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POLIOMYELITIS OR LEPTOSPIROSIS ?
306
largely negative the value of this innovation. In the case of inpatients, there seems to be no good reason for not using 24-hour collections if one wishes to record the 24-hour output. The objections mentioned above may or may not hold good ; on an entirely different basis, however, is the now very considerable evidence, from widely differing sources, that pregnanediol excretion, even when measured in terms of 24-hour outputs, can vary to such an extent as to reduce the clinical value of its measurement to a low level except in special circumstances. As I pointed out at the Congress of Obstetrics and Gynaecology, it appeared improbable that this state of affairs could be ascribed entirely to technical inadequacies, while at the same time there were no solid grounds for believing that pregnanediol excretion at all closely paralleled the production of progesterone (as had been shown most convincingly by Professor Marrian in his paper at the congress). I would reiterate now, what I suggested then, that a simple direct method of estimating the blood-progesterone would surely supply evidence of much more clinical value than could ever be expected from the pregnanediol excretion in the urine. Obstetric Hospital, University College G. I. M. SWYER. Hospital, London, W.C.1.
PREVENTION OF BURNS AND SCALDS
S]IR,-l read with interest the paper by Dr. Leonard Colebrook (July 30), which has had considerable puba leading article in the Manchester I was surprised to find that it makes no Guardian. mention of the activities of the professional fire brigades in encouraging fire-protection methods in the design of domestic appliances and better appreciation of fire prevention amongst members of the public. Under the Fire Services Act, 1947, every fire brigade is responsible for giving, when requested, advice in respect of buildings and other property as to fire prevention, restricting the spread of fire, and means of escape in case of fire. Many fire brigades are actively concerned in carrying out propaganda and publicity towards this end, and I should like to congratulate Dr. Colebrook and your journal on publishing this article. We hope
licity, including
that, together with the efforts of the professional fire
POLIOMYELITIS OR LEPTOSPIROSIS ? SiR,—It is said that many cases of anterior polio. myelitis may be expected this autumn. Hence we think it should be noted that the meningeal form of leptospirosis
resembles mild poliomyelitis without paralysis. Infections with Leptospira icterohaemorrhagiae and L. canicola are being recognised with increasing frequency in this country, and many of these cases occur in the autumn. The possibility that the meningitis may be due to L. icterohaemorrhagiae should be considered if the patient has bathed in stagnant fresh-water, or if he is likely to come into contact, at work, with water which might be contaminated with rat urine. Contact with a sick dog would suggest the chance of infection with L. canicola. The diagnosis can most easily be confirmed by testing the patient’s serum for the presence of leptospiral anti-bodies, which first appear about the seventh day of illness. Unfortunately, laboratory diagnosis is not usually practicable in the earliest stages of the disease. Other forms of meningitis may resemble poliomyelitis, and bacteriological examination of blood or cerebrospinal fluid can detect the responsible micro-organism or virus in many instances. As regards poliomyelitis, the diagnosis by laboratory methods cannot always be assured in mild cases. If leptospiral meningitis is the correct diagnosis, the prognosis is improved, because death and permanent disability are almost unknown. In addition, this diagnosis removes anxiety about poliomyelitis developing in the patient’s neighbourhood.
closely
Group Laboratory, Archway Hospital, N.19. Leptospira Reference Laboratory, Wellcome Research Institution, N.W.1.
it will
bring home to danger which exists
the public the constant source of in every home and the number of avoidable deaths which are caused year after year through neglect to take reasonable ,precautions. K. N. HOARE Fairfield Street,
brigades,
As pointed out before, stimulation of the genitofemoral nerve at the point where the ureter crosses it cannot possibly explain the descending nature of calculus pain any more than a station-master at Newcastle can - see all the Flying Scotsman’s movements between London and Edinburgh. Testicular retraction in calculus obstruction by no means refutes this. The motor- nerve-fibres are stimulated reflexly, not directly ; so it is fallacious to adduce testicular retraction as evidence of direct nerve stimulation. FELIX E. WEALE. East Barnet, Herts.
Manchester, 1.
Chief Officer, City of Manchester Fire Brigade.
TESTICULAR PAIN
SiR,—Dr. MacDougall’s
account o the
somatic
nerve-
supply to the testis is accurate ; it strictly agrees with The visceral nerve-supply is not Gray’s 37aatomy. absolutely agreed on by all anatomists. ’In so far as he includes the renal and aortic plexuses, and therefore additional spinal segments, he merely argues my point with greater eloquence than I do. For my point is that testicular pain cannot be localised to a single invariable spot (point B, fig. 3 of Mr. Brown’s article), whether its path be along visceral or somatic or both sets of nerves. As he says, the tunica vaginalis is presumably innervated from the overlying somatic nerves. My own view is that the ilio-inguinal nerve is responsible most of all, because its course betrays its elongation as the tunica vaginalis descends into the scrotum ; also, pain is not usually referred along the perineal nerves. What Mr. Brown actually calls " tunica vaginalis pain "-i.e., the testicular pain of the intact body-Dr. MacDougall would therefore assign to all the scrotal nerves. In this he unwittingly and fundamentally differs from the view he set out to defend-namely, that the genital nerve alone is wholly responsible.
MALE TOADS
J. M. ALSTON. J. C. BROOM.
IN PREGNANCY TESTS
SIR,-As the letter from Professor Bach and Dr. Szmuk (July 30) may prove misleading to those who did not see the previous letter by Bach et al,l we should like to point out that their series of 610 tests was apparently performed on J2
Bach, I., Szmuk, I., Robert, L., Klinger, B. Lancet, 1949, i, 124. Frazer, J. F. D., Wohlzogen, F. X. Ibid, July 16, p. 134.
largely negative the value of this innovation. In the case of inpatients, there seems to be no good reason for not using 24-hour collections if one wishes to record the 24-hour output. The objections mentioned above may or may not hold good ; on an entirely different basis, however, is the now very considerable evidence, from widely differing sources, that pregnanediol excretion, even when measured in terms of 24-hour outputs, can vary to such an extent as to reduce the clinical value of its measurement to a low level except in special circumstances. As I pointed out at the Congress of Obstetrics and Gynaecology, it appeared improbable that this state of affairs could be ascribed entirely to technical inadequacies, while at the same time there were no solid grounds for believing that pregnanediol excretion at all closely paralleled the production of progesterone (as had been shown most convincingly by Professor Marrian in his paper at the congress). I would reiterate now, what I suggested then, that a simple direct method of estimating the blood-progesterone would surely supply evidence of much more clinical value than could ever be expected from the pregnanediol excretion in the urine. Obstetric Hospital, University College G. I. M. SWYER. Hospital, London, W.C.1.
PREVENTION OF BURNS AND SCALDS
S]IR,-l read with interest the paper by Dr. Leonard Colebrook (July 30), which has had considerable puba leading article in the Manchester I was surprised to find that it makes no Guardian. mention of the activities of the professional fire brigades in encouraging fire-protection methods in the design of domestic appliances and better appreciation of fire prevention amongst members of the public. Under the Fire Services Act, 1947, every fire brigade is responsible for giving, when requested, advice in respect of buildings and other property as to fire prevention, restricting the spread of fire, and means of escape in case of fire. Many fire brigades are actively concerned in carrying out propaganda and publicity towards this end, and I should like to congratulate Dr. Colebrook and your journal on publishing this article. We hope
licity, including
that, together with the efforts of the professional fire
POLIOMYELITIS OR LEPTOSPIROSIS ? SiR,—It is said that many cases of anterior polio. myelitis may be expected this autumn. Hence we think it should be noted that the meningeal form of leptospirosis
resembles mild poliomyelitis without paralysis. Infections with Leptospira icterohaemorrhagiae and L. canicola are being recognised with increasing frequency in this country, and many of these cases occur in the autumn. The possibility that the meningitis may be due to L. icterohaemorrhagiae should be considered if the patient has bathed in stagnant fresh-water, or if he is likely to come into contact, at work, with water which might be contaminated with rat urine. Contact with a sick dog would suggest the chance of infection with L. canicola. The diagnosis can most easily be confirmed by testing the patient’s serum for the presence of leptospiral anti-bodies, which first appear about the seventh day of illness. Unfortunately, laboratory diagnosis is not usually practicable in the earliest stages of the disease. Other forms of meningitis may resemble poliomyelitis, and bacteriological examination of blood or cerebrospinal fluid can detect the responsible micro-organism or virus in many instances. As regards poliomyelitis, the diagnosis by laboratory methods cannot always be assured in mild cases. If leptospiral meningitis is the correct diagnosis, the prognosis is improved, because death and permanent disability are almost unknown. In addition, this diagnosis removes anxiety about poliomyelitis developing in the patient’s neighbourhood.
closely
Group Laboratory, Archway Hospital, N.19. Leptospira Reference Laboratory, Wellcome Research Institution, N.W.1.
it will
bring home to danger which exists
the public the constant source of in every home and the number of avoidable deaths which are caused year after year through neglect to take reasonable ,precautions. K. N. HOARE Fairfield Street,
brigades,
As pointed out before, stimulation of the genitofemoral nerve at the point where the ureter crosses it cannot possibly explain the descending nature of calculus pain any more than a station-master at Newcastle can - see all the Flying Scotsman’s movements between London and Edinburgh. Testicular retraction in calculus obstruction by no means refutes this. The motor- nerve-fibres are stimulated reflexly, not directly ; so it is fallacious to adduce testicular retraction as evidence of direct nerve stimulation. FELIX E. WEALE. East Barnet, Herts.
Manchester, 1.
Chief Officer, City of Manchester Fire Brigade.
TESTICULAR PAIN
SiR,—Dr. MacDougall’s
account o the
somatic
nerve-
supply to the testis is accurate ; it strictly agrees with The visceral nerve-supply is not Gray’s 37aatomy. absolutely agreed on by all anatomists. ’In so far as he includes the renal and aortic plexuses, and therefore additional spinal segments, he merely argues my point with greater eloquence than I do. For my point is that testicular pain cannot be localised to a single invariable spot (point B, fig. 3 of Mr. Brown’s article), whether its path be along visceral or somatic or both sets of nerves. As he says, the tunica vaginalis is presumably innervated from the overlying somatic nerves. My own view is that the ilio-inguinal nerve is responsible most of all, because its course betrays its elongation as the tunica vaginalis descends into the scrotum ; also, pain is not usually referred along the perineal nerves. What Mr. Brown actually calls " tunica vaginalis pain "-i.e., the testicular pain of the intact body-Dr. MacDougall would therefore assign to all the scrotal nerves. In this he unwittingly and fundamentally differs from the view he set out to defend-namely, that the genital nerve alone is wholly responsible.
MALE TOADS
J. M. ALSTON. J. C. BROOM.
IN PREGNANCY TESTS
SIR,-As the letter from Professor Bach and Dr. Szmuk (July 30) may prove misleading to those who did not see the previous letter by Bach et al,l we should like to point out that their series of 610 tests was apparently performed on J2
Bach, I., Szmuk, I., Robert, L., Klinger, B. Lancet, 1949, i, 124. Frazer, J. F. D., Wohlzogen, F. X. Ibid, July 16, p. 134.