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A SIMPLIFICATION OF THE " HALO " METHOD OF MEASURING THE DIAMETER OF RED BLOOD CORPUSCLES.
275
CLINICAL AND LABORATORY NOTES.
successful phage-therapy cases, two were immediate failures, and two were complete failures. They are
Summary. general result of phage treatment dysentery appears very much in its The
for bacillaryfavour: 70 per cent. of the cases showed a well-defined response The good effect was the TABLE IIL-Bacterial Flora Before and After Phage and rapid improvement. in Six Cases. more marked the earlier the treatment was begun ; it was relatively less favourable the younger the patientIt was particularly successful in patients aged 10 years and upwards. Cases with proteus group organisms - especially B. proteus No. 2-in the intestinal flora did not do so well. Incidentally, during the progress of the treatment and side by side with it, a noteworthy lowering in death-rates from dysentery was recorded. Whether this is a simple coincidence, or affords evidence of a causeand-effect relationship, it is not at present possible to affirm. During the investigation there undoubtedly occurred a certain dissemination of the living ultra-virus Protobios bacteriophagus dysenterice in the surroundings of the patients, with a probable dissemination of natural protection. Distribution of phage to patients, in a region means an increased proportion of phage " carriers" among the population, with, in all probability, a correspondingly increased distribution of phage to food and drink. Here doubtless the flythe great distributor of dysentery bacteria in nature * Third day ill, but first day of blood and mucus " in stools. -may reasonably be assumed to play a role. The cases were sister and brother respectively. (a) Fermenting glucose, maltose, and saccharose, but not My best thanks are due to the many colleaguesmannite or dulcite. representatives of the Air Forces, the Army, and the civil practitioners in Alexandria, too numerous for The two cases (Nos. 33 and 40) which did well on individual mention-who kindly collaborated with phage-therapy had classical B. dysenterice (Sonne me in this investigation. and Hiss respectively) present in the stools before References. the administration of phage, while, after phage Da Costa Cruz, J. : Compt. rend. Soc. de Biol., 1924, xci., 845. administration, these organisms could not be recovered Davidson, W. C.: Amer. Jour. Dis. Child., 1922, xxiii., 531. on culture from the stools : in the one case 36 hours d’Herelle, F.: The Bacteriophage and Its Behaviour, Trans. after commencing the treatment, and in the other G. H. Smith, Baltimore, 1926, p. 439 ; ibid., p. 257. by on the fourth day. B. proteus No. 2 is practically Dopter, C., and Saquepée : Précis de Bacteriologie, Paris, 1921, p.575. constant in the failure cases. This is very striking. Fletcher, W., and Kanagarayer, K.: Bull. Inst. Med. Res., Its absence, before and after, in the successful Kuala Lumpur, 1927, No. 3 ; see THE LANCET, 1927, ii., 402. cases is equally noteworthy. It suggests, I Kolle, W., and Hetsch, H.: La Bactériologie Expérimentale. Geneva, 1918, p. 329. think, the need for the revision of our ideas Otto, R., and Munter, H.: Deut. Med. Woch., 1921, xlvii., 1579. the role of in the H. M., and Benstead, H. J.: Trans. Roy. Soc. Trop. Perry, concerning proteus organisms Med. and Hyg. 1928, xxi., 417. summer diarrhoeas of children and the bacillary dysenteries of adults. Most authors consider them rather as concomitants. I suggest that the presence of proteus organisms, more especially B. proteus No. 2, constitutes an setiological factor of considerable importance in bacillary dysentery, particularly in children. This organism only differs from B. morgani No. 1, so frequently found in summer diarrhoea, A SIMPLIFICATION OF THE by liquefaction of gelatin and by failure to produce " HALO " METHOD OF MEASURING THE indol. It is, I think, chiefly because of its presence DIAMETER OF RED BLOOD CORPUSCLES. that the results of phage-therapy were so disappointing in the cases under two years old. To combat proteus BY D. MERLIN PRYCE, M.B. LOND., organisms by phage-therapy is fraught with difficulty, SECOND ASSISTANT PATHOLOGIST, ST. MARY’S HOSPITAL. because the proteus group of bacteria is not homogeneous, as is the dysentery group, in its susceptibility THIS optical method was introduced into heamatoto phage action ; and because proteus organisms are " diffraction method," rich in specific endotoxins, allied to botulinus toxin logy by Pijper 12 and, as the a high state of perfection. to him has been no less There brought by is, therefore, guarantee though powerful. 2 that a phage active against a B. proteus causing trouble In his last paper in which the theory is fully in one intestinal tract -will be active against the discussed, a method is given by which the patient’s B. proteus of another case. Moreover, lysis in vitro blood can be examined at the same time as the normal. * of the bacterial bodies of proteus organisms, by It has, however, been suggested in this journal on account of the elaborate nature of the into that, their contained toxins which pass liberating the filtrate, may render such a liquid too toxic for apparatus required, the general application of the method is somewhat limited. The purpose of the immediate therapeutic use. d’Herelle (19262) records having isolated two races of present communication is to describe two methods bacteriophage which, at the moment of their isolation in which the necessary apparatus is reduced to a from the stools of two infants who had died of infantile minimum. First Method. cholera, were very virulent for B. proteus vulgaris, ’ The observer looks through a blood-film at two yet of 12 strains of B. proteus only three were found susceptible, and they were the same for each of the electric lamps placed about two feet apart at right two races. Again, he found the filtrate from a bacterio- angles to the line of sight. Two " halos " are seen, phaged suspension of B. proteus vulgaris was extremely each consisting of a number of concentric spectra. toxic for rabbits immediately after the dissolution The apparent size of these two " halos " is dependent of the bacilli (0-5 c.cm. subcutaneously causing on the distance from the twin source of light. They death within a few hours). When kept, however, appear to become smaller on stepping forwards, and for 10 days the toxicity had diminished, the rabbit to become larger on stepping backwards. In this way then surviving the intravenous injection of 2 c.cm. any pair of corresponding coloured rings in the two
summarised in Table III.
"
I.
Clinical and
Laboratory Notes
276
CLINICAL AND LABORATORY NOTES.
"
halos" can be made to meet, overlap, or separate. The distance at which contact is made between a
selected
pair of corresponding rings is directly
proportional
to the diameter of the red blood
cor-
FiG. 1.
This method requires no special apparatus, is quite sufficient for diagnostic purposes, and could easily be used by the general practitioner in his ordinary
consulting
room.
Second Method. This method, devised by Thomas Young (17731829) and described in text-books of physics under the heading of Young’s eriometer,4 is admirably suited to the present purpose. The apparatus required, which is easily constructed, consists of : (A) A source of light (sodium flame or electric lamp). (B) Optical bench with rider for carrying blood-film. (c) Metal plate with a central aperture 1-2 mm. in diameter, surrounded by a ring of 2 cm. radius, of pin-point holes. (The measurements are, of course, arbitrary.)
puscles. The coloured ring which is easiest to use is the red fringe of the innermost complete spectrum order). (Spectrum of firstblood-film is
The patient’s examined at the position of contact for the normal. Any difference in the size of the " halos " is shown by overlapping or separation of the selected diffraction rings {see Fig. 2). For example, in pernicious ansemia the " halos " are obviously smaller, and it is necessary to step back a distance
FiG. 2. A dark room is necessary when but is not essential for white
using sodium light, On looking through the blood-film, rings are seen around the central aperture in c, whilst the ring of holes appears as a circle of luminous points. The film is moved about until apparent coincidence is obtained between the circle of luminous points and a selected diffraction (say the yellow of the spectrum of the first order). Thedistance of the film from the metal plate at which this takes place varies directly as the diameter of the red corpuscles. Since the diameter of the normal corpuscles is known, that of the patient’s corpuscles can be calculated by simple proportion. With sodium light, concentric yellow rings are seen instead of spectra. Readings are taken for both borders of a selected ring (say the first). The difference and the mean correspond with the anisocytosis and average size respectively. My thanks are due to Dr. Wilfrid Newcomb and
light. diffraction
ring
Mr.
Leslie Paton for their kind
and valuable advice.
References.—(1) Pijper, Adrianus : THE LANCET, 1924, ii., 367. (2) Pijper, Adrianus : Brit. Med. Jour., 1929, i., 635. (3) THE LANCET, 1929, i., 1261. (4) Preston, T.: Theory of Light, 4th ed., p. 234. A CASE OF
LOBAR PNEUMONIA IN A CHILD. BY KENNETH
Twinspeotra of (1) acholuric jaundice, (2) normal, and (3) b. pernicious anaemia blood-fdms at position of contact for the normal.
McPADYEAN, M.R.C.S. ENG.
THE following case because it illustrates
seems some
to be worth recording of the difficulties of
in children :which is proportional to the increase in the size of the diagnosing pneumonia A girl, aged 5t years, complained of earache on Dec. 6th. red corpuscles. If the method is adopted as a routine On the 6th, in the early afternoon, she said she felt cold, the floor may be calibrated with chalk lines, so that and was put to bed with a temperature of 100° F. She was one foot corresponds to 1 . This is done by adjusting first seen by me at 8 P.M. on that day, when a diagnosis of the distance between the lamps so that, with normal lobar pneumonia was made. There were definite alterations blood-films, apparent contact is made at a distance of in the breath sounds and some crepitations over the lower 7 feet. They will then be about 2 feet 4 inches apart. left lobe, and a few fine crepitations scattered over a small
CLINICAL AND LABORATORY NOTES.
successful phage-therapy cases, two were immediate failures, and two were complete failures. They are
Summary. general result of phage treatment dysentery appears very much in its The
for bacillaryfavour: 70 per cent. of the cases showed a well-defined response The good effect was the TABLE IIL-Bacterial Flora Before and After Phage and rapid improvement. in Six Cases. more marked the earlier the treatment was begun ; it was relatively less favourable the younger the patientIt was particularly successful in patients aged 10 years and upwards. Cases with proteus group organisms - especially B. proteus No. 2-in the intestinal flora did not do so well. Incidentally, during the progress of the treatment and side by side with it, a noteworthy lowering in death-rates from dysentery was recorded. Whether this is a simple coincidence, or affords evidence of a causeand-effect relationship, it is not at present possible to affirm. During the investigation there undoubtedly occurred a certain dissemination of the living ultra-virus Protobios bacteriophagus dysenterice in the surroundings of the patients, with a probable dissemination of natural protection. Distribution of phage to patients, in a region means an increased proportion of phage " carriers" among the population, with, in all probability, a correspondingly increased distribution of phage to food and drink. Here doubtless the flythe great distributor of dysentery bacteria in nature * Third day ill, but first day of blood and mucus " in stools. -may reasonably be assumed to play a role. The cases were sister and brother respectively. (a) Fermenting glucose, maltose, and saccharose, but not My best thanks are due to the many colleaguesmannite or dulcite. representatives of the Air Forces, the Army, and the civil practitioners in Alexandria, too numerous for The two cases (Nos. 33 and 40) which did well on individual mention-who kindly collaborated with phage-therapy had classical B. dysenterice (Sonne me in this investigation. and Hiss respectively) present in the stools before References. the administration of phage, while, after phage Da Costa Cruz, J. : Compt. rend. Soc. de Biol., 1924, xci., 845. administration, these organisms could not be recovered Davidson, W. C.: Amer. Jour. Dis. Child., 1922, xxiii., 531. on culture from the stools : in the one case 36 hours d’Herelle, F.: The Bacteriophage and Its Behaviour, Trans. after commencing the treatment, and in the other G. H. Smith, Baltimore, 1926, p. 439 ; ibid., p. 257. by on the fourth day. B. proteus No. 2 is practically Dopter, C., and Saquepée : Précis de Bacteriologie, Paris, 1921, p.575. constant in the failure cases. This is very striking. Fletcher, W., and Kanagarayer, K.: Bull. Inst. Med. Res., Its absence, before and after, in the successful Kuala Lumpur, 1927, No. 3 ; see THE LANCET, 1927, ii., 402. cases is equally noteworthy. It suggests, I Kolle, W., and Hetsch, H.: La Bactériologie Expérimentale. Geneva, 1918, p. 329. think, the need for the revision of our ideas Otto, R., and Munter, H.: Deut. Med. Woch., 1921, xlvii., 1579. the role of in the H. M., and Benstead, H. J.: Trans. Roy. Soc. Trop. Perry, concerning proteus organisms Med. and Hyg. 1928, xxi., 417. summer diarrhoeas of children and the bacillary dysenteries of adults. Most authors consider them rather as concomitants. I suggest that the presence of proteus organisms, more especially B. proteus No. 2, constitutes an setiological factor of considerable importance in bacillary dysentery, particularly in children. This organism only differs from B. morgani No. 1, so frequently found in summer diarrhoea, A SIMPLIFICATION OF THE by liquefaction of gelatin and by failure to produce " HALO " METHOD OF MEASURING THE indol. It is, I think, chiefly because of its presence DIAMETER OF RED BLOOD CORPUSCLES. that the results of phage-therapy were so disappointing in the cases under two years old. To combat proteus BY D. MERLIN PRYCE, M.B. LOND., organisms by phage-therapy is fraught with difficulty, SECOND ASSISTANT PATHOLOGIST, ST. MARY’S HOSPITAL. because the proteus group of bacteria is not homogeneous, as is the dysentery group, in its susceptibility THIS optical method was introduced into heamatoto phage action ; and because proteus organisms are " diffraction method," rich in specific endotoxins, allied to botulinus toxin logy by Pijper 12 and, as the a high state of perfection. to him has been no less There brought by is, therefore, guarantee though powerful. 2 that a phage active against a B. proteus causing trouble In his last paper in which the theory is fully in one intestinal tract -will be active against the discussed, a method is given by which the patient’s B. proteus of another case. Moreover, lysis in vitro blood can be examined at the same time as the normal. * of the bacterial bodies of proteus organisms, by It has, however, been suggested in this journal on account of the elaborate nature of the into that, their contained toxins which pass liberating the filtrate, may render such a liquid too toxic for apparatus required, the general application of the method is somewhat limited. The purpose of the immediate therapeutic use. d’Herelle (19262) records having isolated two races of present communication is to describe two methods bacteriophage which, at the moment of their isolation in which the necessary apparatus is reduced to a from the stools of two infants who had died of infantile minimum. First Method. cholera, were very virulent for B. proteus vulgaris, ’ The observer looks through a blood-film at two yet of 12 strains of B. proteus only three were found susceptible, and they were the same for each of the electric lamps placed about two feet apart at right two races. Again, he found the filtrate from a bacterio- angles to the line of sight. Two " halos " are seen, phaged suspension of B. proteus vulgaris was extremely each consisting of a number of concentric spectra. toxic for rabbits immediately after the dissolution The apparent size of these two " halos " is dependent of the bacilli (0-5 c.cm. subcutaneously causing on the distance from the twin source of light. They death within a few hours). When kept, however, appear to become smaller on stepping forwards, and for 10 days the toxicity had diminished, the rabbit to become larger on stepping backwards. In this way then surviving the intravenous injection of 2 c.cm. any pair of corresponding coloured rings in the two
summarised in Table III.
"
I.
Clinical and
Laboratory Notes
276
CLINICAL AND LABORATORY NOTES.
"
halos" can be made to meet, overlap, or separate. The distance at which contact is made between a
selected
pair of corresponding rings is directly
proportional
to the diameter of the red blood
cor-
FiG. 1.
This method requires no special apparatus, is quite sufficient for diagnostic purposes, and could easily be used by the general practitioner in his ordinary
consulting
room.
Second Method. This method, devised by Thomas Young (17731829) and described in text-books of physics under the heading of Young’s eriometer,4 is admirably suited to the present purpose. The apparatus required, which is easily constructed, consists of : (A) A source of light (sodium flame or electric lamp). (B) Optical bench with rider for carrying blood-film. (c) Metal plate with a central aperture 1-2 mm. in diameter, surrounded by a ring of 2 cm. radius, of pin-point holes. (The measurements are, of course, arbitrary.)
puscles. The coloured ring which is easiest to use is the red fringe of the innermost complete spectrum order). (Spectrum of firstblood-film is
The patient’s examined at the position of contact for the normal. Any difference in the size of the " halos " is shown by overlapping or separation of the selected diffraction rings {see Fig. 2). For example, in pernicious ansemia the " halos " are obviously smaller, and it is necessary to step back a distance
FiG. 2. A dark room is necessary when but is not essential for white
using sodium light, On looking through the blood-film, rings are seen around the central aperture in c, whilst the ring of holes appears as a circle of luminous points. The film is moved about until apparent coincidence is obtained between the circle of luminous points and a selected diffraction (say the yellow of the spectrum of the first order). Thedistance of the film from the metal plate at which this takes place varies directly as the diameter of the red corpuscles. Since the diameter of the normal corpuscles is known, that of the patient’s corpuscles can be calculated by simple proportion. With sodium light, concentric yellow rings are seen instead of spectra. Readings are taken for both borders of a selected ring (say the first). The difference and the mean correspond with the anisocytosis and average size respectively. My thanks are due to Dr. Wilfrid Newcomb and
light. diffraction
ring
Mr.
Leslie Paton for their kind
and valuable advice.
References.—(1) Pijper, Adrianus : THE LANCET, 1924, ii., 367. (2) Pijper, Adrianus : Brit. Med. Jour., 1929, i., 635. (3) THE LANCET, 1929, i., 1261. (4) Preston, T.: Theory of Light, 4th ed., p. 234. A CASE OF
LOBAR PNEUMONIA IN A CHILD. BY KENNETH
Twinspeotra of (1) acholuric jaundice, (2) normal, and (3) b. pernicious anaemia blood-fdms at position of contact for the normal.
McPADYEAN, M.R.C.S. ENG.
THE following case because it illustrates
seems some
to be worth recording of the difficulties of
in children :which is proportional to the increase in the size of the diagnosing pneumonia A girl, aged 5t years, complained of earache on Dec. 6th. red corpuscles. If the method is adopted as a routine On the 6th, in the early afternoon, she said she felt cold, the floor may be calibrated with chalk lines, so that and was put to bed with a temperature of 100° F. She was one foot corresponds to 1 . This is done by adjusting first seen by me at 8 P.M. on that day, when a diagnosis of the distance between the lamps so that, with normal lobar pneumonia was made. There were definite alterations blood-films, apparent contact is made at a distance of in the breath sounds and some crepitations over the lower 7 feet. They will then be about 2 feet 4 inches apart. left lobe, and a few fine crepitations scattered over a small