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ANNOTATIONS

LATENT SYPHILIS

IN the present state of knowledge the most reliablesign of syphilitic infection is a positive serum

reaction ; and to say that the infection is " latent "

is simply to admit that its site of activity is for themoment unknown. A positive reaction is oftenfound more or less accidentally in the examinationof blood donors, at antenatal clinics, or in the routineof hospital treatment, and in the absence of othersigns it may be taken too lightly. Cannon 1 describes96 such " latent " cases, seen in the last two yearsat the Vanderbilt Clinic in New York or in privatepractice, in which the symptoms were not at first

suspected, either by patient or doctor, of beingsyphilitic, but which yielded so readily to anti-

syphilitic treatment as to suggest that the diseasewas at least a contributory cause. Once the idea of

syphilis arose a number were found to show sug-gestive signs such as sluggish pupils, absent knee-jerks, an accentuated aortic second sound, or a

history of repeated miscarriages. Of this group 21sought treatment for gastro-intestinal disorders.

Vague dyspepsia and flatulence without definiterelation to food was the commonest complaint, but3 patients had vomited blood, 2 had had melaena,and others complained of burning sensations in theabdomen or of pain in the right iliac fossa. Seven ofthese had been found to have cardiovascular disease,which may have been the basis of their dyspepsia,and various diagnoses had been attached to the restafter thorough investigation. Antisyphilitic treatmentcured or strikingly improved 16 of them when dieteticor other measures had had little effect. A second

group of 18 patients had respiratory or cardio-vascular symptoms, usually of long standing, such ascough, pleuritic pain, asthma, sore-throat, hoarse-ness, or "sinus trouble," and their diagnoses hadranged from a common cold to pulmonary tuber-culosis. Many were referred from the tuberculosisclinic, to which their cough with expectoration, nightsweats, loss of appetite and weight, and pains in thechest had naturally led them, but where no con-

firmatory signs of tubercle had been found. A groupof 9 patients complained of urinary troubles-

frequent, difficult, or painful micturition, slightenuresis, acute retention, haematuria, or pain in thelower part of the back. Several of these gave a

history of gonorrhoea but had not been relieved bysuitable treatment, and all but one responded to

syphilitic remedies by lessening or disappearance ofsymptoms. A number of women with menorrhagiaor metrorrhagia were cured by antisyphilitic treat-ment while awaiting admission for operation. Theremainder of the 96 patients were sent to the clinicfor conditions as various as vague mental or physicalill health, thyroid enlargement, subcutaneous swell-ings, painful mandibular joints, glycosuria, andinguinal hernia.

In Cannon’s experience, if there is no activesyphilitic process of the brain structure, all asympto-matic patients can be made Wassermann-negative ifthe best drugs are used, and if the treatment iscontinuous and persisted in long enough, and herecommends the thorough treatment of all whoshow a strongly positive Wassermann reaction,even in the absence of other signs. He does notclaim that all of his 96 patients were sufferingsolely from syphilis ; some for instance probably

1 Cannon, A. B., J. Amer. med. Ass. 1937, 109, 348.

had an associated tuberculosis ; but he does makeout a strong case for routine serum tests, forcareful inquiry for a syphilitic history, and forexamination of the nervous system, heart andaorta, and eyes, wherever an ailment proves obscureor obstinate.

CINERADIOTHERAPY

UNDER this name Prof. A. 0. Almeida describes anew technique of X ray therapy in which the beamof rays, instead of being centred at one point on theskin, is moved regularly over a given area. The tubeis mounted in a carriage drawn from side to side ata constant speed by an electric motor working throughgears, and is itself moved up and down within thiscarriage by another similar mechanism. The areaover which the tube will operate, and the speed ofmovement of the beam relative to the field of irradia-tion, can be precisely regulated. Prof. de Almeidaand his colleagues claim that by this means the dis-tribution of the dose and its decrease in accordancewith the depth of the tissues and the distance fromthe centre of the beam may be modified at will soas to make it as homogeneous as possible over thewhole of the irradiated tissues, or to concentrate iton any given point within them. He argues that, asthe dose is the product of intensity and time, thetime factor is the one to vary in order to control thedose administered to a given volume of the body.His experiments have reached the stage of depth-dose determination with wax phantoms, and heclaims to have obtained percentage depth doses of93.1 per cent. at 40 cm. and 87-7 per cent. at 90 cm.These figures, as his assistants point out in theirreport, are far in excess of those obtainable with afixed tube. The mathematical basis of the results isworked out fully in the same number of these proceed-ings, which are published in English as well as Portu-guese. Radiologists will await with interest theclinical results of moving-tube treatment. The

principle could obviously be applied to therapy by aradium bomb.

A NEW SPECIFIC FOR AMŒBIC DYSENTERY

THE seeds of ya tan tzu, a plant well known inSouth China, Malaya, and India, have been usedsince 1765 in the treatment of diarrhoea, haemorrhoids,and chronic dysentery. It is known botanically asBrucea sumatrana and its properties have been

investigated for more than a year by Dr. Liu Hsiao-Liang,2 of Chefoo, Shantung. An alkaloid bruca-marine has been separated from the seeds and

Physalis and Bertrand have found a bitter glucosidethey call kosamine. Dr. Hsiao-Liang has treated19 patients suffering from acute or chronic amoebicdysentery with this preparation and 80 per cent. havebeen benefited. These cases were diagnosed bydemonstrating the active parasite in the stools ;no other amoobicidal drug except ya tan tzu wasgiven. The dose was determined by a study of theChinese literature and also from animal tests. Toadults 20-50 seeds-unbroken, but with the shellsremoved-were administered in capsules in a singledose, or in several divided throughout the day. Theamoebae disappeared from the stools in 2 cases ina day, in 7 cases after two days, in 4 after three days,in 1 case after five days, and in another after six days.

1 Archivos da Fundaçao Gaffrée e Guinle, Rio de Janeiro,June, 1937.

2 Chin. med. J. 1937, 52, 89.