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A NOTE ON THE RESPIRATORY FORM OF PARATYPHOID.
136
Clinical N
A NOTE ON THE RESPIRATORY FORM OF
otes :
BY
MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL.
As
a
PARATYPHOID.1 E. STOLKIND, M.D.
preface to this
note I wish to state my convic-
tion that paratyphoid infection as well as typhoid
are
only symptom-complexes. Referring both to cases which I have observed in Moscow and during my HARE-LIP. study in the clinics abroad and to those recorded, I have adopted and found useful the following BY TOM BATES, JUN., F.R.C.S. ENG., HONORARY SURGEON, WORCESTER GENERAL INFIRMARY. clinical classification: (1) Influenzal or respiratory form of paratyphoid; (2) gastro-intestinal form; (3) choleraic form; and (4) typhoid form. As in THE patient was a boy, aged 14 years, with double most other diseases the clinical classification of hare-lip. The premaxillary bone was removed, paratyphoid is schematic, and based not only on and the section of the lips made with a sharp- pathological, but also on clinical symptoms. Apart pointed tenotomy knife, sutures of silkworm gut from these typical cases there are not seldom found cases or transition forms, in which the being passed through and through. The illustra- atypical disease with a combination of two forms begins tions show the condition before and after operaor with one form changing later into another. tion and the steps of the operation itself, the latter Further, besides these we meet cases of infection taken from Jacobson and Steward’s " Operations of of separate organs, which we may call, for example, Surgery," fourth edition. appendicitis paratyphosa, cystitis paratyphosa, and HAGEDORN’S OPERATION FOR DOUBLE
so tortn.
FiG. 2.
FiG. 1.
raratypnoi(t also appear as a, secondary disease. The first form of paratyphoid, which 1. have proposed to call the influenza or respiratory form, does not differ clinically can
from respiratory inThe first, fluenza. typical case I observed in Moscow. A patient, 38 years of age, was suddenly attacked with coryza, cough, angina
catarrhalis, headache, moderate fever, and lassi-
tude; the spleen was. slightly enlarged; constipa-
After
Before operation.
operation.
FlG.3.
tion was present. On the’ ninth day several roseolar spots appeared on the abdomen. Pulse 78-94. The fever was irregular and lasted 14 days. After thefirst three days the patient, perspired very much. Bacteriologically p ar atyphoid was shown to be’ present. Pfeiffer’s bacillus’ was absent.
Later I observed other cases. Beliaew records in Moscow a case of paratyphoid B, in which coryza, sorethroat, cough, bron-
chitis, fever, sleeplessness, lassitude, and enlarged spleen were, present. Allen deof parain Australia ;. typhoid the attack began with coryza, cough, and
scribed
a case
1 Being part of a paper read before the Royal Society of Medicine (Section of Medicine)
Diagram showing stages
in
Hagedorn’s operation
for double
hare-lip.
on
Nov. 23rd, 1915.
137 headache. Baer observed an epidemic of para. typhoid B in 56 soldiers, all of whom had fever, conjunctivitis, and pharyngitis ; some of them had also bronchitis. Grattan and Wood, and also Sufford, have observed cases of paratyphoid A in British soldiers in India, in " which the attack might easily be mistaken for the onset of influenza; in about half the cases there were symptoms of sorethroat and bronchitis ; the conjunctivae were suffused." Rolly observed a male, aged 22, with status typhosus, angina catarrhalis, acute laryngitis with erosions as in influenza. Wilucki has recently recorded an epidemic of 33 cases of paratyphoid B, in 7 of which the onset began suddenly with
respiratory
shivering, fever, lassitude, coryza, angina catarrhalis, bronchitis, conjunctivitis, and headache. Similar cases have been described by Bofinger, Conradi, Drigalski and Jurgens, Lenz, Walker, and others. We may conclude, therefore, that a definite clinical form of paratyphoid exists, resembling influenza, and that the possibility of this disease being present must be borne in mind when influenzal symptoms occur. Bibliography.—Stolkind: Paratyphus, Medizinskoie Obozrenie, 1907, Moscow; Practicheski Wratch, 1911 (St. Petersburg); Contrib. a.
Clinica del Paratifo (Clinica di Univers. di Siena diret. da Professor V. Patella), Clinica med. Ital., 1912; Die Klinik des Paratyphus, Wiirzburg. Abhandlungen, 1912, vol. xii , H. 7 (with references) ; Archiv f. Kinderbeilk., vol. xlix.; Typhoid and Paratyphoid Infections (Russian). Wilucki: Archiv f. Schiffs- u. Tropen-Hygiene, 1915, vol. xix., H. 12.
Reviews
and
Notices of Books.
Radium, X Rays, and the Living Cell. With Physical Introduction. By HECTOR
A. COLWELL, M.B. Lond’l D.P.H. Oxon., late Assistant in the Cancer Research Laboratories, Middlesex Hospital ; and SIDNEY Russ, D,Sc. Lond., Physicist to the Middlesex Hospital. With 61 figures and 2 coloured plates. London : G. Bell and Sons, Limited. 1915. Pp. 324. Price 12s. 6d. net.
THE object of the authors is the description of the experimental facts showing the effects that the X rays and the rays from radium exert upon living cells. The book is divided into two parts; in the first the physical properties of the radiations The introductory chapters are conare described. cerned with the explanation of the attributes of the X rays-photographic action, fluorescence, ionisation, and penetration. The details of the researches of Bragg, Moseley, and Darwin are given, in which an analysis of the rays by means of crystals has been realised. The X rays are capable of producing a continuous spectrum, since they contain different wave-lengths over a considerable range, and are therefore of the same nature as the waves of heat, light, and electricity, with the peculiarity that the lengths are very short. The remainder of the first part is devoted to the radio-active substances,
uranium, radium, thorium, and actinium, and a full account of the a, j8, and y rays is afforded-the rays consisting of positively-charged helium atoms with high speed, intense ionisative and small penetrative powers; the /3 rays with considerable penetrative power; while that of the yrays is highest of all, and corresponds to a very hard type of X ray. The question how nearly the hard X ray approximates in penetration the hard gamma ray of radium depends upon the substance employed to test this power. The fraction appears to lie between one-fifth and one-thirtieth. Experimentation is still proceeding in order to produce harder X rays which will approach in quality that
of the radium ’/ rays. In the case of the X ray, the penetration appears to be connected largely with the nature of the generator rather than The radio-active with the X ray tube itself. emanations, the " active deposit," and accurate methods of measurement of radium are then fully narrated. Part II. is concerned with the chemical action of the rays. Commencing with the effects of X rays, radium rays and emanations on inanimate bodies like water, carbon dioxide, lecithin, sodium urate, colloids and enzymes, we pass to the results of their influence upon various sporozoa, infusoria, hydrozoa and rotifera, developing echinoderms, nematodes, upon the embryos of fish, amphibians and birds, and upon various species of bacteria and plant forms. Long chapters are given to the consequences of the activity of radium and X rays on the skin and the blood. Two beautifully coloured plates are reproduced from Clunet’s researches on the skin. These are triple-stained with heamateineosin-aurantia, after which the nuclei appear blue, the protoplasm and connective tissue The effect on red, and the keratin yellow. the skin depends both upon the wave-length of the particular X rays-soft rays, with twice the length of the hard rays, producing much greater reaction-and upon the manner of application, whether a single large dose or repeated small doses are administered. In acute dermatitis the upper layers of the epidermis, the hairs, glands, dermal papillae disappear, and the deeper layers of the dermis become keratinised. In chronic atrophic radio-dermatitis there is also great sclerosis of the dermis, and the epidermis may be reduced to a few layers of living cells. In the vessels the lumina become narrower and the walls are thickened. Then follows a full description of the action of radium and X rays on the spleen, thymus, and thyroid. Repeated moderate clinical doses of X rays given to kittens, at intervals of a week, produce a permanent atrophy of the thymus. It becomes reduced to a mere fibro-adipose residuum. The X ray treatment of the status thymo-lymphaticus and thymic asthma can therefore be recommended as likely to be beneficial. On the thyroid neither macroscopical nor microscopical changes are to be discovered after the X rays, although, as radiotherapy teaches us, the effect on exophthalmic goitre is often considerable. If the thymus is too, the effect should be more immediate. A complete account of the action on the gonads is given. The spermatocytes and spermatogonia are destroyed, and of the cells of the seminiferous tubule those of Sertoli alone persist. The result appears to be due to a chemical and morphological alteration followed by resorption in situ. Similar destructive effects follow irradiation of the ovaries by the X rays-the Graafian follicles become atrophied and disappear. Bergonie and Tribondeau were led by these results to the formulation of the law that " immature cells and cells in an active state of division are more sensitive to the X rays than cells which have already acquired their fixed adult morphological or physiological characters." The rest of Part II. is concerned with the effects of the rays on malignant cells, the production of malignant disease by the rays, idiosyncrasies of the human subject to the rays, certain physiological actions, and their selective and differential activities. The effect of radium has been studied on those tumours of rats and mic
enlarged
Clinical N
A NOTE ON THE RESPIRATORY FORM OF
otes :
BY
MEDICAL, SURGICAL, OBSTETRICAL, AND THERAPEUTICAL.
As
a
PARATYPHOID.1 E. STOLKIND, M.D.
preface to this
note I wish to state my convic-
tion that paratyphoid infection as well as typhoid
are
only symptom-complexes. Referring both to cases which I have observed in Moscow and during my HARE-LIP. study in the clinics abroad and to those recorded, I have adopted and found useful the following BY TOM BATES, JUN., F.R.C.S. ENG., HONORARY SURGEON, WORCESTER GENERAL INFIRMARY. clinical classification: (1) Influenzal or respiratory form of paratyphoid; (2) gastro-intestinal form; (3) choleraic form; and (4) typhoid form. As in THE patient was a boy, aged 14 years, with double most other diseases the clinical classification of hare-lip. The premaxillary bone was removed, paratyphoid is schematic, and based not only on and the section of the lips made with a sharp- pathological, but also on clinical symptoms. Apart pointed tenotomy knife, sutures of silkworm gut from these typical cases there are not seldom found cases or transition forms, in which the being passed through and through. The illustra- atypical disease with a combination of two forms begins tions show the condition before and after operaor with one form changing later into another. tion and the steps of the operation itself, the latter Further, besides these we meet cases of infection taken from Jacobson and Steward’s " Operations of of separate organs, which we may call, for example, Surgery," fourth edition. appendicitis paratyphosa, cystitis paratyphosa, and HAGEDORN’S OPERATION FOR DOUBLE
so tortn.
FiG. 2.
FiG. 1.
raratypnoi(t also appear as a, secondary disease. The first form of paratyphoid, which 1. have proposed to call the influenza or respiratory form, does not differ clinically can
from respiratory inThe first, fluenza. typical case I observed in Moscow. A patient, 38 years of age, was suddenly attacked with coryza, cough, angina
catarrhalis, headache, moderate fever, and lassi-
tude; the spleen was. slightly enlarged; constipa-
After
Before operation.
operation.
FlG.3.
tion was present. On the’ ninth day several roseolar spots appeared on the abdomen. Pulse 78-94. The fever was irregular and lasted 14 days. After thefirst three days the patient, perspired very much. Bacteriologically p ar atyphoid was shown to be’ present. Pfeiffer’s bacillus’ was absent.
Later I observed other cases. Beliaew records in Moscow a case of paratyphoid B, in which coryza, sorethroat, cough, bron-
chitis, fever, sleeplessness, lassitude, and enlarged spleen were, present. Allen deof parain Australia ;. typhoid the attack began with coryza, cough, and
scribed
a case
1 Being part of a paper read before the Royal Society of Medicine (Section of Medicine)
Diagram showing stages
in
Hagedorn’s operation
for double
hare-lip.
on
Nov. 23rd, 1915.
137 headache. Baer observed an epidemic of para. typhoid B in 56 soldiers, all of whom had fever, conjunctivitis, and pharyngitis ; some of them had also bronchitis. Grattan and Wood, and also Sufford, have observed cases of paratyphoid A in British soldiers in India, in " which the attack might easily be mistaken for the onset of influenza; in about half the cases there were symptoms of sorethroat and bronchitis ; the conjunctivae were suffused." Rolly observed a male, aged 22, with status typhosus, angina catarrhalis, acute laryngitis with erosions as in influenza. Wilucki has recently recorded an epidemic of 33 cases of paratyphoid B, in 7 of which the onset began suddenly with
respiratory
shivering, fever, lassitude, coryza, angina catarrhalis, bronchitis, conjunctivitis, and headache. Similar cases have been described by Bofinger, Conradi, Drigalski and Jurgens, Lenz, Walker, and others. We may conclude, therefore, that a definite clinical form of paratyphoid exists, resembling influenza, and that the possibility of this disease being present must be borne in mind when influenzal symptoms occur. Bibliography.—Stolkind: Paratyphus, Medizinskoie Obozrenie, 1907, Moscow; Practicheski Wratch, 1911 (St. Petersburg); Contrib. a.
Clinica del Paratifo (Clinica di Univers. di Siena diret. da Professor V. Patella), Clinica med. Ital., 1912; Die Klinik des Paratyphus, Wiirzburg. Abhandlungen, 1912, vol. xii , H. 7 (with references) ; Archiv f. Kinderbeilk., vol. xlix.; Typhoid and Paratyphoid Infections (Russian). Wilucki: Archiv f. Schiffs- u. Tropen-Hygiene, 1915, vol. xix., H. 12.
Reviews
and
Notices of Books.
Radium, X Rays, and the Living Cell. With Physical Introduction. By HECTOR
A. COLWELL, M.B. Lond’l D.P.H. Oxon., late Assistant in the Cancer Research Laboratories, Middlesex Hospital ; and SIDNEY Russ, D,Sc. Lond., Physicist to the Middlesex Hospital. With 61 figures and 2 coloured plates. London : G. Bell and Sons, Limited. 1915. Pp. 324. Price 12s. 6d. net.
THE object of the authors is the description of the experimental facts showing the effects that the X rays and the rays from radium exert upon living cells. The book is divided into two parts; in the first the physical properties of the radiations The introductory chapters are conare described. cerned with the explanation of the attributes of the X rays-photographic action, fluorescence, ionisation, and penetration. The details of the researches of Bragg, Moseley, and Darwin are given, in which an analysis of the rays by means of crystals has been realised. The X rays are capable of producing a continuous spectrum, since they contain different wave-lengths over a considerable range, and are therefore of the same nature as the waves of heat, light, and electricity, with the peculiarity that the lengths are very short. The remainder of the first part is devoted to the radio-active substances,
uranium, radium, thorium, and actinium, and a full account of the a, j8, and y rays is afforded-the rays consisting of positively-charged helium atoms with high speed, intense ionisative and small penetrative powers; the /3 rays with considerable penetrative power; while that of the yrays is highest of all, and corresponds to a very hard type of X ray. The question how nearly the hard X ray approximates in penetration the hard gamma ray of radium depends upon the substance employed to test this power. The fraction appears to lie between one-fifth and one-thirtieth. Experimentation is still proceeding in order to produce harder X rays which will approach in quality that
of the radium ’/ rays. In the case of the X ray, the penetration appears to be connected largely with the nature of the generator rather than The radio-active with the X ray tube itself. emanations, the " active deposit," and accurate methods of measurement of radium are then fully narrated. Part II. is concerned with the chemical action of the rays. Commencing with the effects of X rays, radium rays and emanations on inanimate bodies like water, carbon dioxide, lecithin, sodium urate, colloids and enzymes, we pass to the results of their influence upon various sporozoa, infusoria, hydrozoa and rotifera, developing echinoderms, nematodes, upon the embryos of fish, amphibians and birds, and upon various species of bacteria and plant forms. Long chapters are given to the consequences of the activity of radium and X rays on the skin and the blood. Two beautifully coloured plates are reproduced from Clunet’s researches on the skin. These are triple-stained with heamateineosin-aurantia, after which the nuclei appear blue, the protoplasm and connective tissue The effect on red, and the keratin yellow. the skin depends both upon the wave-length of the particular X rays-soft rays, with twice the length of the hard rays, producing much greater reaction-and upon the manner of application, whether a single large dose or repeated small doses are administered. In acute dermatitis the upper layers of the epidermis, the hairs, glands, dermal papillae disappear, and the deeper layers of the dermis become keratinised. In chronic atrophic radio-dermatitis there is also great sclerosis of the dermis, and the epidermis may be reduced to a few layers of living cells. In the vessels the lumina become narrower and the walls are thickened. Then follows a full description of the action of radium and X rays on the spleen, thymus, and thyroid. Repeated moderate clinical doses of X rays given to kittens, at intervals of a week, produce a permanent atrophy of the thymus. It becomes reduced to a mere fibro-adipose residuum. The X ray treatment of the status thymo-lymphaticus and thymic asthma can therefore be recommended as likely to be beneficial. On the thyroid neither macroscopical nor microscopical changes are to be discovered after the X rays, although, as radiotherapy teaches us, the effect on exophthalmic goitre is often considerable. If the thymus is too, the effect should be more immediate. A complete account of the action on the gonads is given. The spermatocytes and spermatogonia are destroyed, and of the cells of the seminiferous tubule those of Sertoli alone persist. The result appears to be due to a chemical and morphological alteration followed by resorption in situ. Similar destructive effects follow irradiation of the ovaries by the X rays-the Graafian follicles become atrophied and disappear. Bergonie and Tribondeau were led by these results to the formulation of the law that " immature cells and cells in an active state of division are more sensitive to the X rays than cells which have already acquired their fixed adult morphological or physiological characters." The rest of Part II. is concerned with the effects of the rays on malignant cells, the production of malignant disease by the rays, idiosyncrasies of the human subject to the rays, certain physiological actions, and their selective and differential activities. The effect of radium has been studied on those tumours of rats and mic
enlarged