PURPURA HÆMORRHAGICA FOLLOWING MEASLES

1036

PUBLIC HEALTH

PROPHYLACTIC ENUCLEATION OF LOWER WISDOM TOOTH FOLLICLES To the Editor

of

THE LANCET

SIR,-I am sure that the medical profession as whole will be grateful to Mr. Bowdler Henry for bringing forward such an easy and entirely satisfactory procedure to cope with what is often a menace namely, a badly impacted unerupted lower molar tooth. By such a prophylactic measure as Mr. Henry has introduced, all the numerous risks which are attendant upon maleruption are eliminated. Surgeons are familiar with some of the complications which follow the extraction of a badly unerupted third molar and it has been my lot to be called into consultation several times when fracture of the jaw has resulted from attempts to remove such a tooth. I can vouch that prophylactic enucleation is entirely free from trauma, and is quite a simple operation ; one only wonders why such an easy remedy had not been thought of years ago. I am, Sir, yours faithfully, CECIL P. G. G. WAKELEY. WAKELEY. a

Queen Anne-street, W., April 22nd.

99° F. ; pulse-rate, 120. She was given 20 c.cm. of whole blood from her father, as well as glucose and saline intramuscularly. Both punctures bled very freely, but curiously when 20 c.cm. of scarlatinal antitoxin was given, also intramuscularly, the puncture did not bleed. She passed a dark tarry stool; the urine was bright red with blood. Bloodplatelets numbered 35,000 per c.mm. ; otherwise there was nothing strikingly abnormal in the blood. Prof. J. F. Wilkinson was consulted and advised intensive vitamin-C therapy, both oral and hypodermic ; ascorbic acid was used, and in addition eight lemons were given daily. She continued to pass blood until April 15th, when both faeces and urine were clear. The skin gradually cleared, but peeled profusely and serum continued to ooze in places. She is making good progress towards complete recovery. On April 24th the blood-platelets were up to 100,000 per c.mm., and the general condition has improved considerably. I am,

of THE

LANCET

SIR,-Your last issue contained an account of purpura complicating scarlet fever, and it may be of interest to put on record a case in which it followed measles. A

girl, aged 4,

was

admitted to this

hospital

on

,.

with the provisional diagnosis of black measles." It appeared that she had a measles rash on March 29th ; on April 7th she came out with a haemorrhagic rash and passed blood in the faeces and urine. She had widespread petechial and purpuric haemorrhages all over the body and sordes of coagulated blood. The hands were a deep dark blue, the face pale and the child obviously poorly. Temp.,

April 8th,

yours

faithfully, W. EDGE,

April 27th.

Medical Superintendent, Ladywell Sanatorium and Isolation Hospital, Salford.

OMNIPRATICIENS To the Editor of THE LANCET

PURPURA HÆMORRHAGICA FOLLOWING MEASLES

To the Editor

Sir,

SIR,-I have just observed that in a circular emanating from the publishers of a medical book in Paris they state that " Tous les medecins (omnipraticiens et specialistes) doivent avoir ce petit volume sur leur bureau." The word " omnipraticiens " is new to me, and I suppose is nearer akin to the English " general practitioner " than was the old expression " medecin praticien." I have no the is of far new word how knowledge generally used in France, but it is certainly compact if it means " " general practitioner as in English, and it may be quite useful to our own doctors visiting France if they wish to describe their position concisely in modern language.-I am, Sir, yours faithfully, London, April 24th.

BLANCUS.

PUBLIC HEALTH producers who are suitably qualified. If tuberculinDesignations tested milk has been bottled on the farm-like the THE Milk (Special Designations) Order, 1936, was present Certified milk-it may be described as. made available last Saturday and will come into force tuberculin-tested (certified) ; if it has been pasteurised on June 1st. It supersedes the two draft orders it will be called tuberculin-tested (pasteurised). which have been issued and lays down the new Furthermore accredited milk may be described as. system of milk grading. "farm bottled." Hence the varieties available to the public (not necessarily in order of merit) will beThe grades at present in force are :Revised Milk

Tuberculin-tested (certified) Tuberculin-tested (pasteurised) Tuberculin-tested Accredited (farm bottled) Accredited Pasteurised

Certified Grade A (tuberculin tested) Grade A [Grade A (pasteurised)]

Pasteurised.

There is no necessity for producers to conform to the standards established for these grades, and most milk sold to the public is undesignated. The new regulations make no change in this policy: they do not require that all milk shall be graded. Instead they continue the plan by which designations are given as a mark of commendation for efforts to reach a better standard. The

scheme is simpler than the there are only three grades :—

new

essentially

old,

and

Tuberculin-tested Accredited Pasteurised.

Additional

descriptions

may,

however, be added by

milk. It will be observed that all tuberculin-tested milk will now be described as such-whether or not the term " certified " is applied in addition. The old requirements were that certified milk should contain not more than 30,000 bacteria per c.cm. and Grade A (T.T.) not more than 200,000; and until the end of this year the latter standard will hold good for the new T.T. grade. After that time the bacterial plate-count will be discontinued in favour ofa methylene-blue reduction test (see THE LANCET, April llth, p. 866). In addition, no coliform bacilli should be found in 0-01 millilitre-a requirement similar3 to that for Grade A (T.T.). Tuberculin-

and, of

course,

undesignated