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FILAMENTOUS FORMS ASSOCIATED WITH NEWLY ISOLATED INFLUENZA VIRUS
602 Our experience of total cystoprostatectomy for carcinoma of the bladder has shown us that this is not so, and that the membranous urethra can be exposed far better through the perineum than retropubically.
FILAMENTOUS FORMS ASSOCIATED WITH NEWLY ISOLATED INFLUENZA VIRUS C. M. CHU * I. M. DAWSON M.B. Shanghai, Ph.D. Camb. Ph.D. Glasg. W. J. ELFORD Ph.D. Brist. From the National Institute for Medical Research, London, N.W.3
With illustrations
on
plate
of the long forms elementary bodies,
and their numbers relative to the were obtained from twelve virus
isolations. IDENTITY OF LONG FORMS
The question immediately arises : " Are these long forms influenza virus" We are not yet certain of the answer., It is only possible here to summarise some relevant observations, which must be elaborated and discussed more fully later. (1) That the long forms seen in electron micrographs are not artefacts produced by drying or derived from the laked fowl cells is proved by the fact that the filamentous forms may be seen in untreated allantoic fluid with a gooddark-ground microscope-i.e., Zeiss Cardioid’ ultramicroscope. Yet another means for their quantitative study is thus provided.
filamentous forms have been observed directly spread across in,(2)or No seen in micrographs of, normal allantoic fluids in the recent months has Europe opportunity provided of studying freshly isolated virus from widely separated of 10-13 day eggs. Heinmets and Golub (1948) have shown that fibrillar structures may be derived from the localities and making comparisons with the known classical A and B strains. This note reports observa- normal cells of allantoic membranes. These exhibited the banded structure with 64 mµ spacing characteristic tions on the morphological characters exhibited by of collagen. The long forms of our influenza preparations isolated virus and recently passaged amniotic ally have. not possessed this banded structure but have had allantoically in fertile hens’ eggs. all the appearances of genuine growth processes, with We have taken electron micrographs of specimens internal structures often evident. Only in one instance on the new of the technique prepared by adsorption out of numerous preparations carefully examined has membrane of fowl erythrocytes described by Dawson a banding with a 64 mµ spacing been observed. and Elford (1949a). Virus is adsorbed directly from freshly harvested allantoic or amniotic fluid, and the (3) Virus has been passed through the tightest gradocol cell-ghosts may be sedimented in the centrifuge in a membranes likely to permit passage of influenza virus. few minutes at 500 r.p.m., so that washings before and The filtrates inoculated into eggs have yielded both long after fixation with osmic acid are quickly effected. The and round forms. This suggests that the elementary final aqueous suspension for electron microscopy is thus body can give rise to the elongated forms when grown produced without subjecting the material to harsh in a suitable environment. manipulation. A representative picture of the adsorb(4) The filaments and round elementary bodies are able elements is obtained, and this may, under controlled adsorbed on and eluted from the red-cell membrane. conditions, be interpreted quantitatively. When heat-inactivated virus was adsorbed on the fowl With the active-collaboration of our colleagues Drs. C. H. red-cell membranes at 0°C it did not spontaneously elute ; H. and A. Gledhill we W. have Andrewes, T. Flewett, but, when it was incubated with ferret antisera at been able to examine the infective fluids from the 37°C, the homologous antiserum removed both long and earliest egg passages of strains sent to the laboratory round forms from the membrane. With heterologous of the World Influenza Centre, in this institute, from sera of the classical A (PR8) and B (Lee) strains a cases of influenza in Italy, France, Holland, Czechoslovakia, and England. Electron micrographs of the considerable portion remained adsorbed. classical A and B strains of influenza show the virus as (5) We examined, in the cardioid ultramicroscope, round bodies 90±11.5 mµ and 103±8 mµ in diameter mixtures of.A/Paris PLI/49 virus with (a) homologous ferret antiserum (obtained by inoculating a ferret respectively. Mosley and Wyckoff (1946) reported that they had directly with the human gargling), (b) A (PR8) ferret observed elongated forms associated with several A and antiserum, and (c) B (Lee) ferret antiserum. After an B strains of influenza virus passaged in eggs. We have hour’s incubation at 37°C with homologous antiserum confirmed these observations for PR8 (A) and Lee (B), the virus, particularly the long forms, became almost strains, using the red-cell membrane adsorption tech- completely agglutinated in large clusters, whereas in the nique (fig. 1). The elongated forms were, however, presence of heterologous sera there remained many free rod forms together with some in relatively small very few compared with the round elementary bodies and were not consistently encountered. The temptation groups. The diffraction from the filaments treated with was to dismiss them as artefacts or material having antiserum was quite different from the normal control nothing to do with the virus. This problem of the long in that it was more diffuse and coloured and the surface forms, however, clearly had to be faced seriously when we observed long filamentous forms with a strain of LEGENDS TO ILLUSTRATIONS ON PLATE fowl-plague virus adsorbed on the red-cell membrane (Dawson and Elford 1949b.) DR. CHU AND OTHERS : FILAMENTOUS FORMS ASSOCIATED The first of the recently isolated influenza viruses to be WITH NEWLY ISOLATED INFLUENZA VIRUS examined was allantoic fluid of ’the A/Nederland 1/49 I—Electron micrograph of influenza A (PR8) adsorbed on the Fig. strain after three egg passages. The electron micromembrane of the laked fowl red cell. Shadowed with palladium. The elementary virus bodies are generally round or ovoid, but graphs revealed long filamentous forms, rods of interelongated forms can be seen in the bottom left-hand corner. mediate length, and round or slightly ovoid elementary 2—Influenza A/Paris (PLI)/49 adsorbed from the allantoic fluid Fig. bodies (figs. 2-4). The numbers of elongated forms of the first egg passage. This electron micrograph is of unshadowed material by direct transmission. Note the variation in length and adsorbed were often comparable with the numbers of width of the filaments and the internal structure having intense elementary bodies, in striking contrast to their paucity absorption for electrons. in preparations of the old PR8 and Lee strains. Similar Fig. 3-Influenza A’Nederland 1/49 adsorbed from allantoic fluid of the 4th egg passage. Palladium shadowed. This electron micrograph photographs, with some variation in the average lengths THE epidemic of influenza that has
*
Working at the World Influenza Centre (W.H.O.).
illustrates the exceptionally long filaments associated with these recently isolated influenza viruses.
DR. CHU AND OTHERS :
FILAMENTOUS FORMS ASSOCIATED WITH INFLUENZA VIRUS
NEWLY ISOLATED -
-
DR.
CHU AND OTHERS :
FILAMENTOUS FORMS ASSOCIATED WITH INFLUENZA VIRUS
NEWLY ISOLATED
4-Electron micrograph (by direct transmission) of virus cf influenza A Ocean Island/48 strain adsorbed on laked fowl red cell. The nucleus is surrounded by the delicate membrane, which is of double thickness, showing folds and creases. Both filamentous and round forms associated with the virus are seen. Note the variation in length of the filaments and the often beaded structure. The over-all picture is very similar to those obtained wth Continental strains.
Fig.
603
of the rods appeared roughened
or
beaded.
This
was
presumably due to the superficial attachment of antibody or possibly particulate forms of virus.
RÔLE OF DI-ISOPROPYL FLUOROPHOSPHONATE IN SURGERY
(6) Two lines of egg passage with Nederland I virus T. A. QUILLIAM J. P. QUILLIAM have been maintained with (a) undiluted allantoic fluid M.B. Lond. M.Sc. Lond. M.B., and (b) 0.35 jjt. membrane filtrate. After the eight LATELY RESIDENT LECTURER IN PHYSIOLOGY, passages so far made both lines exhibit the long and the KING’S COLLEGE, ASSISTANT SURGEON, round forms. Allantoic fluid from eggs infected with the LONDON ST. CHARLES’ HOSPITAL, LONDON 1947 A strain, ’Barrett,’ both mouse-adapted (11passes) Di-isopropyl fluorophosphonate (D.F.P.) is a powerful and unadapted (at least 15 passes in eggs), has been anticholinesterase having an eserine-like action except forms in each to contain found instance, that its combination with tissue cholinesterase seems elongated though in numbers and average length much less than to be irreversible. Its pharmacology and its clinical It is observed with the recently isolated viruses. in myasthenia gravis and glaucoma have a of interest and point great importance to applications clearly been reviewed by Quilliam.1 Here we discuss its use know whether or not the morphological character of a in the postoperative syndromes of paralytic ileus, virus, grown in a particular host, can alter on continued abdominal Our distension, and retention of urine. passage. experience of D.F.P. as an agent to deflate the gastro(7) The newly isolated influenza viruses have not yet intestinal tract before operation for partial intestinal been fully adapted to mice ; but after one pass in mice obstruction or before radiography, and its use in one or ferrets and then one pass in eggs the long forms were case of megacolon, is also reported. In all 27 cases of still observed. The presence of the filamentous forms in various types, treated by us with D.F.P., are reviewed. virus preparations of infected mouse-lung, or in tracheal POSTOPERATIVE PARALYTIC ILEUS washings from infected mice and nasal washings from has not been demonstrated. We have previously reportedthat D.F.P. showed ferrets, yet convincingly considerable promise in the treatment of paralytic ileus,SEROLOGICAL AFFINITIES and this has been confirmed in America.3 Since then we studies, to be reported later, show that the have extended our studies, though happily the skill of our surgical colleagues has somewhat restricted our strains of virus A obtained in the recent outbreak are antigenically alike and closely related to, but not identical experience of this condition. Our view. that D.F.P. has with, strains obtained in the U.S.A. and Europe in 1947. a definite part to play in the treatment of paralytic They are rather remotely related to the classical PR8 ileus has been considerably strengthened, but we also think that it shduld by no means displace entirely such strain of A virus. They have been isolated in this basic treatment as the relief of pain, sleeplessness, and or obtained from the sources : laboratory following Italy (Prof. B. Barbudieri, Rome, and Prof. E. anxiety, and the use of intravenous fluids and intragastric Carlinfanti, Naples), Switzerland (Dr. J. Wirth, Geneva), (or intestinal) suction, to which alone a fair proportion France (Dr. Dujarric de la Riviere and Prof. P. Lepine, of cases respond. If these procedures do not arrest a Paris), Holland (Prof. J. Mulder, Leiden), and England deteriorating situation, then the use of D.F.P. may prove (Drs. J. A. Dudgeon, F. 0. MacCallum, and A. P. Goffe). life-saving. The surgeon who operates must be prepared to institute and maintain any or all of the basic measures A virus apparently identical serologically and morphologically was recovered in October, 1948, from Ocean referred to above as the changing clinical picture may Island in the mid-Pacific and sent us by Dr. F. M. demand, calling upon D.F.P. as an additional measure when required. Burnet. Only further work will show if the appearances we describe are particularly well marked in these 1948-49 Postoperative paralytic ileus may be defined as the viruses, or if they are to be seen in all recently isolated inability of the patient to pass faeces or flatus within sixty hours of the end of an abdominal operation. The time strains. A few long forms were found in preparations of onset varies so that too rigid adherence to this definition of a B strain recently isolated in Czechoslovakia by Prof. D. Blaskovic but they were much less numerous may occasionally lead to withholding treatment in the than with the A viruses. prodromal period, often a particularly propitious time at which to start therapy, especially in cases in which CONCLUSION suture or anastomosis of the- gut has not been performed. Three degrees of paralysis of the gut may be recognised The evidence available suggests that these elongated filamentous structures seen in allantoic and amniotic after an abdominal operation : fluids of eggs infected with recently isolated influenza (1) Mild.-Mild postoperative abdominal distension unacvirus represent a stage in virus multiplication. This companied by clinical dehydration, in which the patient’s view, should it be confirmed by more exhaustive studies, general condition remains almost unaffected. This is quite common, and recovery from this state of ileus," as it may would revolutionise our conception of the way some be termed, is usually spontaneous on or after the third viruses can multiply. Such dependence of virus postoperative day. If this does not happen, the response form on the environment would constitute yet to a single enema (once repeated if necessary) is speedy another point of resemblance between these viruses and and copious. some well-known micro-organisms. Further, it might (2) Moderate.—When the patient does not respond to obviously prove of practical importance in the preparation such measures, the onset of paralytic ileus of moderate
Serological
"
of vaccine.
-
We have
recently discussed our findings with Prof. P. Lépine (Pasteur Institute) and Prof. B. Barbudieri (Rome), both of whom report having observed long forms of influenza strains recently isolated in their respective countries.
REFERENCES I. M., Elford, W. J. (1949a) Nature, Lond. 163, 63. (1949b) J. gen. Microbiol. (in the press). Heinmets, F., Golub, O. J. (1948) J. Bact. 56, 509. Mosley, V. M., Wyckoff, R. W. G. (1946) Nature, Lond. 157, 263.
Dawson,
— —
may be recognised. Bowel sounds are inaudible, and abdominal distension becomes severe (.the patient being the most reliable guide to the degree of enlargement of his abdomen). Mild clinical dehydration appears after a short interval, and the patient’s general condition begins to deteriorate. It is sometimes evident before the expiry of the sixty hours that paralytic ileus is inevitable;g and, according to the probable cause of the condition and to whether or not the bowel-has been anastomosed or sutured,
severity
1. Quilliam, J. P. Post-grad. med. J. 1947, 23, 280. 2. Quilliam, J. P., Quilliam, T. A. Med. Pr. 1947, 218, 378. 3. Grob, D., Lilienthal, J. L. jun., Harvey, A. M. Bull. Johns Hopk. Hosp. 1947, 81, 245.
P 3
FILAMENTOUS FORMS ASSOCIATED WITH NEWLY ISOLATED INFLUENZA VIRUS C. M. CHU * I. M. DAWSON M.B. Shanghai, Ph.D. Camb. Ph.D. Glasg. W. J. ELFORD Ph.D. Brist. From the National Institute for Medical Research, London, N.W.3
With illustrations
on
plate
of the long forms elementary bodies,
and their numbers relative to the were obtained from twelve virus
isolations. IDENTITY OF LONG FORMS
The question immediately arises : " Are these long forms influenza virus" We are not yet certain of the answer., It is only possible here to summarise some relevant observations, which must be elaborated and discussed more fully later. (1) That the long forms seen in electron micrographs are not artefacts produced by drying or derived from the laked fowl cells is proved by the fact that the filamentous forms may be seen in untreated allantoic fluid with a gooddark-ground microscope-i.e., Zeiss Cardioid’ ultramicroscope. Yet another means for their quantitative study is thus provided.
filamentous forms have been observed directly spread across in,(2)or No seen in micrographs of, normal allantoic fluids in the recent months has Europe opportunity provided of studying freshly isolated virus from widely separated of 10-13 day eggs. Heinmets and Golub (1948) have shown that fibrillar structures may be derived from the localities and making comparisons with the known classical A and B strains. This note reports observa- normal cells of allantoic membranes. These exhibited the banded structure with 64 mµ spacing characteristic tions on the morphological characters exhibited by of collagen. The long forms of our influenza preparations isolated virus and recently passaged amniotic ally have. not possessed this banded structure but have had allantoically in fertile hens’ eggs. all the appearances of genuine growth processes, with We have taken electron micrographs of specimens internal structures often evident. Only in one instance on the new of the technique prepared by adsorption out of numerous preparations carefully examined has membrane of fowl erythrocytes described by Dawson a banding with a 64 mµ spacing been observed. and Elford (1949a). Virus is adsorbed directly from freshly harvested allantoic or amniotic fluid, and the (3) Virus has been passed through the tightest gradocol cell-ghosts may be sedimented in the centrifuge in a membranes likely to permit passage of influenza virus. few minutes at 500 r.p.m., so that washings before and The filtrates inoculated into eggs have yielded both long after fixation with osmic acid are quickly effected. The and round forms. This suggests that the elementary final aqueous suspension for electron microscopy is thus body can give rise to the elongated forms when grown produced without subjecting the material to harsh in a suitable environment. manipulation. A representative picture of the adsorb(4) The filaments and round elementary bodies are able elements is obtained, and this may, under controlled adsorbed on and eluted from the red-cell membrane. conditions, be interpreted quantitatively. When heat-inactivated virus was adsorbed on the fowl With the active-collaboration of our colleagues Drs. C. H. red-cell membranes at 0°C it did not spontaneously elute ; H. and A. Gledhill we W. have Andrewes, T. Flewett, but, when it was incubated with ferret antisera at been able to examine the infective fluids from the 37°C, the homologous antiserum removed both long and earliest egg passages of strains sent to the laboratory round forms from the membrane. With heterologous of the World Influenza Centre, in this institute, from sera of the classical A (PR8) and B (Lee) strains a cases of influenza in Italy, France, Holland, Czechoslovakia, and England. Electron micrographs of the considerable portion remained adsorbed. classical A and B strains of influenza show the virus as (5) We examined, in the cardioid ultramicroscope, round bodies 90±11.5 mµ and 103±8 mµ in diameter mixtures of.A/Paris PLI/49 virus with (a) homologous ferret antiserum (obtained by inoculating a ferret respectively. Mosley and Wyckoff (1946) reported that they had directly with the human gargling), (b) A (PR8) ferret observed elongated forms associated with several A and antiserum, and (c) B (Lee) ferret antiserum. After an B strains of influenza virus passaged in eggs. We have hour’s incubation at 37°C with homologous antiserum confirmed these observations for PR8 (A) and Lee (B), the virus, particularly the long forms, became almost strains, using the red-cell membrane adsorption tech- completely agglutinated in large clusters, whereas in the nique (fig. 1). The elongated forms were, however, presence of heterologous sera there remained many free rod forms together with some in relatively small very few compared with the round elementary bodies and were not consistently encountered. The temptation groups. The diffraction from the filaments treated with was to dismiss them as artefacts or material having antiserum was quite different from the normal control nothing to do with the virus. This problem of the long in that it was more diffuse and coloured and the surface forms, however, clearly had to be faced seriously when we observed long filamentous forms with a strain of LEGENDS TO ILLUSTRATIONS ON PLATE fowl-plague virus adsorbed on the red-cell membrane (Dawson and Elford 1949b.) DR. CHU AND OTHERS : FILAMENTOUS FORMS ASSOCIATED The first of the recently isolated influenza viruses to be WITH NEWLY ISOLATED INFLUENZA VIRUS examined was allantoic fluid of ’the A/Nederland 1/49 I—Electron micrograph of influenza A (PR8) adsorbed on the Fig. strain after three egg passages. The electron micromembrane of the laked fowl red cell. Shadowed with palladium. The elementary virus bodies are generally round or ovoid, but graphs revealed long filamentous forms, rods of interelongated forms can be seen in the bottom left-hand corner. mediate length, and round or slightly ovoid elementary 2—Influenza A/Paris (PLI)/49 adsorbed from the allantoic fluid Fig. bodies (figs. 2-4). The numbers of elongated forms of the first egg passage. This electron micrograph is of unshadowed material by direct transmission. Note the variation in length and adsorbed were often comparable with the numbers of width of the filaments and the internal structure having intense elementary bodies, in striking contrast to their paucity absorption for electrons. in preparations of the old PR8 and Lee strains. Similar Fig. 3-Influenza A’Nederland 1/49 adsorbed from allantoic fluid of the 4th egg passage. Palladium shadowed. This electron micrograph photographs, with some variation in the average lengths THE epidemic of influenza that has
*
Working at the World Influenza Centre (W.H.O.).
illustrates the exceptionally long filaments associated with these recently isolated influenza viruses.
DR. CHU AND OTHERS :
FILAMENTOUS FORMS ASSOCIATED WITH INFLUENZA VIRUS
NEWLY ISOLATED -
-
DR.
CHU AND OTHERS :
FILAMENTOUS FORMS ASSOCIATED WITH INFLUENZA VIRUS
NEWLY ISOLATED
4-Electron micrograph (by direct transmission) of virus cf influenza A Ocean Island/48 strain adsorbed on laked fowl red cell. The nucleus is surrounded by the delicate membrane, which is of double thickness, showing folds and creases. Both filamentous and round forms associated with the virus are seen. Note the variation in length of the filaments and the often beaded structure. The over-all picture is very similar to those obtained wth Continental strains.
Fig.
603
of the rods appeared roughened
or
beaded.
This
was
presumably due to the superficial attachment of antibody or possibly particulate forms of virus.
RÔLE OF DI-ISOPROPYL FLUOROPHOSPHONATE IN SURGERY
(6) Two lines of egg passage with Nederland I virus T. A. QUILLIAM J. P. QUILLIAM have been maintained with (a) undiluted allantoic fluid M.B. Lond. M.Sc. Lond. M.B., and (b) 0.35 jjt. membrane filtrate. After the eight LATELY RESIDENT LECTURER IN PHYSIOLOGY, passages so far made both lines exhibit the long and the KING’S COLLEGE, ASSISTANT SURGEON, round forms. Allantoic fluid from eggs infected with the LONDON ST. CHARLES’ HOSPITAL, LONDON 1947 A strain, ’Barrett,’ both mouse-adapted (11passes) Di-isopropyl fluorophosphonate (D.F.P.) is a powerful and unadapted (at least 15 passes in eggs), has been anticholinesterase having an eserine-like action except forms in each to contain found instance, that its combination with tissue cholinesterase seems elongated though in numbers and average length much less than to be irreversible. Its pharmacology and its clinical It is observed with the recently isolated viruses. in myasthenia gravis and glaucoma have a of interest and point great importance to applications clearly been reviewed by Quilliam.1 Here we discuss its use know whether or not the morphological character of a in the postoperative syndromes of paralytic ileus, virus, grown in a particular host, can alter on continued abdominal Our distension, and retention of urine. passage. experience of D.F.P. as an agent to deflate the gastro(7) The newly isolated influenza viruses have not yet intestinal tract before operation for partial intestinal been fully adapted to mice ; but after one pass in mice obstruction or before radiography, and its use in one or ferrets and then one pass in eggs the long forms were case of megacolon, is also reported. In all 27 cases of still observed. The presence of the filamentous forms in various types, treated by us with D.F.P., are reviewed. virus preparations of infected mouse-lung, or in tracheal POSTOPERATIVE PARALYTIC ILEUS washings from infected mice and nasal washings from has not been demonstrated. We have previously reportedthat D.F.P. showed ferrets, yet convincingly considerable promise in the treatment of paralytic ileus,SEROLOGICAL AFFINITIES and this has been confirmed in America.3 Since then we studies, to be reported later, show that the have extended our studies, though happily the skill of our surgical colleagues has somewhat restricted our strains of virus A obtained in the recent outbreak are antigenically alike and closely related to, but not identical experience of this condition. Our view. that D.F.P. has with, strains obtained in the U.S.A. and Europe in 1947. a definite part to play in the treatment of paralytic They are rather remotely related to the classical PR8 ileus has been considerably strengthened, but we also think that it shduld by no means displace entirely such strain of A virus. They have been isolated in this basic treatment as the relief of pain, sleeplessness, and or obtained from the sources : laboratory following Italy (Prof. B. Barbudieri, Rome, and Prof. E. anxiety, and the use of intravenous fluids and intragastric Carlinfanti, Naples), Switzerland (Dr. J. Wirth, Geneva), (or intestinal) suction, to which alone a fair proportion France (Dr. Dujarric de la Riviere and Prof. P. Lepine, of cases respond. If these procedures do not arrest a Paris), Holland (Prof. J. Mulder, Leiden), and England deteriorating situation, then the use of D.F.P. may prove (Drs. J. A. Dudgeon, F. 0. MacCallum, and A. P. Goffe). life-saving. The surgeon who operates must be prepared to institute and maintain any or all of the basic measures A virus apparently identical serologically and morphologically was recovered in October, 1948, from Ocean referred to above as the changing clinical picture may Island in the mid-Pacific and sent us by Dr. F. M. demand, calling upon D.F.P. as an additional measure when required. Burnet. Only further work will show if the appearances we describe are particularly well marked in these 1948-49 Postoperative paralytic ileus may be defined as the viruses, or if they are to be seen in all recently isolated inability of the patient to pass faeces or flatus within sixty hours of the end of an abdominal operation. The time strains. A few long forms were found in preparations of onset varies so that too rigid adherence to this definition of a B strain recently isolated in Czechoslovakia by Prof. D. Blaskovic but they were much less numerous may occasionally lead to withholding treatment in the than with the A viruses. prodromal period, often a particularly propitious time at which to start therapy, especially in cases in which CONCLUSION suture or anastomosis of the- gut has not been performed. Three degrees of paralysis of the gut may be recognised The evidence available suggests that these elongated filamentous structures seen in allantoic and amniotic after an abdominal operation : fluids of eggs infected with recently isolated influenza (1) Mild.-Mild postoperative abdominal distension unacvirus represent a stage in virus multiplication. This companied by clinical dehydration, in which the patient’s view, should it be confirmed by more exhaustive studies, general condition remains almost unaffected. This is quite common, and recovery from this state of ileus," as it may would revolutionise our conception of the way some be termed, is usually spontaneous on or after the third viruses can multiply. Such dependence of virus postoperative day. If this does not happen, the response form on the environment would constitute yet to a single enema (once repeated if necessary) is speedy another point of resemblance between these viruses and and copious. some well-known micro-organisms. Further, it might (2) Moderate.—When the patient does not respond to obviously prove of practical importance in the preparation such measures, the onset of paralytic ileus of moderate
Serological
"
of vaccine.
-
We have
recently discussed our findings with Prof. P. Lépine (Pasteur Institute) and Prof. B. Barbudieri (Rome), both of whom report having observed long forms of influenza strains recently isolated in their respective countries.
REFERENCES I. M., Elford, W. J. (1949a) Nature, Lond. 163, 63. (1949b) J. gen. Microbiol. (in the press). Heinmets, F., Golub, O. J. (1948) J. Bact. 56, 509. Mosley, V. M., Wyckoff, R. W. G. (1946) Nature, Lond. 157, 263.
Dawson,
— —
may be recognised. Bowel sounds are inaudible, and abdominal distension becomes severe (.the patient being the most reliable guide to the degree of enlargement of his abdomen). Mild clinical dehydration appears after a short interval, and the patient’s general condition begins to deteriorate. It is sometimes evident before the expiry of the sixty hours that paralytic ileus is inevitable;g and, according to the probable cause of the condition and to whether or not the bowel-has been anastomosed or sutured,
severity
1. Quilliam, J. P. Post-grad. med. J. 1947, 23, 280. 2. Quilliam, J. P., Quilliam, T. A. Med. Pr. 1947, 218, 378. 3. Grob, D., Lilienthal, J. L. jun., Harvey, A. M. Bull. Johns Hopk. Hosp. 1947, 81, 245.
P 3