1493EPSOM COLLEGE : ST. ANNE’S SCHOLARSHIPS

CONGENITAL SYPHILIS FROM BLOOD

TRANSFUSION

THAT the popularity of blood transfusion in thetreatment of a variety of conditions carries with itthe risk of transmitting syphilis must not be

forgotten, and it behoves those who are concernedin the operation of transfusion to make as certainas they reasonably can of the absence of syphilisin the donor. There are occasions, no doubt, whenthe transfusion is a matter of urgency, but evenif there is not time for a Wassermann reaction,one of the flocculation tests can be done. Unfor-tunately such precautions are not always effectivein preventing infection ; in a number of recorded.cases the donor’s blood gave a negative W.R. atthe time of the test, but became positive shortlyafterwards. In the American Journal of Syphilisof October, 1933, G. R. Williamson and R. A. Strongquote a number of cases of transmitted infectionwhich they have collected from published records,and describe a curious case of congenital syphilisderived from a blood transfusion to the mother

during pregnancy. The mother was a trained nursewho for financial reasons had to return to workwhen four months’ pregnant. From a patient,a case of suppurative appendicitis, she contracted-an infection of the finger which developed into ageneral septicaemia so severe as to call for a trans-fusion ; two days later she was given a secondtransfusion, and in neither case was the donor’sblood examined for syphilis. About six weekslater she developed a rash, and two months afterher baby was born, a fortnight prematurely. Hewas healthy at birth, but at the age of 1 month

developed snuffles, and the examination of his andhis mother’s blood showed markedly positive W.R.,though when tested on previous occasions she hadshown a negative reaction. The father’s bloodand that of an older child were negative. Theauthors conclude, apparently with justification, thatthe child’s syphilis was the result of the mother’stransfusion, and it is clear that this possible sourceof congenital infection must not be ignored.

ANÆSTHESIA IN LABOUR

ONE difficulty has now been removed whichformerly opposed attempts to estimate the value ofvarious anaesthetics and analgesias in labour. Werefer to the necessity for having observations madebyan anaesthetist in charge of the patients-a condi-tion now fulfilled in more than one lying-in hospital.Its existence has been put to good use at the RoyalFree Hospital by Dame Louise McIlroy,! who records,in conjunction with Dr. Helen Rodway, the residentanaesthetist of the obstetrical unit, some carefulstudies on the alleviation of pain in 560 cases of

spontaneous labour. Although nothing novel wasintroduced into the investigation, and the resultsachieved will doubtless tally with the already formedopinions of those who have given much study to thesubject, there are many who will be glad of definiteguidance given on firm grounds, and to these wecommend the paper. Its authors point out the valueof potassium bromide and chloral hydrate (in half-drachm doses of each) in the first stage and the

advantages of "gas-and-oxygen " in the second.On the important practical question of anaesthesiafor patients delivered by midwives alone they arecautious and say that " the problem will have to bediscussed more fully in the future." They hold

1 Jour. Obst. and Gyn., Brit. Emp., December, 1933, p. 1175.

that efforts should be made to train midwives inthe administration of gas-and-oxygen, and it is

interesting to note that this plan, rather than thedistribution of chloroform capsules, was the lineadvocated by many at the recent meeting of theAssociation of Anaesthetists of Great Britain andIreland. In addition to, or without, bromide andchloral, Opoidine or morphine was used in the firststage and the statement is made that " morphine,with or without other alkaloidal derivatives of opium,is probably still the most valuable sedative and

analgesic drug in use during labour." It is consideredfar safer than many of the barbiturates which are

just now so popular, and good reasons are given fordisregarding the fear of its having a bad influenceon the infant-provided that dosage and time ofadministration are properly managed.

EPSOM COLLEGE: ST. ANNE’S SCHOLARSHIPS

IN connexion with the vacancy now existing forone of these scholarships, the regulation regarding theage of the candidates has been amended to read :" That candidates be not. less than nine years of

age on 30th July, 1934." The maximum age limithas been abolished. The age limit was originallyover 9 and under 12, but the Council found that,with the change from day scholars to boardingscholars, many good schools did not want to receivegirls until they were over 12. The maximum agelimit consequently restricted the field. Actuallythe change took place two years ago, for in Januaryof that year the Council fixed the age limit as 12 years.While Epsom College no longer administers the fundsof the St. Anne’s Scholarships, the College is interestedin the endowments, having under its eegis certain

scholarships for girls.The final date for receiving applications for the

vacancy has therefore been extended to Jan. 7th,1934. The necessary forms are to be obtained fromthe Secretary, Epsom College Office, 49, Bedford-

square, London, W.C.I.

INTRACRANIAL LESIONS FOLLOWING TRAUMA

By way of preface to an account of his systematicstudies of traumatic brain lesions Dr. 0. Berner 1

briefly refers to the case which first drew attentionto them. A man, between 50 and 60, with a recordof increasing high blood pressure, was found deadin an hotel bedroom, the door of which had to beforced. The only lesion found in the brain was ahaemorrhage into the fourth ventricle, but therewas a not inconsiderable bruise on the face over the

zygomatic arch. The patient’s life was heavilyinsured with two accident insurance companies whosemedical advisers were opposed to payment of thesum assured on the assumption that the haemorrhagehad been spontaneous and primary, and the injuryto the face a sequel to a fall induced by loss ofconsciousness. This interpretation of the cause

of death was endorsed by six other Scandinavianexperts, all of whom dismissed as untenable the theorythat the hemorrhage was secondary to the externallesion. Berner’s dissent from this interpretationwas strengthened by going into the published records,in which he found that the French surgeon, Duret,noted the presence of haemorrhages in the walls ofthe fourth ventricle after injuries to the head,particularly the front of the head. Theodor Kocher

paid a tribute to the Frenchman’s researches bycalling these Duret’s lesions. Duret’s theory of a" choc cephalorachidien " assumed that a blow on

1 Nordisk Med. Tidskrift, Oct. 7th, 1933.