PROFESSOR C. A. EWALD.
1
1271 Why do the leucocytes in the "lymph cup" experi- ment maintain their vitality and cause a diminu- tion of microbes (even, I suppose, in the presence of trypsin), while on a denuded surface they do not live long ?-I am, Sir, yours faithfully, -- - Oxford, Nov. 29th, 1915. H. T. GILLETT, M.D. PROFESSOR C. A. EWALD. To the Editor of THE LANCET. SIR,—I am sorry to hear of the death of Pro- fessor C. A. Ewald, of Berlin, whom I have known for more than 30 years, and I deplore the harsh terms in which the Münchener Medizinische Wochenschrift speaks of him (see THE LANCET, Nov. 27th, p. 1195). Both he and his wife were well known to many colleagues in this country, and in spite of the war I have I never ceased to think of them as friends. When they were at the recent International Medical Congress Professor Ewald looked older than he appears to have been, but in other respects he was in fairly good health. His reputation as a writer on diseases of the digestive organs stood very high, both here and in America, where his character and attainments were warmly appre- ciated. A foreigner is not in the best position for forming an estimate of the opinion enter- tained of a man in his own country, but I should like to testify to the uniform gentleness and kindness of disposition he showed in all my relations with him. If there were any truth in the charge of hardness and lack of feeling it surely conflicts with our sense of justice to write in this way of the dead. I am, Sir, yours faithfully, Birmingham, Nov. 29th, 1915. ROBERT SAUNDBY. ILLUMINATION IN OPERATIONS. To the Editor of THE LANCET. SIR,-The important question raised by Sir Berkeley Moynihan in THE LANCET of Sept. 18th as to colour and direct lights is one of interest to all surgeons. For some considerable time past I have pointed out that the day would come when surgeons would only operate by means of a constant light. It must be known to many that upon the continent reflected lights from powerful lamps outside the theatre have been in use for some time. It seems to me that the green colour is quite unnecessary and that the restful condition can always be obtained by operating in partially darkened rooms. At least, this is my experi- ence. As to the question of light directed upon the operative area, of the advantage of such a system there can be no doubt, and that it is used by many surgeons in such a manner is common knowledge. What I wish to draw attention to is the neglect of the use of direct illumination. In all intranasal and throat operations I have for some time adopted the use of very small electric pea-lamps mounted upon silver stems. The darkened room and the use of such direct light is infinitely superior to the dazzling reflected light from a powerful lamp. I strongly recommend to the notice of abdominal surgeons the use of powerful lights encased in varying shaped glass tubes and 3/4 inch diameter; these lights must be carefully fixed in such tubes, and a complete vacuum formed; there will then be no heat whatever. Such lights can be plunged into the abdominal cavity without doing the least harm, and their diagnostic value will be found of great assistance. I am, Sir, yours faithfully, -. -- Johannesburg, Oct. 20th, 1915. J. L. AYMARD. PLEOMORPHISM OF GERMS. To the Editor of THE LANCET. SIR,-It may be worth while, without expressing any opinion regarding the possibility of a specific organism assuming various forms, to call attention to a fault in reasoning into which clinicians and pathologists fell in the past, and from which it is possible that some have not yet shaken free. The discovery of a specific cause of certain groups of symptoms led to the conclusion that every disease is due to a germ. This axiom is fully established. It does not follow that the converse is true—viz., "every germ produces a (specific) disease." The possibilities of reaction to toxins are very limited. We find three or four morphologically distinct germs producing an identical disease, typhoid fever. If we classify symptoms, not groups of symptoms, we find a given reaction evoked by a large number of different poisons. It may well turn out to be the case that there are many more kinds of pathogenic germ than there are diseases; and yet it would be a mistake to throw any doubt upon the individuality of "diseases." Each disease is a group of physio- logical reactions which always occur in combina- tion, resulting in a condition which calls for a perfectly definite course of treatment. I I am, Sir, yours faithfully, Southampton, Nov. 22nd, 1915. ALEX. HILL. ABSENCE OF GLYCOGEN IN THE SUPRARENAL BODIES. To the Editor of THE LANCET. SIR,-Having found no reference in literature to the presence or absence of glycogen in the supra- renal bodies, I examined a series of these bodies from subjects of different ages on whom necropsies were performed. Seventeen suprarenal bodies were examined from nine subjects. The age, sex, and lesions which accounted for death are set out in the following table. (In every case except No. 6 both suprarenal bodies were examined.) To demonstrate the presence of glycogen, the tissues were fixed in absolute alcohol, embedded in celloidin, and stained by Best’s carmine method. As a control, portions of a Grawitz’s tumour of the kidney and of two diabetic kidneys were fixed and embedded in the same way; sections of these were put through the staining process with each batch of sections of the suprarenal bodies. No glycogen was found in the diabetic kidneys. When,
Transcript of PROFESSOR C. A. EWALD.
1271
Why do the leucocytes in the "lymph cup" experi-ment maintain their vitality and cause a diminu-tion of microbes (even, I suppose, in the presence oftrypsin), while on a denuded surface they do notlive long ?-I am, Sir, yours faithfully,
-- -
Oxford, Nov. 29th, 1915. H. T. GILLETT, M.D.
PROFESSOR C. A. EWALD.
To the Editor of THE LANCET.
SIR,—I am sorry to hear of the death of Pro-
fessor C. A. Ewald, of Berlin, whom I haveknown for more than 30 years, and I deplorethe harsh terms in which the MünchenerMedizinische Wochenschrift speaks of him (seeTHE LANCET, Nov. 27th, p. 1195). Both he andhis wife were well known to many colleagues inthis country, and in spite of the war I have
Inever ceased to think of them as friends. When
they were at the recent International MedicalCongress Professor Ewald looked older than he
appears to have been, but in other respects hewas in fairly good health. His reputation as awriter on diseases of the digestive organs stoodvery high, both here and in America, where hischaracter and attainments were warmly appre-ciated. A foreigner is not in the best positionfor forming an estimate of the opinion enter-tained of a man in his own country, but I shouldlike to testify to the uniform gentleness andkindness of disposition he showed in all myrelations with him. If there were any truth inthe charge of hardness and lack of feeling it surelyconflicts with our sense of justice to write in thisway of the dead.
I am, Sir, yours faithfully,Birmingham, Nov. 29th, 1915. ROBERT SAUNDBY.
ILLUMINATION IN OPERATIONS.
To the Editor of THE LANCET.
SIR,-The important question raised by Sir
Berkeley Moynihan in THE LANCET of Sept. 18thas to colour and direct lights is one of interestto all surgeons. For some considerable time past Ihave pointed out that the day would come whensurgeons would only operate by means of a constantlight. It must be known to many that upon thecontinent reflected lights from powerful lampsoutside the theatre have been in use for some time.It seems to me that the green colour is quiteunnecessary and that the restful condition can
always be obtained by operating in partiallydarkened rooms. At least, this is my experi-ence. As to the question of light directed
upon the operative area, of the advantage ofsuch a system there can be no doubt, andthat it is used by many surgeons in such a
manner is common knowledge. What I wishto draw attention to is the neglect of the useof direct illumination. In all intranasal and throatoperations I have for some time adopted the use ofvery small electric pea-lamps mounted upon silverstems. The darkened room and the use of suchdirect light is infinitely superior to the dazzlingreflected light from a powerful lamp. I stronglyrecommend to the notice of abdominal surgeons theuse of powerful lights encased in varying shapedglass tubes and 3/4 inch diameter; these lights mustbe carefully fixed in such tubes, and a completevacuum formed; there will then be no heatwhatever. Such lights can be plunged into the
abdominal cavity without doing the least harm,and their diagnostic value will be found of greatassistance. I am, Sir, yours faithfully, --- -. --Johannesburg, Oct. 20th, 1915. J. L. AYMARD.
PLEOMORPHISM OF GERMS.To the Editor of THE LANCET.
SIR,-It may be worth while, without expressingany opinion regarding the possibility of a specificorganism assuming various forms, to call attentionto a fault in reasoning into which clinicians andpathologists fell in the past, and from which it is
possible that some have not yet shaken free. Thediscovery of a specific cause of certain groups ofsymptoms led to the conclusion that every diseaseis due to a germ. This axiom is fully established. Itdoes not follow that the converse is true—viz., "everygerm produces a (specific) disease." The possibilitiesof reaction to toxins are very limited. We find threeor four morphologically distinct germs producingan identical disease, typhoid fever. If we classifysymptoms, not groups of symptoms, we find a givenreaction evoked by a large number of different
poisons. It may well turn out to be the case thatthere are many more kinds of pathogenic germthan there are diseases; and yet it would be a
mistake to throw any doubt upon the individualityof "diseases." Each disease is a group of physio-logical reactions which always occur in combina-tion, resulting in a condition which calls for a
perfectly definite course of treatment.I I am, Sir, yours faithfully,
Southampton, Nov. 22nd, 1915. ALEX. HILL.
ABSENCE OF GLYCOGEN IN THESUPRARENAL BODIES.
To the Editor of THE LANCET.
SIR,-Having found no reference in literature tothe presence or absence of glycogen in the supra-renal bodies, I examined a series of these bodiesfrom subjects of different ages on whom necropsieswere performed. Seventeen suprarenal bodies wereexamined from nine subjects. The age, sex, andlesions which accounted for death are set out inthe following table.
(In every case except No. 6 both suprarenal bodies were examined.)
To demonstrate the presence of glycogen, thetissues were fixed in absolute alcohol, embedded incelloidin, and stained by Best’s carmine method. Asa control, portions of a Grawitz’s tumour of thekidney and of two diabetic kidneys were fixedand embedded in the same way; sections of thesewere put through the staining process with eachbatch of sections of the suprarenal bodies. No
glycogen was found in the diabetic kidneys. When,
