sympathetic ophthalmia as a seasonal affection

1127

culous and 100 were healthy. In addition, therewas a separate group of 15 patients subject to ulcerat-ing chilblains. It was found that while chilblainswere much commoner among the offspring of healthyparents than among the offspring of tuberculous

parents, their course was more benign in the latter-a difference which Stephani-Cherbuliez compareswith the observation that tuberculosis developing inpreviously healthy stock is liable to run a com-

paratively violent course. Chilblains, she argues,are an allergic response to the tubercle bacillus whichitself may not be present in the chilblain but in someother part of the body where it may even play thepart allotted to it by the Germans in their conceptionof the Primdrkomplex. If this were so, chilblains mightcome to be regarded as a valuable warning-i.e.,as evidence of tuberculous activities which demandthat precautions should be taken by the patient lestworse befall him. But while none will deny thatchilblains and tuberculosis are often associated, it willtake much new evidence to persuade us 1 hat theassociation is essential.

SYMPATHETIC OPHTHALMIA AS A SEASONAL

AFFECTION

No important advance has been made for manyyears in explaining the pathology of sympatheticophthalmia. Our Budapest correspondent tells usof an elaborate study made by Dr. Bela Waldmannwhich was recently awarded the prize of the OradeaMedical Society. Dr. Waldmann believes that

sympathetic ophthalmia depends upon some toxic

agent conveyed to the eyeball from an accessorynasal sinus, and thence to the second eye via eitherthe optic or the ciliary nerve. His belief is foundedon the fact that out of 69 cases of which he haspersonal knowledge 53 started during what he termsthe influenza months (October to April), while duringthe summer months (May to September) less than aquarter started. To test his theory from furtherstatistics he sent inquiry forms to various eye clinics(in Baltimore, Berlin, Budapest, Ghizeh, London,Madras, Manchester, Munich, Stockholm, and Vienna),and by this means obtained answers respecting 124additional cases and these told the same story.Three-quarters of the cases began during the coldhalf of the year and only one-quarter during thewarm. In Prof. Meller’s clinic in Vienna the ratiowas 7 : 1. On the strength of these data Dr. Wald-mann feels justified in asserting that sympatheticophthalmia is a seasonal affection. This is a newobservation and, whether or not his suggestion as tothe channel of infection should ultimately prove to bejustified, it is one that should not be lost sight of.

THE RELATIONS OF THE ŒSOPHAGUS

SURROUNDED by translucent lung tissue, the heartand aortic arch are favourably placed for radio-

graphical inspection. But the posterior surface ofthe heart and the descending aorta, because of theirproximity to the spinal column, are not alwaysreadily visualised. The oesophagus, in traversingthe thorax, is closely applied to the back of the heart,the aorta, and the tracheo-bronchial tree, so thatits course is easily influenced by changes in cardio-vascular structure. When filled with a suitableemulsion of barium, the oesophagus serves as a valu-able radiological landmark in the chest. Kreuzfuchs(1921) made use of the barium-filled oesophagus inmeasuring the diameter of the aortic arch. Gabert(1924) studied the displacement of the oesophaguscaused by enlargement of the left auricle, thus extend-

ing the anatomical investigations of Kovács andStoerk (1910). Renander (1926), Biedermann (1931),and others noted the characteristic cesophagogramassociated with a right-sided aortic arch, a congenitalanomaly which occasionally causes dysphagia.Parkinson and Bedford described in our own columns(1931, ii., 337) the middle oesophageal impression,due to the left bronchus and indirectly to the rightpulmonary artery, and discussed its clinical significancein relation to cardiovascular disease. A furthervaluable contribution to our knowledge of the

oesophagus in relation to the heart and aorta hasbeen made by Dr. William Evans, in a report 1issued by the Medical Research Council. Dr. Evanshas made an extensive study of the normal aesophago-gram in healthy subjects, confirming his interpreta-tions of the various impressions by anatomical dis-section. He establishes four normal cesophagealimpressions made, from above down, by the aorticarch, the left bronchus, the left auricle, and thedescending aorta. Each of these is described firstas seen in healthy subjects, then as modified bydifferent pathological changes in the heart and aorta.A large series of radiograms is given, each with itsanatomical interpretation, illustrating in turn thedifferent forms of oesophagogram found in healthand in cardiovascular disease. Dr. Evans’s mono-

graph, which combines with his own investigationsa survey of previous work on the subject, shouldlead to a better appreciation of the importance ofthe visualised oesophagus in relation to the heart.

THE BRITISH HEALTH RESORTS

THE waning popularity of the continental healthresorts and the renewed vigour of their Britishrivals is referred to in the report on page 1137 ofthe conference of the British Health Resorts Associa-tion at Woodhall Spa. In his foreword to theAssociation’s Handbook for 1936,2 Sir KingsleyWood writes : "It is true to say that the benefitswhich British Health Resorts can offer in a greatvariety of cases are not known or used to the extentthey deserve. Modern research has done much to

explore and explain the relation of environment tohealth, and to add to our knowledge of the preciseimportance of factors like climate, air, and medicinalwaters in the treatment and prevention of disease.But this increased knowledge cannot have its fulleffect unless it reaches the public. It is the objectof the British Health Resorts Association to ensurethat it shall. The task which the Association hasundertaken is threefold ; to bring before the publicthe claims of British spas and watering places topossess curative resources in no way inferior tocontinental health resorts; to offer to the medicalprofession and its clients expert advice on the naturalconditions most favourable to the Successful treat-ment of the maladies with which they are concerned ;and to inform them where these conditions maybe found in this country." The handbook, now inits fourth edition as a separate work, ably serves allthese purposes. Considerable changes have beenmade in the new and enlarged edition, which willincrease its usefulness both to the general publicand to the medical profession. The informationabout the British wintering places has been augmentedby detailed meteorological reports on the climateduring each of the winter months; these are in

1 Spec. Rep. Ser. No. 208, pp. 93, 2s. 6d.2 British Health Resorts : Spa, Seaside, Inland. Official

Handbook of the British Health Resorts Association. Editedfor the Association by A. Fortescue Fox, M.D., F.R.C.P.London: J. & A. Churchill, Ltd. 1936. 1s.