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PLEUROPERICARDITIS
199 the period of incapacity from work, if it is given the modern facilities now known to be necessary. This is a long-term -programme, involving an expenditure of at least £ a0 million over several years ; but, though this sum is large it represents no more than one-sixth of the annual cost of accidents to this country. Here indeed is a challenge to administrative authority as well as to modern medicine, on which at least, a start should be
made now. The treatment of injuries belongs to no special group of surgeons old or new, but it does require a special type of hospital service which for the twenty-four hours of each day works at a tempo at present unfamiliar both to general surgery and its many specialties. Birmingham Accident Hospital, Birmingham, 15.
WILLIAM GISSANE.
PLEUROPERICARDITIS
leading article of July which receives some
SiR,ŇYour
14 contains the
statement, support from the textbooks, that uraemic pericarditis is asymptomatic. That this is not true is shown
by
the
following
case-histories :
1. A woman, aged 63, was admitted to Leith Hospital July, 1954, with retrosternal pain which had been present for three days. Before the onset of pain she had felt well and was doing her normal household duties. Examination showed an extensive pericardial rub, the blood-urea nitrogen was 150 mg. per 100 r-ril., and she died a week later in urasmic coma. Necropsy showed bilateral congenital cystic disease of the kidneys. 2. A man, aged 28, was admitted to the hospital in July, 1955, with a diagnosis of perforated peptic ulcer. He had been discharged from the Army in 1948 with chronic-nephritis but had remained fairly well and was regularly employed as a baker’s vanman. Twelve hours before admission he complained of retrosternal pain which increased in intensity and spread to the abdomen. He was in severe pain when admitted, there was board-like rigidity of the abdomen, and no pericardial rab could be detected. After some discussion a laparotomy was performed which revealed no abdominal lesion. The following day a pericardial rub appeared, blood-urea nitrogen was 137 mg. per 100 ml., and death from uraemia occurred three days later. Necropsy confirmed the presence of extensive renal disease with pericarditis. in
Leith Hospital, Edinburgh 6.
CHALMERS H. DAVIDSON.
APPARENT PLEIOTROPIC EFFECT OF GENES DETERMINING TASTE THRESHOLDS FOR PHENYLTHIOUREA
SiR,ŇIn your issue of July 14, Mr. Saldanha describes significant differences between the phenylthioureatasting thresholds in samples of healthy and tuberculous white " individuals in Brazil, and he suggests that the susceptibility to tuberculosis and the ability to taste phenylthiourea may depend on the same genes." As Mr. Saldanha has used the methods described by Harris and myself,l and as I had myself an opportunity of testing the phenylthiourea thresholds in various Brazilian populations, I may perhaps comment on this interpretation, which I consider not proven. The mistake probably arose from considering the control group2 as " presenting the same racial characteristics " as the group of tuberculous patients. The control group was a sample of the highest stratum of Brazilian society, which, as I can confirm, contains a large proportion of non-tasters ; it is not stated where Mr. Saldanha’s tuberculous patients came from but, judging from my own work in a Brazilian tuberculosis sanatorium, they might not have come from the same "
"
stratum
as
the control and,
as
European admixture, would fewer non-tasters.
a
be t
consequence of nonto contain
expected
Before, therefore, accepting any pleiotropic relation-
ship between tasting thresholds 1. 2.
and resistance to tubercu-
Harris, H., Kalmus, H. Ann. Eugen., London. 1949, 15, 24. Saldanha, P. H., Guinsburg, S. Rev. bras. Biol. 1954, 14, 285.
would want to-see the result of similar tests in a less obviously stratified population than that of Brazil.
losis,
one
performed Galton
Laboratory, University College, London.W.C.1.
H. KALMUS.
CORTICOTROPHIN AND ANTIBIOTIC-RESISTANT INFECTIONS
SiR,-The
course
of
antibiotic-resistant
infections,
especially those due to staphylococci, may often be altered by giving corticotrophin (A.C.T.H.) or corticoid therapy. Our long experience with corticotrophin in dermatology led us to believe that apart from the adrenocorticotrophic action there must be some other direct action on the skin that differentiates this hormonesometimes in a striking way-from corticosteroids. 28
patients
with
staphylococcal
or
streptococcal
infections
(furunculosis, multiple abscesses, relapsing axillary hydradenitis, infectious eczematous dermatitis) who failed to respond
previous sulphonamide or antibiotic therapy were treated corticotrophin. 20-40 i.u. of corticotrophin gel was given daily for 3 to 14 days without other treatment except topical iodinated alcohol or aluminium acetate. Generally, after 24 to 48 hours inflammatory signs subsided, with diminution of pain and pruritus. The ’inflammatory infiltration and oedema lessened and even big furuncles disappeared after a few days. With a total dose ranging from 80 to 400 i.u. the different processes were brought under
to
with
control.
The
following
cases
illustrate the
use
of this treatment.
A 7-month-old infant with sweat-duct infection and multiple abscesses on the head, neck, and upper thorax was treated with penicillin, erythromycin, and chloramphenicol without benefit. The abscesses were opened twice but relapses continued and the lymph-glands were grossly enlarged. 80 i.u. of corticotrophin gel (2 consecutive days on 20 i.u. per day, and 40 i.u. given at the rate of 20 i.u. every 48 hours) cleared up the condition in a week. Some weeks later the skin and general condition were normal. A man of 42 had had many bouts of furunculosis for several months. There had been some improvement after chloramphenicol and erythromycin, and erratic results from‘ Supronal, ’ sulphafurazole (’ Gantrisin ’), and tetracyclines. After 120 LU. of corticotrophin gel, given at the rate of 40 i.u; every 48 hours, the furunculosis disappeared and the patient, seen 3 months afterwards, had had no relapse. A man of 60, a mild diabetic well controlled by diet and 20 units of protamine zinc insulin daily, had acute furunculosis and hydradenitis. Erythromycin and an increase of insulin to 80 units daily improved the staphylococcal infections without curing them. 200 i.u. of corticotrophin gel in 10 days and 40 units of insulin daily ended the trouble, and the patient now reports after 2 months that he is perfectly well on an antidiabetic diet only. A hospital nurse of 42 suffered from bouts of axillary hydradenitis since 1954. All known antibiotics, staphylococcal toxoids and anatoxins, autohsemotherapy, and X rays had all been used with only partial relief. This patient needed only 60 i.u. of corticotrophin, given on 3 consecutive days, to cure her. A man of 40 had streptococcal and staphylococcal skin infection which began a year earlier with a perigenital intertrigo. The usual antibiotics, local treatment, and vitamins had only a slight effect. He was given 200 i.u. of corticotrophin in 14 days, and the infection disappeared. A week later a slight perigenital relapse was definitely controlled by 80 i.u. and a local antiseptic. A woman of 56 had for the second time a neck abscess which responded only slightly to antibiotics, X rays, and local medication. The severe pain was much relieved in 24 hours by the first 40 i.u. of corticotrophin. The infection subsided in 2 weeks with a total dose of 400 iu.
The action of corticotrophin on the foci probably allows the body to solve its without the help of antibiotics. Department of Dermatology, Argerich Hospital. Buenos Aires, Argentina.
inflammatory own
problem
ARTURO M. MOM.
made now. The treatment of injuries belongs to no special group of surgeons old or new, but it does require a special type of hospital service which for the twenty-four hours of each day works at a tempo at present unfamiliar both to general surgery and its many specialties. Birmingham Accident Hospital, Birmingham, 15.
WILLIAM GISSANE.
PLEUROPERICARDITIS
leading article of July which receives some
SiR,ŇYour
14 contains the
statement, support from the textbooks, that uraemic pericarditis is asymptomatic. That this is not true is shown
by
the
following
case-histories :
1. A woman, aged 63, was admitted to Leith Hospital July, 1954, with retrosternal pain which had been present for three days. Before the onset of pain she had felt well and was doing her normal household duties. Examination showed an extensive pericardial rub, the blood-urea nitrogen was 150 mg. per 100 r-ril., and she died a week later in urasmic coma. Necropsy showed bilateral congenital cystic disease of the kidneys. 2. A man, aged 28, was admitted to the hospital in July, 1955, with a diagnosis of perforated peptic ulcer. He had been discharged from the Army in 1948 with chronic-nephritis but had remained fairly well and was regularly employed as a baker’s vanman. Twelve hours before admission he complained of retrosternal pain which increased in intensity and spread to the abdomen. He was in severe pain when admitted, there was board-like rigidity of the abdomen, and no pericardial rab could be detected. After some discussion a laparotomy was performed which revealed no abdominal lesion. The following day a pericardial rub appeared, blood-urea nitrogen was 137 mg. per 100 ml., and death from uraemia occurred three days later. Necropsy confirmed the presence of extensive renal disease with pericarditis. in
Leith Hospital, Edinburgh 6.
CHALMERS H. DAVIDSON.
APPARENT PLEIOTROPIC EFFECT OF GENES DETERMINING TASTE THRESHOLDS FOR PHENYLTHIOUREA
SiR,ŇIn your issue of July 14, Mr. Saldanha describes significant differences between the phenylthioureatasting thresholds in samples of healthy and tuberculous white " individuals in Brazil, and he suggests that the susceptibility to tuberculosis and the ability to taste phenylthiourea may depend on the same genes." As Mr. Saldanha has used the methods described by Harris and myself,l and as I had myself an opportunity of testing the phenylthiourea thresholds in various Brazilian populations, I may perhaps comment on this interpretation, which I consider not proven. The mistake probably arose from considering the control group2 as " presenting the same racial characteristics " as the group of tuberculous patients. The control group was a sample of the highest stratum of Brazilian society, which, as I can confirm, contains a large proportion of non-tasters ; it is not stated where Mr. Saldanha’s tuberculous patients came from but, judging from my own work in a Brazilian tuberculosis sanatorium, they might not have come from the same "
"
stratum
as
the control and,
as
European admixture, would fewer non-tasters.
a
be t
consequence of nonto contain
expected
Before, therefore, accepting any pleiotropic relation-
ship between tasting thresholds 1. 2.
and resistance to tubercu-
Harris, H., Kalmus, H. Ann. Eugen., London. 1949, 15, 24. Saldanha, P. H., Guinsburg, S. Rev. bras. Biol. 1954, 14, 285.
would want to-see the result of similar tests in a less obviously stratified population than that of Brazil.
losis,
one
performed Galton
Laboratory, University College, London.W.C.1.
H. KALMUS.
CORTICOTROPHIN AND ANTIBIOTIC-RESISTANT INFECTIONS
SiR,-The
course
of
antibiotic-resistant
infections,
especially those due to staphylococci, may often be altered by giving corticotrophin (A.C.T.H.) or corticoid therapy. Our long experience with corticotrophin in dermatology led us to believe that apart from the adrenocorticotrophic action there must be some other direct action on the skin that differentiates this hormonesometimes in a striking way-from corticosteroids. 28
patients
with
staphylococcal
or
streptococcal
infections
(furunculosis, multiple abscesses, relapsing axillary hydradenitis, infectious eczematous dermatitis) who failed to respond
previous sulphonamide or antibiotic therapy were treated corticotrophin. 20-40 i.u. of corticotrophin gel was given daily for 3 to 14 days without other treatment except topical iodinated alcohol or aluminium acetate. Generally, after 24 to 48 hours inflammatory signs subsided, with diminution of pain and pruritus. The ’inflammatory infiltration and oedema lessened and even big furuncles disappeared after a few days. With a total dose ranging from 80 to 400 i.u. the different processes were brought under
to
with
control.
The
following
cases
illustrate the
use
of this treatment.
A 7-month-old infant with sweat-duct infection and multiple abscesses on the head, neck, and upper thorax was treated with penicillin, erythromycin, and chloramphenicol without benefit. The abscesses were opened twice but relapses continued and the lymph-glands were grossly enlarged. 80 i.u. of corticotrophin gel (2 consecutive days on 20 i.u. per day, and 40 i.u. given at the rate of 20 i.u. every 48 hours) cleared up the condition in a week. Some weeks later the skin and general condition were normal. A man of 42 had had many bouts of furunculosis for several months. There had been some improvement after chloramphenicol and erythromycin, and erratic results from‘ Supronal, ’ sulphafurazole (’ Gantrisin ’), and tetracyclines. After 120 LU. of corticotrophin gel, given at the rate of 40 i.u; every 48 hours, the furunculosis disappeared and the patient, seen 3 months afterwards, had had no relapse. A man of 60, a mild diabetic well controlled by diet and 20 units of protamine zinc insulin daily, had acute furunculosis and hydradenitis. Erythromycin and an increase of insulin to 80 units daily improved the staphylococcal infections without curing them. 200 i.u. of corticotrophin gel in 10 days and 40 units of insulin daily ended the trouble, and the patient now reports after 2 months that he is perfectly well on an antidiabetic diet only. A hospital nurse of 42 suffered from bouts of axillary hydradenitis since 1954. All known antibiotics, staphylococcal toxoids and anatoxins, autohsemotherapy, and X rays had all been used with only partial relief. This patient needed only 60 i.u. of corticotrophin, given on 3 consecutive days, to cure her. A man of 40 had streptococcal and staphylococcal skin infection which began a year earlier with a perigenital intertrigo. The usual antibiotics, local treatment, and vitamins had only a slight effect. He was given 200 i.u. of corticotrophin in 14 days, and the infection disappeared. A week later a slight perigenital relapse was definitely controlled by 80 i.u. and a local antiseptic. A woman of 56 had for the second time a neck abscess which responded only slightly to antibiotics, X rays, and local medication. The severe pain was much relieved in 24 hours by the first 40 i.u. of corticotrophin. The infection subsided in 2 weeks with a total dose of 400 iu.
The action of corticotrophin on the foci probably allows the body to solve its without the help of antibiotics. Department of Dermatology, Argerich Hospital. Buenos Aires, Argentina.
inflammatory own
problem
ARTURO M. MOM.