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CARCINOMA OF THE STOMACH
1455 I have been told that
during the Bournemouth epidemic, notwithstanding official advice to the contrary, large numbers of the public availed them-
.
selves of inoculation. I cannot share your views with regard to active immunisation with an antityphoid vaccine, but I agree completely with those expressed by Sir John Ledingham in his letter of Dec. llth. I have yet to be convinced of the dangers of the " negative phase," and I would at present advocate inoculation of all those who have been exposed to infection. My view is strengthened by my experience with P.S.I. vaccine (Wynn’s formula) in the treatment of pneumonia. It seems to me that the dangers of the " negative phase " must be much greater if a vaccine is given during the acute stage of an illness, than if it is given during the incubation period as in the case of typhoid inoculation during an epidemic. I have been impressed by the beneficial effect of P.S.I. vaccine in pneumonia, andcannot say that I have ever seen any untoward effect which I could attribute to a summation effect during the " negative I am, Sir, yours faithfully, phase." G. M. M. GREIG. Tiverton, Devon, Dec. 12th. CARCINOMA OF THE STOMACH To the Editor of THE LANCET SiR,-Dr. Jennings is so grossly inaccurate in his statements, as Dr. Thompson Hancock has pointed out in your issue of Dec. llth, that I will not occupy your space by replying to his latest letter in detail but will content myself with quoting from Konjetzny, as he has done more work and has written more extensively on gastric carcinoma than any of the other authorities I mentioned in my first letter. " Carcinoma of the stomach," he writes, " never develops in healthy gastric mucous membrane, as I have over and over again stated as a result of my extensive investigations, an opinion which in recent times has been confirmed by many authorities, among whom I wish to refer especially to A. F. Hurst on account of his wide experience in gastric pathology " 1934, 2, 65). Later in the (.Msc?M-. j)’e6s&eMmjt?/’. same paper Konjetzny quotes with approval my statistics as to the relative frequency of the ment of carcinoma from chronic gastritis and gastric ulcer. But in spite of this Dr. Jennings says that Konjetzny does not agree with any of my views on gastric pathology, and especially those connected with carcinoma of the stomach ! I am, Sir, yours faithfully, ARTHUR F. HURST.
develop-
New Lodge Clinic, Windsor Forest, Dec. 13th.
PS.-Through a slip in my last letter I referred to Korbsch when I meant Katsch. I know nothing about Korbsch’s views, as he does not refer to the subject in his book on gastroscopy. But Prof. Katsch in his opening paper on carcinoma of the stomach at the International Gastro-Enterological Congress in Paris held in September of this year expressed his belief that carcinoma of the stomach was secondary to chronic gastritis in 75 per cent. of cases and to gastric ulcer in 20 per cent. He has ’thus apparently altered his views since he wrote the article referred to by Dr. Jennings in his second letter. MINERS’ NYSTAGMUS
To the Editor of THE LANCET SIR,-Last year I contributed to your columns an article on changes in blood pressure on descent into mines, with special reference to miners’ nystagmus (Lancet, 1936, 2, 247). A theory that might
help in elucidating the condition has presented itself as the result of the observations made at that time. It was recorded in my paper that a certain number of men showed nystagmus immediately after descent, although they did not complain of the condition and were considered free from it. Secondly, men recognised to have nystagmus complained of aggravation On of their symptoms immediately after descent. the basis of the reverse fistula symptom, or compression nystagmus, arising from condensation and rarefaction of air in the external auditory meatus I have formed the opinion that persons predisposed to miners’ nystagmus suffer from undue mobility of the stapes. Such a condition would produce nystagmus following rapid descent into the mine, which causes increase of pressure on the ear drums. The constrained position adopted when going to work, and later at work, in poor illumination, produces a myopathy and prolonged postural nystagmus. Later it becomes possible to elicit nystagmus merely by making the man bend the head and simultaneously raise the eyesthe position he must adopt when proceeding to work, if he is to avoid injury from low overhead beams. I am not aware that undue mobility of the stapes has hitherto been considered as a primary precipitating factor in nystagmus. If my suggestion should prove correct men likely to develop nystagmus could be discovered by compressing air into the meatus before descent into the mine. Those giving a positive response to this test could be given employment elsewhere. I am, Sir, yours faithfully, F. O’SULLIVAN. O’SULLIVAN. Harrow Weald, Middlesex, Dec. 10th.
APLASTIC AND ACHRESTIC ANÆMIAS
To the Editor
of
THE LANCET
SiR,—I must thank Dr. J. F. Wilkinson and Dr. M. C. G. Israels for their comments, in your issue of Nov. 6th, on my article on sternal puncture. The first point they raise, concerning the bonemarrow in achrestic anaemia and pernicious anaemia, is discussed in detail in a separate paper, and it is perhaps appropriate to postpone controversy until after this has appeared.** I would like to refer briefly, however, to the " macroblast." This term was introduced by Naegeli to characterise a cell which though of the same size as a megaloblast nevertheless showed important histological differences. A description and illustration will be found in detail in Naegeli’s book " Blutkrankheiten and Blutdiagnostik (Berlin 1931). The German school of haematology and some other workers recognise anatomical as well as genetic differences between the macroblast and megaloblast. I personally do not recognise the genetic differences. The staining of fresh films obtained by sternal puncture throws much light on the mother-cells of the erythrocytes. Fine differentiation is now possible and more exact. The premegaloblastic-megaloblastic marrow of pernicious anaemia is unique and quite distinct, and although the bone-marrow of cases appearing to conform with Wilkinson’s own criteria of achrestic anaemia contains large nucleated red cells, their fine histology in films was found to be different. With those who share my views, I await with great interest Dr. Wilkinson’s own experience of sternal puncture in achrestic anaemia, for such fine differences cannot be easily recognised in post-mortem material or in sections. I hope that this will stimulate various workers to undertake "
*
This second paper
appeared in
our
last issue.—ED. L.
.
during the Bournemouth epidemic, notwithstanding official advice to the contrary, large numbers of the public availed them-
.
selves of inoculation. I cannot share your views with regard to active immunisation with an antityphoid vaccine, but I agree completely with those expressed by Sir John Ledingham in his letter of Dec. llth. I have yet to be convinced of the dangers of the " negative phase," and I would at present advocate inoculation of all those who have been exposed to infection. My view is strengthened by my experience with P.S.I. vaccine (Wynn’s formula) in the treatment of pneumonia. It seems to me that the dangers of the " negative phase " must be much greater if a vaccine is given during the acute stage of an illness, than if it is given during the incubation period as in the case of typhoid inoculation during an epidemic. I have been impressed by the beneficial effect of P.S.I. vaccine in pneumonia, andcannot say that I have ever seen any untoward effect which I could attribute to a summation effect during the " negative I am, Sir, yours faithfully, phase." G. M. M. GREIG. Tiverton, Devon, Dec. 12th. CARCINOMA OF THE STOMACH To the Editor of THE LANCET SiR,-Dr. Jennings is so grossly inaccurate in his statements, as Dr. Thompson Hancock has pointed out in your issue of Dec. llth, that I will not occupy your space by replying to his latest letter in detail but will content myself with quoting from Konjetzny, as he has done more work and has written more extensively on gastric carcinoma than any of the other authorities I mentioned in my first letter. " Carcinoma of the stomach," he writes, " never develops in healthy gastric mucous membrane, as I have over and over again stated as a result of my extensive investigations, an opinion which in recent times has been confirmed by many authorities, among whom I wish to refer especially to A. F. Hurst on account of his wide experience in gastric pathology " 1934, 2, 65). Later in the (.Msc?M-. j)’e6s&eMmjt?/’. same paper Konjetzny quotes with approval my statistics as to the relative frequency of the ment of carcinoma from chronic gastritis and gastric ulcer. But in spite of this Dr. Jennings says that Konjetzny does not agree with any of my views on gastric pathology, and especially those connected with carcinoma of the stomach ! I am, Sir, yours faithfully, ARTHUR F. HURST.
develop-
New Lodge Clinic, Windsor Forest, Dec. 13th.
PS.-Through a slip in my last letter I referred to Korbsch when I meant Katsch. I know nothing about Korbsch’s views, as he does not refer to the subject in his book on gastroscopy. But Prof. Katsch in his opening paper on carcinoma of the stomach at the International Gastro-Enterological Congress in Paris held in September of this year expressed his belief that carcinoma of the stomach was secondary to chronic gastritis in 75 per cent. of cases and to gastric ulcer in 20 per cent. He has ’thus apparently altered his views since he wrote the article referred to by Dr. Jennings in his second letter. MINERS’ NYSTAGMUS
To the Editor of THE LANCET SIR,-Last year I contributed to your columns an article on changes in blood pressure on descent into mines, with special reference to miners’ nystagmus (Lancet, 1936, 2, 247). A theory that might
help in elucidating the condition has presented itself as the result of the observations made at that time. It was recorded in my paper that a certain number of men showed nystagmus immediately after descent, although they did not complain of the condition and were considered free from it. Secondly, men recognised to have nystagmus complained of aggravation On of their symptoms immediately after descent. the basis of the reverse fistula symptom, or compression nystagmus, arising from condensation and rarefaction of air in the external auditory meatus I have formed the opinion that persons predisposed to miners’ nystagmus suffer from undue mobility of the stapes. Such a condition would produce nystagmus following rapid descent into the mine, which causes increase of pressure on the ear drums. The constrained position adopted when going to work, and later at work, in poor illumination, produces a myopathy and prolonged postural nystagmus. Later it becomes possible to elicit nystagmus merely by making the man bend the head and simultaneously raise the eyesthe position he must adopt when proceeding to work, if he is to avoid injury from low overhead beams. I am not aware that undue mobility of the stapes has hitherto been considered as a primary precipitating factor in nystagmus. If my suggestion should prove correct men likely to develop nystagmus could be discovered by compressing air into the meatus before descent into the mine. Those giving a positive response to this test could be given employment elsewhere. I am, Sir, yours faithfully, F. O’SULLIVAN. O’SULLIVAN. Harrow Weald, Middlesex, Dec. 10th.
APLASTIC AND ACHRESTIC ANÆMIAS
To the Editor
of
THE LANCET
SiR,—I must thank Dr. J. F. Wilkinson and Dr. M. C. G. Israels for their comments, in your issue of Nov. 6th, on my article on sternal puncture. The first point they raise, concerning the bonemarrow in achrestic anaemia and pernicious anaemia, is discussed in detail in a separate paper, and it is perhaps appropriate to postpone controversy until after this has appeared.** I would like to refer briefly, however, to the " macroblast." This term was introduced by Naegeli to characterise a cell which though of the same size as a megaloblast nevertheless showed important histological differences. A description and illustration will be found in detail in Naegeli’s book " Blutkrankheiten and Blutdiagnostik (Berlin 1931). The German school of haematology and some other workers recognise anatomical as well as genetic differences between the macroblast and megaloblast. I personally do not recognise the genetic differences. The staining of fresh films obtained by sternal puncture throws much light on the mother-cells of the erythrocytes. Fine differentiation is now possible and more exact. The premegaloblastic-megaloblastic marrow of pernicious anaemia is unique and quite distinct, and although the bone-marrow of cases appearing to conform with Wilkinson’s own criteria of achrestic anaemia contains large nucleated red cells, their fine histology in films was found to be different. With those who share my views, I await with great interest Dr. Wilkinson’s own experience of sternal puncture in achrestic anaemia, for such fine differences cannot be easily recognised in post-mortem material or in sections. I hope that this will stimulate various workers to undertake "
*
This second paper
appeared in
our
last issue.—ED. L.
.