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IMMUNISATION AGAINST CATARRH.
889 for subcutaneous injection killed cultures of Bacillus .qeptits, MieroCOa01(’S aata’frlwlis, and M. paratetragen2cs: I took the first injection on Nov. 10th, 1908, and the me
Correspondence.
second on Dec. 1st. Up to the first week of January I remained free from trouble, but then had a little cough,
II Audlalteram partem."
THE NATURE OF ANGINA PECTORIS. To the Editor of THE LANCET.
SiR,-There is one class of case of angina which cannot be readily explained by Sir Clifford Allbutt’s view that ’’the seat of the essential lesion is in the suprasigmoid aorta " ; I refer to severe angina associated with mitral stenosis, which is independent of chronic renal disease or arteriosclerosis. In these cases the pulmonary vessels rather than the aorta would be stretched or diseased. We know that the strain on the pulmonary artery may be so great as to produce pulmonary regurgitation or atheroma. Further, it is significant that these cases show an obvious relationship between the severity or number of the anginal attacks and the pressure in the pulmonary circuit. When the right ventricle begins to fail the anginal attacks become less severe or less frequent. At the same time the pulmonary arterial blood pressure must fall, but that in the systemic arteries does not, because in the systemic circuit the cardiac failure is compensated, and generally over-compensated, by arterial vaso-constriction. It seems reasonable, therefore, to suppose that, if the essential lesion in angina is situated outside the heart, the site of the lesion in the cases referred to is in the pulmonary artery rather than in the aorta. The fact that failure of the right ventricle lessens the anginal attacks in cases of mitral stenosis, and vice versiz, is opposed to the view that the attacks are due either to stretching of the cardiac muscle or to embarrassment of the coronary circulation. It is just when the right ventricle is most dilated and the coronary circulation is at its worst that the anginal attacks are least marked or may be absent altogether. Further, mitral regurgitation, which does not produce either pulmonary regurgitation or atheroma, but does lead to dilatation of the right ventricle and upset of the coronary circulation, has no special relationship to angina. These considerations seem to lend some support to the idea that the pulmonary artery may be the site of the essential lesion in cases of angina associated with mitral stenosis. I am, Sir, yours faithfully, A. P. BEDDARD. Seymour-street, W., Sept. 10th, 1903.
IMMUNISATION AGAINST CATARRH.
.1’
with a small amount of loose and easy expectoration, and some increase of nasal secretion, but no feverishness or malaise. Dr. Allen made a culture from my expectoration, and I injected a dose on Jan. 9th, another on the 26th, and a third on Feb. 2nd. On Feb. 15th I noted "some tracheal irritation with teasing cough, and soreness on swallowing. Some obstruction of left Eustachian tube. Little or no tracheal secretion, but more from nasal passages." I took a full dose of the autogenous culture, and repeated it on March 8th. During the interval I had never been quite free from secretion, and on March 9th I sent Dr. Allen a specimen, which he found to be" swarming with BaciU1tS i1ifl1lenzae." He made a fresh culture, which I injected on March 15th, and the symptoms disappeared. On April 17th a profuse nasal catarrh commenced suddenly about 7 P. M., the abundant thin secretion soon soaking a handkerchief, but it began to diminish about 9 and had ceased by 10. The same thing occurred on May 18th. On June 23rd I had again been troubled for a day or two by occasional short periods of nasal catarrh attended by a little loose cough, and I saw Dr. Allen again. He found B. influenzae and pne1/moc(}eei in the sputum, and made a fresh culture, but pending its arrival I injected a dose of that made in March. On the 30th I injected a mixture of the March and of the new cultures, and repeated this mixture in increasing doses on July 9tb, 20th, and 31st. Since then I have held my hand, and do not propose to inject again until November, unless symptoms should arise to call for action. The general result may be summed up by saying that since last November I have been absolutely free from any trace of the febrile indisposition which is the usual forerunner of catarrh, and that I have been absolutely free from viscid tracheal secretion and from the harassing cough which it produces. I have had a few short periods of increased nasal secretion, probably due to successive infections which my phagocytes have been enabled by the injections quickly to subdue ; and I have now and then had a slight cough with a little loose secretion. I cannot doubt that in March I was protected against an acute attack of influenza. During the ben months I have not had one "cold," and I have not been hindered for an hour in the pursuit of my usual occupations. As the most convenient locality for self-administration, jhe injections were made in the left flank, either late in the afternoon or at bedtime ; and they never produced any inconvenience, either local or general. For perhaps 24 hours, jhe spot was barely discoverable on pressure. In the hope ihat my experience may be useful to other sufferers, I have ihe honour to be, Sir, Your most obedient servant, R. BRUDENELL CARTER. .
To the Editor of THE LANCET. SIR,—At a time when the calendar reminds us of the approach of winter, with its too frequent accompaniments in the way of colds and coughs, a personal record of ten months immunisation against these evils will perhaps not be wholly uninteresting to the profession. I may begin it by saying" that I have all my life been a frequent sufferer from "colds of the ordinary type, but of considerable severity, commencing with 24 hours or so of feverish indisposition, and continuing through the ordinary stages of nasal catarrh. Fifty years or more ago I tried to render these colds abortive by complete abstinence from fluid, but found the remedy worse than the disease, and since then I have tried many other methods of treatment with very little advantage. During the iast few years the frequently recurring attacks have assumed a more formidable character in the direction of early extension to the trachea. Soon after the onset of symptoms I have had sore throat, some obstruction of the Eustachian tubes, with tenderness on swallowing, and then an irritating tracheal secretion comparable to birdlime in its tenacity, and occasioning prolonged and exhausting paroxysms of coughing which have produced some amount of emphysema of the lungs. I began to regard the whole process as an instalment of the force which Nature would gradually exert for my extinction ; and my attention was first directed towards a more hopeful view by the perusal of the chapter on Catarrh in Dr. R. W. Allen’s treatise on "Vaccine Therapy," the chapter which he soon afterwards expanded in your columns. In consequence of this perusal I consulted him, and he gave
THE ULTRA-MICROSCOPE. To the Editor of THE LANCET.
SiR,—It is advisable to make an early protest against the misuse of the term ’ultra-microscope " by Mr. Hugh Wansey Bayly in his note on the Use of the Ultra-Microscope for the Early Diagnosis of Syphilis in your issue of Sept. llth, p. 782. The same error has apparently been committed by the French writer referred to by him, and confusion and misunderstanding would result were the expression to be used in the same sense by other writers. The "ultra-microscope"is an apparatus designed by Siedentopf and Zsigmondy to show the existence of particles which are beyond the limits of microscopic resolution-say less than 0 - 25,u. Its principle is the illuminating of such particles by a very narrow and minute beam of light at right angles to the optic axis of the microscope, and by its means such "ultra-microscopic"" particles as those found in gold ruby-glass have been made evident, and colloidal solutions investigated. The limit of visibility of such particles is bounded only by the means of powerful illumination at our disposal, not excepting sunlight, but it must be carefully borne in mind that the apparent size of objects thus seen is illusory and their appearance is that of diffraction discs
Correspondence.
second on Dec. 1st. Up to the first week of January I remained free from trouble, but then had a little cough,
II Audlalteram partem."
THE NATURE OF ANGINA PECTORIS. To the Editor of THE LANCET.
SiR,-There is one class of case of angina which cannot be readily explained by Sir Clifford Allbutt’s view that ’’the seat of the essential lesion is in the suprasigmoid aorta " ; I refer to severe angina associated with mitral stenosis, which is independent of chronic renal disease or arteriosclerosis. In these cases the pulmonary vessels rather than the aorta would be stretched or diseased. We know that the strain on the pulmonary artery may be so great as to produce pulmonary regurgitation or atheroma. Further, it is significant that these cases show an obvious relationship between the severity or number of the anginal attacks and the pressure in the pulmonary circuit. When the right ventricle begins to fail the anginal attacks become less severe or less frequent. At the same time the pulmonary arterial blood pressure must fall, but that in the systemic arteries does not, because in the systemic circuit the cardiac failure is compensated, and generally over-compensated, by arterial vaso-constriction. It seems reasonable, therefore, to suppose that, if the essential lesion in angina is situated outside the heart, the site of the lesion in the cases referred to is in the pulmonary artery rather than in the aorta. The fact that failure of the right ventricle lessens the anginal attacks in cases of mitral stenosis, and vice versiz, is opposed to the view that the attacks are due either to stretching of the cardiac muscle or to embarrassment of the coronary circulation. It is just when the right ventricle is most dilated and the coronary circulation is at its worst that the anginal attacks are least marked or may be absent altogether. Further, mitral regurgitation, which does not produce either pulmonary regurgitation or atheroma, but does lead to dilatation of the right ventricle and upset of the coronary circulation, has no special relationship to angina. These considerations seem to lend some support to the idea that the pulmonary artery may be the site of the essential lesion in cases of angina associated with mitral stenosis. I am, Sir, yours faithfully, A. P. BEDDARD. Seymour-street, W., Sept. 10th, 1903.
IMMUNISATION AGAINST CATARRH.
.1’
with a small amount of loose and easy expectoration, and some increase of nasal secretion, but no feverishness or malaise. Dr. Allen made a culture from my expectoration, and I injected a dose on Jan. 9th, another on the 26th, and a third on Feb. 2nd. On Feb. 15th I noted "some tracheal irritation with teasing cough, and soreness on swallowing. Some obstruction of left Eustachian tube. Little or no tracheal secretion, but more from nasal passages." I took a full dose of the autogenous culture, and repeated it on March 8th. During the interval I had never been quite free from secretion, and on March 9th I sent Dr. Allen a specimen, which he found to be" swarming with BaciU1tS i1ifl1lenzae." He made a fresh culture, which I injected on March 15th, and the symptoms disappeared. On April 17th a profuse nasal catarrh commenced suddenly about 7 P. M., the abundant thin secretion soon soaking a handkerchief, but it began to diminish about 9 and had ceased by 10. The same thing occurred on May 18th. On June 23rd I had again been troubled for a day or two by occasional short periods of nasal catarrh attended by a little loose cough, and I saw Dr. Allen again. He found B. influenzae and pne1/moc(}eei in the sputum, and made a fresh culture, but pending its arrival I injected a dose of that made in March. On the 30th I injected a mixture of the March and of the new cultures, and repeated this mixture in increasing doses on July 9tb, 20th, and 31st. Since then I have held my hand, and do not propose to inject again until November, unless symptoms should arise to call for action. The general result may be summed up by saying that since last November I have been absolutely free from any trace of the febrile indisposition which is the usual forerunner of catarrh, and that I have been absolutely free from viscid tracheal secretion and from the harassing cough which it produces. I have had a few short periods of increased nasal secretion, probably due to successive infections which my phagocytes have been enabled by the injections quickly to subdue ; and I have now and then had a slight cough with a little loose secretion. I cannot doubt that in March I was protected against an acute attack of influenza. During the ben months I have not had one "cold," and I have not been hindered for an hour in the pursuit of my usual occupations. As the most convenient locality for self-administration, jhe injections were made in the left flank, either late in the afternoon or at bedtime ; and they never produced any inconvenience, either local or general. For perhaps 24 hours, jhe spot was barely discoverable on pressure. In the hope ihat my experience may be useful to other sufferers, I have ihe honour to be, Sir, Your most obedient servant, R. BRUDENELL CARTER. .
To the Editor of THE LANCET. SIR,—At a time when the calendar reminds us of the approach of winter, with its too frequent accompaniments in the way of colds and coughs, a personal record of ten months immunisation against these evils will perhaps not be wholly uninteresting to the profession. I may begin it by saying" that I have all my life been a frequent sufferer from "colds of the ordinary type, but of considerable severity, commencing with 24 hours or so of feverish indisposition, and continuing through the ordinary stages of nasal catarrh. Fifty years or more ago I tried to render these colds abortive by complete abstinence from fluid, but found the remedy worse than the disease, and since then I have tried many other methods of treatment with very little advantage. During the iast few years the frequently recurring attacks have assumed a more formidable character in the direction of early extension to the trachea. Soon after the onset of symptoms I have had sore throat, some obstruction of the Eustachian tubes, with tenderness on swallowing, and then an irritating tracheal secretion comparable to birdlime in its tenacity, and occasioning prolonged and exhausting paroxysms of coughing which have produced some amount of emphysema of the lungs. I began to regard the whole process as an instalment of the force which Nature would gradually exert for my extinction ; and my attention was first directed towards a more hopeful view by the perusal of the chapter on Catarrh in Dr. R. W. Allen’s treatise on "Vaccine Therapy," the chapter which he soon afterwards expanded in your columns. In consequence of this perusal I consulted him, and he gave
THE ULTRA-MICROSCOPE. To the Editor of THE LANCET.
SiR,—It is advisable to make an early protest against the misuse of the term ’ultra-microscope " by Mr. Hugh Wansey Bayly in his note on the Use of the Ultra-Microscope for the Early Diagnosis of Syphilis in your issue of Sept. llth, p. 782. The same error has apparently been committed by the French writer referred to by him, and confusion and misunderstanding would result were the expression to be used in the same sense by other writers. The "ultra-microscope"is an apparatus designed by Siedentopf and Zsigmondy to show the existence of particles which are beyond the limits of microscopic resolution-say less than 0 - 25,u. Its principle is the illuminating of such particles by a very narrow and minute beam of light at right angles to the optic axis of the microscope, and by its means such "ultra-microscopic"" particles as those found in gold ruby-glass have been made evident, and colloidal solutions investigated. The limit of visibility of such particles is bounded only by the means of powerful illumination at our disposal, not excepting sunlight, but it must be carefully borne in mind that the apparent size of objects thus seen is illusory and their appearance is that of diffraction discs