- Email: [email protected]
Societies
April, 1931]
TUBERCLE
came to the following conclusions: I n the first place there were no great differences in the results obtained with various concentrations of the organism. On the other hand, it was found that the organism offered more resistance in distilled water and in water free from ammonia than in well water. Secondly, the results obtained on culture media were not so constant as those obtained by inoculation of guinea-pigs, Pugnani's final conclusion being that the humantype of tubercle bacillus loses its capacity of multiplying in vitro before that of infecting guinea-pigs. PALMIERI, u g . Rieerche sperimeutali sulla resistenza del bacillo tubercolare alla putrefazione. Gior. di Batteriol. e Immunol., 1930, 8, 135. As the result of his observations at the Medico legal Institute of Naples University, Palmieri comes to the following conclusions : - (1) The more or less advanced putrefaction of material suspected to be tuberculous does not prevent the presence of tubercle bacilli being discovered within two months of death and sometimes even later. (q) When it is suspected that acidfast organisms are not tubercle bacilli,
BACILLUS
329
it will be advisable to grow them on special media, and to inoculate them into susceptible animals. During the time required for these tests, cultures of the suspected material should be made on broth not treated with glycerine and kept at the temperature of the atmosphere, i.e., below 30 ~ C. If these acid-fast bacilli are found in cultures in twenty-four to thirty-six hours, the possibility of their being tubercle bacilli can be excluded. (3) Cultures on special media (Petroff and o t h e r s ) a n d inoculation of susceptible animals may be negative when the tubercle bacilli are scanty or of feeble virulence owing to the antagonism of putrefactive organisms, especially B. putrificus and B. verrucosus, or to unfavourable environment. It is advisable, therefore, not to attach an absolute value to a negative finding but only to say that the existence of living and virulent tubercle bacilli cannot be proved in such cases. (4) I t is also advisable to be very cautious in interpreting the histological picture of experimental inoculation, since acid-fast pseudo-tubercle bacilli may produce appearances very similar to tuberculosis on superficial examination.
SOCIETIES. NORTH
WESTERN TUBERCULOSIS SOCIETY. A m e e t i n g was held on T h u r s d a y , J a n u a r y 29, at t h e Tuberculosis Dispensary, Eccles. Dr. D. P. S u t h e r l a n d (Vice-President), was in t h e chair. An i n t e r e s t i n g d e m o n s t r a t i o n a n d discussion on " A c t i n o t h e r a p y in T u b e r c u l o s i s " tool: place. Dr, A. D. B r u n w i n regarded artificial light as a tonic and s t i m u l a n t . T u b e r c u l o u s children did n o t gain weight a n y more t h a n n o r m a l children. He h a d used iron-cored carbons (Grade C), which produce m a n y rays of s h o r t wave leugth, a n d give rapid e r y t h e m a with shor~ exposures, but he found t h e m too irritati n g a n d preferred S i e m e n s irou carbons, w h i c h are one-third to a q u a r t e r as s t r o n g as W a t s o n ' s Grade C. If time were no object, he t h o u g h t plain carbons were ideal and long exposures desirable. As regards type of case, he h a d been disappointed in lupus, as some eases regarded as q u i e s c e n t were n o t so in reality.
He obtained 25 to 30 per cent. cures, but it m u s t be r e m e m b e r e d t h a t l u p u s occasionally m a y heal s p o n t a n e o u s l y . Glands without abscess improved slowly, b u t he preferred opera~ion to light. I n glands ~ i t h abscess ultra-violet t h e r a p y was useful. W i t h bones and joints the results were variable. Turning to finance, he did not t h i n k t h e t i m e of doctors a n d nurses, who were n o t paid extra for the work, s h o u l d be taken into account, b u t only those additionally employed owing to t h i s work. The cost would t h u s be lower t h a n h a s been given. I n populous areas he preferred l u p u s cases to be treated at t h e o u t - p a t i e n t departm e n t s of large hospitals. Dr. G. Jessel read a paper e m b o d y i n g three years' experience at t h e Eeeles L i g h t Centre with 273 cases, 152 of w h o m h a d beeonlo quiescent. He h a d s t u d i e d various m e t h o d s , b u t considered t h e m o s t suitable one for disp e n s a r y practice was an a d a p t a t i o n with less costly l a m p s of t h e procedure so successfully adopted by Sequeira a n d O ' D o n o v a n at t h e
330
[April, 1931
TUBERCLE
L o n d o n Hospital. He h a d two 30 ampere long-flame carbon-arc l a m p s , one Jesiouek m e r c u r y - v a p o u r l a m p a n d one K r o m a y e r water-cooled m e r c u r y - v a p o u r l a m p . The p a t i e n t s were treated in groups, according to nge a n d sex, a n d received l i g h t b a t h s w i t h plain carbons, beginning with fifteen m i n u t e s at three feet distance back and front to a m a x i m u m of seventy-five m i n u t e s back a n d front. T h e y a t t e n d e d thrice weekly. The results with ~he m e r c u r y - v a p o u r b a t h were n o t so good, b u t t h e Jesionek l a m p was used somet i m e s a n d also for local t r e a t m e n t of glands. T h e K r o m a y e r l a m p was useful in l u p u s cases, provided t h a t care was t a k e n to express blood from t h e part by pressure. I n l u p u s cases, especially w h e n thick, w a r t y or extensive, energetic t r e a t m e n t with creosote a n d salicylic plaster was helpful, as was " s p i k i n g " of isolated nodules with acid n i t r a t e of m e r c u r y . L i g h t t r e a t m e n t was m o s t effective w h e n combined w i t h other forms of t r e a t m e n t , e.g., opening of abscesses, aspiration, etc. He considered t h e m o s t suitable cases for disp e n s a r y practice to be lupus, adenitis with a n d w i t h o u t abscesses, scrofulous conditions, a n d s m a l l or superficial bone a n d joint. As regards results of 273 cases, 63 ceased t r e a t m e n t for various causes, 152 were discharged as quiescent, 3 as improved a n d 2 as s t a t i o n a r y , leaving 53 u n d e r t r e a t m e n t at t h e e n d of 1930. The average d u r a t i o n of t r e a t m e n t of t h e quiescent eases was seven a n d t h r e e - q u a r t e r m o n t h s . L u p u s cases s o m e t i m e s took years a n d showed a t e n d e n c y to recurrence. Those previously treated elsewhere by X-rays needed special w a t c h f u l n e s s owing to a t e n d e n c y towards malignancy. As regards p i g m e n t a t i o n , 90 showed deep, 51 m e d i u m , 6 slight a n d 5 (who received local t r e a t m e n t only), n o n e ; 112 gained weight, 33 lost weight, a n d there was no c h a n g e in 7. He was of opinion t h a t success or failure depended largely upon careful a t t e n t i o n to detail. T h e carbon arc b a t h w i t h p l a i n carbons was particularly suitable to t h e r e q u i r e m e n t s of tuberculosis officers, who h a d m a n y o t h e r duties outside t h e i r dispensaries, a n d he quoted t h e e x p e r i m e n t s of Hill a n d Eidenow, w h i c h showed t h e value of infra-red (heat) rays in t h i s connection.
Dr. Jessel showed a n u m b e r of p a t i e n t s receiving t r e a t m e n t a n d some quiescent cases, as well as several p h o t o g r a p h s i l l u s t r a t i n g t h e r e s u l t s of t r e a t m e n t . Dr. D ' E w a r t spoke of his experience a t t h e B o o t h H a l l C h i l d r e n ' s Hospital, M a n c h e s t e r . I-Ie h a d h a d good results, which he ascribed in part to improved c a l c i u m m e t a b o l i s m . In g l a n d u l a r cases he preferred a c t i n o t h e r a p y to operation. On t h e other h a n d , even in M a n c h e s t e r he h a d better results in S u m m e r w i t h s u n s h i n e t h a n with artificial light. Dr. E. H. P a s k reported six cases of pulm o n a r y tuberculosis treated with ultra-violet rays at h i s dispensary. F o u r completed a course but still h a d tubercle bacilli in their s p u t u m , t h o u g h t h e y improved subjectively. Dr. G. F l e t c h e r considered it d a n g e r o u s to give ultra-violet r a y s in p u l m o n a r y cases. In three of his n o n - p u l m o n a r y cases p u l m o n a r y disease h a d developed, due probably to t h e presence of p u l m o n a r y lesions. X - r a y e x a m ination beforehand was desirable. He had h a d good results with m u l t i p l e lesions in s m a l l e r bones a n d joints a n d in a b d o m i n a l eases, t h o u g h s o m e m i g h t dispute the diagnosis of tuberculosis. As regards adenitis of neck, good results were obtainable with artificial l i g h t t r e a t m e n t as with other m e t h o d s . L u p u s cases did well a n d he agreed w i t h Dr. Jessel as ~o t h e value of caustic plasters in t r e a t m e n t of extensive lupus. As regards t h e K r o m a y e r l a m p , h e considered t h a t m a n y people were u n d u l y optimistic. Dr. G. H. Leigb advocated t h e use of D a n i s h m e t h o d s , i.e., t h e short-flamed carbon-are working on direct current. He h a d bad good results at his dispensary in bone a n d joint cases. He regarded ultra-violet l i g h t as a help b u t n o t a " cure all." Dr. D. P. S u t h e r l a n d , in s u m m i n g up, m e n t i o n e d t h a t in M a n c h e s t e r t h e skinspecialists, who h a d wide experience with various m e t h o d s of t r e a t m e n t in lupus, were favourably impressed w i t h a c t i n o t h e r a p y , w h i c h was useful also w i t h superficial sinuses. W i t h deeper lesions, bone a n d joint, a n d g e n i t o - u r i n a r y cases he h a d seen no improvement.
BIBLIOGRAPHY. ORIGINAL
ARTICLES
PUB'LISHED.
NOVEmBeR, 1930-FEBRUARY, 1931. (See also previous N u m b e r s . )
imeriean Journal of Diseaaes of Children, JANUARY. Survey of Tuberculosis in Schools in Colorado. R. P. FOrBeS, R. VERPZOEG a n d M. K, BA ZEMORE--p. 26.
/Lmerican Journal of Hyglene.--JANuARY. Effect of Prolonged E x p o s u r e of t h e Siliceous Spicules of a F r e s h - w a t e r Sponge (Spongilla fragilis) to t h e Action of A n i m a l Tissues : a Contribution to t h e P a t h o g e n e s i s of Silicosis in 5Inn. R . G . MILLS--p. 224.
American Journal of Pub]ic Health, JANUARY. Decrease of Tuberculosis in Mexico. P. MIaANDA--p. 37.
F. Dn
TUBERCLE
came to the following conclusions: I n the first place there were no great differences in the results obtained with various concentrations of the organism. On the other hand, it was found that the organism offered more resistance in distilled water and in water free from ammonia than in well water. Secondly, the results obtained on culture media were not so constant as those obtained by inoculation of guinea-pigs, Pugnani's final conclusion being that the humantype of tubercle bacillus loses its capacity of multiplying in vitro before that of infecting guinea-pigs. PALMIERI, u g . Rieerche sperimeutali sulla resistenza del bacillo tubercolare alla putrefazione. Gior. di Batteriol. e Immunol., 1930, 8, 135. As the result of his observations at the Medico legal Institute of Naples University, Palmieri comes to the following conclusions : - (1) The more or less advanced putrefaction of material suspected to be tuberculous does not prevent the presence of tubercle bacilli being discovered within two months of death and sometimes even later. (q) When it is suspected that acidfast organisms are not tubercle bacilli,
BACILLUS
329
it will be advisable to grow them on special media, and to inoculate them into susceptible animals. During the time required for these tests, cultures of the suspected material should be made on broth not treated with glycerine and kept at the temperature of the atmosphere, i.e., below 30 ~ C. If these acid-fast bacilli are found in cultures in twenty-four to thirty-six hours, the possibility of their being tubercle bacilli can be excluded. (3) Cultures on special media (Petroff and o t h e r s ) a n d inoculation of susceptible animals may be negative when the tubercle bacilli are scanty or of feeble virulence owing to the antagonism of putrefactive organisms, especially B. putrificus and B. verrucosus, or to unfavourable environment. It is advisable, therefore, not to attach an absolute value to a negative finding but only to say that the existence of living and virulent tubercle bacilli cannot be proved in such cases. (4) I t is also advisable to be very cautious in interpreting the histological picture of experimental inoculation, since acid-fast pseudo-tubercle bacilli may produce appearances very similar to tuberculosis on superficial examination.
SOCIETIES. NORTH
WESTERN TUBERCULOSIS SOCIETY. A m e e t i n g was held on T h u r s d a y , J a n u a r y 29, at t h e Tuberculosis Dispensary, Eccles. Dr. D. P. S u t h e r l a n d (Vice-President), was in t h e chair. An i n t e r e s t i n g d e m o n s t r a t i o n a n d discussion on " A c t i n o t h e r a p y in T u b e r c u l o s i s " tool: place. Dr, A. D. B r u n w i n regarded artificial light as a tonic and s t i m u l a n t . T u b e r c u l o u s children did n o t gain weight a n y more t h a n n o r m a l children. He h a d used iron-cored carbons (Grade C), which produce m a n y rays of s h o r t wave leugth, a n d give rapid e r y t h e m a with shor~ exposures, but he found t h e m too irritati n g a n d preferred S i e m e n s irou carbons, w h i c h are one-third to a q u a r t e r as s t r o n g as W a t s o n ' s Grade C. If time were no object, he t h o u g h t plain carbons were ideal and long exposures desirable. As regards type of case, he h a d been disappointed in lupus, as some eases regarded as q u i e s c e n t were n o t so in reality.
He obtained 25 to 30 per cent. cures, but it m u s t be r e m e m b e r e d t h a t l u p u s occasionally m a y heal s p o n t a n e o u s l y . Glands without abscess improved slowly, b u t he preferred opera~ion to light. I n glands ~ i t h abscess ultra-violet t h e r a p y was useful. W i t h bones and joints the results were variable. Turning to finance, he did not t h i n k t h e t i m e of doctors a n d nurses, who were n o t paid extra for the work, s h o u l d be taken into account, b u t only those additionally employed owing to t h i s work. The cost would t h u s be lower t h a n h a s been given. I n populous areas he preferred l u p u s cases to be treated at t h e o u t - p a t i e n t departm e n t s of large hospitals. Dr. G. Jessel read a paper e m b o d y i n g three years' experience at t h e Eeeles L i g h t Centre with 273 cases, 152 of w h o m h a d beeonlo quiescent. He h a d s t u d i e d various m e t h o d s , b u t considered t h e m o s t suitable one for disp e n s a r y practice was an a d a p t a t i o n with less costly l a m p s of t h e procedure so successfully adopted by Sequeira a n d O ' D o n o v a n at t h e
330
[April, 1931
TUBERCLE
L o n d o n Hospital. He h a d two 30 ampere long-flame carbon-arc l a m p s , one Jesiouek m e r c u r y - v a p o u r l a m p a n d one K r o m a y e r water-cooled m e r c u r y - v a p o u r l a m p . The p a t i e n t s were treated in groups, according to nge a n d sex, a n d received l i g h t b a t h s w i t h plain carbons, beginning with fifteen m i n u t e s at three feet distance back and front to a m a x i m u m of seventy-five m i n u t e s back a n d front. T h e y a t t e n d e d thrice weekly. The results with ~he m e r c u r y - v a p o u r b a t h were n o t so good, b u t t h e Jesionek l a m p was used somet i m e s a n d also for local t r e a t m e n t of glands. T h e K r o m a y e r l a m p was useful in l u p u s cases, provided t h a t care was t a k e n to express blood from t h e part by pressure. I n l u p u s cases, especially w h e n thick, w a r t y or extensive, energetic t r e a t m e n t with creosote a n d salicylic plaster was helpful, as was " s p i k i n g " of isolated nodules with acid n i t r a t e of m e r c u r y . L i g h t t r e a t m e n t was m o s t effective w h e n combined w i t h other forms of t r e a t m e n t , e.g., opening of abscesses, aspiration, etc. He considered t h e m o s t suitable cases for disp e n s a r y practice to be lupus, adenitis with a n d w i t h o u t abscesses, scrofulous conditions, a n d s m a l l or superficial bone a n d joint. As regards results of 273 cases, 63 ceased t r e a t m e n t for various causes, 152 were discharged as quiescent, 3 as improved a n d 2 as s t a t i o n a r y , leaving 53 u n d e r t r e a t m e n t at t h e e n d of 1930. The average d u r a t i o n of t r e a t m e n t of t h e quiescent eases was seven a n d t h r e e - q u a r t e r m o n t h s . L u p u s cases s o m e t i m e s took years a n d showed a t e n d e n c y to recurrence. Those previously treated elsewhere by X-rays needed special w a t c h f u l n e s s owing to a t e n d e n c y towards malignancy. As regards p i g m e n t a t i o n , 90 showed deep, 51 m e d i u m , 6 slight a n d 5 (who received local t r e a t m e n t only), n o n e ; 112 gained weight, 33 lost weight, a n d there was no c h a n g e in 7. He was of opinion t h a t success or failure depended largely upon careful a t t e n t i o n to detail. T h e carbon arc b a t h w i t h p l a i n carbons was particularly suitable to t h e r e q u i r e m e n t s of tuberculosis officers, who h a d m a n y o t h e r duties outside t h e i r dispensaries, a n d he quoted t h e e x p e r i m e n t s of Hill a n d Eidenow, w h i c h showed t h e value of infra-red (heat) rays in t h i s connection.
Dr. Jessel showed a n u m b e r of p a t i e n t s receiving t r e a t m e n t a n d some quiescent cases, as well as several p h o t o g r a p h s i l l u s t r a t i n g t h e r e s u l t s of t r e a t m e n t . Dr. D ' E w a r t spoke of his experience a t t h e B o o t h H a l l C h i l d r e n ' s Hospital, M a n c h e s t e r . I-Ie h a d h a d good results, which he ascribed in part to improved c a l c i u m m e t a b o l i s m . In g l a n d u l a r cases he preferred a c t i n o t h e r a p y to operation. On t h e other h a n d , even in M a n c h e s t e r he h a d better results in S u m m e r w i t h s u n s h i n e t h a n with artificial light. Dr. E. H. P a s k reported six cases of pulm o n a r y tuberculosis treated with ultra-violet rays at h i s dispensary. F o u r completed a course but still h a d tubercle bacilli in their s p u t u m , t h o u g h t h e y improved subjectively. Dr. G. F l e t c h e r considered it d a n g e r o u s to give ultra-violet r a y s in p u l m o n a r y cases. In three of his n o n - p u l m o n a r y cases p u l m o n a r y disease h a d developed, due probably to t h e presence of p u l m o n a r y lesions. X - r a y e x a m ination beforehand was desirable. He had h a d good results with m u l t i p l e lesions in s m a l l e r bones a n d joints a n d in a b d o m i n a l eases, t h o u g h s o m e m i g h t dispute the diagnosis of tuberculosis. As regards adenitis of neck, good results were obtainable with artificial l i g h t t r e a t m e n t as with other m e t h o d s . L u p u s cases did well a n d he agreed w i t h Dr. Jessel as ~o t h e value of caustic plasters in t r e a t m e n t of extensive lupus. As regards t h e K r o m a y e r l a m p , h e considered t h a t m a n y people were u n d u l y optimistic. Dr. G. H. Leigb advocated t h e use of D a n i s h m e t h o d s , i.e., t h e short-flamed carbon-are working on direct current. He h a d bad good results at his dispensary in bone a n d joint cases. He regarded ultra-violet l i g h t as a help b u t n o t a " cure all." Dr. D. P. S u t h e r l a n d , in s u m m i n g up, m e n t i o n e d t h a t in M a n c h e s t e r t h e skinspecialists, who h a d wide experience with various m e t h o d s of t r e a t m e n t in lupus, were favourably impressed w i t h a c t i n o t h e r a p y , w h i c h was useful also w i t h superficial sinuses. W i t h deeper lesions, bone a n d joint, a n d g e n i t o - u r i n a r y cases he h a d seen no improvement.
BIBLIOGRAPHY. ORIGINAL
ARTICLES
PUB'LISHED.
NOVEmBeR, 1930-FEBRUARY, 1931. (See also previous N u m b e r s . )
imeriean Journal of Diseaaes of Children, JANUARY. Survey of Tuberculosis in Schools in Colorado. R. P. FOrBeS, R. VERPZOEG a n d M. K, BA ZEMORE--p. 26.
/Lmerican Journal of Hyglene.--JANuARY. Effect of Prolonged E x p o s u r e of t h e Siliceous Spicules of a F r e s h - w a t e r Sponge (Spongilla fragilis) to t h e Action of A n i m a l Tissues : a Contribution to t h e P a t h o g e n e s i s of Silicosis in 5Inn. R . G . MILLS--p. 224.
American Journal of Pub]ic Health, JANUARY. Decrease of Tuberculosis in Mexico. P. MIaANDA--p. 37.
F. Dn