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ROAD ACCIDENTS
to treatment ; and (2) purified liver extracts. Here it should have been indicated that we had in mind those prepared by the technique of Dakin and West and other similar methods ; we to the concentrated " refined " were not referring extracts which are popular in the U.S.A., but which we are not allowed to import.-ED. L.
notoriously resistant
THE EOSINOPHIL CELL
SiR,—According to Duran-Jorda1 the granules of the eosinophil cells are round in man and many other mammals, whereas in the camel they are oval. It is well known that the mature erythrocytes of camels and llamas are oval or elliptical, whereas their immature red cells found in the bone-marrow are round. DuranJorda considered his observation to prove his earlier view that erythrocytes are derived not from immature red cells through maturation of erythroblasts but from the eosinophil granules. In his opinion the assumption that human round eosinophil granules are converted into round erythrocytes, and oval granules in camels to oval erythrocytes, is more likely than the assumption that round immature red blood-cells turn into oval
erythrocytes.
In 1946 J. Matsch and I published data concerning two elliptocytic families.2 The erythroblasts of the bonemarrow of elliptocytic people are round, whereas in the peripheral blood more than 25% of the red bloodcells are elliptical. In some cases observed by us the elliptocytes in the peripheral blood were more than 90 %. In one of the two families (four generations were reported) cases of severe haemolytic anasmia occurred. In three of the brothers and sisters the haemolytic anaemia was so severe as to need splenectomy. Afcer splenectomy the degree of haemolysis has become normal in all three patients, the anaemia has ceased, and erythropoiesis, which was increased in the bone-marrow, has now become normal, like the resistance of the erythrocytes and the number of reticulocytes. During the heemolytic- stage the thickness of the erythrocytes was greater (3-3 ) ; after splenectomy their thickness became normal (2-2 .). The elliptocytosis remained unchanged. The result of the operation lasted 7-18 years. As regards heredity, the parents were cousins : one of the paternal grandparents was the brother of one of the maternal grandparents. Elliptocytosis was transmitted from the maternal side, this maternal grandparent being the partial carrier of the anomaly. On the paternal side haemolytic anaemia also was probably transmitted, because 14 brothers and sisters of the father, who was already dead at the time of examination, had died in early childhood, very likely of haemolytic anaemia. We inferred that elliptocytosis and a haemolytic tendency had been simultaneously inherited. The increased 1. Duran-Jorda, F. Lancet, 1948, ii, 451. 2. Lendvai, J., Matsch, J. Orv. Lapja, 1946, 2, 445.
thickness and diminished resistance of the elliptocytes secondary to this hsemolytic mechanism. Otherwise it could not be explained why splenectomy-i.e., the removal of the central organ of this system-led to normal cell thickness and regression of the hsemolytie phenomena, while the erythrocytes remained elliptical. In our patients it was in the reticulocyte stage that round and elliptical cells were found at the same time. The shape of the eosinophil granules is interesting. The accompanying figure shows a slightly damaged myelocyte, found in the bone-marrow, and its eosinophil granules, which are round, whereas the erythrocytes are elliptical. In this patient over 90 % of the erythrocytes were, as in the camel, elliptical by heredity, whereas the eosinophil granules were not elliptical but round. We believe that the conclusions drawn from the similarity of erythrocytes and eosinophil granules have been erroneously applied to human erythropoiesis, the shape of the erythrocytes and the granules being different in our were
patient.
-
-
J. LENDVAI.
Budapest. ROAD ACCIDENTS
SiR,-Your correspondents on road accidents have not mentioned dogs as a factor. Some months ago I wrote to the R.A.C., suggesting that research should be initiated on the reactions of dogs to road vehicles. It is the experience of every motorist, at times, to sound the horn vigorously, and the dog still stands in the middle of the road. I wondered whether this may be due to tone-deafness at the frequency of the ordinary motor-horn. I suggested to the R.A.C. that they might investigate this question, and produce a horn possibly inaudible to the human ear but offensive to a dog’s ear, rather on the lines of dog whistles which are of such high frequency that the human ear cannot detect them. Furthermore, large-scale research should be undertaken on the general reactions of dogs to motor vehicles, with a view to finding some offensive instrument which would frighten them from the road. I think the figures show that the stray dog is as much responsible for accidents as the other factors, but I have seen no evidence that this problem is being seriously studied. B. SANDLER. Urmston, Lanes. MYASTHENIA GRAVIS
SiR,-Having seen the account of myasthenia gravis in your issue of Jan. 29, by a contributor to the Disabilities series, I feel that my own experience of this disease may be of interest. The trouble started at the end of 1942 when I was aged 22, and the first symptoms were, in my case also, imbalance of the eye muscles resulting in double vision. Within three months, excessive fatigue became apparent, and I found myself unable to continue with my fairly light manual job. Unlike your contributor, however, I experienced no variations in the rigour of the symptoms, my decline in strength steadily progressing until I was sent into hospital. There an injection of 20 mg. neostigmine bromide with dramatic results, and shortly afterwards I was discharged with instructions to take three 15 mg. tablets by mouth daily, together with ephedrine gr. 1/2’ It soon became clear that my steady decline in strength was continuing, the tablets only affording very temporary relief ; and after consultation with another neurologist, and increasing the dosage up to nine or ten tablets per day, I decided to try deep X-ray therapy to the thymus gland. The eight-week course of treatment was finished about the end of August, 1943, and a fortnight later I came to the conclusion that my decline in strength had been checked. At this stage I was taking the maximum dose of neostigmine ; I could walk about 100 yards if the going was smooth : I could open my eyes about half-way for short periods with difficulty ; I could talk for about one minute ; grimaces were impossible ; and I was having considerable difficulty in I had
swallowing
solid food.
From this time on, my
improvement,
though slow, was steady. Gradually I was able to reduce the dose of neostigmine until finally it became unnecessary. In the spring of 1944 I started a part-time clerical job, and was subsequently able to resume full-time clerical work. In 1946, however, much to my dismay I had a recurrence of the diplopia, and gradually my old symptoms began to
,
notoriously resistant
THE EOSINOPHIL CELL
SiR,—According to Duran-Jorda1 the granules of the eosinophil cells are round in man and many other mammals, whereas in the camel they are oval. It is well known that the mature erythrocytes of camels and llamas are oval or elliptical, whereas their immature red cells found in the bone-marrow are round. DuranJorda considered his observation to prove his earlier view that erythrocytes are derived not from immature red cells through maturation of erythroblasts but from the eosinophil granules. In his opinion the assumption that human round eosinophil granules are converted into round erythrocytes, and oval granules in camels to oval erythrocytes, is more likely than the assumption that round immature red blood-cells turn into oval
erythrocytes.
In 1946 J. Matsch and I published data concerning two elliptocytic families.2 The erythroblasts of the bonemarrow of elliptocytic people are round, whereas in the peripheral blood more than 25% of the red bloodcells are elliptical. In some cases observed by us the elliptocytes in the peripheral blood were more than 90 %. In one of the two families (four generations were reported) cases of severe haemolytic anasmia occurred. In three of the brothers and sisters the haemolytic anaemia was so severe as to need splenectomy. Afcer splenectomy the degree of haemolysis has become normal in all three patients, the anaemia has ceased, and erythropoiesis, which was increased in the bone-marrow, has now become normal, like the resistance of the erythrocytes and the number of reticulocytes. During the heemolytic- stage the thickness of the erythrocytes was greater (3-3 ) ; after splenectomy their thickness became normal (2-2 .). The elliptocytosis remained unchanged. The result of the operation lasted 7-18 years. As regards heredity, the parents were cousins : one of the paternal grandparents was the brother of one of the maternal grandparents. Elliptocytosis was transmitted from the maternal side, this maternal grandparent being the partial carrier of the anomaly. On the paternal side haemolytic anaemia also was probably transmitted, because 14 brothers and sisters of the father, who was already dead at the time of examination, had died in early childhood, very likely of haemolytic anaemia. We inferred that elliptocytosis and a haemolytic tendency had been simultaneously inherited. The increased 1. Duran-Jorda, F. Lancet, 1948, ii, 451. 2. Lendvai, J., Matsch, J. Orv. Lapja, 1946, 2, 445.
thickness and diminished resistance of the elliptocytes secondary to this hsemolytic mechanism. Otherwise it could not be explained why splenectomy-i.e., the removal of the central organ of this system-led to normal cell thickness and regression of the hsemolytie phenomena, while the erythrocytes remained elliptical. In our patients it was in the reticulocyte stage that round and elliptical cells were found at the same time. The shape of the eosinophil granules is interesting. The accompanying figure shows a slightly damaged myelocyte, found in the bone-marrow, and its eosinophil granules, which are round, whereas the erythrocytes are elliptical. In this patient over 90 % of the erythrocytes were, as in the camel, elliptical by heredity, whereas the eosinophil granules were not elliptical but round. We believe that the conclusions drawn from the similarity of erythrocytes and eosinophil granules have been erroneously applied to human erythropoiesis, the shape of the erythrocytes and the granules being different in our were
patient.
-
-
J. LENDVAI.
Budapest. ROAD ACCIDENTS
SiR,-Your correspondents on road accidents have not mentioned dogs as a factor. Some months ago I wrote to the R.A.C., suggesting that research should be initiated on the reactions of dogs to road vehicles. It is the experience of every motorist, at times, to sound the horn vigorously, and the dog still stands in the middle of the road. I wondered whether this may be due to tone-deafness at the frequency of the ordinary motor-horn. I suggested to the R.A.C. that they might investigate this question, and produce a horn possibly inaudible to the human ear but offensive to a dog’s ear, rather on the lines of dog whistles which are of such high frequency that the human ear cannot detect them. Furthermore, large-scale research should be undertaken on the general reactions of dogs to motor vehicles, with a view to finding some offensive instrument which would frighten them from the road. I think the figures show that the stray dog is as much responsible for accidents as the other factors, but I have seen no evidence that this problem is being seriously studied. B. SANDLER. Urmston, Lanes. MYASTHENIA GRAVIS
SiR,-Having seen the account of myasthenia gravis in your issue of Jan. 29, by a contributor to the Disabilities series, I feel that my own experience of this disease may be of interest. The trouble started at the end of 1942 when I was aged 22, and the first symptoms were, in my case also, imbalance of the eye muscles resulting in double vision. Within three months, excessive fatigue became apparent, and I found myself unable to continue with my fairly light manual job. Unlike your contributor, however, I experienced no variations in the rigour of the symptoms, my decline in strength steadily progressing until I was sent into hospital. There an injection of 20 mg. neostigmine bromide with dramatic results, and shortly afterwards I was discharged with instructions to take three 15 mg. tablets by mouth daily, together with ephedrine gr. 1/2’ It soon became clear that my steady decline in strength was continuing, the tablets only affording very temporary relief ; and after consultation with another neurologist, and increasing the dosage up to nine or ten tablets per day, I decided to try deep X-ray therapy to the thymus gland. The eight-week course of treatment was finished about the end of August, 1943, and a fortnight later I came to the conclusion that my decline in strength had been checked. At this stage I was taking the maximum dose of neostigmine ; I could walk about 100 yards if the going was smooth : I could open my eyes about half-way for short periods with difficulty ; I could talk for about one minute ; grimaces were impossible ; and I was having considerable difficulty in I had
swallowing
solid food.
From this time on, my
improvement,
though slow, was steady. Gradually I was able to reduce the dose of neostigmine until finally it became unnecessary. In the spring of 1944 I started a part-time clerical job, and was subsequently able to resume full-time clerical work. In 1946, however, much to my dismay I had a recurrence of the diplopia, and gradually my old symptoms began to
,