DIAGNOSIS AND TREATMENT OF TUBERCULOSIS

2. Eclampsiain Sydney is more prevalentin the winter months,and at that time the mortality rate is higher. 3. Eclampsia in Sydney is more prevalent in personsbelow the age of twenty-oneyears,but may occur at any age. Themortality is low before the age of twenty-oneyears and is higher over the age of thirty years. 4. The prognosis is worse in eclampsia supervenlng before the thirty-sixth week than later in pregnancy. The severe type predominatesbefore the thirty-sixth week, and the mild predominates after the thirty-sixth week. 5. The classificationadoptedby the London Committee into mild and severetypes is an advancein the study of the disease,and its general adoption would make future reports more valuable. 6. The incidence of eclampsia in Sydney is slightly lower than that of Great Britain, but the incidence in primigramdm and multiparm and the percentageof mild and Reverecasesare about the same. 7. The most importantprognosticphenomenaare: the degreeof coma, the numberof fits, the temperature, the amountof albumin, the pulserate, ann the height of the blood pressurein that order. S. Ante parium. eclampsiais associatedin Sydney with a higher mortality than }Jost partum, 9. The severetype of eclampsiais about twice as dangerousin muUipa;rm as in primtigrO!Vidm. 10. Eclampsiacan be preventedin most casesby thorough ante-natalsupervision,but not in all. 11. The history of previous illnessesis of value in determiningthe liability of eclampsiaensuing. 12. Eclampsiarecursin about3% of casesand is followed by signs suggestive of some permanent renal damagein about20% of cases. 13. Conservativetreatment with a minimum of obstetricinterferenceyields the best results. 14. The results of treatment at the Women's Hospital comparevery favourably with the average results in Great Britain and America, but fall below Stroganoff'slatest results. 15. Eclampsia shows no marked variation in its generalmanifestationsin Sydneyas comparedwith other parts of the world. OF Robert Koch's original pupils who studied the pathologyand diagnosisof tuberculosiswith him in Berlin In the ninth decade of last century but few remain to carryon his work. Of these the protagonistin England is Dr. Camac Wilkinson who, with magniflcent courage. has reentered the fray in publishing a new book on tuberculin.' This small work consistsof two parts. The first Is on the pathology, diagnosis and treatment ef chronic tuberculosisof the eye, such as keratitis punctata. scleritis, episclerltis, chorioiditis, iritis, iridocyclitis, periphlebitis retinalis tuberculosa. and possiblysympathetic ophthalmltis. All theselesions may, of course,have other causes-syphilis,gonorrhcea et ッ・エ・イセ「オエL as is shown by numerous cases, the chronic forms are often tuberculous. The common attribution of them to rheumatism Is much less fashionablesince Poncetand Lerlche in France, Schaeffer In Germany, and Rolleston in England showed how often vague pains and inflammation of joints and other structures so frequently called rheumatism are really by-effects of an unrecognized tuberculosis. In a review of 53 such ocular cases,43 of which, after their progress had rendered other causes unlikely, were diagnosed as tuberculous by reaction to tuberculinand successfullytreatedby hypodermicInjection of tuberculm, and 10 of which did not react and formed useful controls, Dr. Wilkinson establisheshis thesis that the possibilities of direct observation,aided, if necessary. by optical instruments,permit here a far clearer demonstration of the value of tuberculin than is possible in most other parts of the body. Dr. Charles Leonard Gimblett, an ophthalmic surgeon, who followed the progress of many of these patients, has been completely convinced, and In a foreword to the book he expresses his admiration for Dr. Wilkinson's profound knowledge, not only of tuberculosis,but also of generalmedicineand pathology, and his unqualified satisfactionwith tuberculin as a diagnostic and therapeuticagent. Of the 43 cases referred to above, copious notes are given, and 31 of them are Illustrated by charts. The secondpart of the book is entitled "The Diagnosis, Treatment and Prevention of Phthisis". It contains descriptionsof some new work and ideas. notably on the characterand course of infection described by Ranke as the primary complex, but consists mostly of an eloquent expositionof the author'sviews, so often brilliantly stated. but, alas, so little appreciated,of the economicinadequacy of sanatoriumtreatmentand of the best means for the prevention of acute tuberculosis in infants and children by the thorough exploitation of tuberculin at special clinics, the only meansfor the treatmentof phthisis in tne aggregate available to a nation of limited monetary resources. Camae Wilkinson's admirers, of whom there are many in the profession, though by no meansso numerousand vociferous as his detractors, will receive this latest production with interest. gratitude and enthusiasm.


Conclusions.
As a result of a. study of 101 cases of eclampsia treated by all members of the honorary medical staff at the Women's Hospital, Crown Street, Sydney, I have formed the following conclusions: 1. A symptom suggestive that eclampsia may occur is a blood pressure which is low in the early months of pregnancy, which gradually rises in the later months of pregnancy to 140 millimetres of mercury or over, and which is associated with oedema and albuminuria.
2. Eclampsia in Sydney is more prevalent in the winter months, and at that time the mortality rate is higher.
3. Eclampsia in Sydney is more prevalent in persons below the age of twenty-one years, but may occur at any age. The mortality is low before the age of twenty-one years and is higher over the age of thirty years.
4. The prognosis is worse in eclampsia supervenlng before the thirty-sixth week than later in pregnancy. The severe type predominates before the thirty-sixth week, and the mild predominates after the thirty-sixth week.
5. The classification adopted by the London Committee into mild and severe types is an advance in the study of the disease, and its general adoption would make future reports more valuable.
6. The incidence of eclampsia in Sydney is slightly lower than that of Great Britain, but the incidence in primigramdm and multiparm and the percentage of mild and Revere cases are about the same.
7. The most important prognostic phenomena are: the degree of coma, the number of fits, the temperature, the amount of albumin, the pulse rate, ann the height of the blood pressure in that order.
S. Ante parium. eclampsia is associated in Sydney with a higher mortality than }Jost partum, 9. The severe type of eclampsia is about twice as dangerous in muUipa;rm as in primtigrO!Vidm. 10. Eclampsia can be prevented in most cases by thorough ante-natal supervision, but not in all.
11. The history of previous illnesses is of value in determining the liability of eclampsia ensuing.
12. Eclampsia recurs in about 3% of cases and is followed by signs suggestive of some permanent renal damage in about 20% of cases.
13. Conservative treatment with a minimum of obstetric interference yields the best results.
14. The results of treatment at the Women's Hospital compare very favourably with the average results in Great Britain and America, but fall below Stroganoff's latest results.
15. Eclampsia shows no marked variation in its general manifestations in Sydney as compared with other parts of the world.
OF Robert Koch's original pupils who studied the pathology and diagnosis of tuberculosis with him in Berlin In the ninth decade of last century but few remain to carryon his work. Of these the protagonist in England is Dr. Camac Wilkinson who, with magniflcent courage. has reentered the fray in publishing a new book on tuberculin. ' This small work consists of two parts. The first Is on the pathology, diagnosis and treatment ef chronic tuberculosis of the eye, such as keratitis punctata. scleritis, episclerltis, chorioiditis, iritis, iridocyclitis, periphlebitis retinalis tuberculosa. and possibly sympathetic ophthalmltis. All these lesions may, of course, have other causes-syphilis, gonorrhcea et ｯ ･ ｴ ･ ｲ ｾ ｢ ｵ ｴ Ｌ as is shown by numerous cases, the chronic forms are often tuberculous. The common attribution of them to rheumatism Is much less fashionable since Poncet and Lerlche in France, Schaeffer In Germany, and Rolleston in England showed how often vague pains and inflammation of joints and other structures so frequently called rheumatism are really by-effects of an unrecognized tuberculosis. In a review of 53 such ocular cases, 43 of which, after their progress had rendered other causes unlikely, were diagnosed as tuberculous by reaction to tuberculin and successfully treated by hypodermic Injection of tuberculm, and 10 of which did not react and formed useful controls, Dr. Wilkinson establishes his thesis that the possibilities of direct observation, aided, if necessary. by optical instruments, permit here a far clearer demonstration of the value of tuberculin than is possible in most other parts of the body.
Dr. Charles Leonard Gimblett, an ophthalmic surgeon, who followed the progress of many of these patients, has been completely convinced, and In a foreword to the book he expresses his admiration for Dr. Wilkinson's profound knowledge, not only of tuberculosis, but also of general medicine and pathology, and his unqualified satisfaction with tuberculin as a diagnostic and therapeutic agent. Of the 43 cases referred to above, copious notes are given, and 31 of them are Illustrated by charts.
The second part of the book is entitled "The Diagnosis, Treatment and Prevention of Phthisis". It contains descriptions of some new work and ideas. notably on the character and course of infection described by Ranke as the primary complex, but consists mostly of an eloquent exposition of the author's views, so often brilliantly stated. but, alas, so little appreciated, of the economic inadequacy of sanatorium treatment and of the best means for the prevention of acute tuberculosis in infants and children by the thorough exploitation of tuberculin at special clinics, the only means for the treatment of phthisis in tne aggregate available to a nation of limited monetary resources.
Camae Wilkinson's admirers, of whom there are many in the profession, though by no means so numerous and vociferous as his detractors, will receive this latest production with interest. gratitude and enthusiasm.

SCIENCE AND THE ECONOMIC SYSTEM.
DR. ｆ ｒ ａ ｾ ｋ TRINCA, in his book, "Science and Democracy", shows that he sees in the present economic system two distinct relationships, that of science to industry and that of Industry to finance! Thus, modern Industry is reacted upon by two separate forces, the net outcome being the series of booms and depressions with which we are so familiar.