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CEREBRO-SPINAL MENINGITIS: MENINGOCOCCI FOUND IN PERIPHERAL BLOOD FILMS.
1046
Correspondence. II Audi alteram
SANITATION
partem."
IN
INDIA.
To the Editor of THE LANCET.
SIR,—’In your issue of March 6th a joint letter :from Professor R. Tanner Hewlett, Colonel W. G. King, and Professor W. J. Simpson was published under the above heading. The responsible positions that these three gentlemen occupy in educational sanitary circles in London secure every consideration for contributions from their pen, and I am authorised to say that the Government of India are in entire agreement with the views set forth in the joint letter in question as regards the value of British Diplomas in Public Health. Indeed, in the resolution to which the writers refer it is - clearly laid down that a British Diploma in Public Health is a sine qud non for appointment either as a Deputy Sanitary Commissioner, or, for the present .at least, as a first-class health officer. The Government of India, too, fully concur in the view that it is distinctly desirable that Indian - candidates for important sanitary appointments should regard training in Great Britain as the foundation of their careers. In this connexion I may state that since 1912, 27 Indians holding British Diplomas in Public Health have been
;appointed to the Sanitary Department-11 as Deputy Sanitary Commissioners and 16 as firstclass health officers. In these circumstances it is scarcely fair to hold the Government of India ,responsible for the private opinions of a Provincial .Sanitary Commissioner, especially when it is borne in mind that the only evidence as to the existence of such opinions is that furnished by the unsupported statements of a disappointed candidate. I am, Sir, yours faithfully, P. LUKIS, M.D., F.R.C.S. (Surgeon-General), Director-General, Indian Medical Service.
Simla, April 15th, 1915.
CEREBRO-SPINAL MENINGITIS: MENINGOCOCCI FOUND IN PERIPHERAL BLOOD FILMS. To the Editor of THE LANCET.
it more readily in this manner than from the throat....... If there were any symptoms showing involvement of the nervous system, we found the germ in the blood....... We had cases of every degree of severity-from a man who started with agonising pain in the head and was dead in a few hours to cases in which diarrhoea, giddiness, and malaise of a slight degree were the only symptoms. In many cases the latter (meningococci) were in the leucocytes....... In blood the meningococci I have seen often have a capsule....... Personally I believe this to be the method of diagnosis which will shortly be widely adopted." 3. I have heard from two or three bacteriologists, who all state they have entirely failed to find the organisms in the blood of any of the cases they have examined. 4. Thanks to Dr. A. D. Edwards, medical officer of health of Bournemouth, I have had an opportunity of examining films made from ear or finger blood of six undoubted cases of cerebro-spinal fever. One of these was a fulminating, rapidly fatal one. After a prolonged and careful search of these films I have been quite unable to recognise any meningococci, either free or intracellular in position, in any of these. The only case in which I found the organism is the one described and that was an intensely septicaemic type. The patient had " a purpuric rash on the brow and face," and later on extra. vasation of blood on the trunk. I should think that meningococci could have been found in the blood taken from any part of the body, but what I did notice casually at the time was that when I pricked the lobe of the left ear it felt firm, and somewhat indurated, and it might even have been the seat of the purpuric rash, or even an area in which there was extravasation of blood, but the ward was somewhat dimly lighted and I did not observe this. However, it occurred to me afterwards that it would be a good plan to make the film from the blood taken from a spot of the rash. I therefore wrote to Dr. Edwards: " Please do not trouble to send me any more films from cases of cerebro-spinal fever, unless you happen to meet with another of the septicæmic type. It might, in future, be worth while taking the blood from a spot should the rash be present, just as is done in making cultures from the blood of the rose-coloured spots in the case of typhoid fever." I think we may, therefore, conclude: 1. That meningococci may be occasionally found in the peripheral blood, but only in rare cases. 2. That this method of examination cannot be used as a means of diagnosis. 3. That Dr. Mary Williams’s remarkably successful results have not been obtained by other observers during the present epidemic. I am, Sir, yours faithfully, ALFRED C. COLES. Bournemouth, May 6th, 1915. ......
SIR,-At the end of a short article under the - above title in THE LANCET of April 10th I asked the question, " Are the organisms to be oommonly found in films made from the peripheral blood in cases of cerebro-spinal fever, and is this a ; practical method of diagnosis, or are the meningo. cocci only to be found in the septicæmic type of the disease ? " In view of the frequent inquiries I receive from various correspondents, I think it would save some confusion if I now tried to answer that ,question. THE BALNEOLOGICAL COMMITTEE OF 1. Sir William Osler kindly wrote: "Iwas very THE ROYAL SOCIETY OF MEDICINE much interested in the figures in your paper AND ITS METHODS. in to-day’s LANCET, as the first demonstration 1’o the Editor of THE LANCET. of the meningococci. in the blood was made in my wards. Wenever had a case with so many SIR,-Early in February of this year I received a in the leucocytes, as shown in your Figures 14, 5, letter from the secretaries of the above recently and 6. On several occasions we got the cultures formed committee-Dr. R. Fortescue Fox and Dr. J. when it was difficult to find the organisms by Campbell McClure-intimating the formation of the simple staining." 2. Dr. Mary Williams, judging committee, on the suggestion of the War Office, to from her letters in the British Medical Journal of collect information and give advice to the War Office April 3rd and THE LANCET of April 17th, seems "to regarding " the scientific distribution of wounded I - soldiers among the British health resorts." In accordhave been exceptionally fortunate. She says : .found the germ, in 80 consecutive cases,.and found ance with the request madefurnished a preliminary ’
Correspondence. II Audi alteram
SANITATION
partem."
IN
INDIA.
To the Editor of THE LANCET.
SIR,—’In your issue of March 6th a joint letter :from Professor R. Tanner Hewlett, Colonel W. G. King, and Professor W. J. Simpson was published under the above heading. The responsible positions that these three gentlemen occupy in educational sanitary circles in London secure every consideration for contributions from their pen, and I am authorised to say that the Government of India are in entire agreement with the views set forth in the joint letter in question as regards the value of British Diplomas in Public Health. Indeed, in the resolution to which the writers refer it is - clearly laid down that a British Diploma in Public Health is a sine qud non for appointment either as a Deputy Sanitary Commissioner, or, for the present .at least, as a first-class health officer. The Government of India, too, fully concur in the view that it is distinctly desirable that Indian - candidates for important sanitary appointments should regard training in Great Britain as the foundation of their careers. In this connexion I may state that since 1912, 27 Indians holding British Diplomas in Public Health have been
;appointed to the Sanitary Department-11 as Deputy Sanitary Commissioners and 16 as firstclass health officers. In these circumstances it is scarcely fair to hold the Government of India ,responsible for the private opinions of a Provincial .Sanitary Commissioner, especially when it is borne in mind that the only evidence as to the existence of such opinions is that furnished by the unsupported statements of a disappointed candidate. I am, Sir, yours faithfully, P. LUKIS, M.D., F.R.C.S. (Surgeon-General), Director-General, Indian Medical Service.
Simla, April 15th, 1915.
CEREBRO-SPINAL MENINGITIS: MENINGOCOCCI FOUND IN PERIPHERAL BLOOD FILMS. To the Editor of THE LANCET.
it more readily in this manner than from the throat....... If there were any symptoms showing involvement of the nervous system, we found the germ in the blood....... We had cases of every degree of severity-from a man who started with agonising pain in the head and was dead in a few hours to cases in which diarrhoea, giddiness, and malaise of a slight degree were the only symptoms. In many cases the latter (meningococci) were in the leucocytes....... In blood the meningococci I have seen often have a capsule....... Personally I believe this to be the method of diagnosis which will shortly be widely adopted." 3. I have heard from two or three bacteriologists, who all state they have entirely failed to find the organisms in the blood of any of the cases they have examined. 4. Thanks to Dr. A. D. Edwards, medical officer of health of Bournemouth, I have had an opportunity of examining films made from ear or finger blood of six undoubted cases of cerebro-spinal fever. One of these was a fulminating, rapidly fatal one. After a prolonged and careful search of these films I have been quite unable to recognise any meningococci, either free or intracellular in position, in any of these. The only case in which I found the organism is the one described and that was an intensely septicaemic type. The patient had " a purpuric rash on the brow and face," and later on extra. vasation of blood on the trunk. I should think that meningococci could have been found in the blood taken from any part of the body, but what I did notice casually at the time was that when I pricked the lobe of the left ear it felt firm, and somewhat indurated, and it might even have been the seat of the purpuric rash, or even an area in which there was extravasation of blood, but the ward was somewhat dimly lighted and I did not observe this. However, it occurred to me afterwards that it would be a good plan to make the film from the blood taken from a spot of the rash. I therefore wrote to Dr. Edwards: " Please do not trouble to send me any more films from cases of cerebro-spinal fever, unless you happen to meet with another of the septicæmic type. It might, in future, be worth while taking the blood from a spot should the rash be present, just as is done in making cultures from the blood of the rose-coloured spots in the case of typhoid fever." I think we may, therefore, conclude: 1. That meningococci may be occasionally found in the peripheral blood, but only in rare cases. 2. That this method of examination cannot be used as a means of diagnosis. 3. That Dr. Mary Williams’s remarkably successful results have not been obtained by other observers during the present epidemic. I am, Sir, yours faithfully, ALFRED C. COLES. Bournemouth, May 6th, 1915. ......
SIR,-At the end of a short article under the - above title in THE LANCET of April 10th I asked the question, " Are the organisms to be oommonly found in films made from the peripheral blood in cases of cerebro-spinal fever, and is this a ; practical method of diagnosis, or are the meningo. cocci only to be found in the septicæmic type of the disease ? " In view of the frequent inquiries I receive from various correspondents, I think it would save some confusion if I now tried to answer that ,question. THE BALNEOLOGICAL COMMITTEE OF 1. Sir William Osler kindly wrote: "Iwas very THE ROYAL SOCIETY OF MEDICINE much interested in the figures in your paper AND ITS METHODS. in to-day’s LANCET, as the first demonstration 1’o the Editor of THE LANCET. of the meningococci. in the blood was made in my wards. Wenever had a case with so many SIR,-Early in February of this year I received a in the leucocytes, as shown in your Figures 14, 5, letter from the secretaries of the above recently and 6. On several occasions we got the cultures formed committee-Dr. R. Fortescue Fox and Dr. J. when it was difficult to find the organisms by Campbell McClure-intimating the formation of the simple staining." 2. Dr. Mary Williams, judging committee, on the suggestion of the War Office, to from her letters in the British Medical Journal of collect information and give advice to the War Office April 3rd and THE LANCET of April 17th, seems "to regarding " the scientific distribution of wounded I - soldiers among the British health resorts." In accordhave been exceptionally fortunate. She says : .found the germ, in 80 consecutive cases,.and found ance with the request madefurnished a preliminary ’