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EFFECT OF CORTISONE ON WATER METABOLISM
1090 ment of choice
in
selected cases of
perforated
ulcer.
11 our
results prove comparable with those of Professor Nuboer we shall be prepared to extend our indications to include .all patients whom we consider fit to stand the operation -except for the very young with a short history of indigestion, who, in our experience, are, the least prone to recurrent ulceration. Edgware General Hospital, Middlesex
FRANK FORTY.
EFFECT OF CORTISONE ON WATER
METABOLISM ascertain the influence of the SIR,,-In adrenals on water metabolism, we have studied the effect of cortisone on renal function in rheumatoid-arthritis patients (100 mg. daily for 10 days) and in one case of Addison’s disease (30 mg daily for 10 days). Thiosulphate and para-aminohippurate clearance tests were before and after cortisone treatment. performed In the majority of rheumatic patients the glomerular filtration-rate increased greatly, and renal plasma-flow increased to a lesser extent or remained unchanged ; the reabsorption of water by the tubules increased in every case. In the patient with Addison’s disease a daily dose of 30 mg. of cortisone for 10 days improved the renal function and restored to normal the diuretic response after water-loading ; in the same patient deoxycortone acetate (10 mg. daily for 10 days), while improving renal function, did not correct the abnormal diuretic response. Our results suggest that the water retention in normal subjects after cortisone therapy depends on increased tubular reabsorption. On the other hand, cortisone inhibits the pathologically increased tubular reabsorption after water-loading that characterises adrenal
order
to
-
’
insufficiency.
G.
Medical Clinic, University of Milan,
Italy.
SALA
F. SERENI C. B. BALLABIO.
BOVINE TUBERCULOSIS PREVENTS HUMAN TUBERCULOSIS?
SIR,—In his letter of Oct. 27, Mr. Pitcher presents some interesting figures which suggest that in areas where the milk has been largely freed from tubercle bacilli the notifications of pulmonary tuberculosis have increased ; whilst in areas where progress in clearing up the supply has been less marked, notifications are declining. Mr. Pitcher’s letter reminded me of an informative article by Mr. Francis 1—also a member of the veterinary profession-in which a map of Great Britain showing by counties the incidence of tuberculosis in cattle was compared with a map of the tuberculosis mortality in The heavily shaded portions of the latter map man. seemed to coincide largely with the lightly affected parts of the former and vice versa. In my report for 1950, I compared the notifications of pulmonary tuberculosis with the percentage of milk samples positive for tubercle bacilli over the past 20 years. This comparison suggests that the notificationrate of pulmonary tuberculosis has increased as the samples of milk positive for tubercle bacilli have decreased. I pointed out that our figures were small, but that the two factors showed a significant negative correlation. I expressed the opinion that, whilst no-one wishes to go back to the days of heavily infected milk, it is possible that such milk gave rise, not only to the tragedies of bone and joint tuberculosis, but also possibly to an immunising effect in the more fortunate. Dr. J. L. Horne, medical officer of health for Ross and Cromarty, at a recent conference suggested that one reason why tuberculosis had increased so much in the Island of Lewis was that the incidence of bovine infections 1. Francis. J.
Lancet, 1950, i, 34.
had been consistently low there. Of the mainland part of his countv he said: " One feels that the low mainrate is in a way related to land the high incidence of bovine infection." To come back to Mr. Pitcher’s letter, the lack of data on the percentage of cattle attested in the earlier years to which he refers makes it impossible to subject his figures to the usual statistical -methods. One would also like to know that the total notification figures are correct, as I suspect they refer to counties only—i.e., they do not include figures for the large boroughs within the counties. I suggest that any relationship between bovine and human infection could quite readily be decided by the central departments. The Ministry of Agriculture might, for example, give the figures for attested cattle in the years 1935 (when the attestation scheme came into force) and, say, 1950, relating to the Scottish counties which consume milk produced within their boundaries only ; and the Department of Health might give the figures for notifications in like years and counties. A decided inverse relationship would naturally support the use of some’ such substance as B.c.G. vaccine to replace what was no longer present in milk. Such a relationship would make many agree with the opinion of Francis.! " As milk is freed from tubercle bacilli by the eradication of tuberculosis from cattle and by pasteurisation, more will have to be done to protect adolescents from infection and increase their resistance by immunisation." Public Health Department, BRYCE R. NISBET
respiratory-tuberculosis
Kilmarnock.
Medical Officer of Health.
NERVE NIPPING AT THE INTERCOSTAL MARGIN
SiR,-In your issue of Nov. 24 Dr. Harwood Stevenson describes what he calls traumatic intercostal neuritis. In 1939 I published an article2 on displaced ribs, which was republished in the American Year Book of 1940. This describes a very similar condition, although I considered that the causative mechanism was different. Since then I have been seeing six or seven cases every year. I understand that similar conditions have been described from time to time by writers on manipulative surgery. It is interesting and even depressing that such a wellmarked and painful entity which is amenable to treatment should be unrecognised by the profession at large. Many cases of pleurodynia are easily cured by simple
manipulation. W. A. BALL.
Petworth, Sussex.
BACT. COLI MENINGITIS IN INFANCY
SIR,—The account by Dr. Ebsworth and Dr. Leys (Nov. 17) of a baby with Bacterium coli meningitis cured and polymyxin prompts me to which occurred in the same month. This little boy was born on Oct. 24, 1950, and became ill
by chloramphenicol report a similar case
week before his admission to Whipps Cross 3 ; he was then 6 weeks old. The presenting features were convulsions, a high-pitched cry, a bulging fontanelle, and a pyrexia of 101—102°F. As with the patient described by Dr. Ebsworth and Dr. Leys, lumbar puncture was unsuccessful until the child had recovered, although four different members of the staff made repeated attempts. On the 4th day after admission a ventricular tap yielded a gush of turbid greenish-yellow fluid. This gave a heavy growth of Bact. coli, sensitive to’Aureomycin’ and chloramphenicol and less so to streptomycin. The treatment was 50 mg. streptomycin intraventricularly each day for 5 days, streptomycin 75 mg. intramuscularly twice daily for 5 days, and sulphadiazine 0’5 g. 4-hourly and aureomycin 25 mg. 6-hourly by mouth for a fortnight. An ampoule of streptokinase was also injected twice into the ventricles.
insidiously
a
Hospital on Dec.
2. Ibid, 1939, i, 1102.
in
selected cases of
perforated
ulcer.
11 our
results prove comparable with those of Professor Nuboer we shall be prepared to extend our indications to include .all patients whom we consider fit to stand the operation -except for the very young with a short history of indigestion, who, in our experience, are, the least prone to recurrent ulceration. Edgware General Hospital, Middlesex
FRANK FORTY.
EFFECT OF CORTISONE ON WATER
METABOLISM ascertain the influence of the SIR,,-In adrenals on water metabolism, we have studied the effect of cortisone on renal function in rheumatoid-arthritis patients (100 mg. daily for 10 days) and in one case of Addison’s disease (30 mg daily for 10 days). Thiosulphate and para-aminohippurate clearance tests were before and after cortisone treatment. performed In the majority of rheumatic patients the glomerular filtration-rate increased greatly, and renal plasma-flow increased to a lesser extent or remained unchanged ; the reabsorption of water by the tubules increased in every case. In the patient with Addison’s disease a daily dose of 30 mg. of cortisone for 10 days improved the renal function and restored to normal the diuretic response after water-loading ; in the same patient deoxycortone acetate (10 mg. daily for 10 days), while improving renal function, did not correct the abnormal diuretic response. Our results suggest that the water retention in normal subjects after cortisone therapy depends on increased tubular reabsorption. On the other hand, cortisone inhibits the pathologically increased tubular reabsorption after water-loading that characterises adrenal
order
to
-
’
insufficiency.
G.
Medical Clinic, University of Milan,
Italy.
SALA
F. SERENI C. B. BALLABIO.
BOVINE TUBERCULOSIS PREVENTS HUMAN TUBERCULOSIS?
SIR,—In his letter of Oct. 27, Mr. Pitcher presents some interesting figures which suggest that in areas where the milk has been largely freed from tubercle bacilli the notifications of pulmonary tuberculosis have increased ; whilst in areas where progress in clearing up the supply has been less marked, notifications are declining. Mr. Pitcher’s letter reminded me of an informative article by Mr. Francis 1—also a member of the veterinary profession-in which a map of Great Britain showing by counties the incidence of tuberculosis in cattle was compared with a map of the tuberculosis mortality in The heavily shaded portions of the latter map man. seemed to coincide largely with the lightly affected parts of the former and vice versa. In my report for 1950, I compared the notifications of pulmonary tuberculosis with the percentage of milk samples positive for tubercle bacilli over the past 20 years. This comparison suggests that the notificationrate of pulmonary tuberculosis has increased as the samples of milk positive for tubercle bacilli have decreased. I pointed out that our figures were small, but that the two factors showed a significant negative correlation. I expressed the opinion that, whilst no-one wishes to go back to the days of heavily infected milk, it is possible that such milk gave rise, not only to the tragedies of bone and joint tuberculosis, but also possibly to an immunising effect in the more fortunate. Dr. J. L. Horne, medical officer of health for Ross and Cromarty, at a recent conference suggested that one reason why tuberculosis had increased so much in the Island of Lewis was that the incidence of bovine infections 1. Francis. J.
Lancet, 1950, i, 34.
had been consistently low there. Of the mainland part of his countv he said: " One feels that the low mainrate is in a way related to land the high incidence of bovine infection." To come back to Mr. Pitcher’s letter, the lack of data on the percentage of cattle attested in the earlier years to which he refers makes it impossible to subject his figures to the usual statistical -methods. One would also like to know that the total notification figures are correct, as I suspect they refer to counties only—i.e., they do not include figures for the large boroughs within the counties. I suggest that any relationship between bovine and human infection could quite readily be decided by the central departments. The Ministry of Agriculture might, for example, give the figures for attested cattle in the years 1935 (when the attestation scheme came into force) and, say, 1950, relating to the Scottish counties which consume milk produced within their boundaries only ; and the Department of Health might give the figures for notifications in like years and counties. A decided inverse relationship would naturally support the use of some’ such substance as B.c.G. vaccine to replace what was no longer present in milk. Such a relationship would make many agree with the opinion of Francis.! " As milk is freed from tubercle bacilli by the eradication of tuberculosis from cattle and by pasteurisation, more will have to be done to protect adolescents from infection and increase their resistance by immunisation." Public Health Department, BRYCE R. NISBET
respiratory-tuberculosis
Kilmarnock.
Medical Officer of Health.
NERVE NIPPING AT THE INTERCOSTAL MARGIN
SiR,-In your issue of Nov. 24 Dr. Harwood Stevenson describes what he calls traumatic intercostal neuritis. In 1939 I published an article2 on displaced ribs, which was republished in the American Year Book of 1940. This describes a very similar condition, although I considered that the causative mechanism was different. Since then I have been seeing six or seven cases every year. I understand that similar conditions have been described from time to time by writers on manipulative surgery. It is interesting and even depressing that such a wellmarked and painful entity which is amenable to treatment should be unrecognised by the profession at large. Many cases of pleurodynia are easily cured by simple
manipulation. W. A. BALL.
Petworth, Sussex.
BACT. COLI MENINGITIS IN INFANCY
SIR,—The account by Dr. Ebsworth and Dr. Leys (Nov. 17) of a baby with Bacterium coli meningitis cured and polymyxin prompts me to which occurred in the same month. This little boy was born on Oct. 24, 1950, and became ill
by chloramphenicol report a similar case
week before his admission to Whipps Cross 3 ; he was then 6 weeks old. The presenting features were convulsions, a high-pitched cry, a bulging fontanelle, and a pyrexia of 101—102°F. As with the patient described by Dr. Ebsworth and Dr. Leys, lumbar puncture was unsuccessful until the child had recovered, although four different members of the staff made repeated attempts. On the 4th day after admission a ventricular tap yielded a gush of turbid greenish-yellow fluid. This gave a heavy growth of Bact. coli, sensitive to’Aureomycin’ and chloramphenicol and less so to streptomycin. The treatment was 50 mg. streptomycin intraventricularly each day for 5 days, streptomycin 75 mg. intramuscularly twice daily for 5 days, and sulphadiazine 0’5 g. 4-hourly and aureomycin 25 mg. 6-hourly by mouth for a fortnight. An ampoule of streptokinase was also injected twice into the ventricles.
insidiously
a
Hospital on Dec.
2. Ibid, 1939, i, 1102.