auto-suggestion prompted by popular tradition; they occur chiefly among the uneducated and in first pregnancies. Such morbid cravings should never be gratified, but call for judi cious treatment. Alcohol is generally harmful. It is true that it forms an important ingredient in Prochownik's dietary, while in rare cases of deficient nutrition and incapacity for assimilation a sound wine taken during a limited period does increase the digestive power; yet it is seldom called for, and must usually be forbidden. Its potentiality for evil in the form of hyperemesis and post partum hæmorrhage has often been recognised; recently further possibilities of mischief have been foreshadowed by its detection in the tissues of the foetus. Nicloux has even proved that alcohol given to a pregnant woman one hour before delivery can be found in the blood of the umbilical cord. Not only the course of pregnancy, but of labour itself, and also the puerperium, may be much modified by the diet adopted; it has long been known that habitual indulgence in alcohol exerts an unfavourable influence. More recently it has been noticed that when meat is excluded from the dietary, labour is in every way easier; the tissues, as well as the muscles, are healthier; consequently such complications as lacerations of the cervix and perineum are reduced to a minimum. Partly for this reason, and partly owing to the increased natural resistance, puerperal infection is less like'v to occur. In aseptic midwifery there is more than one factor involved; the general health of the patient requires attention, as well as the hands of the attendants. It is wofully disappointing, when every precaution has been taken by the obstetrician himself, to find that, after all, a septic condition is developing owing to abnormal activity of the bacillus coli or some other parasite of the mother. Observations such as these are confirmed by investigators in other provinces; thus the experiments are well known in which it was found that dogs fed on septic offal suffered from autosepsis when their bones and periostea were injured, while those fed on healthy food escaped sepsis, similar precautions being taken in both cases to prevent sepsis ab extero. Again, Surgeon-Major Seaman has recorded a series of comparative observations in the Spanish-American and Russo-Japanese wars. While describing the American army as “in a state bordering on collapse at the end of the war," he states that the Japanese, fed on a practically fruitarian dietary, are "in superb physical condition" when brought back to the base hospital after severe wounds. His investigations led him to the conclusion that the great difference was due to the diet. Several surgeons have recorded marked improvement in the results of surgical operations when the patient had previously been placed on a fruitarian diet. Some of the systems of diet that have been described involve much denial. The purin-free diet, however, is one that appeals to a large number of women, and as it is seldom necessary to cut off all purin-containing foods, a satisfactory modus operandi can generally be arrived at; for instance, small quantities of China tea can often be permitted. Yet even if the most stringent precautions must be observed, little difficulty is experienced women are notoriously selfsacrificing, and during pregnancy will submit to considerable hardship if they are assured it is for the good of their offspring. We must spare no pains to guide them towards this. end. ABSTRACTS. RECURRENT FEVER, ASSOCIATED WITH LYMPHADENOMA. A Contribution to the Study of Fever in Lymphadenoma, with special reference to Seventeen Reported Cases of Terminal Recurrent Fever in Lymphadenoma and Sarcomatous Disease. By H. BATTY SHAW, M.D. (Edinburgh Medical Journal, December, 1901). Notes on the Fever of Hodgkin's Disease; Recurrent (Rückfall) Fever; Ebstein's Disease. By J. H. MUSSER, M.D. (Transactions of the Association of American Physicians, 1901). A Case of Lymphadenoma associated with Recurrent Fever. By HENRY T. BEWLEY, M.D., and ALFRED J. SCOTT, F.R.C.S.I. (Transactions of the Royal Academy of Medicine in Ireland, Vol. XXI., 1903). DR. BATTY SHAW and DR. MUSSER both give a summary of the literature of this condition, the chief feature of which is the association of successive periods of fever, separated by apyrexial intervals, with enlargement of the spleen and lymph glands. In the cases quoted these recurrent attacks of fever have been terminal events in the course of Hodgkin's disease, lymphadenoma, or sarcoma. But they have also been noted in carcinoma, and rarely in cases of tuberculosis. The case published by Ebstein, which, though not the first recorded, was the first to call prominent attention to the condition, may be briefly summarised from Dr. Musser's account :-The patient, a man, aged nineteen, first complained in June, 1886, of malaise, headache, loss of appetite, and intermittent pain in the right side of the abdomen. In September of the same year the temperature records began. In 211 days there were nine paroxysms of fever of an average duration of thirteen to fourteen days, with afebrile intervals of ten to eleven days, making the intervals between the highest temperatures about twenty-four days. During the attacks the temperature rose slowly and sank rather suddenly, the defervescence often being accompanied by sweating. The appetite was lost during the paroxysms, but became ravenous in the intervals. The spleen was enlarged, and became even larger during the attacks of fever, but the lymph glands were not enlarged. After the tenth attack the temperature remained raised for twenty-two days, and then fell, but rose again almost immediately, and the patient died five days later in a state of collapse. Post mortem, white nodules were found in the pleura; the bronchial and mediastinal glands were enlarged, and there were nodules in the spleen, liver, and kidneys. Ebstein regarded the case as one of malignant lymphoma. Dr. Musser publishes two similar cases of his own, and notes of another are given by Dr. Shaw. In the first of Dr. Musser's the illness lasted eighteen months. There was enlargement of the spleen and lymph glands. The temperature is summarised as follows: Febrile period.—November 27 to December 3 (6 days). From subsequent inquiry it was known that the temperature was subnormal on February 4, that there was a transient rise just before the 12th, and that it was normal again on the 19th. The next recorded febrile period began on March 4 and continued till the 11th, but had ceased some time before the 18th. An afebrile period of fourteen days followed, but on the 25th the temperature rose to 104°, becoming subnormal again on April 8. Death ultimately occurred from exhaustion. During the paroxysms the glands in the neck and axilla became swollen, and a heart murmur developed. The patient had loss of appetite, nausea, and vomiting, and emaciated rapidly. Towards the end of the attack there was slight jaundice, with bile in the urine. During the intervals the swelling of the glands subsided, the appetite returned, and the patient ate ravenously and increased in. weight. There was some reduction of red cells, but no leucocytosis. In Dr. Musser's second case similar symptoms were present, but the case gave evidence of general tubercular infection-a condition which was also present in one of the previously-recorded cases. The case published by Dr. Bewley and Mr. Scott is that of a man, thirty-five years of age, who first had an attack of fever, supposed to have been enteric, lasting four weeks, followed by two relapses of ten days' duration each, with periods. or normal temperature in between. A second attack occurred two months later, accompanied by an irritating cough, which was believed to be due to enlargement of some of the intra-thoracic glands. A blood count showed 3,570,000red cells, and one or two white to 2,288 red cells. The hæmoglobin was 90 per cent. The fever continued for some five or six weeks, and it was thought that the patient was going to die, when the temperature fell to normal in three days, and in a week he was to all appearances practically well. A month later there was a relapse, with another period of apparent recovery, only to be followed by a further prolonged period of fever, at the end of which the patient died of exhaustion. Post mortem, a large mass was found' behind the sternum arising from the mediastinal glands, with: another small mass attached to the inner pleural surface of the right upper lobe, and extending into the lung substance.. Enlarged glands were also found at the attachment of the mesentery round the aorta. There was a small grey spot in the liver, and the spleen was mottled and irregular. Microscopically, the growths were composed of fibrous tissue strands, with a few cells lying in the interspaces. No microorganisms could be found. |