical Development in Cincinnati Schoolchildren\", Public Health Reports, Volume XLI, 1926. page 1881. (4) H. S. Mustard and J. I. 'Varing: \"Thyroid Enlargement. Occurrence in Schoolchildren in Rutherford County, Tennesseee\", The Journal of the American Medical Association, Volume LXXXVIII, 1927, page 714. . (5) J. F. McClendon and J. C. Hathaway: \"Inverse Relationship between Iodine in Food and Drink and Goiter, Simple and Exophthalmic\". The Journal of the American Medical Association, Volume LXXXII, 1924, page 1668. (0) C. E. Hercus and K. C. Roberts: \"The Iodine Content of Food, Manures and Animal Products in Relation to the Prophylaxis of Endemic Goitre in New Zealand\", Journal of Hygiene, Volume XXVI, 1927, page 49. (7) \"Goiter Prevention\", The Journal of the American Medical AS80ciation. Volume CXXXV, 1947, page 36. (8) C. E. Hercus, W. N. Benson and C. L. Carter: \"Endemic Goitre in New Zealand, and its Relation to the Soil Iodine\", Jou1\"1tal of Hygiene, Volume XXIV, 1925, page 321. (0) R. A. Shore and R. L. Andrew: \"Goitre in SchoolChildren. The Incidence of Goitre in School-Children in relation to the Amount of Iodine in Soil and Water in Certain Districts of the North Island of New Zealand\", New Zealand Department of Scientific and Industrial Research and Department of Health, Bulletin Number 45, 1934. (10) G. Lunde: \"The Excretion of Iodine in the Urine and the Goiter Prophylaxis with Sea-Fish\", Report of the International Conference on Goiter in Berne, 1927, page 502. (11) R. McCarrison: \"Pathogenesis of Deficiency Diseases, The ·Effect of Some Food Deficiencies and Excesses on the Th,yroid Gland\", The indian Journal of Medical Research, Volume VII, 1920, page 633. (12) B. Sure: \"Influence of Avitaminoses on the Weights of Endocrine Glands\", Endocrinology, Volume XXIII, 1938, page 575. (L1) K. D. Harris and E. A. Smith: \"Histological Study of the Thyroid of the Guinea Pig in Experimental Scurvy\", The American JOllrnal of Physiology, Volume LXXXIV, 1928, page 599. (\") V. A. Drill: \"Interrelations between Thyroid Function and Vitamin Metabolism\", Physiological Reviews, Volume XXIII, 1943, page 355. (6) W. F. Abercrombie: \"Histological Effects of Potassium Iodide and Thyroid Substance on the Thyroid Gland of the Guinea Pig in Experimental Scurvy\", The American Journal of Pathology, Volume XI, 1935, page 469. (16) J. Eason: \"The Significance of Goitre\", B1'itish Medi,*l Journal, Volume I, 1939, page 1303. ' (7) \"Report on Medical Inspection and School Hygiene;', Education Department, Melbourne, July 31, 1911. . (1.) \"Goitre in Victoria\", Report of the Minister of PublIC Instruction, Victoria, for the Year 1915-1916. :J (19) E. Fitzgerald: \"Report on Medical Inspection\", Appendix F.9079/42. ' (20) \"Endemi\" Goitre\", Department of Public Health, Victorlh, Health Bulletin Number 2, 1925, page 37. (21) W. Summons: \"Goitre in Gippsland\", Supplement to THE MEDICAL JOURNAL OF AUOTRALIA .. Volume II, 1927, page 59. (22) Commonwealth Bureau of Census and Statistics, ClasBifications of Industries and Occupations, June, 1945. (23) \"Food Consumption and Dietary Levels in 2370 Australil!lf) Family Households in 1944\", National Health and Mediqtl Research Council, Special Report Series Number 1. . (U) National Research Council, Reprint and Circular Series, NumLer 115, 1943. (2,;) National Research Council, Heport and Circular Series, Number 122, 1945. . . . (26) Lister Institute and Medical Research CouncIl, Vltamm .\",,Sub-Committee of the Accessory Food Factors Committee, \"Vitamin A Deficiency and the Requirements of Huml\ Adults\", Nat\"Te, Volume CLVI, 19-15, page 11. (\"') V. Pecover, A. Osmond, P. Goldacre and F. 'V. Clements: To be published. •

The individual and the environment.

Abstract: S FR01U MEDICAL LITERATURE-

The urinary excretion of 17-ketosteroids and of corticosteroid-like hormones by the newborn infant.

Abstract: 2. Of the various retiological factors, arterial degeneration, congenital defects of the vessel wall and endocarditis are the most likely. Syphilis, trauma, splenomegaly, increased portal pressure and periarteritis nodosa are comparatively rare causes. The association of pregnancy with the formation of these aneurysms is more apparent than real. 3. The clinical features vary according to whether rupture has occurred or not. Even in the former case, the clinical picture is not clear cut, as the aneurysm may rupture by a single or "two stage" process.

Human botulism in Australia.

Abstract: (SO) J. C. Maloney: \"On Oriental Stoicism\", The American Journal ot Psychiatry. Volume ClII, 1946, page 60. . ranR. E. L. Faris: \"Ecological Factors in Human Behaviour\", Chapter 24 of \".Personality and the Behaviour Disorders\", edited by J. McV. Hunt, 1944. (\") W. Brown: \"Psychology and Psychotherapy\", 1944. (33) C. Burt: \"Our Waning Intelligence\", Bdtish Medical Journal, Volume I, 1947, page 185. (M) S. L. Halperin: \"Clinico-Genetical Study of Mental Defect\", American Journal o] Mental Deficiency, Volume L, 1945, page 8. (35) M. L. Terman: \"Psychological Approaches to the Biography of Genius\", 1947; quoted in The Lancet, Volume II, 1947, page 878. (SO) L. S. Penrose : \"A Clinical and Genetic Study of 1280 Case\" of Me n ta l Dcfect\", Medica l Research Council of the Privy Council, Special Report Series, Number 229, In8. (37) L. Bender: \"Psychopathic Behaviour Disorders in Children\", in \"Handbook of Correctional Medicine\", edited by R. Lindner, 1946. (38) W. Goldfarb: \"Effects of Psychological Deprivation in Infancy and Subsequent Stimulation\", The American Jounwl ot Psychiatl'y, Volume CII, 1945, page 18. (ao) W. C. Menninger: \"The Role of Psychiatry in the World To-day\", The American Journal ot Psychiatry, Volume CIV, 1947, page 155. (40) F. Lundberg and M. F. Farnham: \"Modern Woman\", 1947. (<1) British Medical Association: Report of Committee on Mental Health, 1941, page 9. (\") M. McBee: \"A Mental Hygiene Clinic in a High School\", Mental Hygiene, Volume XIX, 1935, page 238. (43) R. Fraser et alii: \"The Incidence of Neurosis among Factory Workers\", Medical Research Council, Industrial Healtb Research Board Report, Number 90, 1947. (\") F. Post: \"Study of Psychiatric Illness in Coal Miners\", The Journal ot Mental Science, Volume XCII, 1946, page 574. «') F. Dunbar: \"Emotion and Bodily Changes\", 1946. «0) L. Z. Cosm : \"Modern Methods in the Care of the Aged; Extract from Report of Meeting Held at Royal Institute of Public Health\", British Medical Journal, Volume II, 1947, page 870. (<7) J. R. Rees: \"Shaping of Psychiatry by War\", 1945. «8) W. C. Menninger: \"Lessons from Military Psychiatry for Civilian Psychiatry\", Mental Hygiene, Volume XXX, 1946, page 571. (41) W. C. Porter and H. A. Davidson: \"Alumni Appraisal of Medical Education\", The American Journal ot Psychiatry, Volume CIII, 1947, page 450. (50) A. E. 'Bennett: \"Faulty Management of Psychiatric Syndromes Simulating Organic Disease\", The Journal o] the American Medical Association. Volume CXXX, 1946, page 1203. (51l N. D. C. Lewis: \"What Should be Taught\", The American Journal o] Psychiatry, Volume CIlI, 1947, page 450. (\") T. A. C. Rennie: \"Psychotherapy for the General Practitioner. A Programme for Training\", The American Journal ot Psychiatry, Volume CIlI, 1947, page 653. (53) \"Yale Reorganises Psychiatry Department\", The Journal 01 the American Medical Association, Volume CXXXV, 1947, page 522. (50) \"Medical Education; Royal College of Physicians' Report\", British Medical Journal, Volume I, 1944, page 668. (ee) W. S. Dawson: \"Psychosomatic Medicine\", THE MEDICAL JOURNAL OF AUSTRALIA, Volume I, 1948, page 84. (50) K. Menninger et alii: \"The New Role of Psychological Testing in Psychiatry\", The American Journal ot Psychiatry, Volume CIlI, 1947, page 473. (M) D. Blain: \"Priorities in Psychiatric Treatment of Veterans\", paper read before the Convention of Association of Military Surgeons of the United States, Boston, Massachusetts, November 14, 1947, issued by the Veterans' Administration (United States of America). (58) W. C. Menninger: \"Development of Psychiatry in the Army in World War 11\", War Medicine, Volume VIII, 1945, page 229. (50) D. Blain and J. H. Baird: \"The Neuropsychiatric Programme of the Veterans' Administration\", The American Journal ot Psychiatry, Volume CIlI, 1947, page 463. (60) A. Knudson: \"Activities of the Veterans' Administration in Rehabilitation\", Occupational Therapy, Volume XXX, 1946, page 191. (81) G. Hyatt: \"Occupational Therapy: Can Doses be Exact?\" Occupational Therapy, Volume XXV, 1946, page 57. (50) \"This Is Being Done\" (Roanoke, Virginia), from Imformation Bulletin of Neuropsychiatric Division of Department of Medicine and Surgery, Veterans' Administration (United States of America), October, 1947. (83) H. M. Pollock: \"Development of Statistics of Mental Disease in United States during Past Century\", The American Jot,rnal of Psychiatry, Volume CIl, 1945, page 351. (M) A. Stoller: \"Modern Trends in British Psychiatry\", THE MEDICAL JOURNAL OF' AUSTRALIA, Volume II, 1947, page 765. (1l5) C. D. Bridges: \"Epilepsy and Job Placement\", Industrial Medicine. Volume XV, 1946, page 51. (..) V. ·V. Anderson: \"Psychiatry in Industry\", 1929. ('7) E. V. Clarke: \"Psychiatric Problems at Oak Ridge\", The American Journal o] Psychiatry, Volume CIl, 1946, page 473. (58) R. R. Prewer: \"The Kielder Experiment\", The Journal ot Mental Science, Volume XCI, 1945, page 481. (50) \"The Doctor in the Magistrate's Court\", British Medical Journal, Volume I, 1948, page 355. (70) H. Mannheim: \"Criminal Justice and Social Reconstruction\", 1947. (71) \"The Criminal Justice Bill\", British Medical Journal, Volume II, 1947, page 826. (72) \"Treatment of Delinquency\", British Medical Journal, Volume I, 1947, page 419. (TJ) Coronet, Volume XXII, 1947, page 3. (74) A. Stoller: \"Sexual Deviation in the Male\", Medical Press, Volume CCXVI, 1946, page 262. (75) Appendix to \"Heport on the Planning of Hospital Services in the Berks, Bucks and Oxon Region, Nuffield Provincial Hospitals Trust\", 'I'lie Lancet, Volume II, 1947, page 836. (10) \"Report of the Care of Children Committee\", 1947. (77) \"Summary of the Main Provisions of the Children Bill\", 1948. (7') \"Repor-t of the London Council of Social Services (1946-7)\", quoted in B1·itish Medical Journal, Volume II, 1947, page 509. (.9) E. M. Jellinck: \"Recent Trends in Alcoholism and Alcohol Consumption\", 1947; reviewed in British Medical Journal, Volume II, 1947, page 911. rs» K. 1\\1. Bowman: \"Alcohol: Review of PSYChiatric Progress, 1946\", The American Journal o] Psychiatry, Volume CIII, 1947, page 528. (81) L. H. Bartemeier: \"The Psychiatric Foundation: Introductory Remarks\", The American Journal o] Psychiatry, Volume CIV, 1947, page 145. (82) A. H. Ruggles: \"The Foundation and the American Psychiatric Association\", The America1~ Journal o] Psychiatry, Volume ClV, 1947, page 148. (83) P. S. du Pont: \"The Foundation and Public Education\", The American Journal o] Psychiatry, Volume CIV, 1947, page 151. •

Art and science in medicine.

Abstract: Great dimculty is often encounteredin エィッウセ patients who haveslight thyreoid enlargement。 ウ ウ ッ 」 ゥ 。 エ ・ セ with an anxiety stateand marked tremor and tachycarda. Among these, in contrast to the subjects f hyperthyreoidism, the appetite is otten poor, theJte is no increasedtoleranceto cold, the skin is cool and clammy, the pulse pressureis otten low, there is little or no loss of weight, thereare no genuineeye signs,and エ ィ セ patient, insteadof being bright, alert and fidgety, is more inclined to be apatheticand listless. . Due considerationshould also begiven to the presence or absenceof rarer toxic manifestations,such as pruritus, glycosuria, intermittent diarrhcea, myasthenia,! particularly in the thigh muscles, and ・ ク エ イ 。 ウ ケ ウ エ ッ ャ ・ セ in the presenceof rapid heartaction. Careful watch should also be kept for those conditions with atypical onset in Which, in the early ウ エ 。 ァ ・ セ L one or more phenomenadominatethe clinical picture,roresamnte, noticeable loss of weight, exophthalmos,pruritus, myasthenia, or gastro-intestinalsymptoms. It, after a careful considerationof all the evidence,both clinical and laboratory, the diagnosis is still in doubt, a therapeutic test with iodine or thiouracil may be most helpful in bringing about a decision. In the numerous discussionswhich have appearedin the medical Press in the past few years as to' whether thiouracil will replaceoperationin the treatmentOf diffuse toxic goitres, insumcient weight has been give. to the knowledgegained by years of clinical experience!concerning variationsin the natural courseof the diseaseand its later sequelee,Natural remissionsarenot at all uncommon, and may last for a considerableperiod. A goitre which appearsto be diffusemay at operationprove to be nodular. Cardio-vasculardiseaseand cancermay develop at a time when there is little or no evidenceof presenttoxicity and no elevationof the basal metabolic rate. It is generallyagreedthat thiouracil, it properly.admtnletered, will alleviate thyreotoxic symptomsin a vllry large proportion of patients with a diffuse toxic goltre. Most observershavefound that, within a period of a few months to a year or two, there is a high percentage of recurrences. ! It is quite possiblethat the low relapserate recp'rded by some workers may be due to more careful control and better techniquein the medical management. I Sumcienttime, however,hasnot yet elapsedto ' make it possible to say in what proportion of casesthe cure is permanent,nor can any pronouncement be madeII-s to the possibility or probability of the later development of cardio-vasculardiseaseor cancer. The incidenceQf cancer is by no meansnegligible, and by the time the classical picture of malignancyhas developedthe time for' surgical cure has passed. The early diagnosis of malid-ancy of the thyreoid is exceedinglydimcult and often iQipossible before operation. . In addition, toxic manifestations,some of キィゥ」セ may be fatal, occur in an appreciablepercentageof cases,and very careful and long-eontinuedmedical control is necessary. Truth has been well called the daughterof tセュ・L and enoughtime has not yet elapsedto enableus to $8.y with any degreeof precision what part thiouracil will' play in the treatment, other than pre-operative,of diffuse toxic goitres. . Clinical scienceand laboratory scienceeach ー ャ セ ケ their part in the diagnosisof diseaseand in the allevfatlon of human suffering. In any particular patient, one or the other may be the decisive factor in the making of a decision or the planning of a courseof action. Both are liable to human error and should be constantly subjected to critical analysisand review. . Medicine is not a science. \"Each little 、 ゥ ウ 」 ッ カ ・ イ セ G pushes the curtain back a little further but inAnity lies eyond,\" With so many of the fundamentalproblems of ite still unsolved,and humannaturebeing what it is, it ゥ セ hardly likely that medicine will ever becomea science ゥ セ which everythingis capableof quantitativeexpression. But, paradoxically,we may say that scientific medicine is a compound of science,empiricism and mysticism, in which the collecting and placing of facts in their true perspective, the giving of due weight to the fruits of experience,the balancing of probabilities and a careful assessment of personaland psychologicalfactors all play an important part. To neglect any of these is to enter the battle incompletelyarmedand imperfectly equipped.