1337

tion corrections have been obtained for tubes of

platinum and monel metal. The protection of thoseengaged in radium therapy has been the subject offurther study and experiment. Two factors of

gamma-ray protection have been studied-viz.,remoteness and lead-shielding in a variety of routinecircumstances. As a result the minimum shieldingand the tolerance working distance have been deter-mined under the various conditions commonly metwith in radium therapy. A development which willbe watched with interest is the application of X raycrystallographic methods to the study of toothstructures. A technique has been developed for

obtaining X ray diffraction patterns directly from thesurfaces of teeth. This study, the report states, isstill in the preliminary stage, but the results alreadyobtained are encouraging.

TROPICAL MEDICINE IN CHINA

THE first volume of the Transactions of the FarEastern Association of Tropical Medicine held in

Nanking, China, in October, 1934, has already beenreviewed in these columns, and now a second equallystout and well-documented volume has followed hardon its heels. This volume, edited with no less assiduity,consists of some 100 papers on such diverse subjectsas malaria, medicine, ophthalmology, parasitology,pathology, pharmacology, physiology, plague, publichealth, quarantine, radiology, and surgery. Under theheading of malaria extensive researches upon treat-ment (notably with atebrin) and on the prevention ofthe disease are published. C. D. de Langen andC. J. Storm have written on the modern medicaltreatment of malaria, from the department of internalmedicine of the Medical School of Batavia, Java,where they have enjoyed the collaboration of a

physiologist who has recorded the ventricular tracingsof the heart and cardiographic curves in monkeystreated with quinine, plasmoquine, and other anti-malarial drugs. A. L. Hoops has made a series ofobservations on the prophylaxis and cure of malariawith atebrin on llalacca Rubber Estates ; his experi-ences have been extremely favourable to the drug.

In the medical section H. S. Gear and H. Pedersencontribute an informative studv on diseases commonto man and animals in China, which appears to swarmwith parasites of all kinds. T. Y. Li and H. GordonThompson write on the treatment of Schistosomiasis.)6)o?Mcct with antimony compounds ; they see no

reason to doubt the generally accepted view thatpotassium antimony tartrate is the best method ofgetting rid of this parasite. Dr. T. S. Kwa has madea study, illustrated by radiograms, of lead encephalo-pathy in Chinese children, in which the children havebeen poisoned by their mother’s milk ; the onset is

apparently encouraged by a state of avitaminosis.There are three papers on beri-beri as it occurs atpresent in China, and it is evident from the work ofY. Y. Ying that this disease is apt to supervene as animportant complication in typhoid fever. TeoduloTopacio, of the Bureau of Animal Industry, Manila,has devised a method of transmission by a singletrypanosome.

In the section of pharmacology B. E. Read has madea historical investigation of the newer pharmacologyand its relation to ancient medicine. Dr. H. A. Borand Dr. C. J. Storm write of a clinical and experimentalinvestigation of evipan-sodium anaesthesia. Lt.-Col.A. J. H. Russell contributes a paper on plague inIndia, in which he shows that the plague mortalityin that country during the five-year period from 1898-1933 totals over twelve million deaths. To thesection of surgery J. Gray and H. Gordon Thompson

have contributed a readable paper on surgicalcomplications of parasitic diseases, and the volumeends with a series of papers upon vesical calculusamongst the Chinese. The fact that these transactionshave appeared within a few months of the congressadds to their interest.

DIAPHRAGMATIC HERNIA

WE have already drawn attention 1 to the symptomswhich, when confirmed by radiological evidence, oftenenable a diagnosis of diaphragmatic hernia to be madewith some confidence before operation. Sir ThomasDunhill, in an Arris and Gale Lecture delivered beforethe Royal College of Surgeons,2 has given an accountof 25 patients suffering from various types ofthis condition, on 6 of whom he has successfullyoperated. He draws the conclusion from his recordsthat the symptoms in a case of diaphragmatic herniastrongly suggest their origin ; and that, when the

patient has an oesophagus of normal length, operationis able to cure the distressing symptoms, and usuallycarries with it a risk less than that inherent in thedisease. Unfortunately the commonest type is thatassociated with a short oesophagus, the cardia beingsituated some distance above the oesophageal orificein the diaphragm ; 14 of Dunhill’s cases were of thisnature, and for such cases no radical cure has as yetbeen planned. The proportion of 11 diaphragmaticherniae" which are really attributable to a short

oesophagus is so high that it may constitute a pitfall forthe radiologist. In one of Dunhill’s cases the originaldiagnosis was " short oesophagus." A lateral X raypicture, however, showed an oesophagus of normallength lying behind the stomach, a large part of whichwas situated in the posterior mediastinum. Completerelief of the very pronounced symptoms followedwithdrawal of the stomach from the thorax andclosure of the gap. Had the original X ray diagnosisbeen accepted, the patient would never have beengiven the chance of operation. The short oesophagusis, in Dunhill’s opinion, a definite failure in develop-ment, and a cause of symptoms which tend, once theyhave appeared, to be progressive. It is not to bedismissed as a mere extension upwards of the gastrictype of mucosa. Hydrostatic pressure from below, andthe suction effects of inspiration, tend to increase theherniation of the stomach, while distension of thethoracic loculus and rotation of the stomach on its longaxis may easily kink the oesophagus and may causepressure effects on the pericardium. Cardiospasm alsotends to occur, and in some cases there is an organicstricture of the oesophagus ; gastric ulceration hasalso been reported. The causes of dysphagia and ofthoracic pain and oppression are thus numerous, andthe reasons for the progression and inconstancy of thesymptoms explained.

In the short oesophagus type of hernia, and inpara-oesophageal hernia, as described by Prof. vonBergmann, Dr. A. F. Hurst,3 and others, there is nodevelopmental defect in the diaphragm. In the othertypes of diaphragmatic hernia, failure either of thenormal process of closure of the pleuroperitoneal canal,or of muscular transformation of the membranous

diaphragm can be recognised. In the process of

muscularisation, Dunhill points out, the crura are lastto develop, and he believes that non-development ofone or of both crura is an important cause of hernia.Thus, although he allows that hernia at the costo-vertebral angle in infants is probably due to a persis-tence of the pleuroperitoneal canal, in adults a definite

1 THE LANCET, 1934, i., 638.2 Brit. Jour. Surg., 1935, xxii., 475.

3 Guy’s Hosp. Rep., 1934, lxxxiv., 43.