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INTERMITTENT VENOUS OCCLUSION
1381
superficially resembled that observed in progressive muscular atrophy, but the muscles of the forearms were relatively normal, and there was no evidence of motor neurone degeneration. The initial symptom of intermittent dysphagia was unaccompanied by any change in the tongue or by weakness of the orbicularis oris muscle. Fibrillary twitchings, however, were observed in the muscles of the calves
and thighs, but not with the frequency associated with progressive muscular atrophy. The result of partial thyroidectomy was soon apparent: within three months the wasted muscles had regained their normal sie and contour, and within six months he felt equal to resuming his usual
occupation. SUMMARY
patient, aged 50, whose usual weight 121 st., was admitted to hospital with dysphagia,
The was
a man
weakness (especially of the limbs), and loss of 2 st. in weight. Chronic thyrotoxic myopathy was diagnosed and partial thyroidectomy performed. Histological examination of the portion removed showed very active epithelial hyperplasia, with some filling of the acini by papillary growths.
increasing muscular
After a prolonged convalescence, complicated by postoperative pneumonia and lung abscess, the patient regained his strength and weight. We wish to thank Dr. Laurence Martin for his advice in the management of this case, and various members of the state of Addenbrooke’s Hospital for the investigations performed.
helpful
’
REFERENCES
Ayer, J. B., Mears, J. H., and Lerman, J. (1934) Endocrinology, 18, 701. Brain, W. R., and Turnbull, H. M. (1938) Quart. J. Med. 7, 293. Starling, H. J., Darke, C. S., Hunt, B. W., and Brain, W. R. (1938) Guy’s Hosp. Rep. 88, 117.
CLINICAL AND LABORATORY NOTES INTERMITTENT VENOUS OCCLUSION A MODIFIED APPARATUS
BY W. J. KOLFF, Arts ASSISTANT IN THE MEDICAL
DEPARTMENT, UNIVERSITY HOSPITAL, GRONINGEN, HOLLAND
upper bottle can be put at various levels for regulating the pressure without making the tubes kink, this being further avoided by keeping the tubes near to each other.. The upper bottle is an ordinary irrigator fixed to the wooden stand. Both limbs of the siphon run over the bracket together with the connecting tube, so that the water rises simultaneously in the connecting tube and the proximal limb of the siphon. The siphon is attached to the sides of the upper bottle. By tilting the siphon more or less (fig. 3) one can regulate the difference in level between the top of the siphon bend and the bottom of the irrigator, and so vary the time during which the maximum pressure is maintained. The outflow of the siphon is directed as nearly
ENCOURAGED by the good results of Collens and Wilensky (1937) in the treatment of peripheral vascular disease by intermittent venous occlusion, we constructed in June, 1938, an apparatus for carrying out this treatment which has proved highly satisfactory. When our attention was called to the paper of Wilson and Ogston (1938) we found that the apparatus they described was generally similar to as possible verour own. For the working principles of the apparatus their paper should be consulted, only the technical tically.theThe air from lower differences being given here. bottle is led to A garden-hose nozzle is attached to a round water tap and is fitted with an all-metal cock which regulates the flow (fig. 1). The cock allows the tap to be kept fully turned on, so that there is no chance of the water gradually stopping, as is likely to happen when a tap is A constant-level running slowly. gauge can be dispensed with. The water runs directly into the lower bottle (fig. 2), and there is therefore no possibility of water and air meeting in the connecting tube. This tube can if necessary be hung over a bracket which projects from the wooden stand. Over this bracket all the tubes are led, so that the
FiG.
’HI c
FiG. I-Tap with garden-hose nozzle and metal cock for
regulating
the flow.
the cuff. Leading the air-conducting tube upwards
2-Diagrarn
to show arrangement of tubes:
2 = irri1= bottle. 3 = cuff.
gator.
FIG. 3-Apparatus working with a pressure of 80 cm. water. The siphon is tilted so that the maximum pressure is maintained for only a very short time.
1382 a point above the top of the siphon makes it impossible for water to enter the cuff even if it should develop a leak. No water-trap is therefore required. For the sake of cheapness a football bladder bandaged
to
to the limb can be used instead of the proper cuff if desired..0
We have had good results with this apparatus in 1 case of arteriosclerosis and intermittent claudication ; 2 cases of thrombo-angiitis obliterans ; 5 patients with varicose ulcers (1 with diabetes) ; and in 2 out of 4 patients with arteriosclerosis and diabetic In varicose ulcers and badly healing gangrene. amputation stumps a considerable increase in exudation was seen during the intermittent occlusion. This was found to be a favourable sign. I should like to thank Prof. L. Polak Daniels, director of the medical department, for his cooperation. REFERENCES
Collens, W. S., Wilensky, N. D.(1937) J. Amer. med. Ass. 109, 2125. Wilson, C., Ogston, A. G. (1938) Lancet, 1, 606.
M. &
B. 693 IN MALARIA
BY R. PAKENHAM-WALSH, D.M.
Oxfd, D.P.M.
SECOND ASSISTANT MEDICAL OFFICER AT THE COUNTY MENTAL HOSPITAL, LANCASTER ; AND
A further relapse took place
on April 23, for which quinine was given.
A. T. RENNIE LABORATORY TECHNICIAN AT THE HOSPITAL
Up to the present no report has been published in this country * on the effect of M. & B. 693 on the malarial parasite. The accompanying chart, showing the effect of treatment on the rigors and parasite counts of a general paralytic inoculated with benign tertian malaria on Jan. 20, 1939, should therefore be of interest to anyone contemplating a more extensive investigation of this subject. It is somewhat similar to that given in our account of the action of sulphonamides in malaria (Lancet, 1938, 2, 79).
The general paralytic undergoing treatment is often infected with coccal organisms besides spirochsetes and malarial parasites. The psychiatrist may then be faced with the problem of destroying the cocci without checking the malaria prematurely. The chart suggests that M. & B. 693 should be given sparingly if it is desired to complete an uninterrupted course of malarial treatment. We wish to thank Dr. J. D. Silverston, medical superintendent of the hospital, for permission to publish this case :and Messrs. May and Baker Ltd. for supplying the drug.
MEDICAL SOCIETIES ROYAL SOCIETY AT a Freiherr
of this society on June 8 Prof. VERSCHUER (Frankfurt a. M.) spoke on
meeting von
Twin Research
Francis Galton, he said, was the founder of human hereditary biology, and in 1875 he read a paper calling attention to the importance of twins for distinguishing between the effects of Nature and Nurture, or heredity and environment. From the existence of two kinds of twin-one kind no more alike than ordinary sibs, the other kind maintaining a noteworthy likeness despite differences in the mode of life-Galton deduced the paramount importance of innate structure in controlling the destiny of the individual. Except by Thorndyke in America, his ideas were not followed up till after the war, and the first serious contributions to twin pathology came from Siemens in 1924. Today there were hundreds and even thousands of papers on the subject from every scientific country in the world. Scientists early learnt to distinguish between twins born in one set of membranes and twins born in two, and thought that this was a method for distinguishing between one-egg (EZ) and two-egg (ZZ) pairs. This was now known to be a fallacious method, and the *
Since submitting this article [for publication we have had opportunity of seeing a report in which the action of M. & B. 693 in ape malaria is recorded (Chopra, R. N., and Das Gupta, B. M., Indian med. Gaz. April, 1939, p. 201). an
two kinds of twins
were now
large number
distinguished by
com-
of characteristics which were known to agree in EZ and to differ frequently in ZZ pairs. The characteristics chosen were not necessarily the same for all races. For instance, eye colour and hair colour were useful in England and Germany because they agreed in EZ, while there was a large range of variation in ordinary sibs and ZZ. In races with universal dark pigmentation, such characteristics would obviously be useless. A large number of characteristics were necessary, because supposing we only took three-eye colour, hair colour and bloodgroup-we should find that not only the EZ agreed, but also some of the ZZ pairs. Similarly, skin folds, papillary patterns, &c., lost much of their value for diagnostic purposes because of the frequency with which ZZ are as alike as EZ. Referring to the reliability of the modern method based on the comparison of independently variable characteristics, Prof. Verschuer said that it had been proved by blood-group investigations. Many hundreds of EZ diagnosed in his clinic had been submitted to serological investigation in an independent laboratory and there was never a single case of difference. Furthermore the group of ZZ showed the same percentage of agreement and disagreement as ordinary sibs; whereas if mistakes had been made and EZ pairs had been included in the group of ZZ, the percentage of agreement would have been too high. After establishing the validity of their methods of diagnosis, the next step had been to test the textbook statements about the foetal membranes. More than
paring
a
superficially resembled that observed in progressive muscular atrophy, but the muscles of the forearms were relatively normal, and there was no evidence of motor neurone degeneration. The initial symptom of intermittent dysphagia was unaccompanied by any change in the tongue or by weakness of the orbicularis oris muscle. Fibrillary twitchings, however, were observed in the muscles of the calves
and thighs, but not with the frequency associated with progressive muscular atrophy. The result of partial thyroidectomy was soon apparent: within three months the wasted muscles had regained their normal sie and contour, and within six months he felt equal to resuming his usual
occupation. SUMMARY
patient, aged 50, whose usual weight 121 st., was admitted to hospital with dysphagia,
The was
a man
weakness (especially of the limbs), and loss of 2 st. in weight. Chronic thyrotoxic myopathy was diagnosed and partial thyroidectomy performed. Histological examination of the portion removed showed very active epithelial hyperplasia, with some filling of the acini by papillary growths.
increasing muscular
After a prolonged convalescence, complicated by postoperative pneumonia and lung abscess, the patient regained his strength and weight. We wish to thank Dr. Laurence Martin for his advice in the management of this case, and various members of the state of Addenbrooke’s Hospital for the investigations performed.
helpful
’
REFERENCES
Ayer, J. B., Mears, J. H., and Lerman, J. (1934) Endocrinology, 18, 701. Brain, W. R., and Turnbull, H. M. (1938) Quart. J. Med. 7, 293. Starling, H. J., Darke, C. S., Hunt, B. W., and Brain, W. R. (1938) Guy’s Hosp. Rep. 88, 117.
CLINICAL AND LABORATORY NOTES INTERMITTENT VENOUS OCCLUSION A MODIFIED APPARATUS
BY W. J. KOLFF, Arts ASSISTANT IN THE MEDICAL
DEPARTMENT, UNIVERSITY HOSPITAL, GRONINGEN, HOLLAND
upper bottle can be put at various levels for regulating the pressure without making the tubes kink, this being further avoided by keeping the tubes near to each other.. The upper bottle is an ordinary irrigator fixed to the wooden stand. Both limbs of the siphon run over the bracket together with the connecting tube, so that the water rises simultaneously in the connecting tube and the proximal limb of the siphon. The siphon is attached to the sides of the upper bottle. By tilting the siphon more or less (fig. 3) one can regulate the difference in level between the top of the siphon bend and the bottom of the irrigator, and so vary the time during which the maximum pressure is maintained. The outflow of the siphon is directed as nearly
ENCOURAGED by the good results of Collens and Wilensky (1937) in the treatment of peripheral vascular disease by intermittent venous occlusion, we constructed in June, 1938, an apparatus for carrying out this treatment which has proved highly satisfactory. When our attention was called to the paper of Wilson and Ogston (1938) we found that the apparatus they described was generally similar to as possible verour own. For the working principles of the apparatus their paper should be consulted, only the technical tically.theThe air from lower differences being given here. bottle is led to A garden-hose nozzle is attached to a round water tap and is fitted with an all-metal cock which regulates the flow (fig. 1). The cock allows the tap to be kept fully turned on, so that there is no chance of the water gradually stopping, as is likely to happen when a tap is A constant-level running slowly. gauge can be dispensed with. The water runs directly into the lower bottle (fig. 2), and there is therefore no possibility of water and air meeting in the connecting tube. This tube can if necessary be hung over a bracket which projects from the wooden stand. Over this bracket all the tubes are led, so that the
FiG.
’HI c
FiG. I-Tap with garden-hose nozzle and metal cock for
regulating
the flow.
the cuff. Leading the air-conducting tube upwards
2-Diagrarn
to show arrangement of tubes:
2 = irri1= bottle. 3 = cuff.
gator.
FIG. 3-Apparatus working with a pressure of 80 cm. water. The siphon is tilted so that the maximum pressure is maintained for only a very short time.
1382 a point above the top of the siphon makes it impossible for water to enter the cuff even if it should develop a leak. No water-trap is therefore required. For the sake of cheapness a football bladder bandaged
to
to the limb can be used instead of the proper cuff if desired..0
We have had good results with this apparatus in 1 case of arteriosclerosis and intermittent claudication ; 2 cases of thrombo-angiitis obliterans ; 5 patients with varicose ulcers (1 with diabetes) ; and in 2 out of 4 patients with arteriosclerosis and diabetic In varicose ulcers and badly healing gangrene. amputation stumps a considerable increase in exudation was seen during the intermittent occlusion. This was found to be a favourable sign. I should like to thank Prof. L. Polak Daniels, director of the medical department, for his cooperation. REFERENCES
Collens, W. S., Wilensky, N. D.(1937) J. Amer. med. Ass. 109, 2125. Wilson, C., Ogston, A. G. (1938) Lancet, 1, 606.
M. &
B. 693 IN MALARIA
BY R. PAKENHAM-WALSH, D.M.
Oxfd, D.P.M.
SECOND ASSISTANT MEDICAL OFFICER AT THE COUNTY MENTAL HOSPITAL, LANCASTER ; AND
A further relapse took place
on April 23, for which quinine was given.
A. T. RENNIE LABORATORY TECHNICIAN AT THE HOSPITAL
Up to the present no report has been published in this country * on the effect of M. & B. 693 on the malarial parasite. The accompanying chart, showing the effect of treatment on the rigors and parasite counts of a general paralytic inoculated with benign tertian malaria on Jan. 20, 1939, should therefore be of interest to anyone contemplating a more extensive investigation of this subject. It is somewhat similar to that given in our account of the action of sulphonamides in malaria (Lancet, 1938, 2, 79).
The general paralytic undergoing treatment is often infected with coccal organisms besides spirochsetes and malarial parasites. The psychiatrist may then be faced with the problem of destroying the cocci without checking the malaria prematurely. The chart suggests that M. & B. 693 should be given sparingly if it is desired to complete an uninterrupted course of malarial treatment. We wish to thank Dr. J. D. Silverston, medical superintendent of the hospital, for permission to publish this case :and Messrs. May and Baker Ltd. for supplying the drug.
MEDICAL SOCIETIES ROYAL SOCIETY AT a Freiherr
of this society on June 8 Prof. VERSCHUER (Frankfurt a. M.) spoke on
meeting von
Twin Research
Francis Galton, he said, was the founder of human hereditary biology, and in 1875 he read a paper calling attention to the importance of twins for distinguishing between the effects of Nature and Nurture, or heredity and environment. From the existence of two kinds of twin-one kind no more alike than ordinary sibs, the other kind maintaining a noteworthy likeness despite differences in the mode of life-Galton deduced the paramount importance of innate structure in controlling the destiny of the individual. Except by Thorndyke in America, his ideas were not followed up till after the war, and the first serious contributions to twin pathology came from Siemens in 1924. Today there were hundreds and even thousands of papers on the subject from every scientific country in the world. Scientists early learnt to distinguish between twins born in one set of membranes and twins born in two, and thought that this was a method for distinguishing between one-egg (EZ) and two-egg (ZZ) pairs. This was now known to be a fallacious method, and the *
Since submitting this article [for publication we have had opportunity of seeing a report in which the action of M. & B. 693 in ape malaria is recorded (Chopra, R. N., and Das Gupta, B. M., Indian med. Gaz. April, 1939, p. 201). an
two kinds of twins
were now
large number
distinguished by
com-
of characteristics which were known to agree in EZ and to differ frequently in ZZ pairs. The characteristics chosen were not necessarily the same for all races. For instance, eye colour and hair colour were useful in England and Germany because they agreed in EZ, while there was a large range of variation in ordinary sibs and ZZ. In races with universal dark pigmentation, such characteristics would obviously be useless. A large number of characteristics were necessary, because supposing we only took three-eye colour, hair colour and bloodgroup-we should find that not only the EZ agreed, but also some of the ZZ pairs. Similarly, skin folds, papillary patterns, &c., lost much of their value for diagnostic purposes because of the frequency with which ZZ are as alike as EZ. Referring to the reliability of the modern method based on the comparison of independently variable characteristics, Prof. Verschuer said that it had been proved by blood-group investigations. Many hundreds of EZ diagnosed in his clinic had been submitted to serological investigation in an independent laboratory and there was never a single case of difference. Furthermore the group of ZZ showed the same percentage of agreement and disagreement as ordinary sibs; whereas if mistakes had been made and EZ pairs had been included in the group of ZZ, the percentage of agreement would have been too high. After establishing the validity of their methods of diagnosis, the next step had been to test the textbook statements about the foetal membranes. More than
paring
a