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INTRACRANIAL INJURIES OF THE NEW-BORN
1225 tion is supported so far Hoseason has produced a to the subject.
by only
two cases Dr. contribution
thoughtful
INFLUENZA: THE RELATION OF ANTIBODIES TO IMMUNITY IN an appeal for fifty first-year St. Bart.’s students to volunteer help in the influenza research being carried on at the National Institute for Medical Research, Hampstead, Dr. C. H. Andrewes sets out succinctly the specific questions to which answers One is, whether the fact that to-day are required.1 the antibodies to influenza of most Londoners appear to be of very inferior quality, or not detectable at all, means that an influenza epidemic is about to break out this winter. The potency of these antibodies is tested by dropping mixtures of serum from persons to be tested and filtrates of influenza virus into the noses of ferrets or mice ; if antibodies are present in the serum the animal fails to develop the disease. Three years ago, says Dr. Andrewes, after a widespread epidemic, nearly all Londoners had antibodies to the virus in their blood; now those tested have only poor ones. Junior students, who will be available for a number of years to come, are being asked to give 5 c.cm. or 10 c.cm. of their blood so that its antibody content may be estimated now and in future years. It is hoped thus to learn whether such bloods will serve as a ’flu barometer-i.e., whether there is any relation between epidemics and the antibody level in a representative section of the community. If, again, there is an epidemic and those students with good antibodies escape while the others fall victims, it will encourage the hope that the increasing of antibodies by vaccination with the killed virus will increase resistance to influenza in humans as it has already been found to do in ferrets and mice. The incidence of influenza among these young volunteers will not be accepted without objective test, since it is fairly certain that several diseases are mixed up together under the name of influenza. They are asked to notify indiswithin 24 when workers from Hamphours, position stead will swoop down upon them to collect their saline garglings for testing on ferrets. This seems to us an excellent plan for testing the significance of the antibody level as regards immunity, and we wish it every success. INTRACRANIAL INJURIES OF THE NEW-BORN THE general opinion of intracranial injuries of the new-born is that they are always serious and better fatal. But according to R. H. Nattrass 2 the commoner examples are usually unrecognised and thus untreated, so that the child survives subject to the risk of mental and physical impairment. From a study of the causes of intracranial injuries, Nattrass deduces that diagnosis is greatly helped by a detailed knowledge of the labour. The clinical signs and symptoms are neither uniform nor characteristic. Respiration, after being established with some difficulty, becomes slow and irregular. There may be focal or general convulsions, rigidity of the neck, inequality of pupils, and either extreme lethargy or The sucking reflex is often great restlessness.
impaired
absent. Nattrass points out that the condition of the anterior fontanelle is often misleading, and he urges the use of lumbar puncture as a relatively easy method of establishing diagnosis as well as affording decompression. In discussing treat1
or
St. Bartholomew’s Hospital Journal, November, 1936, p. 26. 2 Med. Jour. of Australia, Sept. 5th, 1936, p. 326.
ment he mentions, however, that the intracranial pressure may also be lowered by rectal injections of 2 oz. of 10 per cent. saline given every 4-8 hours until symptoms subside. Under the same heading, too, he shows that intracranial damage may be aggravated by the various vigorous methods still, unfortunately, being used for resuscitation. A newborn baby that fails to breathe when the mucus from the throat has been adequately removed-a measure followed perhaps by gentle traction of the tongue and the use of a stimulant drug such as Coramine-has probably sustained a brain injury, so that violent manipulative methods will certainly do harm. Warmth is important and the baby must be treated in a darkened room and not put to the breast until all apparent danger is over. Oxygen and carbon dioxide must be available for dealing with cyanotic attacks, and if slowly continuing haemorrhage is suspected or occurs in association with the lumbar puncture, it is probably useful to inject about 10 c.cm. of maternal blood into the infant’s buttocks in the hope of encouraging coagulation.
URETERIC ENURESIS INCONTINENCE of urine caused by extravesical implantation of the lower end of one or two ureters1 is a rare condition, but as H. C. E. M. Houtappel points out, is of practical importance, because it Several different types of the can usually be cured. anomaly have been reported. In one group of cases
both of the normal ureters open extravesically. so far been reported only as a post-mortem finding in newly born infants.) In another group an extra rudimentary kidney is present and the ureter from this opens outside the bladder ; this is the type most often seen and includes the case on which Houtappel bases his paper. In a third group, of which only two post-mortem examples have been recorded, one of the normal kidneys is absent and its place is taken by a pair of rudimentary organs with ectopically opening ureters. In a fourth group an extra rudimentary kidney is present on each side and one or both of the extra ureters open extravesically. Lastly, one case has been described in which one kidney was replaced by a rudimentary kidney situated in the pelvis close to the bladder and with a ureter opening extravesically. one or
(The second of these types has
In
a single woman case the patient, had suffered all her life from dribbling of urine, which was constant and not influenced by coughing or Normal micturition occurred. laughing. Cystoscopy showed two normal ureteric orifices. On inspection of the vulva, urine was seen to exude slowly from the urethra. The bladder was filled up through a catheter with sterile milk and it was then observed that the drops emerging from the urethra remained clear and did not become milky in appearance, which showed that the fluid did not Several abortive attempts were come from the bladder. made to pass an opaque ureteric catheter into the abnormal ureter and at last a false passage was made into the vagina. This accident proved to be a fortunate one. It was followed by cessation of the extravesical oozing of urine and later by pain in the left loin, thus giving a clue to the position of the abnormal kidney. Operation was carried out and disclosed a miniature extra kidney lying at the upper pole of the normal organ. The extra kidney was removed after ligaturing its ureter. It was bean-shaped, 2-3 cm. long, and microscopically showed normal renal tissue.
Houtappel’s
aged 24,
Emphasising the importance of exact anatomical diagnosis Houtappel points out that this is much
easier in the female than in the male. The nature of the operation will depend upon the condition found ; various alternatives are open to the surgeon,
including nephrectomy, ligature
of the abnormal
ureter, and implantation of the ectopic ureter into the
bladder. Ureteric enuresis is a possibility to be borne in mind in obscure cases of urinary incontinence. 1 Nederl. tijdschr.
v.
geneesk., 1936, lxxx., 4692.
by only
two cases Dr. contribution
thoughtful
INFLUENZA: THE RELATION OF ANTIBODIES TO IMMUNITY IN an appeal for fifty first-year St. Bart.’s students to volunteer help in the influenza research being carried on at the National Institute for Medical Research, Hampstead, Dr. C. H. Andrewes sets out succinctly the specific questions to which answers One is, whether the fact that to-day are required.1 the antibodies to influenza of most Londoners appear to be of very inferior quality, or not detectable at all, means that an influenza epidemic is about to break out this winter. The potency of these antibodies is tested by dropping mixtures of serum from persons to be tested and filtrates of influenza virus into the noses of ferrets or mice ; if antibodies are present in the serum the animal fails to develop the disease. Three years ago, says Dr. Andrewes, after a widespread epidemic, nearly all Londoners had antibodies to the virus in their blood; now those tested have only poor ones. Junior students, who will be available for a number of years to come, are being asked to give 5 c.cm. or 10 c.cm. of their blood so that its antibody content may be estimated now and in future years. It is hoped thus to learn whether such bloods will serve as a ’flu barometer-i.e., whether there is any relation between epidemics and the antibody level in a representative section of the community. If, again, there is an epidemic and those students with good antibodies escape while the others fall victims, it will encourage the hope that the increasing of antibodies by vaccination with the killed virus will increase resistance to influenza in humans as it has already been found to do in ferrets and mice. The incidence of influenza among these young volunteers will not be accepted without objective test, since it is fairly certain that several diseases are mixed up together under the name of influenza. They are asked to notify indiswithin 24 when workers from Hamphours, position stead will swoop down upon them to collect their saline garglings for testing on ferrets. This seems to us an excellent plan for testing the significance of the antibody level as regards immunity, and we wish it every success. INTRACRANIAL INJURIES OF THE NEW-BORN THE general opinion of intracranial injuries of the new-born is that they are always serious and better fatal. But according to R. H. Nattrass 2 the commoner examples are usually unrecognised and thus untreated, so that the child survives subject to the risk of mental and physical impairment. From a study of the causes of intracranial injuries, Nattrass deduces that diagnosis is greatly helped by a detailed knowledge of the labour. The clinical signs and symptoms are neither uniform nor characteristic. Respiration, after being established with some difficulty, becomes slow and irregular. There may be focal or general convulsions, rigidity of the neck, inequality of pupils, and either extreme lethargy or The sucking reflex is often great restlessness.
impaired
absent. Nattrass points out that the condition of the anterior fontanelle is often misleading, and he urges the use of lumbar puncture as a relatively easy method of establishing diagnosis as well as affording decompression. In discussing treat1
or
St. Bartholomew’s Hospital Journal, November, 1936, p. 26. 2 Med. Jour. of Australia, Sept. 5th, 1936, p. 326.
ment he mentions, however, that the intracranial pressure may also be lowered by rectal injections of 2 oz. of 10 per cent. saline given every 4-8 hours until symptoms subside. Under the same heading, too, he shows that intracranial damage may be aggravated by the various vigorous methods still, unfortunately, being used for resuscitation. A newborn baby that fails to breathe when the mucus from the throat has been adequately removed-a measure followed perhaps by gentle traction of the tongue and the use of a stimulant drug such as Coramine-has probably sustained a brain injury, so that violent manipulative methods will certainly do harm. Warmth is important and the baby must be treated in a darkened room and not put to the breast until all apparent danger is over. Oxygen and carbon dioxide must be available for dealing with cyanotic attacks, and if slowly continuing haemorrhage is suspected or occurs in association with the lumbar puncture, it is probably useful to inject about 10 c.cm. of maternal blood into the infant’s buttocks in the hope of encouraging coagulation.
URETERIC ENURESIS INCONTINENCE of urine caused by extravesical implantation of the lower end of one or two ureters1 is a rare condition, but as H. C. E. M. Houtappel points out, is of practical importance, because it Several different types of the can usually be cured. anomaly have been reported. In one group of cases
both of the normal ureters open extravesically. so far been reported only as a post-mortem finding in newly born infants.) In another group an extra rudimentary kidney is present and the ureter from this opens outside the bladder ; this is the type most often seen and includes the case on which Houtappel bases his paper. In a third group, of which only two post-mortem examples have been recorded, one of the normal kidneys is absent and its place is taken by a pair of rudimentary organs with ectopically opening ureters. In a fourth group an extra rudimentary kidney is present on each side and one or both of the extra ureters open extravesically. Lastly, one case has been described in which one kidney was replaced by a rudimentary kidney situated in the pelvis close to the bladder and with a ureter opening extravesically. one or
(The second of these types has
In
a single woman case the patient, had suffered all her life from dribbling of urine, which was constant and not influenced by coughing or Normal micturition occurred. laughing. Cystoscopy showed two normal ureteric orifices. On inspection of the vulva, urine was seen to exude slowly from the urethra. The bladder was filled up through a catheter with sterile milk and it was then observed that the drops emerging from the urethra remained clear and did not become milky in appearance, which showed that the fluid did not Several abortive attempts were come from the bladder. made to pass an opaque ureteric catheter into the abnormal ureter and at last a false passage was made into the vagina. This accident proved to be a fortunate one. It was followed by cessation of the extravesical oozing of urine and later by pain in the left loin, thus giving a clue to the position of the abnormal kidney. Operation was carried out and disclosed a miniature extra kidney lying at the upper pole of the normal organ. The extra kidney was removed after ligaturing its ureter. It was bean-shaped, 2-3 cm. long, and microscopically showed normal renal tissue.
Houtappel’s
aged 24,
Emphasising the importance of exact anatomical diagnosis Houtappel points out that this is much
easier in the female than in the male. The nature of the operation will depend upon the condition found ; various alternatives are open to the surgeon,
including nephrectomy, ligature
of the abnormal
ureter, and implantation of the ectopic ureter into the
bladder. Ureteric enuresis is a possibility to be borne in mind in obscure cases of urinary incontinence. 1 Nederl. tijdschr.
v.
geneesk., 1936, lxxx., 4692.