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Lotta Contro la Tubercolosi
June 1938
TUBE
showed no lesions, ahhough 4o.I per cent had a positive cuff-reaction. O n radiological examination 2I 7 presented lesions of thc thoracic organs, Io lesions of the vertebral column, IO changes in the configuration of t h e heart, and 3 non-specific changes in the ilungs, such as bronchiectasis and post,influenzal infiltration. Tuberculous lesions iof the infantile type were found in 187 children. Inactive lesions were detected in i65 in the lungs, hila and pleura, and active lesions in 22 in the form of a p r i m a r y focus or tracheo-bronchial adenitis. Six children showed tuberculosis of the adult type. T w o children with active tuberculosis were treated by artificial pneumothorax and four w i t h commencing tuberculosis were given a climatic treatment.
Tuberculous infection in children bz urban and rural populations hz the Lwdw district. Experiences of the anti-tuberculous mobile column.--This p a p e r contains an account of tim work on tuberculosis organized by the anti-tuberculosis dispensary of the second medical clinic of the J e a n Casimir University in conjunction with the Polish Red Cross. Most of the ~children examined by the Mantoux test '.underwent a radiological examination. Among 4096 in w h o m the skin reactions w e r e performcd, a positive reaction was .obtained ranging from 7"3 per cent in the third year of life in towns and I4- 7 per cent in the country to 67" 5 per cent in the thirteenth year in the towns and 60. 7 per cent in the country. LANCET VOL. I No. x v APRIL 9, 1938" *The Function of the Bronchial Tubes. Maxwell Ellis. 819 .
Thefunction of the bronchial tubes.--This p a p e r was the subject of the author's Hunterian L e c t u r e delivered at the Royal College of !Surgeons on J a n u a r y 28. Within a compass o f eight pages it gives a compact though iadequate account of the historical development and the present-day research in the field to which the author has made import a n t contribution. T h e anatomy of the bronchial tree with special reference to the !myo-elastic layer is described and its funcitions discussed. Ahhough the invention of t h e bronchoscope m a d e direct observation .possible yet the methods adopted for measuring intrabronchial variations in volume only attained any real degree of accuracy when Ellis and Livingstone elaborated their technique, which is again
CLE
427
described substantially as it first appeared in the Journal of Physiology, three years ago. Using this method it has been shown that the tubes are in a state of constant tone which is subject to spontaneous rhythmic variation and can also be influenced reflexly, both from within and from without the respiratory system. T h e rhythmic c h a n g e s in calibre of the bronchi synchronize with the thoracic respiratory m o v e m e n t s , - o f which they are the passive result. T h e bearing of the experimental findings in asthma and other spasmodic bronchial diseases is touched on and the conclusion come to that in these conditions it is not necessary to postulate any considerable contraction of the bronchial muscle since a small increase in tone will produce a far-reaching effect. Although the experiments were made on the larger bronchi and the behaviour of the smaller deduced by analogy, it is held that such deduction is not unreasonable as the bronchial muscles--concerned entirely with the maintenance of moderate t o n e - - b e h a v e as a unit. L O T T A C O N T R O LA T U B E R C O L O S I VOL IX NO. I .JANUARY 1938. *La mortalifft per tubercolosi nel triennio 193o-= e negli anni 1935 e I936 (Mortality from tuberculosis in the triennium 193o-2 and in 1935 and i936 ). L. de Bernadinis. 3. Tubercolosi evolutiva e cancro del polmone (Active tuberculosis and cancer o f the lung). R. D'Ambrosio. i6. *L'azione dell' atroplna sulla presslone endopleurlca (Action of atropine on endopleural pressure). E. Talarico. 3 o. *Contributo alla iconografia radiologica della opacit~t rotondegglanti de polmone ( O n the radiological iconography of roundish opacities in "the lung). V. Fanano. 64.
llIortality from tuberculosis bz the triennium x93o-2 and in 1935 and 1936.--The mortality throughout Italy from all forms of tuberculosis and in particular from pulmonary tuberculosis during the year I935 to I936 shows a progressive diminution compared with the rates of the period 193o-2.
Action of atropine on endopleural pressure.-Intravenous injection ofo'25 mg. of atropine sulphate caused a fall ofendopleural pressure in 45 out of 6o cases of unilateral artificial pneumothorax, whereas in the remaining 15 no such change occurred.
On the radiological iconography of the roundish opacities in the lung.--The diagnosis of the nature of roundish opacities in the lung is beset with difficulties which are often insurmountable. T h e writer comes to the conclu-
428
TUBERCLE
sion that though radiology may indicate the number, situation and form of thesc opacities, it cannot in most cases supply any information as to their mode of production. To overcome this difficulty and to obtain an accurate diagnosis, a careful consideration of thc history is needed, associated with a study of the symptoms, physical signs and laboratory investigations. MI~NCHENER MEDIZINISCHE WOCHENSCHRIFT VOL. LXXXV NO. 15 APRIL 15, 1938 Die Lungenkrankheitenim Rahmen der deutschcn Heilkunde (The diseases of the lungs from the point of view of German medicine). F. Kellner. 545. *Aktive Diphtherie-Schutzimpfungbcl tuberkul6sen Kindern (Activeimmunizationagainst diphtheria in tuberculouschildren). H. Berger. 55x.
Active immunization agahzst diphtheria in tuberculous children.-- 19~ children of different ages suffering from various forms of tuberculosis at different stages were submitted to active immunization against diphtheria ; the preparation used was AI. F. T. Behring, a formol-toxoid adsorbed to aluminium hydroxide. I n no case did the treatment lead to any untoward effects. There was no evidence of reactivation of the tuberculous process or of any alteration of the child's resistance to the tuberculous infection. No cases of diphtheria occurred after the third week following the injection. The cases of diphtheria which occurred within the first three weeks ran a very mild course. The authors suggest that children admitted to a sanatorium should be immunized on admission in order to prevent the occurrence ofdiphtheria in such institutions. VOL. LXXXV NO. 16 APRIL ~2, X938 *Spontanheilung, interne Behandlung und Indikation zum chirurgischen Eingriff beim Lungenabscess (Spontaneous curc, medical treatment and indications for surgical interference in pulmonary abscess). K. Vosschultc and E. Schwarzhoff. 58o. Plcuracmpyem dutch Fusobakterien (Empyema of the pleura caused by Bac. fusiformis). Ph. O. Sucssmann and H. Dicker. 583 .
Puhnonary abscess.--The treatment of pulmonary abscesses during the first two months following the onset of the suppurative process ought to b c a medical conservative one. Observation carried through over such a period of time will allow a decision to bc reached on the question whether conservative thcrapy is likely to be successful or not. In case a definite improvement has not bccn attained by then no fnrthcr time should be lost with attempts at medical
June
I938
treatment, whereby the chance of a satisfactory result ofsurgical treatment would be reduced. In practice conservative trcatmcnt should not be cxtendcd over more than 6 to 8 weeks. A number of cases will require surgical intervention at an earlier date. The general condition of the patient and the x-ray findings are the most important guides in reaching the ultimate decision. I n a limited number of abscesses of long duration conservative treatment may occasionally be successful, in the majority of cases, however, surgical intervention has proved necessary on account of the occurrence of acute complications. These late stages are poor operative risk. Tile authors stress the !mportance of avoiding unnecessary delay xn reaching a decision as to tile necessity of surgical treatment. R E V U E DE LA T U B E R C U L O S E VOL. IV NO. 2 FEBRUARY 1938. *t~tude critique des rdsultats de deux ans de chirurgie puhnonaire en sanatorium public (Critical study of the results of two years' puhnonary surgery in a public sanatorium). P. Dreyfus-Le Fover, R. Etienne, Cl. Brunet and O. Renid. 13o. " La tubcrculose des noirs, r u e d'Afrique Equatorial Fran~aise (Tuberculosis of Negroes, as observed in French tropical Africa). Pales. 19o.
Puhnonary surgery.--Thc sanatorium at which the authors are working includes among its patients a considcrablc numher of very bad cases which were actually beyond treatment. I n spite of this, surgical therapy was adoptcd in 3"3 per cent of all adult paticnts. Thirty-five cases were subjcctcd to thoracoplasty, although 3 cases only conformed with the classical indications of thc method, all thc others being borderline cases. I n 25 cases thus treated complete curc was attained, as confirmed by clinical, radiological and bacteriological evidence. Subsequent observation carried on over a number of years showed the persistcnce of the good condition of health. According to the type of lesion the subperiosteal or extraperiosteal method or in some cases apicolysis was made use of, in all cases the technique of Maurer was adopted; in no case did the operation lead to immediate death. The good results are attributed to the satisfactory collaboration on the part of the medical and surgical side and to the possibility of combining climatic therapeutical factors with surgical measures. Given such ideal conditions thoracoplasty is an operation which the physician is fully entitlcd to suggest to his patients.
TUBE
showed no lesions, ahhough 4o.I per cent had a positive cuff-reaction. O n radiological examination 2I 7 presented lesions of thc thoracic organs, Io lesions of the vertebral column, IO changes in the configuration of t h e heart, and 3 non-specific changes in the ilungs, such as bronchiectasis and post,influenzal infiltration. Tuberculous lesions iof the infantile type were found in 187 children. Inactive lesions were detected in i65 in the lungs, hila and pleura, and active lesions in 22 in the form of a p r i m a r y focus or tracheo-bronchial adenitis. Six children showed tuberculosis of the adult type. T w o children with active tuberculosis were treated by artificial pneumothorax and four w i t h commencing tuberculosis were given a climatic treatment.
Tuberculous infection in children bz urban and rural populations hz the Lwdw district. Experiences of the anti-tuberculous mobile column.--This p a p e r contains an account of tim work on tuberculosis organized by the anti-tuberculosis dispensary of the second medical clinic of the J e a n Casimir University in conjunction with the Polish Red Cross. Most of the ~children examined by the Mantoux test '.underwent a radiological examination. Among 4096 in w h o m the skin reactions w e r e performcd, a positive reaction was .obtained ranging from 7"3 per cent in the third year of life in towns and I4- 7 per cent in the country to 67" 5 per cent in the thirteenth year in the towns and 60. 7 per cent in the country. LANCET VOL. I No. x v APRIL 9, 1938" *The Function of the Bronchial Tubes. Maxwell Ellis. 819 .
Thefunction of the bronchial tubes.--This p a p e r was the subject of the author's Hunterian L e c t u r e delivered at the Royal College of !Surgeons on J a n u a r y 28. Within a compass o f eight pages it gives a compact though iadequate account of the historical development and the present-day research in the field to which the author has made import a n t contribution. T h e anatomy of the bronchial tree with special reference to the !myo-elastic layer is described and its funcitions discussed. Ahhough the invention of t h e bronchoscope m a d e direct observation .possible yet the methods adopted for measuring intrabronchial variations in volume only attained any real degree of accuracy when Ellis and Livingstone elaborated their technique, which is again
CLE
427
described substantially as it first appeared in the Journal of Physiology, three years ago. Using this method it has been shown that the tubes are in a state of constant tone which is subject to spontaneous rhythmic variation and can also be influenced reflexly, both from within and from without the respiratory system. T h e rhythmic c h a n g e s in calibre of the bronchi synchronize with the thoracic respiratory m o v e m e n t s , - o f which they are the passive result. T h e bearing of the experimental findings in asthma and other spasmodic bronchial diseases is touched on and the conclusion come to that in these conditions it is not necessary to postulate any considerable contraction of the bronchial muscle since a small increase in tone will produce a far-reaching effect. Although the experiments were made on the larger bronchi and the behaviour of the smaller deduced by analogy, it is held that such deduction is not unreasonable as the bronchial muscles--concerned entirely with the maintenance of moderate t o n e - - b e h a v e as a unit. L O T T A C O N T R O LA T U B E R C O L O S I VOL IX NO. I .JANUARY 1938. *La mortalifft per tubercolosi nel triennio 193o-= e negli anni 1935 e I936 (Mortality from tuberculosis in the triennium 193o-2 and in 1935 and i936 ). L. de Bernadinis. 3. Tubercolosi evolutiva e cancro del polmone (Active tuberculosis and cancer o f the lung). R. D'Ambrosio. i6. *L'azione dell' atroplna sulla presslone endopleurlca (Action of atropine on endopleural pressure). E. Talarico. 3 o. *Contributo alla iconografia radiologica della opacit~t rotondegglanti de polmone ( O n the radiological iconography of roundish opacities in "the lung). V. Fanano. 64.
llIortality from tuberculosis bz the triennium x93o-2 and in 1935 and 1936.--The mortality throughout Italy from all forms of tuberculosis and in particular from pulmonary tuberculosis during the year I935 to I936 shows a progressive diminution compared with the rates of the period 193o-2.
Action of atropine on endopleural pressure.-Intravenous injection ofo'25 mg. of atropine sulphate caused a fall ofendopleural pressure in 45 out of 6o cases of unilateral artificial pneumothorax, whereas in the remaining 15 no such change occurred.
On the radiological iconography of the roundish opacities in the lung.--The diagnosis of the nature of roundish opacities in the lung is beset with difficulties which are often insurmountable. T h e writer comes to the conclu-
428
TUBERCLE
sion that though radiology may indicate the number, situation and form of thesc opacities, it cannot in most cases supply any information as to their mode of production. To overcome this difficulty and to obtain an accurate diagnosis, a careful consideration of thc history is needed, associated with a study of the symptoms, physical signs and laboratory investigations. MI~NCHENER MEDIZINISCHE WOCHENSCHRIFT VOL. LXXXV NO. 15 APRIL 15, 1938 Die Lungenkrankheitenim Rahmen der deutschcn Heilkunde (The diseases of the lungs from the point of view of German medicine). F. Kellner. 545. *Aktive Diphtherie-Schutzimpfungbcl tuberkul6sen Kindern (Activeimmunizationagainst diphtheria in tuberculouschildren). H. Berger. 55x.
Active immunization agahzst diphtheria in tuberculous children.-- 19~ children of different ages suffering from various forms of tuberculosis at different stages were submitted to active immunization against diphtheria ; the preparation used was AI. F. T. Behring, a formol-toxoid adsorbed to aluminium hydroxide. I n no case did the treatment lead to any untoward effects. There was no evidence of reactivation of the tuberculous process or of any alteration of the child's resistance to the tuberculous infection. No cases of diphtheria occurred after the third week following the injection. The cases of diphtheria which occurred within the first three weeks ran a very mild course. The authors suggest that children admitted to a sanatorium should be immunized on admission in order to prevent the occurrence ofdiphtheria in such institutions. VOL. LXXXV NO. 16 APRIL ~2, X938 *Spontanheilung, interne Behandlung und Indikation zum chirurgischen Eingriff beim Lungenabscess (Spontaneous curc, medical treatment and indications for surgical interference in pulmonary abscess). K. Vosschultc and E. Schwarzhoff. 58o. Plcuracmpyem dutch Fusobakterien (Empyema of the pleura caused by Bac. fusiformis). Ph. O. Sucssmann and H. Dicker. 583 .
Puhnonary abscess.--The treatment of pulmonary abscesses during the first two months following the onset of the suppurative process ought to b c a medical conservative one. Observation carried through over such a period of time will allow a decision to bc reached on the question whether conservative thcrapy is likely to be successful or not. In case a definite improvement has not bccn attained by then no fnrthcr time should be lost with attempts at medical
June
I938
treatment, whereby the chance of a satisfactory result ofsurgical treatment would be reduced. In practice conservative trcatmcnt should not be cxtendcd over more than 6 to 8 weeks. A number of cases will require surgical intervention at an earlier date. The general condition of the patient and the x-ray findings are the most important guides in reaching the ultimate decision. I n a limited number of abscesses of long duration conservative treatment may occasionally be successful, in the majority of cases, however, surgical intervention has proved necessary on account of the occurrence of acute complications. These late stages are poor operative risk. Tile authors stress the !mportance of avoiding unnecessary delay xn reaching a decision as to tile necessity of surgical treatment. R E V U E DE LA T U B E R C U L O S E VOL. IV NO. 2 FEBRUARY 1938. *t~tude critique des rdsultats de deux ans de chirurgie puhnonaire en sanatorium public (Critical study of the results of two years' puhnonary surgery in a public sanatorium). P. Dreyfus-Le Fover, R. Etienne, Cl. Brunet and O. Renid. 13o. " La tubcrculose des noirs, r u e d'Afrique Equatorial Fran~aise (Tuberculosis of Negroes, as observed in French tropical Africa). Pales. 19o.
Puhnonary surgery.--Thc sanatorium at which the authors are working includes among its patients a considcrablc numher of very bad cases which were actually beyond treatment. I n spite of this, surgical therapy was adoptcd in 3"3 per cent of all adult paticnts. Thirty-five cases were subjcctcd to thoracoplasty, although 3 cases only conformed with the classical indications of thc method, all thc others being borderline cases. I n 25 cases thus treated complete curc was attained, as confirmed by clinical, radiological and bacteriological evidence. Subsequent observation carried on over a number of years showed the persistcnce of the good condition of health. According to the type of lesion the subperiosteal or extraperiosteal method or in some cases apicolysis was made use of, in all cases the technique of Maurer was adopted; in no case did the operation lead to immediate death. The good results are attributed to the satisfactory collaboration on the part of the medical and surgical side and to the possibility of combining climatic therapeutical factors with surgical measures. Given such ideal conditions thoracoplasty is an operation which the physician is fully entitlcd to suggest to his patients.