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A Modified pneumothorax needle
326
TUBERCLE
age, is almost always far advanced whe,~ i~ is allowed to declare itself by symptoms; that the earlier stages of tuberculosis, which may occupy many years, have usually significant signs, often slight, but none pathognomonio ; and
finally, that the only way of dealing with the insidiousness of tuberculosis is to make careful examinations, including X.ray, either at intervals as a routine or on many indications that seem slight and unimportant.
CLINICAL AND LABORATORY A ~IODIFIED PNEU~IOTIIORAX HEEDLE. D R . DAVID B . I{osEsTnAr~, M e d i c a l Superintendent of Gresswell Sanatorium, Victoria [1], describes a pneumothorax needle designed to combine the advantageous features of the Saugman needle and the ordinary lumbar punclure needle. The essential feature of the needle is that the stiletto fits snugly into the needle and is supplied with a position pin to allow the stiletto to lie in the same position as the needle point, tim end of the stiletto being bevelled exactly with that of the needle. Dr. I~osonthal explains that the two advantages of this arrangement are : (1) The needle, with stiletto in position as for introduction through
[April, 1935
METHODS.
the chest wall, offers a smooth face to its passage and therefore does not pick u p tissue on the way, thus avoiding blockage of the needle ; and (2) tile introducing end offers a more solid face to the ploural surface of the lung, tending to push away rather than penetrate tim hmg. He adds that this type of needle may be used more safely in the early stages of development of a pneumothorax, although for the actual induction he prefers the Rivi~re trocar and cannula. The needle is made by l~Iessrs. :Felton, Grimwade and Duerdins, Ltd., of Melbourne. REFERENCE. L1.] ROSENTH.CL, D. B. 3_red. Journ. Auttralla, 1931, 2 1 , ~24.
SOCIETIES. T H E T U B E R C U L O S I S ASSOCIATION. A ~E~:TI~O of t h e Association was held at :5Iansou t t o u s e on F r i d a y , F e b r u a r y 15. T h e President, Dr. L. S. T. Burrell, took t h e Chair. T h e M i n u t e s of t h e last m e e t i n g h a v i n g been read a n d confirmed a n d now m e m b e r s elected, Dr. Halliday S u t h e r l a n d gave a n address on " T u b e r c u l i n . " t i e began by r c m i u d i n g h i s audience t h a t n e i t h e r t h e e~rly s y m p t o m s nor t h e early physical signs were diagnostic of p u l m o n a r y tuberculosis, n o r were t h e early X . r a y signs diagnostic. A s s m a n n ' s focus was a solitary sub-clavicular opacity, a n d according to Belot a n d P e u t e u i l no less t h a n n i n e t e e n different diseases of t h e l u n g m i g h t a c c o u n t for these opacities. Apart from tuberculosis, t h e chief causes of these opacities were : abscess of t h e l u n g , p r i m a r y a n d secondary c a r c i n o m a , sarcoma, t h r o m b u s , h y d a t i d cysts, a n d interlobar c m p y e m a . T h e only way in which early p u l m o n a r y tuberculosis could be diagnosed from o t h e r conditions of t h e l u n g was by m e a n s of t h e s u b c u t a n e o u s t u b e r c u l i n test. F o r this test t h e p a t i e n t ' s t e m p e r a t u r e m u s t be n o r m a l
a n d recorded at 8 a . m . , 4 p.m. a n d 8 p . m . daily. T h e a m o u n t s of tuberculin injected were: 0"0001 c.e., 0'0002 c.c., 0"001 c.c., 0-005 c.c., 0-01 c.c. The injections were given at intervals of four days. A rise of t e m p e r a t u r e was a positive reaction. If t h e t e m p e r a t u r e rose ~o F. t h e exciting dose should be increased so t h a t a m o r e defiuite febrile reaction m i g h t be obtained. Once the febrile reaction h a d occurred t h e test was discontinued. A febrile reaction to 0"0001 c.c., 0"0002 e.e., 0'001 c.c. was diagnostic of tuberculosis. A ~ebrile reaction to 0"005 c.c. was m o r e doubtful, a n d no one would diagnose active disease from a febrile reaction to 0"01 e.c. On t h e other h a n d , n o reaction to 0'01 e.e. excluded t h e possibility of active tuberculosis. I n t h e case of cattle, K o l m e r a n a l y s e d t h e rcsults of 15,000 injections. P o s t - m o r t e m e x a m i n a t i o n of t h e a n i m a l s showed t h a t the error in t h e subcut a n e o u s test was less t h a n 3 per cent. A n o t h e r t u b e r c u l i n test in u s e was t h e c u t a n e o u s t e s t in w h i c h a s m a l l area of t h e skin was tattooed with tuberculin. A positive reaction showed itself in from twelve to t w e n t y -
TUBERCLE
age, is almost always far advanced whe,~ i~ is allowed to declare itself by symptoms; that the earlier stages of tuberculosis, which may occupy many years, have usually significant signs, often slight, but none pathognomonio ; and
finally, that the only way of dealing with the insidiousness of tuberculosis is to make careful examinations, including X.ray, either at intervals as a routine or on many indications that seem slight and unimportant.
CLINICAL AND LABORATORY A ~IODIFIED PNEU~IOTIIORAX HEEDLE. D R . DAVID B . I{osEsTnAr~, M e d i c a l Superintendent of Gresswell Sanatorium, Victoria [1], describes a pneumothorax needle designed to combine the advantageous features of the Saugman needle and the ordinary lumbar punclure needle. The essential feature of the needle is that the stiletto fits snugly into the needle and is supplied with a position pin to allow the stiletto to lie in the same position as the needle point, tim end of the stiletto being bevelled exactly with that of the needle. Dr. I~osonthal explains that the two advantages of this arrangement are : (1) The needle, with stiletto in position as for introduction through
[April, 1935
METHODS.
the chest wall, offers a smooth face to its passage and therefore does not pick u p tissue on the way, thus avoiding blockage of the needle ; and (2) tile introducing end offers a more solid face to the ploural surface of the lung, tending to push away rather than penetrate tim hmg. He adds that this type of needle may be used more safely in the early stages of development of a pneumothorax, although for the actual induction he prefers the Rivi~re trocar and cannula. The needle is made by l~Iessrs. :Felton, Grimwade and Duerdins, Ltd., of Melbourne. REFERENCE. L1.] ROSENTH.CL, D. B. 3_red. Journ. Auttralla, 1931, 2 1 , ~24.
SOCIETIES. T H E T U B E R C U L O S I S ASSOCIATION. A ~E~:TI~O of t h e Association was held at :5Iansou t t o u s e on F r i d a y , F e b r u a r y 15. T h e President, Dr. L. S. T. Burrell, took t h e Chair. T h e M i n u t e s of t h e last m e e t i n g h a v i n g been read a n d confirmed a n d now m e m b e r s elected, Dr. Halliday S u t h e r l a n d gave a n address on " T u b e r c u l i n . " t i e began by r c m i u d i n g h i s audience t h a t n e i t h e r t h e e~rly s y m p t o m s nor t h e early physical signs were diagnostic of p u l m o n a r y tuberculosis, n o r were t h e early X . r a y signs diagnostic. A s s m a n n ' s focus was a solitary sub-clavicular opacity, a n d according to Belot a n d P e u t e u i l no less t h a n n i n e t e e n different diseases of t h e l u n g m i g h t a c c o u n t for these opacities. Apart from tuberculosis, t h e chief causes of these opacities were : abscess of t h e l u n g , p r i m a r y a n d secondary c a r c i n o m a , sarcoma, t h r o m b u s , h y d a t i d cysts, a n d interlobar c m p y e m a . T h e only way in which early p u l m o n a r y tuberculosis could be diagnosed from o t h e r conditions of t h e l u n g was by m e a n s of t h e s u b c u t a n e o u s t u b e r c u l i n test. F o r this test t h e p a t i e n t ' s t e m p e r a t u r e m u s t be n o r m a l
a n d recorded at 8 a . m . , 4 p.m. a n d 8 p . m . daily. T h e a m o u n t s of tuberculin injected were: 0"0001 c.e., 0'0002 c.c., 0"001 c.c., 0-005 c.c., 0-01 c.c. The injections were given at intervals of four days. A rise of t e m p e r a t u r e was a positive reaction. If t h e t e m p e r a t u r e rose ~o F. t h e exciting dose should be increased so t h a t a m o r e defiuite febrile reaction m i g h t be obtained. Once the febrile reaction h a d occurred t h e test was discontinued. A febrile reaction to 0"0001 c.c., 0"0002 e.e., 0'001 c.c. was diagnostic of tuberculosis. A ~ebrile reaction to 0"005 c.c. was m o r e doubtful, a n d no one would diagnose active disease from a febrile reaction to 0"01 e.c. On t h e other h a n d , n o reaction to 0'01 e.e. excluded t h e possibility of active tuberculosis. I n t h e case of cattle, K o l m e r a n a l y s e d t h e rcsults of 15,000 injections. P o s t - m o r t e m e x a m i n a t i o n of t h e a n i m a l s showed t h a t the error in t h e subcut a n e o u s test was less t h a n 3 per cent. A n o t h e r t u b e r c u l i n test in u s e was t h e c u t a n e o u s t e s t in w h i c h a s m a l l area of t h e skin was tattooed with tuberculin. A positive reaction showed itself in from twelve to t w e n t y -