DENGUE FEVER.

DENGUE FEVER.

1348 X RAY NOMENCLATURE. THERE are few branches of medicine with a more troublesome vocabulary than radiology. To begin with, the radiologist is by h...

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1348

X RAY NOMENCLATURE. THERE are few branches of medicine with a more troublesome vocabulary than radiology. To begin with, the radiologist is by his name a specialist in the use of rays. In practice he specialises in X rays and often also in radium, but not by any means always in rays of ultra-violet or infra-red light. The exponents of these last devices may justly be asked to invent names for themselves, for the X ray man was first on the scene. They have indeed begun to do so, for we remember having seen UVology, which perhaps is intended to be read uviology, and IRology or iriology might follow suit. But how is a specialist in X rays to be distinguished from a specialist in radium ? The distinction may seldom arise, but when details of technique are being discussed it may be unavoidable. The French have solved it with precision by using radiothémpie alongside radiumthérapie. The difficulty then arises that there is no adjective or verb corresponding to " X ray." The X ray photographer probably feels this deficiency more keenly than anyone else. His work makes immense demands on skill and patience, and when his child is triumphantly brought forth he has the humiliation of being uncertain what to call it. The word " radiogram " has been snatched from under his nose and applied to a message transmitted by wireless telegraphy, whilst " radiograph," by analogy with " telegraph," suggests an apparatus rather than its product. If he applies to philological friends for a substitute they produce " skiagram," which drives him, baffled, back on the phrase " X ray photograph " ; and after every lecture in which this occurs several times in quick succession he relapses into deeper despair. His difficulty when asked what he is doing to the patient is even worse. He may say he is X raying him or has X rayed him, but he cannot, if he is anything of a purist, write this. Still less can he say he is " X ray photograph" " ing " him. Radiographing is possible, but it does not seem to be generally accepted, and the exponents of wireless have already almost annexed it for the transmission of pictures. To meet the difficulty the Americans have boldly taken " Roentgen," the distinguished name of the inventor of X rays, and used it as the foundation of their X ray vocabulary. The subcommittee on nomenclature recently appointed by the Section on Radiology of the American Medical Association to standardise the terminology of the science have developed this plan very fully.! They restrict the use of " X ray " as an adjective-with a small x-to concrete nouns such as " apparatus," " tube," and presumably also " dermatitis," and recommend " roentgen " when dealing with abstractions. If their report is adopted, it will be necessary to speak of roentgen therapy and roentgen diagnosis ; patients will be roentgenographed and their fractures will be illustrated in roentgenograms. Movements will be studied by roentgenoscopy-and presumably the patient will be roentgenoscoped, since the report does not include the handy term " screened." It is fairly certain that most radiologists in this country, rightly or wrongly, would sooner have no roentgenological vocabulary at all than this one. It is scientific and consistent, and the American workers already consider it adequate and admirable. Why, then, should it seem to English eyes so unspeakably hideous The explanation probably lies in the conditioned reflex which leads the English scientific man-despite neglect of the classics-to expect a Greek or Latin root in his technical terms. When the 1 Jour. Amer. Med. Assoc., Sept. 29th, p. 960.

looks sufficiently like one, the inconpasses unnoticed and no one is injured; faradic, milliamperes, and galvanometry do not offend the most pedantic eye. It is unfortunate that Teutonic inventors, who are so very prolific, should mostly have names that clash with classical termiiiations. Even the simplest attempts to combine them, Hertzian " or " Graafiai-i," do not look such as right after decades of honourable use. The Teutons themselves experience the same difficulty ; a terrible example is the phrase, almost an indispensable one, " struma basedowificata," meaning goitrous tissue which has undergone the changes peculiar to Graves’s In the Middle Ages some or Basedow’s disease. learned monk would have suggested a Latin But there is now no clear way out cognomen. of the difficulty ; there is no equivalent for " roentgenograph," and the English radiologist must simply take it or leave it. In this journal it has for some time been the custom to ignore the competition of wireless, using radiogram for the photograph and radiography for the process which produces it. We do not propose to alter this convenient practice until persuaded that a change is in the public interest; nor until we are convinced that Roentgen is the best way of spelling Rontgen, whose name has just been commemorated in the term Rontgen for the new international unit of X rays. The eponymous society in this country gave a lead some years ago in spelling Rontgen without the umlaut-a lead which we gladly followed and to which we have remained faithful although the Rontgen Society has relapsed. Now that the Society has amalgamated with the British Institute of Radiology we hope they may combine in paying WILHELM CONRAD RONTGEN the well-merited compliment.of anglicising his name. proper

name

gruity

"

DENGUE FEVER. IN 1927 the town Iswarmed with Aëdes

of Durban and its

vicinity egypti (Stegomyia fa.seiatc). The sanitary sloth thus plainly signalled was justly rewarded during the latter half of 1927 with some 50,000 cases of dengue fever.! In the autumn of that year a small epidemic of dengue fever occurred in Athens ; and in the summer and autumn of 1928 an epidemic of dengue of unexampled severity, which from Athens swept over nearly the whole of Greece. The main features of this epidemic were described in our issue of Sept. 1st (p. 454) and Dr. Phocion Copanaris’s report to the Office International d’Hygiene Publique has now appeared.2 Favourable climatic conditions permitted prolongation of life and development of Aëdes egypti all through the winter in certain quarters of the city of Athens, in warm houses, and in cess pits which by their construction held a considerably higher temperature than that of the air outside. In these warm shelters aedes escaping the lethal action of cold formed the connecting chain between the autumn epidemic of 1927 and the culminating enormous epidemic of the summer of 1928. It has

been shown that aedes once infected remains infective for so long as she lives. During winter and spring these addes infected a certain number of persons who in turn infected fresh generations of aedes. It is noteworthy that the epidemic of 1928 started in the same crowded, ill-ventilated, and insanitary quarter of Athens in which began the epidemic in the 2

1 THE LANCET, 1928, i., 256. Bulletin Mensuel, October, 1928, vol. xx., No. 10.

1349 of 1927. Again, occurring in the winter and

autumn

as

in

1927, the and

cases

spring up to as early July, 1928, diagnosed typhoid or In fever. are seen to retrospect they paratyphoid have been typical cases of dengue fever.. The epidemic reached its peak in the second half of August, and from then progressively diminished, but not before nearly every inhabitant of Athens and Piraeus had been stricken. The comparatively few who had been infected in the previous autumn escaped with few exceptions. From mid-August the infection was carried by incubating cases to the provinces outside Athens. It raged in the centre and in

Annotations.

even

were

south of Greece ; the north was less affected, and in the northern mountains the only cases were refugees Altitude by itself, however, is of from Athens. uncertain protection, for in Syria dengue has occurred at 5000 ft. above sea-level. Clinically the illness presented its typical features-sudden onset, slight rigor, headache, increasingly severe bone and muscle pains, and fever rising to 40° C. In most cases during the first two days there was an intense erythema of face and thorax, becoming scarlatiniform on third and fourth days. At this point the temperature fell, to rise again to a maximum on sixth and seventh, or rarely eighth day, and then dropping sharply with profuse sweatings. In some the exanthem was terminal. Gastro-intestinal disturbances were frequent. In not a few there was slight albuminuria and slight pulmonary congestion. During recovery there was bradycardia. At first the epidemic was benign in character ; later it became clinically severe, so that deaths occurred not only in the aged and previously diseased, but a few also in the young and previously healthy. Among these severe cases there occurred haemoptysis, hoematemesis, intestinal and uterine haemorrhages, severe albuminuria and haematuria, cerebral haemorrhage, convulsions, syncope, nervous and psychic troubles. The great majority of fatal cases, however, were among the aged. Relapse appeared only among those who left bed and returned too soon to everyday work, the relapse being in every feature more severe than the primary attack. Autopsies were few. They revealed no inflammatory lesions, but rather a cellular degeneration in liver, kidney, and heart. The stomach and intestines showed submucbus petechiae or larger haemorrhages. The suprarenals were apparently unaffected. There were certainly more than cases : 1240 deaths were 800,000 many recorded. Treatment was symptomatic. The blood of infected persons showed a leucopenia with relative lymphocytosis: no spirochaete was found. Investigations undertaken by the Pasteur Institute in Athens confirmed the findings of Ashburn and Craig. Filtered and unfiltered blood conveyed the disease by direct transmission to healthy persons. The disease was also experimentally transmitted by Aedes egypti 12 days after their feed on infected persons, and the aedes remained infected during their life. Atmospheric temperature during the summer of 1928 in Athens and generally all over Greece was high. In 1927 and throughout the summer of 1928 an astounding increase in the numbers of Aëdes egypti was noted. The untidy sloppiness of most Greek houses and yards provided innumerable and ideal breeding places for aedes. It was noted at Salonika in September, that aedes abounded in the small hutments where lived " refugees "-dengue fever smote all these familiesand was entirely absent from the households of better dwellings not far off where aedes was very scanty. Prevention obviously lies primarily in the destruction of aedes. The community that suffers from dengue fever has deserved the visitation.

" Ne quid nimis."

BACILLUS ABORTUS IN MAN. THE diagnosis of new human diseases is always an interesting process. It needs a particular genius to recognise that things which were thought to be the same are really different, and men like Addison and Bright are few and far between. But ordinary curiosity will often find a thing if it is looking for it, and it seems likely that infection with the organism which causes contagious abortion in cattle may now be definitely added to the list of our endemic human diseases. The evidence is summarised in the papers by Dr. Theodore Thompson and by Dr. H. Harrison and Dr. G. S. Wilson, which will be found in our present issue. It is not finally complete and convincing, for the organism has not been actually isolated from any of the British cases which have been identified by agglutination reactions ; but it constitutes a strong case, and a wider ventilation of the possibility should soon lead to the discovery of more and conclusive examples. It is perhaps significant that the new evidence relates to the north-western counties ; the disease may be commoner in some parts than others. Clinically it belongs to the large class of disease known to the honest practitioner as G.O.K. The onset is gradual and the general illness often too slight to send the patient to bed, the main symptoms being lassitude, headache, and joint pains with a certain amount of fever, which may be irregular, continuous, or paroxysmal. This goes on for weeks or even months, and there is nothing obviously diagnostic. What is so much needed is that suspicious cases should be investigated in detail and the first thing to do is to test the serum against Bacillus (Brucella) abortus. If a positive result is obtained the cultivation of the organism from the blood and urine should be attempted. As Dr. R. A. Kern points outl in an admirable article on the clinical aspects, the more the disease has been looked for in the United States the more it has been found, and the same will probably prove true in this country. He also mentions, which we very much regret, that Dr. Alice Evans, to whom so much of our knowledge of the bacteriology is due, has herself caught the infection. We wish her a speedy recovery. PROBLEMS OF A SCOTTISH BURGH. I’ THE translation of Dr. J. Parlane Kinloch in the year to the Scottish Board of Health adds a special significance to the report which he has issued as chief health officer of the royal burgh of Aberdeen. Dr. Kinloch tells us that in the course of the year 1927 and the town council unified the the parish council services of the city, and thus took hospital statutory the first step in a great project of hospital reform. The former poor-law hospital, reconditioned as a hospital of modern type with 220 beds and an orthopaedic hospital of 160 beds, was formally " opened as Woodend Hospital " on Oct. 14th, 1927, by Sir John Gilmour, Secretary of State for Scotland. The hospital has been recognised as a complete training school for nurses. Under the new arrangement the town council have taken over all the poorlaw medical buildings and have undertaken the treatment of all poor-law patients, thus anticipating the proposed poor-law reforms. An extension of the city fever hospital at a cost of 57,000 is in full progress. The new Royal Hospital for Sick Children ’ is approaching completion, and the success of the Lord Provost’s appeal for 400,000 for the provision of a new Royal Infirmary and a new maternity hospital on the same site is assured. Every effort is being made by the town council to cooperate with THE HEALTH

coming

general

1928,I

1 Amer. Jour. Med. Sci.,

1928, clxxvi., 405.