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FATE OF THE FACE IN POLIOMYELITIS
990
proximal end
of the
intussusceptum.
(78 cm.) proximal to. the
It
was
about 30 in.
ileocæcal valve in the position where
a Meckel’s diverticulum might be expected. The histological report was’ as follows : " The nodular lesion consists of ectopic pancreas. This is situated mainly in the submucosa., but extends into the muscularis. The overlying mucosa
h2emorrhagic and shows early ulceration. A lymph-node shows a widely distended sinus is
mesenteric and mild
inflammation."
Pancreatic tissue is found occasionally in the duodenal region and the upper jejunum, but I can find no published record of its occurrence in the lower ileum. I am indebted to Dr. C. C. S. Pike for the
report.
histological
Of 93 tests made between August, 1951, and April, 1952, are strictly comparable, for the technique did not vary and The results in these cases were : a follow-up was possible. (1) 28 true positives (confirmed clinically); (2) 34 true negatives ; (3) 14 false negatives ; (4) No false positives. Some false negatives were not unexpected, forthe tests were sometimes asked for after as little as four and a half False negatives also occurred when weeks’ amenorrhoea. pregnancy was advanced and fœtal parts visible on X-ray examination. Other workers have found that the level of gonadotropins falls in these circumstances.
76
Toads
Peace Memorial Hospital, Watford.
A. P. KITCHIN.
A PREGNANCY TEST
SiR,,-Although pregnancy tests, such as the AschheimZondek and Friedmann tests, are well established, it is often difficult to obtain mice and rabbits in suitable condition in laboratories where these tests form only a small part of the routine work, such as those at military hospitals. For these laboratories a simple and reliable method, such as that described by Galli-Mainini,1 by Frazer and Wohlzogen,2 and by Haines,3 would be an advantage.
-
In FABELF Command a test using the male frog, Rana rugulosa, has been in use in the physiology department of the University of Hong-Kong and at the publichealth laboratories there, and by courtesy of the directors specimens have been examined for the Services. This frog, however, is not found in the wild state in Malaya. On the other hand, a toad, Bufo melanostictus, is found throughout South-East Asia ; and though it hibernates in Hong-Kong, it is readily available all the year round in Malaya. An experiment by Dr. Audrey Driver and Dr. Hou Chien-Tsun, in the department of physiology at Hong-Kong showed that the frog was slightly more sensitive than the toad to the urine of pregnant women, but agreement was reasonable. It was decided therefore to adopt for routine use in the pathological laboratory at Singapore a test in which three toads were used and the urine concentrated by the method described by Scott.4
Technique An early morning specimen is required. If it cannot be used at once it should be frozen to limit bacterial growth. It is advisable to concentrate the urine tenfold and this takes about an hour. The following reagents are used : 0.4 g. (1) Bromphenol blue...... ’
15 ml. Grind up to make 100 ml. with water. of kaolin 20% aqueous suspension (preferably kaolin B.D.H-.
0-05 N/NaOH
(2)
Results
......
washed with acid). (3) 20 % HC1. (4) 0-1 N/iNaOI-1. (5) 10 % HCI. Take 100 ml. urine, 100 ml. water, and 1 ml. indicator in a measuring funnel. Adjust the pH to 4-0 with 20% HCI until the blue colour almost disappears. Add 10 ml. kaolin suspension. A coarse precipitate rapidly forms. Pour off supernatant liquid and transfer the deposit to a one-ounce bottle. Centrifuge, and extract the deposit with 10 ml. of 0-1 N/NaOH, shaking well. Centrifuge again, pour off the supernatant liquid, and adjust its reaction with 10% HC1 until it is just acid to litmus. Three male toads are then examined to make sure their urine contains no sperms. A glass pipette with rounded ends is inserted into the cloaca for 1/2-3/4 in., and gently moved in and out until some urine is sucked up. This is then examined for sperms under the dry lens. 2 ml. of the concentrated urine is injected into the dorsal lymph-sac of the toads. Urine is collected from the animals after two and four hours, and a drop on a slide is examined for sperms. 1. Galli-Mainini, C. J. Amer. med. Ass. 1948, 138, 121. 2. Frazer, J. F. D., Wohlzogen, F. X. Brit. med. J. 1950, ii, 330. 3. Haines, M. Nature, Lond. 1948, 162, 416. 4. Scott, L. D. Brit. J. exp. Path. 1940, 21, 320.
It was easy enough to catch toads at night either with a torch or near the street lamps where the insects gathered. They were kept in a brick enclosure, sheltered from the sun. There was 2 in. of water and some islands of bricks in the enclosure, and the toads usually hid under a collection of bricks or sat on an island. It was simpler to catch the toads as required, and to keep only a small stock of a dozen. It was then unnecessary to feed them. All toads that were positive in the tests were released far from the collecting area, but toads that were negative were used again. All toads were examined for free sperms before being used, but no free sperms were ever found. Certain toads were found which did not react-hence the use of 3 toads for every test.
No animals _died after injection of the concentrated urine, in preliminary trials some unconcentrated urines were fatal to the toads. Scott4 has pointed out that toxic substances are retained by the kaolin. Toads weighing 25 g. would be unaffected by 5 ml. of isotonic saline, but often killed by 5 ml. urine.
though
In
our
sensitive
limited
experience this
test
was
sufficiently
of
clinical use. Moreover, it was inexpensive, it gave a result on the same day-in some positive cases within an hour and a half of receiving the sample of urine-and it never gave false to
be
positives. Pathology Laboratory, FARELF.
P. C. FARRANT F. E. BUCKLAND.
FATE OF THE FACE IN POLIOMYELITIS
SIR,—After seeing Dr. Moore’s interesting report 5 on the outcome of facial paralysis in poliomyelitis, we thought that it would be of interest to follow up our cases seen in recent years. .
-
-
of poliomyelitis, including 72 nonin the years 1947-50 there were.11 instances of facial weakness. (This excludes a further two or three cases of the severe bulbar form of the disease in which the patients died.) Of the 11 patients 10 were traced. 2 (male aged 18 years, female aged 17 years) had transient weakness which disappeared while they were in
Among paralytic,
188
cases
seen
hospital. (males aged 27 and 9 years, female aged 7 years) had mild affecting the mouth only or the mouth and, very slightly, the eye. These recovered completely. 2 had moderately severe weakness of the mouth and the eye, though both mouth and eye still showed some movement. One patient (male aged 36 years) improved greatly for six months, then was left with slight but definite weakness of mouth and eye. The other patient (female aged 1 year 10 months) recovered completely. 2 had severe weakness of mouth and eye, with hardly any movement remaining. One of these (female aged 9 months) showed a slight flicker of the mouth, and after nine months her eyes were seen to close in sleep ; but no further improvement ensued. The other (female aged 31/2 years) showed little or no improvement. 1 patient (male aged 13½ years) recovered completely; but the degree of weakness was not recorded at the start. 3
weakness
South Middlesex Hospital, Isleworth. 5. Moore, E. W.
R. V. WALLEY R. T. D. EMOND. Lancet, 1952, 1, 1092.
proximal end
of the
intussusceptum.
(78 cm.) proximal to. the
It
was
about 30 in.
ileocæcal valve in the position where
a Meckel’s diverticulum might be expected. The histological report was’ as follows : " The nodular lesion consists of ectopic pancreas. This is situated mainly in the submucosa., but extends into the muscularis. The overlying mucosa
h2emorrhagic and shows early ulceration. A lymph-node shows a widely distended sinus is
mesenteric and mild
inflammation."
Pancreatic tissue is found occasionally in the duodenal region and the upper jejunum, but I can find no published record of its occurrence in the lower ileum. I am indebted to Dr. C. C. S. Pike for the
report.
histological
Of 93 tests made between August, 1951, and April, 1952, are strictly comparable, for the technique did not vary and The results in these cases were : a follow-up was possible. (1) 28 true positives (confirmed clinically); (2) 34 true negatives ; (3) 14 false negatives ; (4) No false positives. Some false negatives were not unexpected, forthe tests were sometimes asked for after as little as four and a half False negatives also occurred when weeks’ amenorrhoea. pregnancy was advanced and fœtal parts visible on X-ray examination. Other workers have found that the level of gonadotropins falls in these circumstances.
76
Toads
Peace Memorial Hospital, Watford.
A. P. KITCHIN.
A PREGNANCY TEST
SiR,,-Although pregnancy tests, such as the AschheimZondek and Friedmann tests, are well established, it is often difficult to obtain mice and rabbits in suitable condition in laboratories where these tests form only a small part of the routine work, such as those at military hospitals. For these laboratories a simple and reliable method, such as that described by Galli-Mainini,1 by Frazer and Wohlzogen,2 and by Haines,3 would be an advantage.
-
In FABELF Command a test using the male frog, Rana rugulosa, has been in use in the physiology department of the University of Hong-Kong and at the publichealth laboratories there, and by courtesy of the directors specimens have been examined for the Services. This frog, however, is not found in the wild state in Malaya. On the other hand, a toad, Bufo melanostictus, is found throughout South-East Asia ; and though it hibernates in Hong-Kong, it is readily available all the year round in Malaya. An experiment by Dr. Audrey Driver and Dr. Hou Chien-Tsun, in the department of physiology at Hong-Kong showed that the frog was slightly more sensitive than the toad to the urine of pregnant women, but agreement was reasonable. It was decided therefore to adopt for routine use in the pathological laboratory at Singapore a test in which three toads were used and the urine concentrated by the method described by Scott.4
Technique An early morning specimen is required. If it cannot be used at once it should be frozen to limit bacterial growth. It is advisable to concentrate the urine tenfold and this takes about an hour. The following reagents are used : 0.4 g. (1) Bromphenol blue...... ’
15 ml. Grind up to make 100 ml. with water. of kaolin 20% aqueous suspension (preferably kaolin B.D.H-.
0-05 N/NaOH
(2)
Results
......
washed with acid). (3) 20 % HC1. (4) 0-1 N/iNaOI-1. (5) 10 % HCI. Take 100 ml. urine, 100 ml. water, and 1 ml. indicator in a measuring funnel. Adjust the pH to 4-0 with 20% HCI until the blue colour almost disappears. Add 10 ml. kaolin suspension. A coarse precipitate rapidly forms. Pour off supernatant liquid and transfer the deposit to a one-ounce bottle. Centrifuge, and extract the deposit with 10 ml. of 0-1 N/NaOH, shaking well. Centrifuge again, pour off the supernatant liquid, and adjust its reaction with 10% HC1 until it is just acid to litmus. Three male toads are then examined to make sure their urine contains no sperms. A glass pipette with rounded ends is inserted into the cloaca for 1/2-3/4 in., and gently moved in and out until some urine is sucked up. This is then examined for sperms under the dry lens. 2 ml. of the concentrated urine is injected into the dorsal lymph-sac of the toads. Urine is collected from the animals after two and four hours, and a drop on a slide is examined for sperms. 1. Galli-Mainini, C. J. Amer. med. Ass. 1948, 138, 121. 2. Frazer, J. F. D., Wohlzogen, F. X. Brit. med. J. 1950, ii, 330. 3. Haines, M. Nature, Lond. 1948, 162, 416. 4. Scott, L. D. Brit. J. exp. Path. 1940, 21, 320.
It was easy enough to catch toads at night either with a torch or near the street lamps where the insects gathered. They were kept in a brick enclosure, sheltered from the sun. There was 2 in. of water and some islands of bricks in the enclosure, and the toads usually hid under a collection of bricks or sat on an island. It was simpler to catch the toads as required, and to keep only a small stock of a dozen. It was then unnecessary to feed them. All toads that were positive in the tests were released far from the collecting area, but toads that were negative were used again. All toads were examined for free sperms before being used, but no free sperms were ever found. Certain toads were found which did not react-hence the use of 3 toads for every test.
No animals _died after injection of the concentrated urine, in preliminary trials some unconcentrated urines were fatal to the toads. Scott4 has pointed out that toxic substances are retained by the kaolin. Toads weighing 25 g. would be unaffected by 5 ml. of isotonic saline, but often killed by 5 ml. urine.
though
In
our
sensitive
limited
experience this
test
was
sufficiently
of
clinical use. Moreover, it was inexpensive, it gave a result on the same day-in some positive cases within an hour and a half of receiving the sample of urine-and it never gave false to
be
positives. Pathology Laboratory, FARELF.
P. C. FARRANT F. E. BUCKLAND.
FATE OF THE FACE IN POLIOMYELITIS
SIR,—After seeing Dr. Moore’s interesting report 5 on the outcome of facial paralysis in poliomyelitis, we thought that it would be of interest to follow up our cases seen in recent years. .
-
-
of poliomyelitis, including 72 nonin the years 1947-50 there were.11 instances of facial weakness. (This excludes a further two or three cases of the severe bulbar form of the disease in which the patients died.) Of the 11 patients 10 were traced. 2 (male aged 18 years, female aged 17 years) had transient weakness which disappeared while they were in
Among paralytic,
188
cases
seen
hospital. (males aged 27 and 9 years, female aged 7 years) had mild affecting the mouth only or the mouth and, very slightly, the eye. These recovered completely. 2 had moderately severe weakness of the mouth and the eye, though both mouth and eye still showed some movement. One patient (male aged 36 years) improved greatly for six months, then was left with slight but definite weakness of mouth and eye. The other patient (female aged 1 year 10 months) recovered completely. 2 had severe weakness of mouth and eye, with hardly any movement remaining. One of these (female aged 9 months) showed a slight flicker of the mouth, and after nine months her eyes were seen to close in sleep ; but no further improvement ensued. The other (female aged 31/2 years) showed little or no improvement. 1 patient (male aged 13½ years) recovered completely; but the degree of weakness was not recorded at the start. 3
weakness
South Middlesex Hospital, Isleworth. 5. Moore, E. W.
R. V. WALLEY R. T. D. EMOND. Lancet, 1952, 1, 1092.