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NOTIFICATION OF INFECTIOUS DISEASES
33 times bicellular bridges, and it is these which account for the appearance of cords on cross-section. The human hepatic lobule therefore consists of a continuous tissue of connected walls, which enclose the spaces for the sinusoids to run through. The polygonal meshwork of bile-capillaries runs between the cells in the plates and bridges, and it forms hexagonal intercellular and pericellular networks within the liver plates. This is in close’ accord with the easily demonstrable network commonly seen in sections, which fits poorly into the hitherto conventional picture. Since in man and the cat the spaces formed for the sinusoids between the plates are like long sacks, their type of liver may be regarded as saccular," in contrast to the " tubular " type of liver of the horse and rabbit, in which the spaces between the hepatic laminae are narrow and cylindrical. "
NEW CONCEPTIONS IN HIRSCHSPRUNG’S DISEASE ANOTHER year’s work on Hirschsprung’s disease here and in the U.S.A. has confirmed the views on its pathology and treatment which Dr. Bodian and his colleaguesat the Hospital for Sick Children, Great Ormond Street, set out in their paper of January, 1949. At that time clinical evidence had placed the site of intestinal obstruction in a narrow " spastic " segment distal to the dilated hypertrophied colon. A careful radiological technique had been developed to display the terminal narrow segment and to obviate the flooding of the lower colon with barium which produces a fallacious appearance of dilatation to the anus. Resection of this abnormal distal segment by rectosigmoidectomy had been reported, first by Swenson,2 of Boston, to the Society of University Surgeons at New Orleans, and then by Stephens,3 one of the Great Ormond Street team, to the surgical section of the Society of Medicine. Histological examination of the distal segment by Bodian in 15 cases had revealed an absence of intramural ganglion cells and the presence of abnormal nerve-trunks at the sites of Auerbach’s and Meissner’s plexuses. Early in 1949, Whitehouse and Kernohan4 published a pathological report on 11 cases of Hirschsprung’s disease from the Mayo Clinic ; 10 of the specimens were obtained at necropsy and 1 after subtotal colectomy ; 8 of the patients were children aged 8 months to 15 years, and 3 were adults. The histological findings were essentially the same as those reported by Bodian et al. During 1949 Swenson and his collaborators 5 amplified their former clinical and radiological reports by a study of colonic peristalsis in 8 cases of Hirschsprung’s disease, using a multiple balloon technique, and by a histological study of -7 specimens. They also reported on a total of 34 rectosigmoidectomy operations. Their physiological experiments proved that peristalsis is absent and tonus increased in the distal colonic segment, and they confirmed that there are no sympathetic ganglion cells in this part of the gut. Their follow-up results for periods up to two years were apparent cures in 33 cases and 1 postoperative death. Radiologically they_de -monstrated return of the colon to approximately normal after operation. In this issue (p. 19) Dr. Bodian, Mr. Stephens, and Dr. Ward bring their findings and results up to date. The number of children with Hirschsprung’s disease treated by rectosigmoidectomy at the for Sick Children is now 26, and the 12 cases which were formerly reported have now been observed for twelve
Royal
Hospital
Bodian, M., Stephens, F. D., Ward, B. C. H. Lancet, 1949, i, 6. 2. Swenson, O., Bill, A. H. Surgery, 1948, 24, 212. 3. Stephens, F. D. Proc. R. Soc. Med. 1948, 41, 831. 4. Whitehouse, F. R., Kernohan, J. W. Arch. intern. Med. 1949, 82, 75. 5. Swenson, O., Rheinlander, H. F., Diamond, I. New Engl. J. Med. 1949, 241, 551. 1.
to fifteen months. This is still too short a time to reveal the final effects of the treatment, but the clinical improvement in the children, the establishment of regular spontaneous bowel actions, and the striking regression of radiological appearances after operation are impressive. The histological findings previously described have now been established in 28 consecutive cases ; there can be no reasonable doubt that they are characteristic of Hirschsprung’s disease and that absent peristaltic movement and increased tone in the distal colonic segment are functional manifestations of these structural changes. On the basis of the new aetiological concept rectosigmoidectomy is a rational treatment, and its value is certainly supported by the results so far
obtained. NOTIFICATION OF INFECTIOUS DISEASES THE classification of notifiable diseases of the central nervous system has now been placed on a more realistic basis. By new regulations, which we outlined last week, the distinction of polioencephalitis from poliomyelitis has been brought to an end ; and poliomyelitis is now notifiable as paralytic " or " non-paralytic." Acute "
"
encephalitis " (" infective " or post-infectious ") replaces the former heading of encephalitis lethargica " ; and the more generic menirrgococcal infection supersedes " cerebrospinal fever." The regulations are discussed in our public-health columns this week. "
"
"
NEW YEAR HONOURS Dr. Haden Guest, who receives a peerage, entered Parliament first in 1923 and is chairman both of the House of Commons Medical Parliamentary Group and of the Medical Personnel (Priority) Committee. He founded the Labour Party’s Commonwealth Group, and the breadth and vitalitv of his interests have likewise been shown by contributions to our columns as a special correspondent abroad in war and peace, as well as by regular parliamentary notes from " Medicus, over many years. - We thus have special reason to be glad at this recognition of his public services and personal merits. The knighthood in the Royal Victorian Order bestowed on Dr. H. K. Graham-Hodgson, of the Middlesex Hospital, is a suitable promotion from the c.v.o. he received as the radiological member of the team who attended King George V in his illness of 1928. Mr. T. E. V. Hurley, who becomes K.B.E., is consulting surgeon to the Royal Melbourne -Hospital, and of the new knights bachelor two (Dr. F. A. Gunasekera, of Ceylon, and Mr. T. G. Wilson, of Adelaide) are distinguished members of our profession overseas. At home it is a pleasure to see the name of Dr. H. E. ABoldero, dean of the Middlesex Hospital medical school and registrar of the Royal College of Physicians, whose wisdom in counsel has been decisive so much more often than his modest demeanour would suggest. Dr. J. A. Charles, who will next May succeed Sir Wilson Jameson as chief medical officer of the Ministry of Health, is another quietly effective man, whose ability was evident when he was -medical officer of health for Newcastle upon Tyne, and who, as a deputy c.M.o. at the Ministry, has won confidence by his readiness to listen and his power to understand. Our colleagues in Northern Ireland will especially welcome the honour paid to Dr. W. W. D. Thomson, professor of medicine at Queen’s University since 1923, and one of those who have helped to make Belfast the outstanding school it is today. These and the other names on a good list appear in full on another page. Outside the Medical Register, one of the highest honours, the G.c.B., goes to Sir William secretary to -the Ministry of Health during its difficult labours of the past few years, and- a knighthood to Mr. Arthur Sims, benefactor of medicine and surgery through his Commonwealth travelling professorships.
Douglas,
.
NEW CONCEPTIONS IN HIRSCHSPRUNG’S DISEASE ANOTHER year’s work on Hirschsprung’s disease here and in the U.S.A. has confirmed the views on its pathology and treatment which Dr. Bodian and his colleaguesat the Hospital for Sick Children, Great Ormond Street, set out in their paper of January, 1949. At that time clinical evidence had placed the site of intestinal obstruction in a narrow " spastic " segment distal to the dilated hypertrophied colon. A careful radiological technique had been developed to display the terminal narrow segment and to obviate the flooding of the lower colon with barium which produces a fallacious appearance of dilatation to the anus. Resection of this abnormal distal segment by rectosigmoidectomy had been reported, first by Swenson,2 of Boston, to the Society of University Surgeons at New Orleans, and then by Stephens,3 one of the Great Ormond Street team, to the surgical section of the Society of Medicine. Histological examination of the distal segment by Bodian in 15 cases had revealed an absence of intramural ganglion cells and the presence of abnormal nerve-trunks at the sites of Auerbach’s and Meissner’s plexuses. Early in 1949, Whitehouse and Kernohan4 published a pathological report on 11 cases of Hirschsprung’s disease from the Mayo Clinic ; 10 of the specimens were obtained at necropsy and 1 after subtotal colectomy ; 8 of the patients were children aged 8 months to 15 years, and 3 were adults. The histological findings were essentially the same as those reported by Bodian et al. During 1949 Swenson and his collaborators 5 amplified their former clinical and radiological reports by a study of colonic peristalsis in 8 cases of Hirschsprung’s disease, using a multiple balloon technique, and by a histological study of -7 specimens. They also reported on a total of 34 rectosigmoidectomy operations. Their physiological experiments proved that peristalsis is absent and tonus increased in the distal colonic segment, and they confirmed that there are no sympathetic ganglion cells in this part of the gut. Their follow-up results for periods up to two years were apparent cures in 33 cases and 1 postoperative death. Radiologically they_de -monstrated return of the colon to approximately normal after operation. In this issue (p. 19) Dr. Bodian, Mr. Stephens, and Dr. Ward bring their findings and results up to date. The number of children with Hirschsprung’s disease treated by rectosigmoidectomy at the for Sick Children is now 26, and the 12 cases which were formerly reported have now been observed for twelve
Royal
Hospital
Bodian, M., Stephens, F. D., Ward, B. C. H. Lancet, 1949, i, 6. 2. Swenson, O., Bill, A. H. Surgery, 1948, 24, 212. 3. Stephens, F. D. Proc. R. Soc. Med. 1948, 41, 831. 4. Whitehouse, F. R., Kernohan, J. W. Arch. intern. Med. 1949, 82, 75. 5. Swenson, O., Rheinlander, H. F., Diamond, I. New Engl. J. Med. 1949, 241, 551. 1.
to fifteen months. This is still too short a time to reveal the final effects of the treatment, but the clinical improvement in the children, the establishment of regular spontaneous bowel actions, and the striking regression of radiological appearances after operation are impressive. The histological findings previously described have now been established in 28 consecutive cases ; there can be no reasonable doubt that they are characteristic of Hirschsprung’s disease and that absent peristaltic movement and increased tone in the distal colonic segment are functional manifestations of these structural changes. On the basis of the new aetiological concept rectosigmoidectomy is a rational treatment, and its value is certainly supported by the results so far
obtained. NOTIFICATION OF INFECTIOUS DISEASES THE classification of notifiable diseases of the central nervous system has now been placed on a more realistic basis. By new regulations, which we outlined last week, the distinction of polioencephalitis from poliomyelitis has been brought to an end ; and poliomyelitis is now notifiable as paralytic " or " non-paralytic." Acute "
"
encephalitis " (" infective " or post-infectious ") replaces the former heading of encephalitis lethargica " ; and the more generic menirrgococcal infection supersedes " cerebrospinal fever." The regulations are discussed in our public-health columns this week. "
"
"
NEW YEAR HONOURS Dr. Haden Guest, who receives a peerage, entered Parliament first in 1923 and is chairman both of the House of Commons Medical Parliamentary Group and of the Medical Personnel (Priority) Committee. He founded the Labour Party’s Commonwealth Group, and the breadth and vitalitv of his interests have likewise been shown by contributions to our columns as a special correspondent abroad in war and peace, as well as by regular parliamentary notes from " Medicus, over many years. - We thus have special reason to be glad at this recognition of his public services and personal merits. The knighthood in the Royal Victorian Order bestowed on Dr. H. K. Graham-Hodgson, of the Middlesex Hospital, is a suitable promotion from the c.v.o. he received as the radiological member of the team who attended King George V in his illness of 1928. Mr. T. E. V. Hurley, who becomes K.B.E., is consulting surgeon to the Royal Melbourne -Hospital, and of the new knights bachelor two (Dr. F. A. Gunasekera, of Ceylon, and Mr. T. G. Wilson, of Adelaide) are distinguished members of our profession overseas. At home it is a pleasure to see the name of Dr. H. E. ABoldero, dean of the Middlesex Hospital medical school and registrar of the Royal College of Physicians, whose wisdom in counsel has been decisive so much more often than his modest demeanour would suggest. Dr. J. A. Charles, who will next May succeed Sir Wilson Jameson as chief medical officer of the Ministry of Health, is another quietly effective man, whose ability was evident when he was -medical officer of health for Newcastle upon Tyne, and who, as a deputy c.M.o. at the Ministry, has won confidence by his readiness to listen and his power to understand. Our colleagues in Northern Ireland will especially welcome the honour paid to Dr. W. W. D. Thomson, professor of medicine at Queen’s University since 1923, and one of those who have helped to make Belfast the outstanding school it is today. These and the other names on a good list appear in full on another page. Outside the Medical Register, one of the highest honours, the G.c.B., goes to Sir William secretary to -the Ministry of Health during its difficult labours of the past few years, and- a knighthood to Mr. Arthur Sims, benefactor of medicine and surgery through his Commonwealth travelling professorships.
Douglas,
.