- Email: [email protected]
LEUKÆMIA IN MOTHER AND CHILD
738
of prophylactics. We cannot be certain that the satisfactory position would be maintained in the present face of a renewed incursion by C. diphtheriae gravis of
guineapigs,
identical with that described by me3 for substance B, but apparently without spread, the oedema being confined to the limits of the weal raised by the intradermal injection. This
the
difference may be accounted for by the very different method of preparation, or it may be that substance B, like substance A, may prove on antigenic analysis to have more than one component. It is, however, encouraging to find that interest in the problem has begun to reach state laboratories and perhaps in these circumstances reference to the continuation of the Dublin work, beyond its initial stages, may be of value to those engaged in the preparation and standardisation of diphtheria antitoxin and prophylactics. I had shown3 that substance B possessed the property of rendering standard diphtheria antitoxin non-avid. Hence, in cases of hypertoxic diphtheria the antitoxin available for treatment was incapable of binding the toxin produced by the infecting organism no matter how large the dose, expressed in conventional laboratory units, administered to the patient. In these circumstances, a number of lines of approach were possible and have been summarised.7 The two actually employed were: (a) to determine whether a truly avid antitoxin
enhanced virulence.
had, in hypertoxic cases, therapeutic properties not shown by the usual, barely avid or non-avid, commercial antitoxins; and (b) to determine whether avid antitoxin could be produced in animals by inoculating them with toxoids and toxins made from freshly isolated strains, in such a way as to contain a high
proportion of substance B. Both approaches gave confirmatory results. In the first it was shown by the late Dr. C. J. McSweeney,8 using an antitoxin which I had had prepared for him to specification with a specially high avidity, as shown by its dilution ratio of 1-2, that hypertoxic diphtheria yielded to antitoxin treatment in a fashion comparable to that recorded by the pioneers of this form of treatment. The response was of an order never seen with standard commercial antitoxin. In the secondit was shown, by using antigens prepared from recently isolated strains of C. diphtherice gravis, that it was possible to produce both in the rabbit and the horse antitoxins which, though of low unitage as judged by the standard tests, were of quite exceptional avidity. The inevitable conclusion from these experiments is that the antibody to substance B either determines the avidity of antitoxin or else runs parallel to it.
None of these experiments is especially difficult to perform, nor are the observations difficult to make. Hence, it is apparent that the scientific approach to the problem is the direct one by transition from the clinical case, studied in all its aspects, to the infecting organism with all its infective properties preserved and thence to the laboratory, where care must be taken to see that they are not lost. By severance of laboratory investigation from the clinical case, immunology rapidly ceases to be a science in the strict
sense
of the
term
and becomes
a
mere
technology. Doubtless the techniques which it develops are of a high order, but their benefits are commonly lost to medicine. Moreover, their unbalanced development may lead to such unnecessary absurdities as an internationally accepted unit for antitoxin of such a character that the therapeutic efficacy of antitoxin diminishes as
the
unitage per unit volume is raised by technical " improvements ". We have been free from significant diphtheria in these
islands for many years and it is conventional to accept that the disease has been controlled by immunisation. This may be correct, but it is certain that the prophylactics used are incomplete, though possibly adequate, for protection against current strains of C. diphtheria. The disease has also disappeared for long periods in the past, before O’Meara, R. A. Q., Balch, H. H., McNally, P. A. 6th series, 1946, p. 799. 8. McSweeney, C. J. Lancet, 1941, i, 208. 7.
Irish J. med. Sci.
days
School of Pathology,
Trinity College, Dublin.
Q. O’MEARA.
R. A.
LEUKÆMIA IN MOTHER AND CHILD
SiR,—I was interested in your editorial of Sept. 5, at the end of which you state that no case (of leukxmia in the newborn) has been reported in which the mother had leukxmia during the pregnancy. In 1958 Cramblett, Friedman, and Najjar1 described an infant in whom acute lymphocytic leukxmia developed at 9 months of age. The child’s mother had petechias and ecchymoses commencing in the seventh month of pregnancy although the diagnosis of acute lymphocytic leukaemia was not estab. lished until eight days post partum. FREDERICK HECHT.
SIR,-In
BRILL’S DISEASE your issue of Oct. 10 Dr. Lloyd and Dr. Urich
lymphoid follicular reticulosis to which Many years ago Dr. Brill described an unusual form of typhus occurring in New York to which his name has been given. Who is their Brill and when was his name given as an alternative to lymphoid follicular reticulosis and by whom ? Eponyms are of interest in medicine, but surely it is absurd to use the same name twice, each for a rare discuss
a case
they give the
of
eponym of Brill’s disease.
disease ? Aston
Clinton, E. LLOYD V. V E LLOYD HART. HART. TT. Bucks...
** We should perhaps have encouraged our contributors to use the name Brill-Symmers disease, which Dorland’s Medical Dictionary acknowledges as "giant follicular lympadenopathy ". The Brill of both diseases was Nathan Brill, of New York, and he described,2 with Douglas Symmers in 1925, a giant follicular hyperplasia in spleen and lymph-nodes.-ED. L. PHARMACOLOGICAL ADJECTIVES SIR,-The increasing flood of drugs in this era of psychopharmacology has brought into frequent use such adjectives as psychotropic, thymoplegic, thymotropic, psychotypic, psycholeptic, phrenotropic, psychotonic, ataractic, analeptic, neuroleptic, neuroplegic, thymoleptic, thymeretic, and dysleptic. As the mode of action of the new drugs is still very speculative, one wonders whether simpler terms, such as sedative, depressant, tranquilliser, stimulant, and anti-depressant, might not cover our practical needs more usefully. One fears that the multiplication of high-sounding pseudoscientific categories may weave a cloak to cover our ignorance, especially when a distinguished psychiatrist at the Cambridge Symposium last month stated that we try to treat diseases of which we know next to nothing with drugs of which we know next to nothing ". It seems that the adjectives are not even clearly understood. A recently introduced drug which many dub as thymoleptic is considered by other authorities to be more appropriately a thymo-analeptic ". "
"
"
"
Park Prewett Hospital, I. ATKIN. Basingstoke, Hampshire. 1. Cramblett, H. G., Friedman, J. L., Najjar, S. New Engl. J. Med. 1958, 259, 727. 2. J. Amer. med. Ass. 1925, 84, 668.
of prophylactics. We cannot be certain that the satisfactory position would be maintained in the present face of a renewed incursion by C. diphtheriae gravis of
guineapigs,
identical with that described by me3 for substance B, but apparently without spread, the oedema being confined to the limits of the weal raised by the intradermal injection. This
the
difference may be accounted for by the very different method of preparation, or it may be that substance B, like substance A, may prove on antigenic analysis to have more than one component. It is, however, encouraging to find that interest in the problem has begun to reach state laboratories and perhaps in these circumstances reference to the continuation of the Dublin work, beyond its initial stages, may be of value to those engaged in the preparation and standardisation of diphtheria antitoxin and prophylactics. I had shown3 that substance B possessed the property of rendering standard diphtheria antitoxin non-avid. Hence, in cases of hypertoxic diphtheria the antitoxin available for treatment was incapable of binding the toxin produced by the infecting organism no matter how large the dose, expressed in conventional laboratory units, administered to the patient. In these circumstances, a number of lines of approach were possible and have been summarised.7 The two actually employed were: (a) to determine whether a truly avid antitoxin
enhanced virulence.
had, in hypertoxic cases, therapeutic properties not shown by the usual, barely avid or non-avid, commercial antitoxins; and (b) to determine whether avid antitoxin could be produced in animals by inoculating them with toxoids and toxins made from freshly isolated strains, in such a way as to contain a high
proportion of substance B. Both approaches gave confirmatory results. In the first it was shown by the late Dr. C. J. McSweeney,8 using an antitoxin which I had had prepared for him to specification with a specially high avidity, as shown by its dilution ratio of 1-2, that hypertoxic diphtheria yielded to antitoxin treatment in a fashion comparable to that recorded by the pioneers of this form of treatment. The response was of an order never seen with standard commercial antitoxin. In the secondit was shown, by using antigens prepared from recently isolated strains of C. diphtherice gravis, that it was possible to produce both in the rabbit and the horse antitoxins which, though of low unitage as judged by the standard tests, were of quite exceptional avidity. The inevitable conclusion from these experiments is that the antibody to substance B either determines the avidity of antitoxin or else runs parallel to it.
None of these experiments is especially difficult to perform, nor are the observations difficult to make. Hence, it is apparent that the scientific approach to the problem is the direct one by transition from the clinical case, studied in all its aspects, to the infecting organism with all its infective properties preserved and thence to the laboratory, where care must be taken to see that they are not lost. By severance of laboratory investigation from the clinical case, immunology rapidly ceases to be a science in the strict
sense
of the
term
and becomes
a
mere
technology. Doubtless the techniques which it develops are of a high order, but their benefits are commonly lost to medicine. Moreover, their unbalanced development may lead to such unnecessary absurdities as an internationally accepted unit for antitoxin of such a character that the therapeutic efficacy of antitoxin diminishes as
the
unitage per unit volume is raised by technical " improvements ". We have been free from significant diphtheria in these
islands for many years and it is conventional to accept that the disease has been controlled by immunisation. This may be correct, but it is certain that the prophylactics used are incomplete, though possibly adequate, for protection against current strains of C. diphtheria. The disease has also disappeared for long periods in the past, before O’Meara, R. A. Q., Balch, H. H., McNally, P. A. 6th series, 1946, p. 799. 8. McSweeney, C. J. Lancet, 1941, i, 208. 7.
Irish J. med. Sci.
days
School of Pathology,
Trinity College, Dublin.
Q. O’MEARA.
R. A.
LEUKÆMIA IN MOTHER AND CHILD
SiR,—I was interested in your editorial of Sept. 5, at the end of which you state that no case (of leukxmia in the newborn) has been reported in which the mother had leukxmia during the pregnancy. In 1958 Cramblett, Friedman, and Najjar1 described an infant in whom acute lymphocytic leukxmia developed at 9 months of age. The child’s mother had petechias and ecchymoses commencing in the seventh month of pregnancy although the diagnosis of acute lymphocytic leukaemia was not estab. lished until eight days post partum. FREDERICK HECHT.
SIR,-In
BRILL’S DISEASE your issue of Oct. 10 Dr. Lloyd and Dr. Urich
lymphoid follicular reticulosis to which Many years ago Dr. Brill described an unusual form of typhus occurring in New York to which his name has been given. Who is their Brill and when was his name given as an alternative to lymphoid follicular reticulosis and by whom ? Eponyms are of interest in medicine, but surely it is absurd to use the same name twice, each for a rare discuss
a case
they give the
of
eponym of Brill’s disease.
disease ? Aston
Clinton, E. LLOYD V. V E LLOYD HART. HART. TT. Bucks...
** We should perhaps have encouraged our contributors to use the name Brill-Symmers disease, which Dorland’s Medical Dictionary acknowledges as "giant follicular lympadenopathy ". The Brill of both diseases was Nathan Brill, of New York, and he described,2 with Douglas Symmers in 1925, a giant follicular hyperplasia in spleen and lymph-nodes.-ED. L. PHARMACOLOGICAL ADJECTIVES SIR,-The increasing flood of drugs in this era of psychopharmacology has brought into frequent use such adjectives as psychotropic, thymoplegic, thymotropic, psychotypic, psycholeptic, phrenotropic, psychotonic, ataractic, analeptic, neuroleptic, neuroplegic, thymoleptic, thymeretic, and dysleptic. As the mode of action of the new drugs is still very speculative, one wonders whether simpler terms, such as sedative, depressant, tranquilliser, stimulant, and anti-depressant, might not cover our practical needs more usefully. One fears that the multiplication of high-sounding pseudoscientific categories may weave a cloak to cover our ignorance, especially when a distinguished psychiatrist at the Cambridge Symposium last month stated that we try to treat diseases of which we know next to nothing with drugs of which we know next to nothing ". It seems that the adjectives are not even clearly understood. A recently introduced drug which many dub as thymoleptic is considered by other authorities to be more appropriately a thymo-analeptic ". "
"
"
"
Park Prewett Hospital, I. ATKIN. Basingstoke, Hampshire. 1. Cramblett, H. G., Friedman, J. L., Najjar, S. New Engl. J. Med. 1958, 259, 727. 2. J. Amer. med. Ass. 1925, 84, 668.