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Pneumoperitoneum
136
TUBERCLE
t h a t c l u m p i n g o f the bacilli m a y o c c u r w h e n they a r e suspended in sterile distilled water. A v a r i a b l e dosage Would also explain certain a n o m a l o u s results o b t a i n e d with the d r y vaccine as c o m p a r e d w i t h fluid B C G .
Acknowledgments T h e a u t h o r s wish to express their g r a t i t u d e in the first place to M r s H a y n e s , without whose help the p a p e r could not h a v e b e e n written. W e should also like to acknowledge the assistance given b y the Principals of the A p p r o v e d Schools at K a b e t e a n d Dagorctti, a n d o f the G o v e r n m e n t African Schools at P u m w a n i a n d N a k u r u , a n d the Superi n t e n d c n t o f Prisons, N a k u r u . T h i s p a p e r is p u b l i s h e d b y permission of
the D i r e c t o r Colony.
June 1951
of Medical
Services, K e n y a
References Aronson, J. D., and Palmer, C. E. (z946) Pub. tlealth
Rep., LXb No. 23, 8o~-82o. Davies,J. N. I'. (1947) East African M.J., xxlv. Ferguson, R. G. (1946) Canadian07. of Pub. IIealth, xxxvn, No. 1I, 435-./5 L Haynes, W. S. (1949) Unpublished Report to the Director of Medical Services, Kenya Colon)', on Tuberculosis in the Natives of Kenya Colon}.'. tleaf, F. (195o) Colonial Office Circular, G.O. 8917/5o. Holm, J. (x948) BCG Vaccination Against Tuberculosis. First Edition. South African Med. Res. C. 0932) Pub. S. Afr. In.st. Med. Res., No. XXX, Vol. v, 97-1o0Stott, H. (195o) East African M.J., xxwz, . Van Deinse, F., and S~n6chal, F. (195o) Tubercle, xxxl, Nos. 7 and 8. Vint, F. W. 0937) Post Mortem Studies in the Natives of Kenya, East African M.07., Reprint. Wallgren, A. (x948) Reprint from Amer#an .7. of Disease of Children, LXXW,485-49 L
Correspondence Pneumoperitoneum
that in the tuberculosis institutions in tile New York Metropolitan Area. the number of successfid initial inductions o f p n e u m o t h o r a x has fallen steadily in the past ten years, while in the same period the number o f ' p n e u m o p e r i t o n e u m s ' has increased tenfold. Yours faithfully,
T h e Editor - 'Tubercle'. S I R , - I entirely agree with Dr Heller about the importance of tile p a p e r on Pneumoperitoneum by E. Clifford Jones and N. Macdonald which was published in TUBERCLF. in June x943. E. LLE~VELYN WILLIAMS. Unfortunately each n u m b e r of TUnE,eLf. now Lewisham Chest Clinic, contains less than half the number of pages of a x, Blagdon Road, pre-war issue, and every contributor, as Dr Lewisham, S.E. 13. Heller knows, has to restrict his article to approximately 4,000 words. It x~'as for this reason that I had to limit m y article on PneumoBCG Vaccination peritoneum (TUBERCLE, February I95I ) to a desThe Scarification Method cription of the clinical findings in a series of Tile E d i t o r - 'Tubercle'. cases and a discussion of the present day' indications for tiffs form of therapy. D~AR SIR, - Having had the privilege of E. Clifford Jones' and N. Macdonald's paper reading Dr Hayne's excellent paper on 'Prewas the first account of a series ofcases treated by liminary investigations into the use of BCG i n pneumoperitoneum in this country. It is interest- K e n y a ' prior to publication, I feel that I must ing to note that they' considered a pneumo- comment on the techniqlte he used in vaccinatperitoneum to be essentially an interim measure, ing by the scarification method. I a m not trying to put forward tile opinion to be used in association with other methods of collapse therapy, in particular, phrenic crush that the scarification technique is superior to and artificial pneumothorax. Even in those the intradermal one. The majority,, including early days these authors realized the value of myself, who have used both methods have come pneumoperitoneum in toxic cases where it is. to the conclusion that intradermal vaccination undesirable to separate the pleural layers. This gives the higher tuberculin conversion rates. is fully recognized today,, and indeed pneumo- I think, however, that Dr Hzwnes would have peritoneum is now being used in cases that would obtained m u c h higher conversion rates if he previously have been considered ideal for had been more liberal in the use of the vaccine. artificial pneumothorax. This is clearly shown in Each ampoule of freeze-dried, vaccine issued Drolet's ~very interesting letter in tile February by tile Pasteur Institute cqntains sufficient issue of TUBERCLE, in which he demonstrates vaccine to vaccinate five persons by the scari-
TUBERCLE
t h a t c l u m p i n g o f the bacilli m a y o c c u r w h e n they a r e suspended in sterile distilled water. A v a r i a b l e dosage Would also explain certain a n o m a l o u s results o b t a i n e d with the d r y vaccine as c o m p a r e d w i t h fluid B C G .
Acknowledgments T h e a u t h o r s wish to express their g r a t i t u d e in the first place to M r s H a y n e s , without whose help the p a p e r could not h a v e b e e n written. W e should also like to acknowledge the assistance given b y the Principals of the A p p r o v e d Schools at K a b e t e a n d Dagorctti, a n d o f the G o v e r n m e n t African Schools at P u m w a n i a n d N a k u r u , a n d the Superi n t e n d c n t o f Prisons, N a k u r u . T h i s p a p e r is p u b l i s h e d b y permission of
the D i r e c t o r Colony.
June 1951
of Medical
Services, K e n y a
References Aronson, J. D., and Palmer, C. E. (z946) Pub. tlealth
Rep., LXb No. 23, 8o~-82o. Davies,J. N. I'. (1947) East African M.J., xxlv. Ferguson, R. G. (1946) Canadian07. of Pub. IIealth, xxxvn, No. 1I, 435-./5 L Haynes, W. S. (1949) Unpublished Report to the Director of Medical Services, Kenya Colon)', on Tuberculosis in the Natives of Kenya Colon}.'. tleaf, F. (195o) Colonial Office Circular, G.O. 8917/5o. Holm, J. (x948) BCG Vaccination Against Tuberculosis. First Edition. South African Med. Res. C. 0932) Pub. S. Afr. In.st. Med. Res., No. XXX, Vol. v, 97-1o0Stott, H. (195o) East African M.J., xxwz, . Van Deinse, F., and S~n6chal, F. (195o) Tubercle, xxxl, Nos. 7 and 8. Vint, F. W. 0937) Post Mortem Studies in the Natives of Kenya, East African M.07., Reprint. Wallgren, A. (x948) Reprint from Amer#an .7. of Disease of Children, LXXW,485-49 L
Correspondence Pneumoperitoneum
that in the tuberculosis institutions in tile New York Metropolitan Area. the number of successfid initial inductions o f p n e u m o t h o r a x has fallen steadily in the past ten years, while in the same period the number o f ' p n e u m o p e r i t o n e u m s ' has increased tenfold. Yours faithfully,
T h e Editor - 'Tubercle'. S I R , - I entirely agree with Dr Heller about the importance of tile p a p e r on Pneumoperitoneum by E. Clifford Jones and N. Macdonald which was published in TUBERCLF. in June x943. E. LLE~VELYN WILLIAMS. Unfortunately each n u m b e r of TUnE,eLf. now Lewisham Chest Clinic, contains less than half the number of pages of a x, Blagdon Road, pre-war issue, and every contributor, as Dr Lewisham, S.E. 13. Heller knows, has to restrict his article to approximately 4,000 words. It x~'as for this reason that I had to limit m y article on PneumoBCG Vaccination peritoneum (TUBERCLE, February I95I ) to a desThe Scarification Method cription of the clinical findings in a series of Tile E d i t o r - 'Tubercle'. cases and a discussion of the present day' indications for tiffs form of therapy. D~AR SIR, - Having had the privilege of E. Clifford Jones' and N. Macdonald's paper reading Dr Hayne's excellent paper on 'Prewas the first account of a series ofcases treated by liminary investigations into the use of BCG i n pneumoperitoneum in this country. It is interest- K e n y a ' prior to publication, I feel that I must ing to note that they' considered a pneumo- comment on the techniqlte he used in vaccinatperitoneum to be essentially an interim measure, ing by the scarification method. I a m not trying to put forward tile opinion to be used in association with other methods of collapse therapy, in particular, phrenic crush that the scarification technique is superior to and artificial pneumothorax. Even in those the intradermal one. The majority,, including early days these authors realized the value of myself, who have used both methods have come pneumoperitoneum in toxic cases where it is. to the conclusion that intradermal vaccination undesirable to separate the pleural layers. This gives the higher tuberculin conversion rates. is fully recognized today,, and indeed pneumo- I think, however, that Dr Hzwnes would have peritoneum is now being used in cases that would obtained m u c h higher conversion rates if he previously have been considered ideal for had been more liberal in the use of the vaccine. artificial pneumothorax. This is clearly shown in Each ampoule of freeze-dried, vaccine issued Drolet's ~very interesting letter in tile February by tile Pasteur Institute cqntains sufficient issue of TUBERCLE, in which he demonstrates vaccine to vaccinate five persons by the scari-