- Email: [email protected]
BCG VACCINATION OF MEDICAL STUDENTS
862 of virus into the anterior chamber of the rabbit’s eye. An acute iritis develops after an incubation period of four to eight days, and later the inflammatory process extends to the cornea with the development -of a keratitis. The eye symptoms subside in one to two
weeks, leaving,
as
a
rule,
a
slight degree
of
age. But during the following two or three of hospital service, 98 per cent. were, or became, years Pirquet-positive. As many as 19 of this group of 339 students developed tuberculosis during this same
period.
Supplementary investigations made between
December, 1929, and May, 1930, have thrown new light
corneal opacity, and the recovered eye is refractory on the fate of the Pirquet-tested students who were, to further inoculations. Both typhus and tsutsuga- in some cases, vaccinated with B C G between 1927 mushi virus are capable of exciting this reaction, and and 1929. This latest study deals with 183 students, -passage can be achieved by means of the aqueous the nature of whose Pirquet reaction was known before humour, though in the case of typhus virus this they began work in hospital. Among 88 who were -failed by the third generation owing to relative Pirquet-positive from the outset, there was only one insusceptibility of the rabbit. Guinea-pigs and who developed clinical tuberculosis during his submonkeys can also be used, and the immunity asso- sequent hospital service. Among 51 with a negative -ciated with recovery is strictly specific. The most Pirquet reaction at the outset and not vaccinated with interesting feature of this work is the observation B C G, there were as many as six students who that if the eye is extirpated at the height of infection developed tuberculosis. Among the 44 whose Pirquet rickettsia can be demonstrated in considerable reaction was negative at the outset, and who were, numbers in scrapings taken from Descemet’s mem- accordingly, vaccinated with B C G, there was not one brane. This method should prove of great value, and who developed tuberculosis. These figures are, of -the possibility of its employment in the study of course, too small to be conclusive, but supported as filtrable viruses should not be overlooked. they are by the earlier work of Dr. Heimbeck and his colleagues on probationers and nurses in hospital,
they
are
significant.
____
BCG VACCINATION OF MEDICAL STUDENTS RECENT meetings1 of the Medisinske Selskap ENTOPTIC PHENOMENA. -of Oslo have considered the basis of modern antiof the Royal Society The Section of tuberculosis work. Prof. F. Harbitz, representing> of Medicine held Ophthalmology their first meeting this session on the older school of pathology, defended its teachings Oct. 8th, when Mr. E. W. Brewerton delivered his with much eloquence. The younger school, repre-, address on entoptic phenomena. Under sented by Dr. J. Heimbeck and others, professed presidential this title he dealt with the subjective observation of itself deeply sceptical of the value of the sanatoriums’ within the eyeball. These are, in fact, .and other institutions which have cost the country objects thrown on the retina by objects in the shadows, millions of kroner. This school would like to see: transparent media of the eye, of a different refractive antituberculosis work based on Pirquet tests, index to the medium in which they lie. It is not followed-by B C G vaccination of all the Pirquet- necessary that objects should be opaque in order to negatives irrespective of their ages. Statistics and throw shadows. If they are not opaque those with charts were presented in support of conflicting a higher refractive index than the surrounding .hypotheses on the development of tuberculosis in medium appear luminous with a dark border, and the various age-groups and the value of shielding those with a lower index have a dark centre andinfants from exposure to infection. Prof. Harbitz luminous edges. The objects may arise from the himself put in a nutshell the difficulties of the position : the the or the retina. Before ’
,
.
cornea, vitreous, lens, result of recent investigations," he said, " it is the advent of the said Brewerton, ophthalmoscope, already claimed that our tuberculosis work should be’ their observation was considered to beMr. of very great completely revolutionised. It would seem that we must not in the future devote so much of our energies as we do at importance. Able oculists and physicists thought it present in combating tuberculosis in childhood and limiting worth while to devote hours to the detailed study of the possibilities of infection in these age-groups ; for in the phenomena and the literature of the subject was .so doing we are, it would appear, merely deferring the period voluminous. At the present time so many elaborate of infection to the years of adolescence when infection is - said to be particularly dangerous. Combating infection instruments are available for the examination of the in childhood would, therefore, logically seem to be directly eye that older and simpler methods of subjective harmful ; the right course would rather be to allow children Various methods were to become infected so that they would pass into the age of examination are seldom used. adolescence with increased resistance to tuberculosis to now available for the subjective examination of the ’which they are henceforth to be immune. But how are we different media of the eye. To examine the pupillary to manage so that the child is exposed only to a benign area of the lens the best method was to make a minute ’and slight infection ? No one can at present give a satisfactory answer, and the whole of this teaching seems to me hole in a piece of paper with the point of a very fine to be dangerous and to depend on many unproven hypotheses needle. If this was held between the eye and a and most uncertain factors. The beneficial work, which electric light an illuminated area was visible has hitherto been carried out, and which has assuredly bright in which many details could be made out, even in to the limitation of contributed greatly infection in childhood, To examine the vitreous all that was normal a lens. and thereby of the morbidity and mortality from tuberculosis in childhood, should, therefore, undoubtedly, be continued, necessary was to look at a bright light with the lids even though more persons enter the years of adolescence nearly closed, when many transparent curly bands with a negative Pirquet reaction." with dark borders could be seen, some larger than " As
a
Dr. Heimbeck offers suggestive figures in support others. The larger ones were further from the of his own contentions. In association with Dr. 0. retina, and their shadows were magnified; strands Scheel, Dr. T. Skaar, and Dr. 0. Thorrud, he has close to the retina threw very small shadows. The found that 56 per cent. of the medical students, who subjective examination of the macular region could had not yet begun to walk the hospitals and come be effected by a light focused through the sclerotic, in contact with tuberculous patients, were Pirquet- which showed up this region with astonishing details, positive-a ratio corresponding approximately to the other parts of the retina being out of focus. It that found in other members of their class at the was not, of course, possible for an observer to see his 1 Reported in the Norsk Magazin for Laegevidenskaben : July, August, and September.
own optic disc by this method. Mr. Brewerton concluded his interesting address with the suggestion
weeks, leaving,
as
a
rule,
a
slight degree
of
age. But during the following two or three of hospital service, 98 per cent. were, or became, years Pirquet-positive. As many as 19 of this group of 339 students developed tuberculosis during this same
period.
Supplementary investigations made between
December, 1929, and May, 1930, have thrown new light
corneal opacity, and the recovered eye is refractory on the fate of the Pirquet-tested students who were, to further inoculations. Both typhus and tsutsuga- in some cases, vaccinated with B C G between 1927 mushi virus are capable of exciting this reaction, and and 1929. This latest study deals with 183 students, -passage can be achieved by means of the aqueous the nature of whose Pirquet reaction was known before humour, though in the case of typhus virus this they began work in hospital. Among 88 who were -failed by the third generation owing to relative Pirquet-positive from the outset, there was only one insusceptibility of the rabbit. Guinea-pigs and who developed clinical tuberculosis during his submonkeys can also be used, and the immunity asso- sequent hospital service. Among 51 with a negative -ciated with recovery is strictly specific. The most Pirquet reaction at the outset and not vaccinated with interesting feature of this work is the observation B C G, there were as many as six students who that if the eye is extirpated at the height of infection developed tuberculosis. Among the 44 whose Pirquet rickettsia can be demonstrated in considerable reaction was negative at the outset, and who were, numbers in scrapings taken from Descemet’s mem- accordingly, vaccinated with B C G, there was not one brane. This method should prove of great value, and who developed tuberculosis. These figures are, of -the possibility of its employment in the study of course, too small to be conclusive, but supported as filtrable viruses should not be overlooked. they are by the earlier work of Dr. Heimbeck and his colleagues on probationers and nurses in hospital,
they
are
significant.
____
BCG VACCINATION OF MEDICAL STUDENTS RECENT meetings1 of the Medisinske Selskap ENTOPTIC PHENOMENA. -of Oslo have considered the basis of modern antiof the Royal Society The Section of tuberculosis work. Prof. F. Harbitz, representing> of Medicine held Ophthalmology their first meeting this session on the older school of pathology, defended its teachings Oct. 8th, when Mr. E. W. Brewerton delivered his with much eloquence. The younger school, repre-, address on entoptic phenomena. Under sented by Dr. J. Heimbeck and others, professed presidential this title he dealt with the subjective observation of itself deeply sceptical of the value of the sanatoriums’ within the eyeball. These are, in fact, .and other institutions which have cost the country objects thrown on the retina by objects in the shadows, millions of kroner. This school would like to see: transparent media of the eye, of a different refractive antituberculosis work based on Pirquet tests, index to the medium in which they lie. It is not followed-by B C G vaccination of all the Pirquet- necessary that objects should be opaque in order to negatives irrespective of their ages. Statistics and throw shadows. If they are not opaque those with charts were presented in support of conflicting a higher refractive index than the surrounding .hypotheses on the development of tuberculosis in medium appear luminous with a dark border, and the various age-groups and the value of shielding those with a lower index have a dark centre andinfants from exposure to infection. Prof. Harbitz luminous edges. The objects may arise from the himself put in a nutshell the difficulties of the position : the the or the retina. Before ’
,
.
cornea, vitreous, lens, result of recent investigations," he said, " it is the advent of the said Brewerton, ophthalmoscope, already claimed that our tuberculosis work should be’ their observation was considered to beMr. of very great completely revolutionised. It would seem that we must not in the future devote so much of our energies as we do at importance. Able oculists and physicists thought it present in combating tuberculosis in childhood and limiting worth while to devote hours to the detailed study of the possibilities of infection in these age-groups ; for in the phenomena and the literature of the subject was .so doing we are, it would appear, merely deferring the period voluminous. At the present time so many elaborate of infection to the years of adolescence when infection is - said to be particularly dangerous. Combating infection instruments are available for the examination of the in childhood would, therefore, logically seem to be directly eye that older and simpler methods of subjective harmful ; the right course would rather be to allow children Various methods were to become infected so that they would pass into the age of examination are seldom used. adolescence with increased resistance to tuberculosis to now available for the subjective examination of the ’which they are henceforth to be immune. But how are we different media of the eye. To examine the pupillary to manage so that the child is exposed only to a benign area of the lens the best method was to make a minute ’and slight infection ? No one can at present give a satisfactory answer, and the whole of this teaching seems to me hole in a piece of paper with the point of a very fine to be dangerous and to depend on many unproven hypotheses needle. If this was held between the eye and a and most uncertain factors. The beneficial work, which electric light an illuminated area was visible has hitherto been carried out, and which has assuredly bright in which many details could be made out, even in to the limitation of contributed greatly infection in childhood, To examine the vitreous all that was normal a lens. and thereby of the morbidity and mortality from tuberculosis in childhood, should, therefore, undoubtedly, be continued, necessary was to look at a bright light with the lids even though more persons enter the years of adolescence nearly closed, when many transparent curly bands with a negative Pirquet reaction." with dark borders could be seen, some larger than " As
a
Dr. Heimbeck offers suggestive figures in support others. The larger ones were further from the of his own contentions. In association with Dr. 0. retina, and their shadows were magnified; strands Scheel, Dr. T. Skaar, and Dr. 0. Thorrud, he has close to the retina threw very small shadows. The found that 56 per cent. of the medical students, who subjective examination of the macular region could had not yet begun to walk the hospitals and come be effected by a light focused through the sclerotic, in contact with tuberculous patients, were Pirquet- which showed up this region with astonishing details, positive-a ratio corresponding approximately to the other parts of the retina being out of focus. It that found in other members of their class at the was not, of course, possible for an observer to see his 1 Reported in the Norsk Magazin for Laegevidenskaben : July, August, and September.
own optic disc by this method. Mr. Brewerton concluded his interesting address with the suggestion