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FRIEDLÄNDER PNEUMONIA A
118 in short supply were increased ; fine chemicals which had not been made hitherto in this country were investigated and plant and working formulas weredevised. Mr. Mortimer referred to a number of crude drugs which are or may be in short supply, although, he added, if care is exercised, and substitutes prescribed wherever possible, we shall have no difficulty in meeting the situation." "
Gentian, squill, liquorice, senega, cassia, belladonna,
hyoscyamus,
stramonium
and
colchicum
should
be
available, in quantities sufficient to meet all ordinary needs, as a result of measures which had been taken to
be isolated though it may be in mixed culture ; the same organism may, of course, be present in sputum apart from a pneumonic infection, as it is often associated with chronic sinusitis. Lung abscess is the most common complication of chronic Friedlander pneumonia and is sometimes accompanied by an encapsuled empyema. Pleural effusion, pulmonary fibrosis and delayed resolu. tion are other complications. Treatment is mostly symptomatic, although Solomon on the basis of 4 treated cases thinks that sulphapyridine is likely to be useful in tiding the patient over the acute phase of the infection though not in preventing complications. He advises against surgical drainage of lung abscess, for this drains ade. quately through the bronchus. This chronic disease may last with intermittent pyrexia for months and even years.
supplies. Foreign-owned British patents had proved a serious handicap to British manufacturers, but medicinal products covered by these patents were now being produced in this country under licences granted by the comptroller of patents and presented under trade TRANSPLANTED CHILDREN names other than those used by the foreign owners of the WE are between the devil and the deep sea when we try trade marks. " There is," he said, " no call upon us as to spare children the strain of war. To see children taken Britons to perpetuate the goodwill in enemy trade names, underground at six in the evening in a large city and kept and a strong appeal is being made that the official names there, exposed to infection, cramped for space to play, should be used wherever possible in preference to profoetid air, disturbed by the pressure of adult life prietary names in scientific literature, by manufacturers breathing around them, is to appreciate fully the value of evacuation. and prescribers, and in the teaching hospitals and To conduct a child-guidance clinic in a reception area is, it institutions." The reference was particularly to those to see the other side of the penny. Speakers at the synthetic products which are the subject of monographs seems, Tavistock Clinic (p. 121) tell that some children carry in the third addendum to the B.P. and he added that the into the country the fear provoked by bombing, some Government naturally expected that every pharmacist break down as a result of their uprooting, some because would refuse to help to keep enemy trade marks warm. they are placed in uncongenial homes and some from Mr. Mortimer ended with an appeal to set up an advisory guilt at leaving their parents behind in danger. The committee for the drug trade. position is not a simple one : there is evidently no clear FRIEDLÄNDER PNEUMONIA A right or wrong about evacuation and we must try to Friedlander’s bacillus, a short thick gram-negative consider what is best for the greatest number. It is capsulated bacillus, has long enjoyed %-reputatioll for probably out of the question, in large schemes, to causing a very severe form of pneumonia, and the consider each case on its merits. Miss W. T. Alcock tendency of older physicians to exaggerate the frequency working in an eastern rural reception area speaks of the of Friedlander pneumonia may be traced to Friedlander’s impact of " 15,000 city-bred evacuees" on fosterearly mistake in confusing his bacillus with the pneumo- mothers, and the repercussions on the children, among coccus-which incidentally he, not Frankel, first whom 420 cases of breakdown had occurred. This isolated from cases of pneumonia. Bacteriological gives an incidence of 28%, and it would be interesting to studies in large series of pneumonias put the incidence know how this compares with the incidence of breakof Friedlander infections at 0-5-1%, although occasiondown among town children in times of peace. Many ally higher and even epidemic incidence has been speakers testified to the fact that children stand up to the reported. While the onset resembles that of a pneumo- strain of actual bombing well ; Dr. R. P. Garrow found coccal lobar pneumonia, certain clinical features help to that during 16 months in a population of 12,000-15,000 distinguish Friedlander pneumonia which attacks mostly children in a heavily bombed area none had been men in the older age-groups. Haemoptysis may be an alleged to suffer from strain, and this may well have initial sign, and the sputum is characteristically gelatingiven an accurate picture of the situation. But we ous and tenacious, and often brick-red in contrast to the must not lose sight of the fact that however well adapted infection. of the pneumococcal Temperature a child may be to stand up to the strain of bombing, he is rusty spit is not high as a rule, the patient quickly becomes very ill, totally unadapted to stand up to a bomb. During and the physical signs of a pneumonia, particularly December 521 children were killed in air-raids, and it is crepitations and bronchial breathing, are often absent. fair to assume that most of these deaths occurred in There may be leucopenia or only slight leucocytosis. towns. If those children had gone to the reception The diagnosis is made by bacteriological examination of areas, at least 500 of them would be alive to-day; the sputum. A gram-stained smear shows many typical and of those about 15 would have broken down from bacilli a halo with representing emotional strain. Even the unlucky ones might have gram-negative negative the capsule ; mouse-inoculation gives a pure culture of preferred the role of live dog to that of dead lion. the Friedlander bacillus. The fatality-rate of this acute It must be remembered, too, that a proportion of the and usually rapidly fatal infection is 70-90%. Besides evacuated children referred to child-guidance clinics this fulminating pneumonia a more chronic form occurs would probably have shown symptoms at home in times either as a sequel to the acute disease or ushered in by an of peace ; and that among the large numbers of children acute phase, and Solomonhas lately recorded the who have settled down reasonably well there are probclinical features in 17 cases of which only 4 died. One of ablv some who have benefited emotionally by evacuation the commonest complications of the acute disease is a and have thus been spared a breakdown. The gain to non-putrid necrosis of the lung ; the resulting cavitation, children in physical health as a result of country life is usually in the upper lobes, is the outstanding feature of reported on all sides and is not lightly to be discounted. the chronic infection, and has led in a proportion of cases This is not to pretend that children do not suffer from to a diagnosis of chronic pulmonary tuberculosis. The transplanting, or that they do not experience emotional sputum is sometimes blood-stained, but more often is stress as a result of separation from their parents. rather copious, purulent and brownish-yellow, but not But the evidence suggests that by far the greater number foul-smelling unless secondary infection occurs. The of them adapt themselves to the new life, that they profit diagnosis is again confirmed by bacteriological examina- physically and that they are exposed to less direct risk of tion of the sputum from which Friedlander’s bacillus can death. The position is not ideal, it has its own dangers, but for the moment it is probably the best we can do. med. Ass. 115, 1527. 1940, 1. Solomon, S. J. Amer.
ensure
Gentian, squill, liquorice, senega, cassia, belladonna,
hyoscyamus,
stramonium
and
colchicum
should
be
available, in quantities sufficient to meet all ordinary needs, as a result of measures which had been taken to
be isolated though it may be in mixed culture ; the same organism may, of course, be present in sputum apart from a pneumonic infection, as it is often associated with chronic sinusitis. Lung abscess is the most common complication of chronic Friedlander pneumonia and is sometimes accompanied by an encapsuled empyema. Pleural effusion, pulmonary fibrosis and delayed resolu. tion are other complications. Treatment is mostly symptomatic, although Solomon on the basis of 4 treated cases thinks that sulphapyridine is likely to be useful in tiding the patient over the acute phase of the infection though not in preventing complications. He advises against surgical drainage of lung abscess, for this drains ade. quately through the bronchus. This chronic disease may last with intermittent pyrexia for months and even years.
supplies. Foreign-owned British patents had proved a serious handicap to British manufacturers, but medicinal products covered by these patents were now being produced in this country under licences granted by the comptroller of patents and presented under trade TRANSPLANTED CHILDREN names other than those used by the foreign owners of the WE are between the devil and the deep sea when we try trade marks. " There is," he said, " no call upon us as to spare children the strain of war. To see children taken Britons to perpetuate the goodwill in enemy trade names, underground at six in the evening in a large city and kept and a strong appeal is being made that the official names there, exposed to infection, cramped for space to play, should be used wherever possible in preference to profoetid air, disturbed by the pressure of adult life prietary names in scientific literature, by manufacturers breathing around them, is to appreciate fully the value of evacuation. and prescribers, and in the teaching hospitals and To conduct a child-guidance clinic in a reception area is, it institutions." The reference was particularly to those to see the other side of the penny. Speakers at the synthetic products which are the subject of monographs seems, Tavistock Clinic (p. 121) tell that some children carry in the third addendum to the B.P. and he added that the into the country the fear provoked by bombing, some Government naturally expected that every pharmacist break down as a result of their uprooting, some because would refuse to help to keep enemy trade marks warm. they are placed in uncongenial homes and some from Mr. Mortimer ended with an appeal to set up an advisory guilt at leaving their parents behind in danger. The committee for the drug trade. position is not a simple one : there is evidently no clear FRIEDLÄNDER PNEUMONIA A right or wrong about evacuation and we must try to Friedlander’s bacillus, a short thick gram-negative consider what is best for the greatest number. It is capsulated bacillus, has long enjoyed %-reputatioll for probably out of the question, in large schemes, to causing a very severe form of pneumonia, and the consider each case on its merits. Miss W. T. Alcock tendency of older physicians to exaggerate the frequency working in an eastern rural reception area speaks of the of Friedlander pneumonia may be traced to Friedlander’s impact of " 15,000 city-bred evacuees" on fosterearly mistake in confusing his bacillus with the pneumo- mothers, and the repercussions on the children, among coccus-which incidentally he, not Frankel, first whom 420 cases of breakdown had occurred. This isolated from cases of pneumonia. Bacteriological gives an incidence of 28%, and it would be interesting to studies in large series of pneumonias put the incidence know how this compares with the incidence of breakof Friedlander infections at 0-5-1%, although occasiondown among town children in times of peace. Many ally higher and even epidemic incidence has been speakers testified to the fact that children stand up to the reported. While the onset resembles that of a pneumo- strain of actual bombing well ; Dr. R. P. Garrow found coccal lobar pneumonia, certain clinical features help to that during 16 months in a population of 12,000-15,000 distinguish Friedlander pneumonia which attacks mostly children in a heavily bombed area none had been men in the older age-groups. Haemoptysis may be an alleged to suffer from strain, and this may well have initial sign, and the sputum is characteristically gelatingiven an accurate picture of the situation. But we ous and tenacious, and often brick-red in contrast to the must not lose sight of the fact that however well adapted infection. of the pneumococcal Temperature a child may be to stand up to the strain of bombing, he is rusty spit is not high as a rule, the patient quickly becomes very ill, totally unadapted to stand up to a bomb. During and the physical signs of a pneumonia, particularly December 521 children were killed in air-raids, and it is crepitations and bronchial breathing, are often absent. fair to assume that most of these deaths occurred in There may be leucopenia or only slight leucocytosis. towns. If those children had gone to the reception The diagnosis is made by bacteriological examination of areas, at least 500 of them would be alive to-day; the sputum. A gram-stained smear shows many typical and of those about 15 would have broken down from bacilli a halo with representing emotional strain. Even the unlucky ones might have gram-negative negative the capsule ; mouse-inoculation gives a pure culture of preferred the role of live dog to that of dead lion. the Friedlander bacillus. The fatality-rate of this acute It must be remembered, too, that a proportion of the and usually rapidly fatal infection is 70-90%. Besides evacuated children referred to child-guidance clinics this fulminating pneumonia a more chronic form occurs would probably have shown symptoms at home in times either as a sequel to the acute disease or ushered in by an of peace ; and that among the large numbers of children acute phase, and Solomonhas lately recorded the who have settled down reasonably well there are probclinical features in 17 cases of which only 4 died. One of ablv some who have benefited emotionally by evacuation the commonest complications of the acute disease is a and have thus been spared a breakdown. The gain to non-putrid necrosis of the lung ; the resulting cavitation, children in physical health as a result of country life is usually in the upper lobes, is the outstanding feature of reported on all sides and is not lightly to be discounted. the chronic infection, and has led in a proportion of cases This is not to pretend that children do not suffer from to a diagnosis of chronic pulmonary tuberculosis. The transplanting, or that they do not experience emotional sputum is sometimes blood-stained, but more often is stress as a result of separation from their parents. rather copious, purulent and brownish-yellow, but not But the evidence suggests that by far the greater number foul-smelling unless secondary infection occurs. The of them adapt themselves to the new life, that they profit diagnosis is again confirmed by bacteriological examina- physically and that they are exposed to less direct risk of tion of the sputum from which Friedlander’s bacillus can death. The position is not ideal, it has its own dangers, but for the moment it is probably the best we can do. med. Ass. 115, 1527. 1940, 1. Solomon, S. J. Amer.
ensure