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ASSOCIATION OF CLINICAL PATHOLOGISTS
112 ASSOCIATION OF CLINICAL PATHOLOGISTS SCIENTIFIC MEETING WITH DEMONSTRATIONS
AT the Sir William Dunn School of Pathology, Oxford, Jan. 4, Prof. A. D. GARDNER demonstrated the diagnostic work-now centred at Oxford in the Emergency Public Health Laboratory Service-on specimens of sera received from patients thought to be suffering from infection with Leptospira icterohœmorrhagiœ. Specimens of sera from the pre-jaundice stage were wanted. It might be possible, he suggested, to make an early diagnosis from the extreme weakness in the febrile stage, muscle pains, photophobia with red conjunctiva, and vomiting. The work of most of the patients hitherto examined exposed them to direct infection from rats-e.g., sewer men, canal hands, farm labourers and a pumper from air-raid shelters: Dr. JOAN TAYLOR demonstrated the identification of the various salmonellas by preliminary cultural tests followed by serological analysis with the standard specific and group-agglutinating sera. She would prefer to call these by their figure and letter constituents rather than the town or district of origin. She discussed slide and tube methods of titration of agglutinogens ; both, she said, were needed. Craigie’s use of a small inserted tube in a culture tube of " sloppy agar " often provided rapidly, from the top layer of the surrounding agar, culture of the most motile bacilli required for testing the flagellar H element. Dr. A. H. ROBB-SMITH demonstrated the histology of lymph nodes. Glands from the inguinal region were on
Reviews of Books Surgery of Modern Warfare Part 2. Edited by HAMILTON BAILEY, F.R.C.S. Edinburgh : E. and S. Livingstone. Pp. 160. 12s. 6d. WITH the publication of part 2 Surgery of Modern "
Warfare " gets fairly into its stride. The chapter on skin grafting is completed and there are full accounts of the war surgery of the chest, abdomen, genito-urinary system and arteries. The overlapping and contradictions which to some extent marred the value of part 1 are here nowhere in evidence. A battery of experts fire their salvos with precision and effect, and Mr. Hamilton Bailey is well justified in saying " What they have to say must be authoritative." For all that a contributor, however eminent, should spare us such expressions as " Plurivisceral damage augments mortality ; multiregional injury determines a heavier death-roll." The chapter on wounds of the chest covers most of the ground in a short space. The genito-urinary system is discussed by four authors each of whom has given us a clear and concise account of the problems involved in this branch of surgery. The final chapters deal with the surgery of the arteries and include a discussion of the different types of tourniquet in common use. The two chapters on the surgical approach to the arteries are stimulating. The author of them has wisely assumed that the anatomist, not God, decided that the third part of the axillary artery should become the brachial artery at the lower border of the teres major ; and that to describe two methods of approach to this continuous structure is superfluous. Throughout, the essentially practical methods of Fiolle and Delmas have been preferred to the classical approaches described by most textbooks. Thus long skin incisions are advised ; the free dissection of tendons and fascia with, if necessary, resection of bone gives the operator a chance to examine carefully the exact source of the bleeding and allows him to ligature only such vessels as require it, thus saving needless sacrifice of the blood-supply to a limb which might otherwise be in danger of gangrene. Duval’s approach to the first part of the anterior tibial artery and Sencert’s and Henry’s approaches to the first part of the subclavian artery are operations which should only be attempted by the expert working in a properly equipped theatre. The first may save a limb when the more simple ligature of the popliteal artery might cause gangrene. Ligature of the first part of the subclavian is a life-saving measure and these approaches should be mastered by the surgeon. By the perfection of such operations our results will improve. In the last
often too fibrous while those from the upper cervical chain might show a, confused picture owing to former inflammation from teeth and tonsillar lesions ; the best gland should be chosen by the clinical pathologist, generally one from the lower cervical chain or the axilla. The whole gland should be carefully excised and immediately fixed. Section before fixation enabled the capsule to retract and so distort the finer details of structure sought by the pathologist in the follicles, ,inuses or medulla of the gland. Dr. C. L. COPE resumed his work on pregnandiol (cf. LANCET, 1940, 2, 158). The absence of pregnandiol in the urine after a threatened miscarriage, he said, enabled the gynaecologist to assume with some confidence that the foetus was dead. Captain L. HANSEN described the estimation of the amounts of sulphanilamide, sulphapyridine or sulphathiazol present in the blood after their administration, either orally or parenterally. Difficulties arose because the same dose in different patients might yield different concentrations in the blood, or even in the same patient on different occasions. The conjugated acetylated forms of the three substances were inactive. Even a trace of Novocain, accidentally admitted from the needle used to the specimen, might falsify the colorimetric determination. After dinner at Oriel College a discussion took place on the regionalisation of hospitals in the future and its effect on clinical pathology. Much emphasis was laid on the direct relationship that should exist between the pathologist and the patient ; the sending of specimens by post and the resulting divorce of the pathologist from access to the patient was deplored.
chapter two problems worthy of further investigation are treated, perhaps a little too authoritatively, as settled. The first relates to simultaneous ligature of the vein when the main artery to a limb is ligatured, about which there are still differences of opinion. Secondly, it is advised that a limb in danger of gangrene should be kept at room temperature and not warmed, the argument being that by increasing the temperature of the limb the metabolism of the part is increased and this may be too much for a flagging circulation to control. The circulation is certainly improved by warmth, however. and the question is whether this augmented circulation is in proportion to
the increased metabolism, whether it is in excess of the demands or whether it falls short of the new metabolic requirements. Fresh investigation is necessary before this extremely important point can be decided. Finally, although many surgeons will not share Mr. Hamilton Bailey’s passion for maggots (a long chapter on which is most will understand his reasons for saying included), " I have learnt more in editing part 2 than by taking a postgraduate course visiting surgical clinics." War Wounds and Injuries Edited by E. FLETCHER, M.B. Camb.. M.R.C.P., physician in the E.M.S. and to Queen Mary’s Hospital for the East End ; and R. W. RAVEN, F.R.C.S., surgeon in the E.M.S. and to outpatients at the French Hospital, London. London : Edward Arnold and Co. Pp. 255. 14s. THIS is a collection of articles on the surgery of wounds and injuries that have appeared in the Postgraduate Medical Journal during the first year of war. It is therefore a symposium rather than a a series of essays rather than a comprehensive review. Some of the contributions are written for the young general surgeon, others are more suitable for the expert. The discussion on injuries of the eye and disturbances of vision which occupies sixty pages is of interest above all to the specialist. On the other hand, in the chapter on war injuries of the jaw and face Cole deals with principles rather than details, and gives an insight into the problems of these important injuries that is essential to the surgeon who may haveto deal with them in the front line. The excellent group of papers on injuries of the chest by Roberts, Sellors, Price Thomas and Alexander should be very helpful to the young war surgeon, and the slight divergence of views on hæmothorax does not detract from the value of the discussion as a whole. Other contributions of real practical importance, because of their sane outlook and their emphasis on principles, are those on amputations by Seymour Barling, on the surgery
textbook,
of deformities by MacMurray, and and spinal cord by Knight.
on
injuries of the spine
AT the Sir William Dunn School of Pathology, Oxford, Jan. 4, Prof. A. D. GARDNER demonstrated the diagnostic work-now centred at Oxford in the Emergency Public Health Laboratory Service-on specimens of sera received from patients thought to be suffering from infection with Leptospira icterohœmorrhagiœ. Specimens of sera from the pre-jaundice stage were wanted. It might be possible, he suggested, to make an early diagnosis from the extreme weakness in the febrile stage, muscle pains, photophobia with red conjunctiva, and vomiting. The work of most of the patients hitherto examined exposed them to direct infection from rats-e.g., sewer men, canal hands, farm labourers and a pumper from air-raid shelters: Dr. JOAN TAYLOR demonstrated the identification of the various salmonellas by preliminary cultural tests followed by serological analysis with the standard specific and group-agglutinating sera. She would prefer to call these by their figure and letter constituents rather than the town or district of origin. She discussed slide and tube methods of titration of agglutinogens ; both, she said, were needed. Craigie’s use of a small inserted tube in a culture tube of " sloppy agar " often provided rapidly, from the top layer of the surrounding agar, culture of the most motile bacilli required for testing the flagellar H element. Dr. A. H. ROBB-SMITH demonstrated the histology of lymph nodes. Glands from the inguinal region were on
Reviews of Books Surgery of Modern Warfare Part 2. Edited by HAMILTON BAILEY, F.R.C.S. Edinburgh : E. and S. Livingstone. Pp. 160. 12s. 6d. WITH the publication of part 2 Surgery of Modern "
Warfare " gets fairly into its stride. The chapter on skin grafting is completed and there are full accounts of the war surgery of the chest, abdomen, genito-urinary system and arteries. The overlapping and contradictions which to some extent marred the value of part 1 are here nowhere in evidence. A battery of experts fire their salvos with precision and effect, and Mr. Hamilton Bailey is well justified in saying " What they have to say must be authoritative." For all that a contributor, however eminent, should spare us such expressions as " Plurivisceral damage augments mortality ; multiregional injury determines a heavier death-roll." The chapter on wounds of the chest covers most of the ground in a short space. The genito-urinary system is discussed by four authors each of whom has given us a clear and concise account of the problems involved in this branch of surgery. The final chapters deal with the surgery of the arteries and include a discussion of the different types of tourniquet in common use. The two chapters on the surgical approach to the arteries are stimulating. The author of them has wisely assumed that the anatomist, not God, decided that the third part of the axillary artery should become the brachial artery at the lower border of the teres major ; and that to describe two methods of approach to this continuous structure is superfluous. Throughout, the essentially practical methods of Fiolle and Delmas have been preferred to the classical approaches described by most textbooks. Thus long skin incisions are advised ; the free dissection of tendons and fascia with, if necessary, resection of bone gives the operator a chance to examine carefully the exact source of the bleeding and allows him to ligature only such vessels as require it, thus saving needless sacrifice of the blood-supply to a limb which might otherwise be in danger of gangrene. Duval’s approach to the first part of the anterior tibial artery and Sencert’s and Henry’s approaches to the first part of the subclavian artery are operations which should only be attempted by the expert working in a properly equipped theatre. The first may save a limb when the more simple ligature of the popliteal artery might cause gangrene. Ligature of the first part of the subclavian is a life-saving measure and these approaches should be mastered by the surgeon. By the perfection of such operations our results will improve. In the last
often too fibrous while those from the upper cervical chain might show a, confused picture owing to former inflammation from teeth and tonsillar lesions ; the best gland should be chosen by the clinical pathologist, generally one from the lower cervical chain or the axilla. The whole gland should be carefully excised and immediately fixed. Section before fixation enabled the capsule to retract and so distort the finer details of structure sought by the pathologist in the follicles, ,inuses or medulla of the gland. Dr. C. L. COPE resumed his work on pregnandiol (cf. LANCET, 1940, 2, 158). The absence of pregnandiol in the urine after a threatened miscarriage, he said, enabled the gynaecologist to assume with some confidence that the foetus was dead. Captain L. HANSEN described the estimation of the amounts of sulphanilamide, sulphapyridine or sulphathiazol present in the blood after their administration, either orally or parenterally. Difficulties arose because the same dose in different patients might yield different concentrations in the blood, or even in the same patient on different occasions. The conjugated acetylated forms of the three substances were inactive. Even a trace of Novocain, accidentally admitted from the needle used to the specimen, might falsify the colorimetric determination. After dinner at Oriel College a discussion took place on the regionalisation of hospitals in the future and its effect on clinical pathology. Much emphasis was laid on the direct relationship that should exist between the pathologist and the patient ; the sending of specimens by post and the resulting divorce of the pathologist from access to the patient was deplored.
chapter two problems worthy of further investigation are treated, perhaps a little too authoritatively, as settled. The first relates to simultaneous ligature of the vein when the main artery to a limb is ligatured, about which there are still differences of opinion. Secondly, it is advised that a limb in danger of gangrene should be kept at room temperature and not warmed, the argument being that by increasing the temperature of the limb the metabolism of the part is increased and this may be too much for a flagging circulation to control. The circulation is certainly improved by warmth, however. and the question is whether this augmented circulation is in proportion to
the increased metabolism, whether it is in excess of the demands or whether it falls short of the new metabolic requirements. Fresh investigation is necessary before this extremely important point can be decided. Finally, although many surgeons will not share Mr. Hamilton Bailey’s passion for maggots (a long chapter on which is most will understand his reasons for saying included), " I have learnt more in editing part 2 than by taking a postgraduate course visiting surgical clinics." War Wounds and Injuries Edited by E. FLETCHER, M.B. Camb.. M.R.C.P., physician in the E.M.S. and to Queen Mary’s Hospital for the East End ; and R. W. RAVEN, F.R.C.S., surgeon in the E.M.S. and to outpatients at the French Hospital, London. London : Edward Arnold and Co. Pp. 255. 14s. THIS is a collection of articles on the surgery of wounds and injuries that have appeared in the Postgraduate Medical Journal during the first year of war. It is therefore a symposium rather than a a series of essays rather than a comprehensive review. Some of the contributions are written for the young general surgeon, others are more suitable for the expert. The discussion on injuries of the eye and disturbances of vision which occupies sixty pages is of interest above all to the specialist. On the other hand, in the chapter on war injuries of the jaw and face Cole deals with principles rather than details, and gives an insight into the problems of these important injuries that is essential to the surgeon who may haveto deal with them in the front line. The excellent group of papers on injuries of the chest by Roberts, Sellors, Price Thomas and Alexander should be very helpful to the young war surgeon, and the slight divergence of views on hæmothorax does not detract from the value of the discussion as a whole. Other contributions of real practical importance, because of their sane outlook and their emphasis on principles, are those on amputations by Seymour Barling, on the surgery
textbook,
of deformities by MacMurray, and and spinal cord by Knight.
on
injuries of the spine