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Archives de medicine des enfants
April I938
TUBERCLE
fibrotic conditions, coagulation occurs also with solutions weaker than tire normal (shift to tile right). Consistent results are obtained in exudative tnbcrculosis, pneumonia, acute rheumatism (left), and in fibrotic tuberculosis, cirrhosis of the liver (right), and in heahhy subjccts. Patients in all stages of tuberculosis were studicd both over long periods, and intensively as individuals. T h e mechanism is unexplained, but there is some correlation between the pH and the Weltmama reaction. The importance of the test especially for tuberculosis is confirmed, and since the test is not subject to the same fluctuations as the red cell sedimentation test, it is more reliable in diagnosis and prognosis. I
A R C H I V E S DE M E D I C I N E DES E N F A N T S \rot,. XLI No. I JANUARY 1938. *Epoque de l'apparltion de la menlngite au cours de I'infcction tttberculeuse. (Onset of meningitis in the course of tuberculous infection.) P. Nobdcourt and S. B. Briskas. 17. *Les images pdrihilaires et pdrlsclssurales h dvolutions chroniques non-bacillaires chcz l'enfant. (Interlobar a n d perihilar processes of t h e chronic and non-bacillary type in chiktren.) F. Tissot. 26.
Onset of menhzgitis in the course of tuberculous bfection.--Among t4,976 children treated in a children's hospital in 19 ~ I- 1936, 368 cases of meningitis (o-15 years of age) occurred. X-ray fihns were taken in 6--. cases, and a postmortem examination was done in 58. Dcfinite and 'relatively r e c e n t ' lesions were discovered in the lungs in 87. 5 per cent. These lesions varied f r o m the childhood type infiltration to caseous loci and recent puhnonary-lympho-glandular lesions. Meningitis developed in ,2.o patients four weeks to three months after contact and in 7 patients four to six months after contact (infants only). Meningitis is therefore considered to be a manifestation of tire ' primosecondary phase,' although sometimes it m a y be a 'reactivation.' Only once was erythema nodosum recorded in the history of the 368 patients.
hzterlobar and perihila) processes of the chronic t)pe.--Three cases are reported and described as pseudo-tuberculous and as due to a 'diath~se neuro-arthrdtique' because the Mantoux test was constantly negative. BRITISH MEDICAL JOURNAL VOL. I NO. I JANUARY I, 1938 *Chronic disseminated tuberculosis. F, S i m m o n d s and W. Pagel. z5.
A.
tl.
33 I
Chronic disseminated tuberculosis.--Clinical and postmortem details of a case of chronic haematogenous tuberculosis, death beingdue to tuberculous meningitis. T h e miliary foei in the hmgs were confined to the corticopleural region, and showed histological evidence of chronicity. This rare form of chronic miliary tuberculosis had previously been reported by Pagel. The possible causes of tire peculiar distribution of the lesions are discussed. VOL. I No. 3 JANUARY 15, x938 *Cultural methods in bacteriological diagnosis of tuberculosis. C. A. Green. z I f . T r e a t m e n t of streptococcal e m p y e m a with intrapleural sulphanilamide. W. F. Nicholson. I 15,
Culture bz diagnosis of tuberculosis.--3,3o6 specimens, mainly sputa, were examined for tul)ercle bacilli in smears and by culture on Lowenstein-Jensen medium. In only 4 I~ (74"3 per cent) of 552 specimens of positive sputa were the bacilli detected by repeated smear examinations, as compared with 543 (98"3 per cent) by culture. 9 (I-6 ber cent) were positive in scanty numbers by the direct method and negative on culture. (No reason for this finding is given.) io 9 cultures (49 from sputa negative on direct examination and 6o from sputa positive on direct examination) were examined by animal inoculation and the cultural diagnosis confirmed in every case. i~ specimens of urine were positive by culture ; in only 5 of these specimens were bacilli found by direct examination. In milk, the results obtained by the two methods showed very little difference. Animal inoculation was carried out on all specimens of milk and in 41 other specimens selected at random. It succeeded in 13 cases where culture failed, but gave a negative result in 4 cases positive by culture. T h e author attempts to correlate the bacteriological findings with the clinical diagnosis. B U L L E T I N S ET M ~ M O I R E S DE LA SOCII2,TI~ DE R A D I O L O G I E MI;21)ICALE D E F R A N C E VOL. XXV SO. ~.~,.~ DECI:;MBI:;R Z937. Erreurs de diagnostique provoqu~es par u n e absence de d i a p h r a g m e droit (Diagnostic errors due to the absence of the right d o m e of the d i a p h r a g m ) . M. Gu,~naux. 783 . *Sur la stratographie pulmonMre ( O n t o m o g r a p h y of the lungs). M. G. R o n n e a u x . 785 .
Tomography of the lungs.--A method ot tomography is described where the tube remains in a fixed position and both tile patient and the film are rotated. When
TUBERCLE
fibrotic conditions, coagulation occurs also with solutions weaker than tire normal (shift to tile right). Consistent results are obtained in exudative tnbcrculosis, pneumonia, acute rheumatism (left), and in fibrotic tuberculosis, cirrhosis of the liver (right), and in heahhy subjccts. Patients in all stages of tuberculosis were studicd both over long periods, and intensively as individuals. T h e mechanism is unexplained, but there is some correlation between the pH and the Weltmama reaction. The importance of the test especially for tuberculosis is confirmed, and since the test is not subject to the same fluctuations as the red cell sedimentation test, it is more reliable in diagnosis and prognosis. I
A R C H I V E S DE M E D I C I N E DES E N F A N T S \rot,. XLI No. I JANUARY 1938. *Epoque de l'apparltion de la menlngite au cours de I'infcction tttberculeuse. (Onset of meningitis in the course of tuberculous infection.) P. Nobdcourt and S. B. Briskas. 17. *Les images pdrihilaires et pdrlsclssurales h dvolutions chroniques non-bacillaires chcz l'enfant. (Interlobar a n d perihilar processes of t h e chronic and non-bacillary type in chiktren.) F. Tissot. 26.
Onset of menhzgitis in the course of tuberculous bfection.--Among t4,976 children treated in a children's hospital in 19 ~ I- 1936, 368 cases of meningitis (o-15 years of age) occurred. X-ray fihns were taken in 6--. cases, and a postmortem examination was done in 58. Dcfinite and 'relatively r e c e n t ' lesions were discovered in the lungs in 87. 5 per cent. These lesions varied f r o m the childhood type infiltration to caseous loci and recent puhnonary-lympho-glandular lesions. Meningitis developed in ,2.o patients four weeks to three months after contact and in 7 patients four to six months after contact (infants only). Meningitis is therefore considered to be a manifestation of tire ' primosecondary phase,' although sometimes it m a y be a 'reactivation.' Only once was erythema nodosum recorded in the history of the 368 patients.
hzterlobar and perihila) processes of the chronic t)pe.--Three cases are reported and described as pseudo-tuberculous and as due to a 'diath~se neuro-arthrdtique' because the Mantoux test was constantly negative. BRITISH MEDICAL JOURNAL VOL. I NO. I JANUARY I, 1938 *Chronic disseminated tuberculosis. F, S i m m o n d s and W. Pagel. z5.
A.
tl.
33 I
Chronic disseminated tuberculosis.--Clinical and postmortem details of a case of chronic haematogenous tuberculosis, death beingdue to tuberculous meningitis. T h e miliary foei in the hmgs were confined to the corticopleural region, and showed histological evidence of chronicity. This rare form of chronic miliary tuberculosis had previously been reported by Pagel. The possible causes of tire peculiar distribution of the lesions are discussed. VOL. I No. 3 JANUARY 15, x938 *Cultural methods in bacteriological diagnosis of tuberculosis. C. A. Green. z I f . T r e a t m e n t of streptococcal e m p y e m a with intrapleural sulphanilamide. W. F. Nicholson. I 15,
Culture bz diagnosis of tuberculosis.--3,3o6 specimens, mainly sputa, were examined for tul)ercle bacilli in smears and by culture on Lowenstein-Jensen medium. In only 4 I~ (74"3 per cent) of 552 specimens of positive sputa were the bacilli detected by repeated smear examinations, as compared with 543 (98"3 per cent) by culture. 9 (I-6 ber cent) were positive in scanty numbers by the direct method and negative on culture. (No reason for this finding is given.) io 9 cultures (49 from sputa negative on direct examination and 6o from sputa positive on direct examination) were examined by animal inoculation and the cultural diagnosis confirmed in every case. i~ specimens of urine were positive by culture ; in only 5 of these specimens were bacilli found by direct examination. In milk, the results obtained by the two methods showed very little difference. Animal inoculation was carried out on all specimens of milk and in 41 other specimens selected at random. It succeeded in 13 cases where culture failed, but gave a negative result in 4 cases positive by culture. T h e author attempts to correlate the bacteriological findings with the clinical diagnosis. B U L L E T I N S ET M ~ M O I R E S DE LA SOCII2,TI~ DE R A D I O L O G I E MI;21)ICALE D E F R A N C E VOL. XXV SO. ~.~,.~ DECI:;MBI:;R Z937. Erreurs de diagnostique provoqu~es par u n e absence de d i a p h r a g m e droit (Diagnostic errors due to the absence of the right d o m e of the d i a p h r a g m ) . M. Gu,~naux. 783 . *Sur la stratographie pulmonMre ( O n t o m o g r a p h y of the lungs). M. G. R o n n e a u x . 785 .
Tomography of the lungs.--A method ot tomography is described where the tube remains in a fixed position and both tile patient and the film are rotated. When