Volume 46 · Issue 11 · 1932

To arrive in a country so vast as to possess all the attributes of a continent, and one which may have boasted a highly developed civilization and culture at a time so remote that bis primitive ancestors then clothed their bodies in the skins of animals, and painted themselves with woad, is a sufficiently exciting experience for the average man. But when added to this, one finds one's self privileged to address a distinguished gathering of scientific workers within a few days on one's arrival, feelings of disquiet and not a little awe. inevitably develop. In these circumstances conscious as I am of my own shortcomings and of my ignorance of the country, I crave your indulgence for the views I shall place before you. In view of my temporary association with the Henry Lester Institute of Medical Research, it would seem appropriate that such observations as I am able to submit should make brief reference to Statistics as an instrument in the field of medical science; this I shall endeavour to do in the most general terms, in the hope that I may succeed in securing the interest of some of you in this most important field of work.

The Adams-Stokes syndrome was first described by Adams (1) in 1827 and was more fully studied by Stokes (11) in 1846. Since then many cases have been reported and studied. The syndrome consists of attacks of epileptiform seizures or syncope acco panied by brady- cardia and it is necessary to bcar in mind the facts that not all cases are associated with auriculo-ventricular block and tbat some accom- pany lesions of the central nervous system (9). Its relation to complete heart-block was first demonstrated with incontestable experimental evidence by Erlanger (6, 7) in 1905. The epileptiform seizures of Adams-Stokes attacks undoubtedly are due to anemia (anoxemia) of the Drain resulting from failure of the heart to supply a sufficient quantity of blood. In all cases we may assume ventricular standstill or fibrillation of greater or less duration. There may be auricular asy.stole as well or thcre may be complete heart-block. Owing to the fact that when complete heart-block occurs the ventricles usually initiate a new rhythm of their own (the itidio-ventricular rhythm") syncope does not accompany all cases of complete heart-block, but only those in which the idio_ventricular rhythm does not sufficiently rapidly develop a rate fast enough to prevent severe cerebral anemia. If this new rhythm does not appear at all, we are dealing with one of the mechanisms of sudden death. Loss of consciousness is common, though not invariably present when ventricular standstilllasts more than two to three seconds. The epilcptiform seizure usually occurs after failure of ventricular contraction for 15 0r 20 seconds. The following case of intermittent complcte heart-block with Adams-Stokes syndrome and normal auriculo-ventricular conduction between attacks seems worth reporting because the condition is unusual.

About a year ago we saw several articles in the journals on venoclysis, or the continuous administration intravenously of dextrose or other suitable solutions. Since then we have been using this method in numerous cases, and have found it such a simple and valuable procedure that I want to bring it to the attention of any who are not now using it.

Cholera Asiatica, according to Koch who discovered the specific organism, is essentially an intestinal disease and the constitutional symptoms are the result of the absorption of toxic substances from the intestine. The possibility that V. cholerœ has a more extensive distribution and is capable of causing a generalized infection has been noted by Bordoni-Uffreduzzi and Abba (1), Diatroptoff (2),Sewastianoff (3), Doyen (4), Fischer (5), Tizzoni and Cattoni (6) and Greig (7). The last observer carefully examined different organs in a series of cases for V. cholerœ and concluded that while this organism is more frequently found in the small intestine, gall-bladder and biliary pas sages, it can also be demonstrated, though rarely, in the liver, spleen, lungs, kidneys, pancreas, urinary bladder, heart, and brain. The presence of V. cholerœ in serous cavity, thoracic duct, esophagus, biceps, embryonic meconium, cerebrospinal fluid, and urine has also been observed by various investigators. In 1909 Kulescha (8) saw a patient with an hepatic abscess caused by V. cholerœ. Four years later Scicluna (9) reported a case of acute meningitis, without intestinal lesion, due to V. cholerœ. Greig (10) thinks that lymph channels play a more important role than the blood stream in the distribution of the comma bacillus since he has not so far cultivated the organism from the circulating blood during life, although he has examined by various methods a number of cases for this purpose. His opinion is strengthened by V. cholerœ in lymph nodes near the intestine. So far there is no case on record in which V. cholerœ has been isolated from the circulating blood during life, although Bordoni-Uffreduzzi and Abba (1) and Sewastianoff (3) have successfully cultivated V. cholerœ from the heart blood at necropsy. In view of this fact the following case is worthy of report.

Of the various parasitic infections of the lower portion of the female genital tract, one of the rarest is an infection by Entotnoeba histolytica. The following are the particulars of two cases of a carcinoma of the cervix uteri associated with Entamoeba histolytica. The writer has been unable to find any report in the literature of a like infection.

The closely related conditions of the teeth known as mottled or chalky enamel, and brown stain are very common in certain regions of North China. Anderson and Stevenson (1) have observed an incidence of chalky enamel as nigh as 82.6 per cent, and of brown stain as high as 45.4 per cent at Taiyuanfu. Their well illustrated article comprises many interesting facts as to its incidence and distribution.

It will be remembered that in Part I, which was embodied in an earlier paper*, a group of ocular tumors was considered which were primarily confined to the eyeballitseIf. The present communication, representing Part II, will limit itself to the consideration of ocular tumors which were located in the spaces between the eyeball and the orbital wall according to the following outline.

On the occasion of our biennial conference it is customary for the President to deliver his opening address. This practice owes its origin in the English speaking world to the resolution taken in 1832 at the foundation meeting of the Provincial Medical and Surgical Association, the predecessor of the British Medical Association, with reference to the conference: "It is proposed that one of the members shall be appointed to give at the next annual meeting, an account of the state of progress of medical science during the last year, or an oration on some subject connected with medical science."

Municipal public health is a comparatively recent innovation in this country. Until the advent of the republican form of government scarcely any attention had been paid to community health outside of the foreign settlements. After the 1911 revolution, the establishment of local governments modelled along Japanese lines made health administration a police function under the direction of laymen who had generally no knowledge of even the elementary principles of public health.