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PRESENT VIEWS ON TUBERCULOUS MENINGITIS
362 of the vessels of the stomach in described by Barclay and Bentley and by Woolf will prove most valuable-. The effects on the gastric vessels of central nervous influences and of vagal and sympathetic stimulation and inhibition deserve further investigation. When we know the relation of these factors to gastric acidity and to muscle-spasm, we may have a clearer understanding In the further
study
health -and disease the
techniques
of the mechanism of peptic ulceration.
A DEATH FROM ANTISERUM DEATHS following injections of antisera are so uncommon that the odds against such a catastrophe occurring after a particular injection are 50,000 or more to 1 ; but they seldom escape the attention of the lay press, and, besides providing ammunition for those whose revulsion from cruelty to animals sometimes leads them to misjudge the aims and methods of experimental medicine, they may well prejudice the public against methods of treatment which are in their best interests. Lately a boy who had been bitten by his dog was given tetanus antiserum and died soon afterwards from anaphylactic shock.- At the inquest it was reported1 that he had suffered from asthma ; and there seems no doubt that Even such people are especially liable to this risk. now there are more deaths from tetanus than from anaphylactic shock, and tetanus deaths could almost always have been prevented. No-one would suggest that in the present ease the doctor erred in giving antiserum, and he would still have been right to give it if he had been toldthe history of asthma, which in Intradermal or conjunctival tests for fact he was not. hypersensitivity to serum proteins have been popular in the U.S.A., but whether they have saved any lives is doubtful. The sovereign remedy for these cases derives from sound pathology and has the support of experience. It is a sterile solution of adrenaline hydrochloride 1/1000, kept at the doctor’s elbow whenever he has to administer antiserum’; and some near-accidents suggest that he would be wise to see that it is in the same place when he injects vaccines and other fluids containing proteins.
PERIODICITY IN DISEASE THERE are plenty of periodic diseases whose explanation clearly lies in the life-cycle of the infecting organism, but there are others in which symptoms recur at fairly regular -intervals for years, for no ascertainable reason, and without much disturbance of the patient’s general health except during the episodes. Reimannoriginally divided such diseases into four categories : periodic fever, abdominalgia, arthralgia, and neutropenia. Now 2 he also includes periodic purpura, thrombopenia, cedema, and urticaria, and the better-recognised syndrome of periodic paralysis. He suggests that the periodicity of these states is some justification for considering them as a single " periodic disease," of which he has seen or found references to 53 cases, 36 in males and 17 in females. The most striking uniformity of rhythm seems to occur in the cases of neutropenia, where apparently a regular cycle of about three weeks may continue for years with normal health between exacerbations ; the duration of disability, with pyrexia and malaise, in these " attacks" may be only a day or two. These conditions have been thoroughly investigated without finding any satisfactory cause. Infection, allergy, endocrinological and nervous factors, and other explanations have been put forward, and Reimann thinks they are a manifestation of a basic physiological rhythm. The frequency of periodic exacerbations in disease is illustrated in our " Disabilities " series where a hæmophilic man has noted periodic variations in his tendency to bleed, a manicdepressive has described the well-recognised ups and downs in mental powers, and a man with ulcerative colitis has reported a purpuric eruption recurring every fortnight for six months. It may even be true that close scrutiny would reveal a periodicity in all chronic ailments.
PRESENT VIEWS ON TUBERCULOUS MENINGITIS WHAT lessons -have been learnt from the three years’ experience -with streptomycin in the treatment of tuberculous meningitis ? Whatwas said at the UNiCEF conference (summarised on p. 365), and the comments LADY TATA TRUST by Dr. MacCarthy and Dr. Mann on children treated under the Medical Research Council scheme (p. 341), THE Lady Tata Memorial Trust has been supporting make it clear that there is no short cut to success. Intraresearch- into leukaemia- and other blood diseases for muscular streptomycin must be given once or twice a seventeen years ; and a short account of the first fifteen day for at least six months, combined with intrathecal of of the international section has now the work years The injections for the first three months or so. been published. Financial assistance has been given to rate has last two survival in increased the steadily 29 = workers in eleven countries in one of two ways : because cases are diagnosed sooner and years largely by, short-term scholarships or expenses grants for one treated immediately, and because the C.S.F. findings, to three years ; and by long-term expenses grants to aidthan the clinical picture, are taken as the guide rather experimental researches by established teams of workers. in when the streptomycin injections can stop. deciding The first ’type of grant has supported, many different Mechanical obstruction to the flow of streptomycin researches. The second type has been used almost the cerebrospinal pathways is a common cause exclusively to support researches into animal leukaemia through of a poor initial response ; administration via the at centres in New York, Paris, and Copenhagen ; this ventricles or cisterna magna may solve this is regarded by many as a branch of cancer research, and but sometimes more extensive neurosurgery is the reports of the three directors confirm this view. Now bacilli are dispersed However, as Prof. Jacob Furth points out, the develop- in the that streptomycin-resistant strain may be found at the a resistant population, ment of urethane and other similar treatments for start of treatment ; so sensitivity tests are advisable leukaemia has been greatly helped by preliminary screenCombined treatment with streptomycin throughout. ing tests on animals ; the disease is readily transferred and acid seems to prevent sensitive p-aminosalicylic from leukaemic to healthy mice. strains becoming resistant, but other combinations, The bulk of the report is taken up by a year-to-year as streptomycin plus Promizole,’ or sulphones such list of the programmes at various centres and their_ plus vitamins A and D, have their advocates, and much published work. In this country the trust has lately work is being done on new antibiotics, such as Waksman’s confined its awards to expenses grants ; this is because Neomycin ’ obtained from Streptomyces fradiœ, to which E400 a year is now too small an income to offer an has not yet learnt to become resistant. bacillus the experienced worker for three years. On the other hand, an expenses grant may enable extra clerical or technical Prof. S. E. WHITNALL, who had held the chairs of assistance to be enlisted, so’furthering work already in at McGill University, Montreal, and in the anatomy progress. The trust has preferred to spread rather than University of Bristol, died on Feb. 19 at the age of 73. concentrate their devalued resources.
difficulty, required.
--
1. Daily
Telegraph and Manchester Guardian for Feb. 14.
1. Reimann, H. A. 2. Reimann, H. A.
J. Amer. med. Ass. 1948, Ibid, 1949, 141, 175.
136, 239.
,
study
health -and disease the
techniques
of the mechanism of peptic ulceration.
A DEATH FROM ANTISERUM DEATHS following injections of antisera are so uncommon that the odds against such a catastrophe occurring after a particular injection are 50,000 or more to 1 ; but they seldom escape the attention of the lay press, and, besides providing ammunition for those whose revulsion from cruelty to animals sometimes leads them to misjudge the aims and methods of experimental medicine, they may well prejudice the public against methods of treatment which are in their best interests. Lately a boy who had been bitten by his dog was given tetanus antiserum and died soon afterwards from anaphylactic shock.- At the inquest it was reported1 that he had suffered from asthma ; and there seems no doubt that Even such people are especially liable to this risk. now there are more deaths from tetanus than from anaphylactic shock, and tetanus deaths could almost always have been prevented. No-one would suggest that in the present ease the doctor erred in giving antiserum, and he would still have been right to give it if he had been toldthe history of asthma, which in Intradermal or conjunctival tests for fact he was not. hypersensitivity to serum proteins have been popular in the U.S.A., but whether they have saved any lives is doubtful. The sovereign remedy for these cases derives from sound pathology and has the support of experience. It is a sterile solution of adrenaline hydrochloride 1/1000, kept at the doctor’s elbow whenever he has to administer antiserum’; and some near-accidents suggest that he would be wise to see that it is in the same place when he injects vaccines and other fluids containing proteins.
PERIODICITY IN DISEASE THERE are plenty of periodic diseases whose explanation clearly lies in the life-cycle of the infecting organism, but there are others in which symptoms recur at fairly regular -intervals for years, for no ascertainable reason, and without much disturbance of the patient’s general health except during the episodes. Reimannoriginally divided such diseases into four categories : periodic fever, abdominalgia, arthralgia, and neutropenia. Now 2 he also includes periodic purpura, thrombopenia, cedema, and urticaria, and the better-recognised syndrome of periodic paralysis. He suggests that the periodicity of these states is some justification for considering them as a single " periodic disease," of which he has seen or found references to 53 cases, 36 in males and 17 in females. The most striking uniformity of rhythm seems to occur in the cases of neutropenia, where apparently a regular cycle of about three weeks may continue for years with normal health between exacerbations ; the duration of disability, with pyrexia and malaise, in these " attacks" may be only a day or two. These conditions have been thoroughly investigated without finding any satisfactory cause. Infection, allergy, endocrinological and nervous factors, and other explanations have been put forward, and Reimann thinks they are a manifestation of a basic physiological rhythm. The frequency of periodic exacerbations in disease is illustrated in our " Disabilities " series where a hæmophilic man has noted periodic variations in his tendency to bleed, a manicdepressive has described the well-recognised ups and downs in mental powers, and a man with ulcerative colitis has reported a purpuric eruption recurring every fortnight for six months. It may even be true that close scrutiny would reveal a periodicity in all chronic ailments.
PRESENT VIEWS ON TUBERCULOUS MENINGITIS WHAT lessons -have been learnt from the three years’ experience -with streptomycin in the treatment of tuberculous meningitis ? Whatwas said at the UNiCEF conference (summarised on p. 365), and the comments LADY TATA TRUST by Dr. MacCarthy and Dr. Mann on children treated under the Medical Research Council scheme (p. 341), THE Lady Tata Memorial Trust has been supporting make it clear that there is no short cut to success. Intraresearch- into leukaemia- and other blood diseases for muscular streptomycin must be given once or twice a seventeen years ; and a short account of the first fifteen day for at least six months, combined with intrathecal of of the international section has now the work years The injections for the first three months or so. been published. Financial assistance has been given to rate has last two survival in increased the steadily 29 = workers in eleven countries in one of two ways : because cases are diagnosed sooner and years largely by, short-term scholarships or expenses grants for one treated immediately, and because the C.S.F. findings, to three years ; and by long-term expenses grants to aidthan the clinical picture, are taken as the guide rather experimental researches by established teams of workers. in when the streptomycin injections can stop. deciding The first ’type of grant has supported, many different Mechanical obstruction to the flow of streptomycin researches. The second type has been used almost the cerebrospinal pathways is a common cause exclusively to support researches into animal leukaemia through of a poor initial response ; administration via the at centres in New York, Paris, and Copenhagen ; this ventricles or cisterna magna may solve this is regarded by many as a branch of cancer research, and but sometimes more extensive neurosurgery is the reports of the three directors confirm this view. Now bacilli are dispersed However, as Prof. Jacob Furth points out, the develop- in the that streptomycin-resistant strain may be found at the a resistant population, ment of urethane and other similar treatments for start of treatment ; so sensitivity tests are advisable leukaemia has been greatly helped by preliminary screenCombined treatment with streptomycin throughout. ing tests on animals ; the disease is readily transferred and acid seems to prevent sensitive p-aminosalicylic from leukaemic to healthy mice. strains becoming resistant, but other combinations, The bulk of the report is taken up by a year-to-year as streptomycin plus Promizole,’ or sulphones such list of the programmes at various centres and their_ plus vitamins A and D, have their advocates, and much published work. In this country the trust has lately work is being done on new antibiotics, such as Waksman’s confined its awards to expenses grants ; this is because Neomycin ’ obtained from Streptomyces fradiœ, to which E400 a year is now too small an income to offer an has not yet learnt to become resistant. bacillus the experienced worker for three years. On the other hand, an expenses grant may enable extra clerical or technical Prof. S. E. WHITNALL, who had held the chairs of assistance to be enlisted, so’furthering work already in at McGill University, Montreal, and in the anatomy progress. The trust has preferred to spread rather than University of Bristol, died on Feb. 19 at the age of 73. concentrate their devalued resources.
difficulty, required.
--
1. Daily
Telegraph and Manchester Guardian for Feb. 14.
1. Reimann, H. A. 2. Reimann, H. A.
J. Amer. med. Ass. 1948, Ibid, 1949, 141, 175.
136, 239.
,