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STREPTOCOCCAL INFECTIONS IN THE ANGLO-EGYPTIAN SUDAN.
612 anterior axillary line. The thick adhesion was burnt through in the course of a few minutes and the lung collapsed at once. The pleural cavity was then aired to disperse the fumes caused by the burning, when it was seen that blood was dripping slowly from the pleural end of the severed adhesion; but this haemorrhage ceased spontaneously, after about 50 c.c. of blood had escaped into the pleural cavity. This blood was absorbed in a few days without becoming septic, as was proved by paracentesis five days after the operation. Dr. Jacobaeus gives a full discussion of each of his cases, coming to the conclusion that his method of dividing pleural adhesions in suitable patients is undoubtedly of great service, promoting the full collapse of the lung, tending to cause the healing of pulmonary cavities and lessening the amount of the sputum. His paper is illustrated by a series of skiagrams, which show clearly the presence of pleural adhesions before operation and the fuller collapse of the lung that follows their severance. In addition he gives a full account of the histology of the pleural adhesions met with in pulmonary tuberculosis; many of them, as two plates show, are highly vascular structures. ____
STREPTOCOCCAL INFECTIONS IN THE ANGLOEGYPTIAN SUDAN. Dr. Albert J.
Chalmers, director of the Wellcome Research Laboratories, Khartoum, has recently, in collaboration with several other experts, published in the Journal of Tropical Medicine and Hygiene a series of very interesting " notes" on streptococcal infections in the Anglo-Egyptian Sudan. Already four of these "notes" have appeared. The first dealt with septicaemia arising from the streptococcus equinus, which was found in pure culture in blood taken from a vein of a young Sudanese groom who had accidentally injured his big toe, the injury having remained untreated for some time. When the case came under observation there were cellulitis and abscess of the groin and scrotum, and from this he died 10 days after admission to hospital. This appears to be the first time that the organism has been recorded as pathogenic to man, and also apparently the first occasion in which it has been recognised in the tropics. When the streptococcus equinus was differentiated by Andrewes and Horder it was thought that the organism was devoid of pathogenic properties. The second "note" on streptococcal puerperal fever in the Sudan was discussed in THE LANCET on its appearance.’ The third of the series deals with some pathogenic streptococci belonging to the faecalis group which are believed not to have been, so far, described as occurring in the tropics. In this " note " four cases of illness are mentioned in which streptococci of the faecalis group were found and which belonged to two species-namely, S. faecalis (Andrewes and Horder, 1906) and S. versatilis (Broadhurst, 1915). These organisms, it seems, may gain an entrance to the circulation in man and may cause a subacute form of septicaemia and heart affection in the tropics, as in temperate climes. The fourth " note" is on the vaccine treatment of streptococcal puerperal fever, and gives incidentally the results of this method in two illustrative instances. In Mahommedan countries, as is known, obstetrical practice is attended with difficulties not experienced by practitioners at home. It is, for
Tropical
"
1
THE
LANCET, April 29th, 1916, p. 926.
I
example, extremely difficult to obtain permission to examine, douche, or curette the uterus in Mahommedan women, though there is less opposition to the taking of blood for examination from a vein. It is therefore possible, when the latter is allowed, to identify the particular organism which is causing the illness, and as a result to treat the case by special vaccine methods. The urgent necessity for cleansing the cavity of an infected uterus is obvious ; but it often happens that the Mahommedan woman prefers to risk death rather than submit to the cleansing process if it is to be carried out by a European medical man. The vaccine treatment offers an opportunity of raising the resistance of the body against the germs which may be passing from the uterus into the blood stream in such small quantities that they are killed in the blood and yet do not produce sufficient reaction to raise the antibacterial powers of that fluid. If necessary, polyvalent serum with saline injections can also be used to combat and Under these conditions it is remove the toxins. important to know the strains of streptococci causing puerperal fever in any district and to prepare a polyvalent vaccine for that district. Having decided that vaccine therapy is to be used, the experience at Khartoum in vaccines of all natures is that the therapeutic dose should be sufficiently large, and it is believed that failures of vaccine therapy may be due to the use of too small doses. It may be mentioned that Dr. George Haddad, medical officer, Civil Hospital, Khartoum; Dr. Atiyah, medical officer in charge of the Civil Hospital, Omdurman; Mr. Alexander Marshall, assistant in the Bacteriological Research Laboratories, Khartoum; and Captain W. R. O’Farrell, R.A.M.C., protozoologist to the Wellcome Tropical Research Laboratories, collaborated respectively in one or other of the four " notes " published by Dr. Chalmers. These communications have all been of value and full of interest to medical practitioners in the tropics and at home, and we trust that the series will be steadily continued. ____
THORIUM
IN
PYELOGRAPHY.
IN the Johns Hopkins Hos_pital Bulletin for June Dr. J. E. Burns has called attention to the value of a new substance for pyelography-thorium. Collargol, which is generally used, has an irritant action when it escapes into the tissues and death has followed its use. Its elimination from the urinary tract is somewhat prolonged in consequence of its viscosity. It stains everything into which it comes in contact and is expensive. Various attempts have been made to replace it without An ideal solution for pyelography should success. be non-toxic (within ordinary limits of usage), non-irritating, quite opaque to the X rays, have a marked degree of fluidity permitting ready escape from the urinary tract, and be inexpensive. As the opacity to the X rays depends on atomic weight, Dr. Burns decided to investigate thorium, which is the second heaviest known element. The nitrate and chloride are very soluble, giving markedly acid and astringent solutions, which precipitate salts in the urine and proteins. They are also irritating. All these qualities render them unfit for clinical use, but they are valuable for the injection of pathological specimens for radiography. After a series of experiments with various salts of thorium it was found that a solution containing a double citrate of sodium and thorium with an excess of sodium citrate and some sodium nitrate gave excellent
STREPTOCOCCAL INFECTIONS IN THE ANGLOEGYPTIAN SUDAN. Dr. Albert J.
Chalmers, director of the Wellcome Research Laboratories, Khartoum, has recently, in collaboration with several other experts, published in the Journal of Tropical Medicine and Hygiene a series of very interesting " notes" on streptococcal infections in the Anglo-Egyptian Sudan. Already four of these "notes" have appeared. The first dealt with septicaemia arising from the streptococcus equinus, which was found in pure culture in blood taken from a vein of a young Sudanese groom who had accidentally injured his big toe, the injury having remained untreated for some time. When the case came under observation there were cellulitis and abscess of the groin and scrotum, and from this he died 10 days after admission to hospital. This appears to be the first time that the organism has been recorded as pathogenic to man, and also apparently the first occasion in which it has been recognised in the tropics. When the streptococcus equinus was differentiated by Andrewes and Horder it was thought that the organism was devoid of pathogenic properties. The second "note" on streptococcal puerperal fever in the Sudan was discussed in THE LANCET on its appearance.’ The third of the series deals with some pathogenic streptococci belonging to the faecalis group which are believed not to have been, so far, described as occurring in the tropics. In this " note " four cases of illness are mentioned in which streptococci of the faecalis group were found and which belonged to two species-namely, S. faecalis (Andrewes and Horder, 1906) and S. versatilis (Broadhurst, 1915). These organisms, it seems, may gain an entrance to the circulation in man and may cause a subacute form of septicaemia and heart affection in the tropics, as in temperate climes. The fourth " note" is on the vaccine treatment of streptococcal puerperal fever, and gives incidentally the results of this method in two illustrative instances. In Mahommedan countries, as is known, obstetrical practice is attended with difficulties not experienced by practitioners at home. It is, for
Tropical
"
1
THE
LANCET, April 29th, 1916, p. 926.
I
example, extremely difficult to obtain permission to examine, douche, or curette the uterus in Mahommedan women, though there is less opposition to the taking of blood for examination from a vein. It is therefore possible, when the latter is allowed, to identify the particular organism which is causing the illness, and as a result to treat the case by special vaccine methods. The urgent necessity for cleansing the cavity of an infected uterus is obvious ; but it often happens that the Mahommedan woman prefers to risk death rather than submit to the cleansing process if it is to be carried out by a European medical man. The vaccine treatment offers an opportunity of raising the resistance of the body against the germs which may be passing from the uterus into the blood stream in such small quantities that they are killed in the blood and yet do not produce sufficient reaction to raise the antibacterial powers of that fluid. If necessary, polyvalent serum with saline injections can also be used to combat and Under these conditions it is remove the toxins. important to know the strains of streptococci causing puerperal fever in any district and to prepare a polyvalent vaccine for that district. Having decided that vaccine therapy is to be used, the experience at Khartoum in vaccines of all natures is that the therapeutic dose should be sufficiently large, and it is believed that failures of vaccine therapy may be due to the use of too small doses. It may be mentioned that Dr. George Haddad, medical officer, Civil Hospital, Khartoum; Dr. Atiyah, medical officer in charge of the Civil Hospital, Omdurman; Mr. Alexander Marshall, assistant in the Bacteriological Research Laboratories, Khartoum; and Captain W. R. O’Farrell, R.A.M.C., protozoologist to the Wellcome Tropical Research Laboratories, collaborated respectively in one or other of the four " notes " published by Dr. Chalmers. These communications have all been of value and full of interest to medical practitioners in the tropics and at home, and we trust that the series will be steadily continued. ____
THORIUM
IN
PYELOGRAPHY.
IN the Johns Hopkins Hos_pital Bulletin for June Dr. J. E. Burns has called attention to the value of a new substance for pyelography-thorium. Collargol, which is generally used, has an irritant action when it escapes into the tissues and death has followed its use. Its elimination from the urinary tract is somewhat prolonged in consequence of its viscosity. It stains everything into which it comes in contact and is expensive. Various attempts have been made to replace it without An ideal solution for pyelography should success. be non-toxic (within ordinary limits of usage), non-irritating, quite opaque to the X rays, have a marked degree of fluidity permitting ready escape from the urinary tract, and be inexpensive. As the opacity to the X rays depends on atomic weight, Dr. Burns decided to investigate thorium, which is the second heaviest known element. The nitrate and chloride are very soluble, giving markedly acid and astringent solutions, which precipitate salts in the urine and proteins. They are also irritating. All these qualities render them unfit for clinical use, but they are valuable for the injection of pathological specimens for radiography. After a series of experiments with various salts of thorium it was found that a solution containing a double citrate of sodium and thorium with an excess of sodium citrate and some sodium nitrate gave excellent