504

than 5000 cases which have been discharged or havedied since the colony was started, there lms been arecovery rate of 3’2 per cent., the standard of recoverybeing freedom from seizures for at least two years.The most interesting feature of the report is a boldattempt at an ætiological classification of the last1500 patients admitted. Among every 100 such

patients the disease is supposed to have originatedin 12 cases from " inflammatory cerebropathics

"

(meningitis or encephalitis), often arising as conmplica-tions of an acute specific fever ; in 11 cases the assignedcause is heredity, in 10 cases developmental defect,in three cases trauma at birth, in five cases traumasince birth, in two cases cerebro-vascular sclerosis, andin two cases syphilis, hereditary or acquired. Of greatinterest are two other groups ; 5 per cent. are

reported as cases of essential epilepsy, due to " person-ality make-up," and 4 per cent. as endocrinopathic.Only 43 per cent. of cases remain as unclassified.The figures given are only a summary of results,and it is difficult to make any comment without someknowledge of the methods adopted in arriving atthem. Nothing is said of multiple factors in any givencase, but we assume that in each case an effort wasmade to select the major factor, and that it is uponthese major factors that the classification is based.It is to be noted that the investigation is an endeavourto state cause and effect. The endocrine conditionsand the developmental defects, for instance, are herecited not as concomitants but as causes of epilepsy.We hope that Dr. Shanahan and his collaboratorswill republish these figures in fuller detail and withsome account of the methods adopted in classification.The numbers are large, and the records, doubtless,thorough and complete. Explained, considered anddiscussed, the figures should prove a valuable aid toall who are seeking to understand epilepsy. Amongother information given in the report it may be noted that the incidence of tuberculosis is higher than Imight be expected, for during the last five yearstuberculous infection was present in 86 patients whodied. More surprising still is the fact that among thelast 165 deaths only one was due to status epilepticus.Pathological investigations during the year haveincluded researches into the rate of sedimentation ofthe red blood cells and into the calcium-content of theblood. In neither case did the figures for epilepticsfall outside the normal limits.

THE INJECTION OF FOREIGN INERT

PARTICLES INTO THE BLOOD.

IT is known that many blood-cells on contact witha non-greasy foreign material are, by capillary action,pulled progressively onward over the foreign surface.like a drop of water on a stone. To such cells, whichinclude mammalian platelets and certain cells of theblood of astacus, Prof. J. Tait has given the name ofthigmocytes. They are not distorted by contact withan oily or greasy surface, and are highly phagocytictowards minute particles of non-greasy matter. Theyhave the power to ingest very minute particles ofinsoluble material without apparently sufferingcytolysis, and are also a source of thrombin. Theplatelets or hyaline thrombocytes of mammals arepeculiar in at least two respects, in their small sizeand in apparent absence of a nucleus. In the courseof some experiments recorded in the Journal ofPhysiology (No.2, December, 1926, vol. lxii.) Tait,working with A. R. Elvidge, injected some excessivelyfine particles of fused quartz, and particles of Indianink and other inert substances such as barium sulphateand carmine, into the ear vein of rabbits. A prioriconsiderations seemed to indicate that an injection ofvery fine particles might fail to cause coagulation ofthe circulating blood, whereas an injection of coarseparticles might cause coagulation. It was found onintravascular injection that even coarse particlesdid not necessarily determine thrombosis. Additionof coarse particles to paraffin-held, drawn blood, bvcausing cytolysis of thrombocytes, eventually caused

coagulation. Addition of an adequate quantity tAfine particles to the drawn blood of the frog similarlycaused coagulation, while addition of a smalletquantity of fine particles did not. Admixture lj(

particles with the circulating blood. while failing tvcause thrombosis, nevertheless effect f-d a transfornca-tion of fibrinpgen into fibrin. According to thobservers the reason why thrombosis does not occuris that the particular conditions of formation of thefibrin allow of a successful response on the part ofthe " natural antithrombic mechanism" " ft thecirculation. However the thrombosis may be broughtabout, it would seem likely that the rate of injectionof the particles is the important factor. Rabbits willtolerate the intravenous injection of a thick suspensionof fine particles of silica with no apparent ill-effects,provided the injection is given fairly slowly. Arapid injection, however, is prone to be followedimmediately by convulsions and death. Tait andElvidge report that as a result of intravascularinjection of particles a fall in the number of circu-lating platelets occurs. After a heavy injection thefall is profound (though complete disappearance wasnever observed), and some days elapse before theprevious number is restored. With injection of asmaller amount the fall of platelets is less and thetime for recovery of the initial number is shorter. Bvrepetitions’of the injections at intervals less than thetime necessary for recovery the number of circulatoryplatelets can be kept low. S. P. Bedson,1 however,investigating the relationship of the reticulo-endV:thelial system to the number of circulating platelets.has shown that blockage of the splenic endothefialcells by carbon causes a considerable increase otplatelets in the blood. He suggests that the spleenregulates the number of circulating platelets byphagocytosing the old and effete elements; thesefindings are diametrically opposed to those of Tait

and Elvidge, and the matter is clearly in need offurther investigation. _____

ANTONIO CARDARELLI.

I WITH the passing away last month of this greatclinician at the advanced age of 96 years, Neapolitanmedicine has lost the most brilliant star it haspossessed in the last half century. It seemed almostas if the wings of Death feared to touch this grandold man who, old as he was, suffered from none ofthe drawbacks of age, and preserved a wonderfulfreshness of interest; but at last the summons cameand was heard with calmness and composure. AntonioCardarelli was born on March 29th, 1831, at

Civitanova del Sannio, his father being a much-respected provincial doctor. In 1890 he was called tothe chair of medical pathology at Naples as successorto Arnaldo Cantani. He was at one time a memberof the Chamber of Deputies and became famous forhis crusades against the high price of salt, alcoholism.and university reform ; in 1896 he was nominatedsenator. The various rivalries which existed amongthe professors at the hospital could not do other-wise than bring into prominence the brilliant gifts ofclinician and teacher, which were so well harmonisedin Cardarelli when he was still young. And aroundthe young professor there gathered a large crowdof pupils who were devoted to him and whom hetaught with untiring zeal. He was the discovererand exponent of much well-recognised physicaltechnique-for instance, laryngotracheal pulsation inaneurysm, percussion and auscultation of the sternumin affections of the mediastinum, transthoracic thrillin hyda,tid cysts of the liver, and a method ofestimating cardiac efficiency. Much interest attachesto his description of a group of morbid signs whichhe united under the name of cardiac neurosis in whichhe indicated the true meaning of Basedowian tremor.and signs relating to the pathology of the vagus anda special form (vasomotor) of angina pectoris. itwas also his conception that the condition of the

1 Brit. Jour. Exp. Path., vol. vii., No. 5.