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TROPICAL EOSINOPHILIA
52
prohahly cxctudcd, hy
the obscrvations
on
which the
report is based.
We
arc at
Department of Clinical Reacarch, University College Hospital Medical School, London, W.C.1
E. ERIC POCHIN.
NITROUS-OXIDE BYPASS ON ANÆSTHETIC APPARATUS arc still numbers of anesthetic machines SIR,-Thcrc in use which have a bypass providing a rapid flow of nitrous oxide as well as one for emergency oxygen. The two controls arc alike, though at opposite ends of the row of flow-mcters. It can easily happen in the stress of an emergency that the wrong bypass is opened when it is intended to inflate a patient’s lungs with oxygen. At least one fatality has been caused in this way. I suggest that lives may be saved if every anesthetist who uses a machine that has a nitrous-oxide bypass takes steps to have it removed. H. R. YOUNGMAN.
UNUSUAL URINE PROTEIN IN MYELOMATOSIS SIR,-Mr. Cummings,1 in describing the urinaryprotein electrophoretogram from a case of myelomatosis in which there were three bands in the y-gtobuun region, reported that this was the only instance in some 40 cases in which he had found more than one band in this region. In Dr. Gobert-Jones’ case2 two bands were present in the :-g!obuiin region. We have recently investigated a patient in whose urine there are apparently four distinct proteins. The electrophoretic pattern shows two distinct bands in the region corresponding to the Y-g!obu!ins, a fainter one in the region corresponding to the :j-globulins. and a fourth which is albumin ’see fig.,.
present studying the relative valuc of different
in differentiating myclomatosis proteinuria from that found in other conditions As an aid to our study we would welcome specimens of urine containing protein from cases of proved or suspected myclomatosis. H. J. WOODLIFF R. W. AINSWORTH Department of Medicine, R. J. FLEMANS. University of Cambridge urine
tests
TROPICAL EOSINOPHILIA SIR,—In their preliminary communication of Sept. 7, Dr. (;ault and !)r Webb reported what appcars to he the anterior end of a nematode larva in the liver in a case of tropical cosinophilia; they have also shown gross pathological changes in the liver. It is increasingly being realised that, in tropical cosinophilia. tissue’, other than the lung arc commonly affected.
Chaudhury,1 in his series of 167cases of tropical cc»inc,philia, noted enlargement of the liver in 52 cases symptoms other than pulmonary (mainly gastrointestinal) in 42, splenomegaly in 14, and enlargement of lymph-nodes in 5. Cupta and Rao2 have reported cosmophilic nrnlulc ff the hrcast in a case of tropical cosinophiha. The work of Danara; ct al.’ with a filanal complementfixation tcst, and that of Gault and Webb. strongly support the view that parasitic infaction plays an important pan in tropical cosinophilia, and that most of these cases are probably of filanal origion. Hilartasis exiiihiti uself in a wide vanety of diverse and apparently unrdated clinical conditions. Apart from the well-recognised clinical features, various other manifestations, such as mastius. parous, thrombophlebitis, rcctal blcrcirng, pruritus, crythematous or papular eruption, have been thought to be due to filarial infcation. Jantscns* noted varrous nervous and psychic ntanrfcstations of filartasis. This vancty of chnical conditions may be explained on the basis of lymphatic blockage and vascular allergy. It seems, therefore, that tropical cosinophilia is just one of the many manifestations of filariasis. In spite of the fact that tilariasis is so widely prevalent, our knowledge of the disease is woefully deficient. Hananabed Lane, Near Market,
Santacruz, Bombay, 23
B. S.
RAHEJA.
A FUNCTIONAL NECESSITY
SIR,—Once again The Lancet has advocated the percreation of a new grade of hospital doctor intermediate between senior registrar and consultant. The letters of Mr. Holmes Sellors, I)r. Rowland Hill, and Professor Strachan must have made it clear that the representatives and leaders of the consultants are opposed to such a plan.I should like you to know that the same is true for the senior registrars and registrars. The B.M.A. Hospital Junior Statrs Group (formerly Registrars Group) provides representative machinery to which all members of these grades have access, and the problem of hospital staffing has been our chief concern for the past four and a half years. Everywhere and always, the majority opinion has been against a permanent subconsultant grade. Of course, there are some now in urgent distress, men around 40 in the major specialties, with higher manent
A man, aged 47, presented with aching limbs and symptoms of anaemia. In addition to the urine and serum findings, smears of a marrow aspirate and radiographs were typical of multiple myelomatosis. The urines were concentrated ten times by freeze-drymg and resolution in 005 AI barbitone buffer (pH 86). Both the urmes (0 05 ml.) and sera (0’01 ml.) were electrophoresed on BX’Iiatinan 3 mm. paper in a horizontal bath using 0 05 Af barbitone buffer (pH 8 ()) for thirteen hours at a current
of 12 1. 2.
milliamps
per
strip.
Cummings, A. J. Lancet, 1957, ii, 598. Gobert-Jones, J. A. ibid. p. 1068.
qualifications, long specialist experience, and satisfactory records who are threatened with dismissal. Plans for a subconsultant grade may tempt some of them as a straw tempts a drowning man. If a few should even clutch at it, that would not be an argument for providing straws 1. Chaudhury, R N. J Indian med. Ass. 1956, 27, 195. 2. Gupta, I M., Rao, M S. N Indian J. med. Sa. 1957, 11, 728. 3. Danaraj, T. J., daSilva, I,. S., Schacher, J. F. Proc. Alumni Ass. Malaya, 1957, 10, 109. 4. Raheja, B. S. An (in the press). 5. Ann. Soc. belge Med trop. 1952, 32, 229. See J. Indian med. Ass. 1954,
23,
269
prohahly cxctudcd, hy
the obscrvations
on
which the
report is based.
We
arc at
Department of Clinical Reacarch, University College Hospital Medical School, London, W.C.1
E. ERIC POCHIN.
NITROUS-OXIDE BYPASS ON ANÆSTHETIC APPARATUS arc still numbers of anesthetic machines SIR,-Thcrc in use which have a bypass providing a rapid flow of nitrous oxide as well as one for emergency oxygen. The two controls arc alike, though at opposite ends of the row of flow-mcters. It can easily happen in the stress of an emergency that the wrong bypass is opened when it is intended to inflate a patient’s lungs with oxygen. At least one fatality has been caused in this way. I suggest that lives may be saved if every anesthetist who uses a machine that has a nitrous-oxide bypass takes steps to have it removed. H. R. YOUNGMAN.
UNUSUAL URINE PROTEIN IN MYELOMATOSIS SIR,-Mr. Cummings,1 in describing the urinaryprotein electrophoretogram from a case of myelomatosis in which there were three bands in the y-gtobuun region, reported that this was the only instance in some 40 cases in which he had found more than one band in this region. In Dr. Gobert-Jones’ case2 two bands were present in the :-g!obuiin region. We have recently investigated a patient in whose urine there are apparently four distinct proteins. The electrophoretic pattern shows two distinct bands in the region corresponding to the Y-g!obu!ins, a fainter one in the region corresponding to the :j-globulins. and a fourth which is albumin ’see fig.,.
present studying the relative valuc of different
in differentiating myclomatosis proteinuria from that found in other conditions As an aid to our study we would welcome specimens of urine containing protein from cases of proved or suspected myclomatosis. H. J. WOODLIFF R. W. AINSWORTH Department of Medicine, R. J. FLEMANS. University of Cambridge urine
tests
TROPICAL EOSINOPHILIA SIR,—In their preliminary communication of Sept. 7, Dr. (;ault and !)r Webb reported what appcars to he the anterior end of a nematode larva in the liver in a case of tropical cosinophilia; they have also shown gross pathological changes in the liver. It is increasingly being realised that, in tropical cosinophilia. tissue’, other than the lung arc commonly affected.
Chaudhury,1 in his series of 167cases of tropical cc»inc,philia, noted enlargement of the liver in 52 cases symptoms other than pulmonary (mainly gastrointestinal) in 42, splenomegaly in 14, and enlargement of lymph-nodes in 5. Cupta and Rao2 have reported cosmophilic nrnlulc ff the hrcast in a case of tropical cosinophiha. The work of Danara; ct al.’ with a filanal complementfixation tcst, and that of Gault and Webb. strongly support the view that parasitic infaction plays an important pan in tropical cosinophilia, and that most of these cases are probably of filanal origion. Hilartasis exiiihiti uself in a wide vanety of diverse and apparently unrdated clinical conditions. Apart from the well-recognised clinical features, various other manifestations, such as mastius. parous, thrombophlebitis, rcctal blcrcirng, pruritus, crythematous or papular eruption, have been thought to be due to filarial infcation. Jantscns* noted varrous nervous and psychic ntanrfcstations of filartasis. This vancty of chnical conditions may be explained on the basis of lymphatic blockage and vascular allergy. It seems, therefore, that tropical cosinophilia is just one of the many manifestations of filariasis. In spite of the fact that tilariasis is so widely prevalent, our knowledge of the disease is woefully deficient. Hananabed Lane, Near Market,
Santacruz, Bombay, 23
B. S.
RAHEJA.
A FUNCTIONAL NECESSITY
SIR,—Once again The Lancet has advocated the percreation of a new grade of hospital doctor intermediate between senior registrar and consultant. The letters of Mr. Holmes Sellors, I)r. Rowland Hill, and Professor Strachan must have made it clear that the representatives and leaders of the consultants are opposed to such a plan.I should like you to know that the same is true for the senior registrars and registrars. The B.M.A. Hospital Junior Statrs Group (formerly Registrars Group) provides representative machinery to which all members of these grades have access, and the problem of hospital staffing has been our chief concern for the past four and a half years. Everywhere and always, the majority opinion has been against a permanent subconsultant grade. Of course, there are some now in urgent distress, men around 40 in the major specialties, with higher manent
A man, aged 47, presented with aching limbs and symptoms of anaemia. In addition to the urine and serum findings, smears of a marrow aspirate and radiographs were typical of multiple myelomatosis. The urines were concentrated ten times by freeze-drymg and resolution in 005 AI barbitone buffer (pH 86). Both the urmes (0 05 ml.) and sera (0’01 ml.) were electrophoresed on BX’Iiatinan 3 mm. paper in a horizontal bath using 0 05 Af barbitone buffer (pH 8 ()) for thirteen hours at a current
of 12 1. 2.
milliamps
per
strip.
Cummings, A. J. Lancet, 1957, ii, 598. Gobert-Jones, J. A. ibid. p. 1068.
qualifications, long specialist experience, and satisfactory records who are threatened with dismissal. Plans for a subconsultant grade may tempt some of them as a straw tempts a drowning man. If a few should even clutch at it, that would not be an argument for providing straws 1. Chaudhury, R N. J Indian med. Ass. 1956, 27, 195. 2. Gupta, I M., Rao, M S. N Indian J. med. Sa. 1957, 11, 728. 3. Danaraj, T. J., daSilva, I,. S., Schacher, J. F. Proc. Alumni Ass. Malaya, 1957, 10, 109. 4. Raheja, B. S. An (in the press). 5. Ann. Soc. belge Med trop. 1952, 32, 229. See J. Indian med. Ass. 1954,
23,
269