i68 MEDICINE 



The name " anaphylaxis," which is now given to this abnormal sensitiveness to the 

 properties of a serum, was first used by Richet, in another connection, in 1902. In its 

 widest sense, the word covers such idiosyncrasies as the occurrence of a rash from eating 

 shell-fish. In relation to serum treatment, there are two types of this hyper-sensitive- 

 ness. In the one type, the patient is naturally hyper-sensitive. In the other type, the 

 patient showed no ill-effects from a first use of serum, but was found, on a second use, 

 not less than a fortnight after the first, to have become, in the interval, markedly hyper- 

 sensitive. 



So far as the treatment of diphtheria is concerned, it is probable that not one case in 

 a thousand is put to any serious trouble by antitoxin: and it is certain that the lives 

 saved must be reckoned, every year, in thousands. In August 1910, the Local Govern- 

 ment Board issued an Order empowering the metropolitan Borough Councils to provide 

 diphtheria-antitoxin for the poorer inhabitants of their districts. This good example 

 has been followed by municipal authorities all over Great Britain. The value of the 

 antitoxin is well shown, in London, by the annual Reports of the Metropolitan Asylums 

 Board. In the Board Hospitals, the antitoxin was first used about November 1894. 

 Before its use the average death-rate of the disease had been 30 per cent: it now is, 8.5 per 

 cent. In the more serious cases, the laryngeal cases, it was 62 per cent in 1894, and now 

 is 14.9 per cent. In the tracheotomy cases, it was 70.5 in 1894, and now is 29.3 per cent. 



Dysentery. In bacillary (not amoebic) dysentery, the value of a serum-treatment, 

 such as Shiga's, seems by this time to be widely recognised. The earlier results with 

 Shiga's serum were brought before the Royal Commission on Vivisection by Dr. C. J. 

 Martin, Director of the Lister Institute (see Minutes of Evidence, iii, 221, July 10, 1907). 

 Riiffer and Willmore have lately published, in the Brit. Med. Journ., 1910, ii, 1519, some 

 good results, with a serum-treatment, in cases of bacillary dysentery at the El Tor 

 pilgrim-camp; even in the " very severe and frequently gangrenous type of the disease 

 found in the aged and worn-out class of pilgrims." In those cases which were of a pure- 

 ly bacillary type, the death-rate in 1909 had been 64.4 per cent; but during 1910, when 

 the serum treatment was used, the death rate was only 10.8 per cent. It would be 

 wrong to put great emphasis on one set of experiences even so favourable as these; but 

 they do not stand alone. 



Heart, Diseases of the. The disorders and diseases of the circulatory system are of 

 themselves sufficient for the study of a life-time: and the literature concerned with them 

 is immeasurable. Among the more important subjects of recent investigation are (i) 

 the bacteriology of ulcerative or septic endocarditis, (2) the tonic action of adrenalin on 

 the heart, (3) the causes of diverse forms of arrhythmia. During 1910-12, arrhythmia 

 has been studied to its finest issues, and the many constituent forces of the heart-beat 

 have been sorted-out and measured and recorded, with wonderful minuteness, by the 

 methods of electro-cardiography. 



"The principles of electro-cardiography," says Dr. Coombs, "maybe briefly stated thus, 

 (i) A contracting muscle is comparable to a galvanic cell; the active end of the muscle is 

 the negative pole, the passive end is the positive; and a current passes through the muscle 

 as through the cell, from positive to negative that is, from passive to active. It follows 

 that when the contraction-wave reaches the middle of the muscle there is no current; and 

 that as it passes this equator the direction of the current becomes reversed. (2) These 

 'action-currents' are set up in the heart-muscle in the course of each rhythmic contraction, 

 and can be 'led-off' from the body by attaching suitable electrodes. Different 'leads' are 

 used; the best Icads-off are from the right arm or hand (corresponding to the base of the 

 heart) and from the left leg or foot (corresponding to the apex). (3) By connecting these 

 electrodes with a delicate recording instrument it is the delicacy of Einthoven's string- 

 galvanometer l which has made electro-cardiography applicable to clinical research 

 graphic records of the variations in the electrical potential of the heart may be obtained." 



Dr. Waller, in his Hitchcock Lectures, Physiology the Servant of Medicine (University 

 of London Press, 1910), gives a full account cf this method, of which he may indeed be 

 called one of the discoverers: 



"To complete an effective circuit between one's heart and a galvanometer, all that is 



1 See Proc. Roy. Soc. Med., April 1912. 



