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A CASE OF MULTIPLE DIVERTICULA OF THE JEJUNUM.
CLINICAL AND LABORATORY NOTES.
496
used. If only those injected with undiluted percentage of negatives falls
dilutions were cases are taken which were or 1 in 10 serum, the
cases
only high
to 22 per cent. Another factor to be borne in mind is the " age " of the rash. A rash that has been present three days is less likely to react than on its first appearance. The actual figures in this series are as follows :.
1st day rashes.... 2nd "
83’3 per cent. ’75’0 "
3rd
50-0
.... ....
"
positive.
Clinical and Laboratory Notes. A CASE OF
MULTIPLE DIVERTICULA OF THE JEJUNUM. BY J. ALLAN BERRY, M.S. DURH., F.R.C.S.
" "
MEDICAL
All cases tested on the fourth day were negative, and it seems probable that the reaction can very rarely be obtained on or after the fourth day. The average interval before blanching occurred was 14t hours, the shortest time being 6t hours. In two cases blanching did not occur until at least 36 hours after the injection. Normal horse serum was used as a control in amounts varying from 0-2 to 1-0 c.cm. in 17 cases, and no blanching occurred.
EDIN.,
SUPERINTENDENT, NAPIER HOSPITAL, NEW ZEALAND.
VERY few examples of diverticula of the jejunum have been placed on record. James T. Case,l writing other than on diverticula of the small intestine Meckel’s diverticulum, collected only 17 cases recorded between 1854 and 1920. Helvestine, 2 writing two years later, refers to 27 cases of false diverticula of the jejunum. In view of their apparent rarity in the small intestine the following record appears to be
Non-Specific Sera. of publication. at the suggestion of Dr. R. A. worthy last, February A man, aged 70, was admitted to hospital in August,. O’Brien, we started using non-specific sera for the 1920, suffering from the effects of prostatic obstruction, In
Schultz-Charlton
reaction.
The
sera
used
were
prepared from the streptococci of erysipelas, puerperal fever, cellulitis, and from a case of streptococcal toxaemia. The results were surprising. The following
table gives some of the results. In each case the various sera used were injected at the same time.
V. sl.
reac.
=Very slight reaction.
*
1 in 10.
A scarlet fever serum, known to give good results, used in each case as a control, and in no instance up to the present has this control failed to blanch when reactions have been obtained with non-specific On the contrary the scarlet fever serum has sera. in most cases produced larger areas. From the table above it will be observed that multivalent antistreptococcal serum was used. This naturally suggested itself when reactions had been obtained with several of the non-specific sera. The areas it produced were much larger than those of the control (sc. fever) was diluted serum when used undiluted, but when itthan 1 in 10 the areas were slightly smaller those of the control. This multivalent serum was prepared from numerous strains of streptococci which included two strains of scarlet fever streptococcus, and was taken from horses which had previously been immunised against scarlet fever toxin. If at some future date we find a number of cases reacting to a serum nonspecific to scarlet fever, and not to scarlatinal antitoxic serum, further investigation of these cases may provide valuable information on the aetiology of scarlet fever.
was
ROYAL NORTHERN HOSPITALS.-The total income for maintenance of the Royal Northern group of Hospitals last year amounted to .881,464, as against 85,859 the year before. The total maintenance expenditure increased from ;B86,596 to jE89,332, but this was partly due to the increased number of patients and partly to an additional 21,852 out-patients’ attendances. An indication of the progress of the hospital is seen in the increase in the total income of the hospital, which in 1913 was only j334,608.
and died from ursemia. A history was obtained, in addition to his urinary symptoms, of some digestive trouble which was described as flatulence, and multiple diverticula of the small intestine were discovered at autopsy. The small intestine-with the exception of the duodenum, which was free from diverticula-was removed and measured 6’3 metres in length. There were upwards of 50 diverticula, and they were limited to the first 2 metres of the intestine, the rest of which showed no abnormality. They were divisible into two groups, large and small, and there were very few of intermediate size. Small diverticula occurred throughout the whole length, but the large ones were limited to a distance of less than the first metre, except for a solitary large one which occurred, as a last example of the condition, 2 metres from the duodeno-jejunal flexure. The first diverticulum arose from the mesenteric attachment about 25 cm. from the duodeno-jejunal fiexure, and then projected forwards on the right side of the gut, to which it was bound by rather dense whitish adhesions. These could easily be freed, when it was found that the diverticulum was spheroidal in shape and communicated with the intestine by a narrow opening bounded at its margins by longitudinal muscle-fibres. The sac itself was thin-walled, covered by serosa, and measured 2’5 cm. in length and 1’5 cm. at its widest part. About 5 em. further down was a similar but larger diverticulum about 3’75 cm. in length and about 2’5 cm. at its widest part. Another 9 cm. further on was a diverticulum of about the same size, but this time attached to the left side of the intestine. Then followed a large number of small diverticula which measured on an These projected average about 1 cm. in all directions. directly backwards into the mesentery. Up to a distance of less than 1 metre from the duodeno-jejunal flexure angle there were about half a dozen large diverticula, usually attached to the intestine on the right side. For the remainder of the distance they were all small except for the large diverticulum which terminated the series and was similar to those described in the upper part of the intestine. At a distance of about 1’25 metres from the last diverticulum were two lipomata, each about 5cm. in diameter, arising in and situated on either side of the mesentery, nearly opposite one another. They did not contain diverticula. On opening the intestine the stomata leading into the diverticula, large or small, were all about 1 cm. in diameter. Those diverticula that were opened There was no evidence of were found to be empty. diverticula of other organs beyond a small inflamed diverticulum of the sigmoid colon.
Discussion. Casein 1920 made the first diagnosis of this condition by means of radiological examination. E. L. Hunt and P. H. Cook,3 writing in 1921, regarded these diverticula as relatively common, an opinion which is probably correct, and described them as roughly pear-shaped, measuring about 3 cm. in depth and 3 cm. in width. The openings into the intestine were about 1 cm. in diameter. All the diverticula went directly backwards into the mesentery. 1 Jour. Amer. Med. Assoc., 1920, lxxv., 1463. 2 Helvestine: Surg., Gynæcol., and Obstet., 1923, 1-5. 3 Ann. Surgery, 1921, lxxiv., 746.
xxxvii.,
CLINICAL AND LABORATORY NOTES.
L. R. Braithwaite 4 described and figured a beautiful specimen of multiple diverticula of the jejunum for - which enterectomy was necessary. The diagnosis had been made by Dr. L. A. Rowden after radiological examination. The diverticula extend directly backHelvestine2 described wards into the mesentery. two cases, the first of which is strikingly similar to the one I have recorded. from the effects of an in uraemia and death. The diverticula were 58 in number, the largest in size being those nearest the duodenum. They were spheroidal in shape, and the stomata which connected the diverticula with the intestinal lumen were much smaller than the cavity of the diverticulum. This point is well illustrated in .a figure which displays the intestine laid open from the antimesenteric border and shows the stomata leading into the diverticula.
The patient,
aged 70, suffered enlarged prostate which resulted
497 A CASE OF
MENINGITIS DUE TO A HÆMOPHILIC BACILLUS. BY JOHN A. BRAXTON HICKS, M.D.,
M.R.C.P. LOND., D.P.H., DIRECTOR OF THE JOHN BURFORD CARLILL WESTMINSTER HOSPITAL.
LABORATORIES,
THE article by Dr. John F. Taylor in THE LANCET of June 25th (p. 1341) on Suppurative Arthritis Due to Haemophilic Bacteria prompts me to publish a brief account of a recent case of suppurative meningitis due to similar organisms.
A female, aged 1 year and 3 months, in the children’s ward of the hospital under the care of Dr. Donald Paterson, Berkeley Moynihan,5 discussing these diver- came to the table 19 days after admission. ticula, remarks : " The pouches may be numerous, Permission topost-mortem examine the head only was given by the are rarely larger than a walnut, are usually on the relatives. On examination, pallor and well-marked carpomesenteric side, and because of their large orifice do pedal spasm were present. The skull bones were greatly not, as a rule, retain food for long periods and do not, engorged, particularly the inner table, and the dura mater firmly adherent to the brain tissue beneath. This therefore, often lead to serious complications." The fairly statement that the diverticula have a large orifice, and adhesion had been caused by the presence of a thick layer of deep yellow-green pus which was plastered over the entire that this is the explanation for their not often leading vertex and base of the brain. The pus was plastered on so to serious complications, is not borne out by the present thickly that in many places the normal contour of the sulci cases in which and convolutions was obliterated. The greenish-yellow case, nor by a number of other recorded the point is mentioned. Where the diverticula are colour of the pus mingling with the bright red colour small the orifice appears to be as large as the cavity, produced by the vascular engorgement gave to the brain, but as soon as the diverticulum approaches its usual when viewed in situ, a most striking marbled appearance. the ventricles of the brain, but not maximal dimension-of something less in size than a Pus was present in both Middle ears and other sinuses that to any marked degree. walnut-the orifice is actually much smaller than the could be examined from. within the skull showed nothing it to be seldom more than cavity. Typically appears abnormal. The meningeal pus contained minute " influenza1 cm. in diameter, although in cases of perhaps long like " bacilli. standing it is sometimes larger. Three samples of cerebro-spinal fluid sent to the laboratory An interesting point in the present case is the fact for examination on the third, fifth, and seventeenth dayss that all the larger diverticula turned forwards and after admission were all more or less similar in character, that the last was very much more purulent than the generally to the right side, obtaining secondarily an save other samples. The leucocytes of the first sample numbered attachment by means of adhesions to the intestine 208 per c.mm., about 40 per cent. of them being polyitself. This does not appear to have been noted in morphonuclears, and there was only a light purulent other cases. It would seem that in the early stage of coagulum. The last sample contained a large purulent formation of the diverticulum the line of least deposit (leucocytes not enumerated) of an entirely polyresistance is directly backwards between the leaves of morphonuclear type. All samples contained large numbers the mesentery, but as the diverticula become larger of a minute pleomorphic, Gram-negative bacillus. Visible growth was only obtained on blood-agar (4 per cent. of they generally tend to project much more on the right whole blood), and then only after 48 hours. The growth side of the mesentery than on the left, and in some was and consisted of minute transparent fairly instances are actually turned forwards. Their pro- colonies, likecopious, small watery streptococcal colonies, and these to as a on the rule, jection, right side, may possibly be were non-haemolytic. Morphologically, the bacilli were explained by the oblique attachment of the mesenteric more pleomorphic in culture than in the direct films from root, and the fact that resistance on the left side the cerebro-spinal fluid. In the films the bacilli appeared as of the mesentery may be greater than on the minute rods of varying length, and also as cocco-bacillary forms. In the cultures, in addition to these shapes and right side, owing to the disposition of the coils of sizes, one encountered filamentous forms. In some respects, intestine. therefore, morphologically, the bacillus resembles the .BacMS Various theories have been advanced to explain the influenzce, but the tendency to filament formation is more causation of these diverticula, and there can be no marked. doubt that they do not all have the same origin. With the greatest difficulty one set of subcultures was Helvestine2 mentions three factors : (1) traction by obtained on blood-agar, and an emulsion from one of these the mesenteric vessels or traction following adhesions ; tubes was made. The emulsion was not actually counted, it was approximately 1000 millions per c.cm. by (2) degeneration of the musculature ; and (3) increased but opacity; 1 c.cm. of this emulsion (approximately 1000 intra-abdominal pressure-tension, leading to increased million living organisms) was injected into the peritoneal intra-intestinal tension, in the causation of which cavity of a guinea-pig of 500 g. The guinea-pig lived rectal and vesical’tenesmus play an important part. 28 hours and died quite suddenly, having exhibited very Prostatic retention, as in Helvestine’s first case, few symptoms of illness and eating well till the last. The and also in the present case, must be regarded as a very peritoneal cavity of the guinea-pig was much injected, and the visceral and parietal peritoneum fairly thickly coated potent factor in the formation of acquired or false with a layer of yellow-green pus, very similar to that seen diverticula of the jejunum. The rest of the viscera m the meninges of the patient. If the diverticula are entered by the fluid contents showed the usual pallor associated with a toxaemia, parof the jejunum they cannot empty themselves by any ticularly the kidneys. The bacilli were found in the pus, but contractile power of their own, for they possess in most all attempts to grow them from pus or heart-blood failed. instances very little musculature, and it is likely that This difficulty of keeping the organism alive in emptying is brought about by the pressure of the
Sir
in
subculture or after passage through animals is in itriking contrast to the behaviour of B. influenza. rhe organism undoubtedly is similar to those so admirably described in a paper on Meningitis Due to Organisms by H. Henry,l to which the 3a>mophilic My thanks are due to Dr. H. Nockolds for permission ’eader is referred for excellent microphotographs and to record this case. )ibliography. It would appear to be in the same lass as the organism Type " Brook " he mentions. 4 Brit. Jour. Surg., 1923, xi., 184, July. 5 Moynihan: THE LANCET, 1927, i., 1061. 1 Jour. of Path and Bact., 1913, xvii., 174.
surrounding coils
of intestine in active contraction. That fluid contents do enter the diverticula is proved by radiological examination, and the emptying is a slow process.
496
used. If only those injected with undiluted percentage of negatives falls
dilutions were cases are taken which were or 1 in 10 serum, the
cases
only high
to 22 per cent. Another factor to be borne in mind is the " age " of the rash. A rash that has been present three days is less likely to react than on its first appearance. The actual figures in this series are as follows :.
1st day rashes.... 2nd "
83’3 per cent. ’75’0 "
3rd
50-0
.... ....
"
positive.
Clinical and Laboratory Notes. A CASE OF
MULTIPLE DIVERTICULA OF THE JEJUNUM. BY J. ALLAN BERRY, M.S. DURH., F.R.C.S.
" "
MEDICAL
All cases tested on the fourth day were negative, and it seems probable that the reaction can very rarely be obtained on or after the fourth day. The average interval before blanching occurred was 14t hours, the shortest time being 6t hours. In two cases blanching did not occur until at least 36 hours after the injection. Normal horse serum was used as a control in amounts varying from 0-2 to 1-0 c.cm. in 17 cases, and no blanching occurred.
EDIN.,
SUPERINTENDENT, NAPIER HOSPITAL, NEW ZEALAND.
VERY few examples of diverticula of the jejunum have been placed on record. James T. Case,l writing other than on diverticula of the small intestine Meckel’s diverticulum, collected only 17 cases recorded between 1854 and 1920. Helvestine, 2 writing two years later, refers to 27 cases of false diverticula of the jejunum. In view of their apparent rarity in the small intestine the following record appears to be
Non-Specific Sera. of publication. at the suggestion of Dr. R. A. worthy last, February A man, aged 70, was admitted to hospital in August,. O’Brien, we started using non-specific sera for the 1920, suffering from the effects of prostatic obstruction, In
Schultz-Charlton
reaction.
The
sera
used
were
prepared from the streptococci of erysipelas, puerperal fever, cellulitis, and from a case of streptococcal toxaemia. The results were surprising. The following
table gives some of the results. In each case the various sera used were injected at the same time.
V. sl.
reac.
=Very slight reaction.
*
1 in 10.
A scarlet fever serum, known to give good results, used in each case as a control, and in no instance up to the present has this control failed to blanch when reactions have been obtained with non-specific On the contrary the scarlet fever serum has sera. in most cases produced larger areas. From the table above it will be observed that multivalent antistreptococcal serum was used. This naturally suggested itself when reactions had been obtained with several of the non-specific sera. The areas it produced were much larger than those of the control (sc. fever) was diluted serum when used undiluted, but when itthan 1 in 10 the areas were slightly smaller those of the control. This multivalent serum was prepared from numerous strains of streptococci which included two strains of scarlet fever streptococcus, and was taken from horses which had previously been immunised against scarlet fever toxin. If at some future date we find a number of cases reacting to a serum nonspecific to scarlet fever, and not to scarlatinal antitoxic serum, further investigation of these cases may provide valuable information on the aetiology of scarlet fever.
was
ROYAL NORTHERN HOSPITALS.-The total income for maintenance of the Royal Northern group of Hospitals last year amounted to .881,464, as against 85,859 the year before. The total maintenance expenditure increased from ;B86,596 to jE89,332, but this was partly due to the increased number of patients and partly to an additional 21,852 out-patients’ attendances. An indication of the progress of the hospital is seen in the increase in the total income of the hospital, which in 1913 was only j334,608.
and died from ursemia. A history was obtained, in addition to his urinary symptoms, of some digestive trouble which was described as flatulence, and multiple diverticula of the small intestine were discovered at autopsy. The small intestine-with the exception of the duodenum, which was free from diverticula-was removed and measured 6’3 metres in length. There were upwards of 50 diverticula, and they were limited to the first 2 metres of the intestine, the rest of which showed no abnormality. They were divisible into two groups, large and small, and there were very few of intermediate size. Small diverticula occurred throughout the whole length, but the large ones were limited to a distance of less than the first metre, except for a solitary large one which occurred, as a last example of the condition, 2 metres from the duodeno-jejunal flexure. The first diverticulum arose from the mesenteric attachment about 25 cm. from the duodeno-jejunal fiexure, and then projected forwards on the right side of the gut, to which it was bound by rather dense whitish adhesions. These could easily be freed, when it was found that the diverticulum was spheroidal in shape and communicated with the intestine by a narrow opening bounded at its margins by longitudinal muscle-fibres. The sac itself was thin-walled, covered by serosa, and measured 2’5 cm. in length and 1’5 cm. at its widest part. About 5 em. further down was a similar but larger diverticulum about 3’75 cm. in length and about 2’5 cm. at its widest part. Another 9 cm. further on was a diverticulum of about the same size, but this time attached to the left side of the intestine. Then followed a large number of small diverticula which measured on an These projected average about 1 cm. in all directions. directly backwards into the mesentery. Up to a distance of less than 1 metre from the duodeno-jejunal flexure angle there were about half a dozen large diverticula, usually attached to the intestine on the right side. For the remainder of the distance they were all small except for the large diverticulum which terminated the series and was similar to those described in the upper part of the intestine. At a distance of about 1’25 metres from the last diverticulum were two lipomata, each about 5cm. in diameter, arising in and situated on either side of the mesentery, nearly opposite one another. They did not contain diverticula. On opening the intestine the stomata leading into the diverticula, large or small, were all about 1 cm. in diameter. Those diverticula that were opened There was no evidence of were found to be empty. diverticula of other organs beyond a small inflamed diverticulum of the sigmoid colon.
Discussion. Casein 1920 made the first diagnosis of this condition by means of radiological examination. E. L. Hunt and P. H. Cook,3 writing in 1921, regarded these diverticula as relatively common, an opinion which is probably correct, and described them as roughly pear-shaped, measuring about 3 cm. in depth and 3 cm. in width. The openings into the intestine were about 1 cm. in diameter. All the diverticula went directly backwards into the mesentery. 1 Jour. Amer. Med. Assoc., 1920, lxxv., 1463. 2 Helvestine: Surg., Gynæcol., and Obstet., 1923, 1-5. 3 Ann. Surgery, 1921, lxxiv., 746.
xxxvii.,
CLINICAL AND LABORATORY NOTES.
L. R. Braithwaite 4 described and figured a beautiful specimen of multiple diverticula of the jejunum for - which enterectomy was necessary. The diagnosis had been made by Dr. L. A. Rowden after radiological examination. The diverticula extend directly backHelvestine2 described wards into the mesentery. two cases, the first of which is strikingly similar to the one I have recorded. from the effects of an in uraemia and death. The diverticula were 58 in number, the largest in size being those nearest the duodenum. They were spheroidal in shape, and the stomata which connected the diverticula with the intestinal lumen were much smaller than the cavity of the diverticulum. This point is well illustrated in .a figure which displays the intestine laid open from the antimesenteric border and shows the stomata leading into the diverticula.
The patient,
aged 70, suffered enlarged prostate which resulted
497 A CASE OF
MENINGITIS DUE TO A HÆMOPHILIC BACILLUS. BY JOHN A. BRAXTON HICKS, M.D.,
M.R.C.P. LOND., D.P.H., DIRECTOR OF THE JOHN BURFORD CARLILL WESTMINSTER HOSPITAL.
LABORATORIES,
THE article by Dr. John F. Taylor in THE LANCET of June 25th (p. 1341) on Suppurative Arthritis Due to Haemophilic Bacteria prompts me to publish a brief account of a recent case of suppurative meningitis due to similar organisms.
A female, aged 1 year and 3 months, in the children’s ward of the hospital under the care of Dr. Donald Paterson, Berkeley Moynihan,5 discussing these diver- came to the table 19 days after admission. ticula, remarks : " The pouches may be numerous, Permission topost-mortem examine the head only was given by the are rarely larger than a walnut, are usually on the relatives. On examination, pallor and well-marked carpomesenteric side, and because of their large orifice do pedal spasm were present. The skull bones were greatly not, as a rule, retain food for long periods and do not, engorged, particularly the inner table, and the dura mater firmly adherent to the brain tissue beneath. This therefore, often lead to serious complications." The fairly statement that the diverticula have a large orifice, and adhesion had been caused by the presence of a thick layer of deep yellow-green pus which was plastered over the entire that this is the explanation for their not often leading vertex and base of the brain. The pus was plastered on so to serious complications, is not borne out by the present thickly that in many places the normal contour of the sulci cases in which and convolutions was obliterated. The greenish-yellow case, nor by a number of other recorded the point is mentioned. Where the diverticula are colour of the pus mingling with the bright red colour small the orifice appears to be as large as the cavity, produced by the vascular engorgement gave to the brain, but as soon as the diverticulum approaches its usual when viewed in situ, a most striking marbled appearance. the ventricles of the brain, but not maximal dimension-of something less in size than a Pus was present in both Middle ears and other sinuses that to any marked degree. walnut-the orifice is actually much smaller than the could be examined from. within the skull showed nothing it to be seldom more than cavity. Typically appears abnormal. The meningeal pus contained minute " influenza1 cm. in diameter, although in cases of perhaps long like " bacilli. standing it is sometimes larger. Three samples of cerebro-spinal fluid sent to the laboratory An interesting point in the present case is the fact for examination on the third, fifth, and seventeenth dayss that all the larger diverticula turned forwards and after admission were all more or less similar in character, that the last was very much more purulent than the generally to the right side, obtaining secondarily an save other samples. The leucocytes of the first sample numbered attachment by means of adhesions to the intestine 208 per c.mm., about 40 per cent. of them being polyitself. This does not appear to have been noted in morphonuclears, and there was only a light purulent other cases. It would seem that in the early stage of coagulum. The last sample contained a large purulent formation of the diverticulum the line of least deposit (leucocytes not enumerated) of an entirely polyresistance is directly backwards between the leaves of morphonuclear type. All samples contained large numbers the mesentery, but as the diverticula become larger of a minute pleomorphic, Gram-negative bacillus. Visible growth was only obtained on blood-agar (4 per cent. of they generally tend to project much more on the right whole blood), and then only after 48 hours. The growth side of the mesentery than on the left, and in some was and consisted of minute transparent fairly instances are actually turned forwards. Their pro- colonies, likecopious, small watery streptococcal colonies, and these to as a on the rule, jection, right side, may possibly be were non-haemolytic. Morphologically, the bacilli were explained by the oblique attachment of the mesenteric more pleomorphic in culture than in the direct films from root, and the fact that resistance on the left side the cerebro-spinal fluid. In the films the bacilli appeared as of the mesentery may be greater than on the minute rods of varying length, and also as cocco-bacillary forms. In the cultures, in addition to these shapes and right side, owing to the disposition of the coils of sizes, one encountered filamentous forms. In some respects, intestine. therefore, morphologically, the bacillus resembles the .BacMS Various theories have been advanced to explain the influenzce, but the tendency to filament formation is more causation of these diverticula, and there can be no marked. doubt that they do not all have the same origin. With the greatest difficulty one set of subcultures was Helvestine2 mentions three factors : (1) traction by obtained on blood-agar, and an emulsion from one of these the mesenteric vessels or traction following adhesions ; tubes was made. The emulsion was not actually counted, it was approximately 1000 millions per c.cm. by (2) degeneration of the musculature ; and (3) increased but opacity; 1 c.cm. of this emulsion (approximately 1000 intra-abdominal pressure-tension, leading to increased million living organisms) was injected into the peritoneal intra-intestinal tension, in the causation of which cavity of a guinea-pig of 500 g. The guinea-pig lived rectal and vesical’tenesmus play an important part. 28 hours and died quite suddenly, having exhibited very Prostatic retention, as in Helvestine’s first case, few symptoms of illness and eating well till the last. The and also in the present case, must be regarded as a very peritoneal cavity of the guinea-pig was much injected, and the visceral and parietal peritoneum fairly thickly coated potent factor in the formation of acquired or false with a layer of yellow-green pus, very similar to that seen diverticula of the jejunum. The rest of the viscera m the meninges of the patient. If the diverticula are entered by the fluid contents showed the usual pallor associated with a toxaemia, parof the jejunum they cannot empty themselves by any ticularly the kidneys. The bacilli were found in the pus, but contractile power of their own, for they possess in most all attempts to grow them from pus or heart-blood failed. instances very little musculature, and it is likely that This difficulty of keeping the organism alive in emptying is brought about by the pressure of the
Sir
in
subculture or after passage through animals is in itriking contrast to the behaviour of B. influenza. rhe organism undoubtedly is similar to those so admirably described in a paper on Meningitis Due to Organisms by H. Henry,l to which the 3a>mophilic My thanks are due to Dr. H. Nockolds for permission ’eader is referred for excellent microphotographs and to record this case. )ibliography. It would appear to be in the same lass as the organism Type " Brook " he mentions. 4 Brit. Jour. Surg., 1923, xi., 184, July. 5 Moynihan: THE LANCET, 1927, i., 1061. 1 Jour. of Path and Bact., 1913, xvii., 174.
surrounding coils
of intestine in active contraction. That fluid contents do enter the diverticula is proved by radiological examination, and the emptying is a slow process.