- Email: [email protected]
SUPPORTIVE THERAPY
198 described by Thrower and Campbell : to 10 ml. of the P.v.p. solution, 0.1ml. of a 0-15" iodine solution in 0-1 N potassium iodide is added, and the optical density is measured after 10-15 minutes. The concentration of P.V.P. present is found by using experimentally determined calibration curves. The urine, plasma, or serum must be pretreated, as previously described, before the above measurements are made. An alternative method of removing proteins by acetic acid :I has been found satisfactory.
viously
A fuller account of this method will be Research Laboratories, May & Baker Ltd., Dagenham, Essex. Electro-medical Research Unit, Stoke Maudeville MandeviIIe Hospital, Aylesbury, Bucks.
published
later.
r< H.CAMPBELL. CAMPBELL.
H G. G HUNTER. Cr. HUNTFR.
SUPPORTIVE THERAPY
SiR,-I
was
interested in the Manchester article of
describing an improved type of dextran. Will someone please tell me why this material is dissolved in physiological saline solution ?f Has 6% dextran no osmotic pressure at all ?’? I feel that it is almost impertiJan. 10
nent to remind you, Sir, that the normal serum-chloride level is equivalent to a 0-58% solution of sodium chloride, and that physiological saline contains (usually) 0-9% of sodium chloride, a somewhat unphysiological excess of chloride. Pathological Department, Whipps Cross Hospital, W. W. WALTHER. London, E.11. BOVINE TUBERCULOSIS AND HUMAN TUBERCULOSIS
SiR,-In reply to Mr. Daw (Dec. 27) I should like to say that population variations were taken into account in every county mentioned in the figures given in my letter (Dec. 6). The increase or decrease in the number of notifications is per 100,000 population. Mr. Daw states that " something more than an apparent statistical relationship is required before any such hypothesis can be accepted." In my view, when 10 out of the 11 Scottish counties, with more than 50% of cattle attested, show an increase in human pulmonary tuberculosis, and when 10 out of IScottish counties, with less than 16-5% of cattle attested, show a reduction, the one result is the consequence of the one cause. I gave the figures for the 11 Scottish counties with the highest and lowest proportions of attested cattle. The 10 counties with proportions between those of these two groups would show no significant alteration. Mr. Daw also says " I find Mr. Pitcher’s argument unconvincing." It has long been assumed that bovine tuberculosis increases human tuberculosis. What I have tried to show is that the elimination of bovine tuberculosis does not decrease human infection, but very substantiallv increases it. Turning to the points raised by Dr. Bradshaw (Jan. 10), I applied in every case to the county medical officer of health for notifications of pulmonary and non-pulmonary tuberculosis for the years 1920 (before tuberculin testing of cattle) to 1950 (when the attested-cattle scheme had been in existence for fourteen years, although tuberculin testing of cattle was being practised to a fairly wide extent before 1936, especially in Scotland). I simply took the average for the first five years and compared it with the average for the last five years, taking into account the number of people notified as having pulmonary tuberculosis. In some cases, where figures for the full period were not obtained, the earliest fiveyears were contrasted with the latest five years. The significant feature in Scotland is that until about 1936 all the Scottish counties were showing a reduction in tuberculosis notifications, and this reduction has continued in the counties with relatively few attested 2.
Hunter, G.
Canad. J. Res.
1949, E27, 230.
cattle, whereas the reverse is taking place in counties with 50% or more of attested cattle. Dr. Bradshaw’s suggestion that the final figure for West Lothian should be +119 and Dumbarton +12 is correct, but this alteration merely emphasises my point. In the matter of Glasgow, Dr. Bradshaw points out my error, and I must confess to having confused the Burgh of Glasgow with the Port of Glasgow, Renfrew. The final figures of notifications of pulmonary tuberculosis for the Burgh of Glasgow per 100,000 population should be : 1930-34, 150 ; 1946-50, 248. There has been relatively little alteration in the population ; and the corrected figures further endorse my point. Dr. Bradshaw remarks " there is a fundamental defect in the logic of Mr. Pitcher’s argument " in not considering whether living tubercle bacilli are ingested. My belief is that the milk of a dairy cow infected with tuberculosis (tuberculosis of the udder and hence infection of the milk is an extremely rare condition) contains a substance which I have called " tuberculin " which, when ingested by human beings, increases their resistance to the human bacillus. I am not prepared to say whether this substance is a secretion or excretion or both of the bovine bacillus, but its existence is supported by my figures. I do not believe that pasteurisation would have any effect on the antibody value of this " tuberculin." L. PITCHER. High Wycombe. ,
INTRATHECAL PENICILLIN
SIR,-I have read with interest Dr. Haynes’s letter last week concerning the death of his patient with Waterhouse-Friderichsen syndrome, following the intrathecal injection of penicillin, and also the letter from Dr. Aronson and his colleagues (Dec. 20) concerning the been danger of intrathecal penicillin to which phenol has added. Other cases have lately been described.1 It is with regret that I record the death, some three years ago, of two patients with pyogenic meningitis following the intrathecal injection of 20,000 units of crystalline penicillin to which no preservative had been added. A few hours after the injection, as in Dr. Haynes’s case, convulsions were followed by death. Since then I have not used penicillin intrathecally. Perhaps those with greater experience can tell us the frequency of this complication. I saw no mention of it in the report of the recent discussion on the treatment of non-tuberculous meningitis held at the Royal Society of Medicine. RONALD LASS. Maidstone, Kent. .
CONGENITAL ANOMALIES OF THE BONY THORAX AND LUNGS
SIR,-I have examined miniature fluorographs of 18,570 soldiers, aged 22-28, and I have found the
following
abnormalities of the
bony
thorax :
31 (0.17%) (1) Supernumerary cervical ribs.. Bilateral ........ 7 (0.04%) Unilateral (rt.-sided 18, It.-sided 6) 24(0-13%) 14 (0.07%) (2) Synostosis of ribs...... 12 Between the 1st and 2nd ribs.. Between the 1st, 2nd, and 3rd ribs 1 Between the 8th and 9th ribs .. 1 3 (0-02%) (3) Rudimentary 1st thoracic ribs .. There were thus 48 (0-26%) rib anomalies in all. These figures, although they refer to young men only, agree quite well with those previously published. None of the 31 men with cervical ribs had any symptoms attributable to the condition, though they were all accustomed to strenuous exercise. In 12 cases the radial pulse disappeared when the hand was raised above the head and bent towards the opposite side. Steinerfound 6 cases of tuberculosis among 59 people who had anomalies of the ribs ; but in only 1 of my cases was there 1. Edmunds. V., Proter, R. J. Brit. med. J. 1952, ii, 668; Going, C. H. Ibid, p. 777. 2. Steiner, H. Radiology, 1943, 40, 175.
viously
A fuller account of this method will be Research Laboratories, May & Baker Ltd., Dagenham, Essex. Electro-medical Research Unit, Stoke Maudeville MandeviIIe Hospital, Aylesbury, Bucks.
published
later.
r< H.CAMPBELL. CAMPBELL.
H G. G HUNTER. Cr. HUNTFR.
SUPPORTIVE THERAPY
SiR,-I
was
interested in the Manchester article of
describing an improved type of dextran. Will someone please tell me why this material is dissolved in physiological saline solution ?f Has 6% dextran no osmotic pressure at all ?’? I feel that it is almost impertiJan. 10
nent to remind you, Sir, that the normal serum-chloride level is equivalent to a 0-58% solution of sodium chloride, and that physiological saline contains (usually) 0-9% of sodium chloride, a somewhat unphysiological excess of chloride. Pathological Department, Whipps Cross Hospital, W. W. WALTHER. London, E.11. BOVINE TUBERCULOSIS AND HUMAN TUBERCULOSIS
SiR,-In reply to Mr. Daw (Dec. 27) I should like to say that population variations were taken into account in every county mentioned in the figures given in my letter (Dec. 6). The increase or decrease in the number of notifications is per 100,000 population. Mr. Daw states that " something more than an apparent statistical relationship is required before any such hypothesis can be accepted." In my view, when 10 out of the 11 Scottish counties, with more than 50% of cattle attested, show an increase in human pulmonary tuberculosis, and when 10 out of IScottish counties, with less than 16-5% of cattle attested, show a reduction, the one result is the consequence of the one cause. I gave the figures for the 11 Scottish counties with the highest and lowest proportions of attested cattle. The 10 counties with proportions between those of these two groups would show no significant alteration. Mr. Daw also says " I find Mr. Pitcher’s argument unconvincing." It has long been assumed that bovine tuberculosis increases human tuberculosis. What I have tried to show is that the elimination of bovine tuberculosis does not decrease human infection, but very substantiallv increases it. Turning to the points raised by Dr. Bradshaw (Jan. 10), I applied in every case to the county medical officer of health for notifications of pulmonary and non-pulmonary tuberculosis for the years 1920 (before tuberculin testing of cattle) to 1950 (when the attested-cattle scheme had been in existence for fourteen years, although tuberculin testing of cattle was being practised to a fairly wide extent before 1936, especially in Scotland). I simply took the average for the first five years and compared it with the average for the last five years, taking into account the number of people notified as having pulmonary tuberculosis. In some cases, where figures for the full period were not obtained, the earliest fiveyears were contrasted with the latest five years. The significant feature in Scotland is that until about 1936 all the Scottish counties were showing a reduction in tuberculosis notifications, and this reduction has continued in the counties with relatively few attested 2.
Hunter, G.
Canad. J. Res.
1949, E27, 230.
cattle, whereas the reverse is taking place in counties with 50% or more of attested cattle. Dr. Bradshaw’s suggestion that the final figure for West Lothian should be +119 and Dumbarton +12 is correct, but this alteration merely emphasises my point. In the matter of Glasgow, Dr. Bradshaw points out my error, and I must confess to having confused the Burgh of Glasgow with the Port of Glasgow, Renfrew. The final figures of notifications of pulmonary tuberculosis for the Burgh of Glasgow per 100,000 population should be : 1930-34, 150 ; 1946-50, 248. There has been relatively little alteration in the population ; and the corrected figures further endorse my point. Dr. Bradshaw remarks " there is a fundamental defect in the logic of Mr. Pitcher’s argument " in not considering whether living tubercle bacilli are ingested. My belief is that the milk of a dairy cow infected with tuberculosis (tuberculosis of the udder and hence infection of the milk is an extremely rare condition) contains a substance which I have called " tuberculin " which, when ingested by human beings, increases their resistance to the human bacillus. I am not prepared to say whether this substance is a secretion or excretion or both of the bovine bacillus, but its existence is supported by my figures. I do not believe that pasteurisation would have any effect on the antibody value of this " tuberculin." L. PITCHER. High Wycombe. ,
INTRATHECAL PENICILLIN
SIR,-I have read with interest Dr. Haynes’s letter last week concerning the death of his patient with Waterhouse-Friderichsen syndrome, following the intrathecal injection of penicillin, and also the letter from Dr. Aronson and his colleagues (Dec. 20) concerning the been danger of intrathecal penicillin to which phenol has added. Other cases have lately been described.1 It is with regret that I record the death, some three years ago, of two patients with pyogenic meningitis following the intrathecal injection of 20,000 units of crystalline penicillin to which no preservative had been added. A few hours after the injection, as in Dr. Haynes’s case, convulsions were followed by death. Since then I have not used penicillin intrathecally. Perhaps those with greater experience can tell us the frequency of this complication. I saw no mention of it in the report of the recent discussion on the treatment of non-tuberculous meningitis held at the Royal Society of Medicine. RONALD LASS. Maidstone, Kent. .
CONGENITAL ANOMALIES OF THE BONY THORAX AND LUNGS
SIR,-I have examined miniature fluorographs of 18,570 soldiers, aged 22-28, and I have found the
following
abnormalities of the
bony
thorax :
31 (0.17%) (1) Supernumerary cervical ribs.. Bilateral ........ 7 (0.04%) Unilateral (rt.-sided 18, It.-sided 6) 24(0-13%) 14 (0.07%) (2) Synostosis of ribs...... 12 Between the 1st and 2nd ribs.. Between the 1st, 2nd, and 3rd ribs 1 Between the 8th and 9th ribs .. 1 3 (0-02%) (3) Rudimentary 1st thoracic ribs .. There were thus 48 (0-26%) rib anomalies in all. These figures, although they refer to young men only, agree quite well with those previously published. None of the 31 men with cervical ribs had any symptoms attributable to the condition, though they were all accustomed to strenuous exercise. In 12 cases the radial pulse disappeared when the hand was raised above the head and bent towards the opposite side. Steinerfound 6 cases of tuberculosis among 59 people who had anomalies of the ribs ; but in only 1 of my cases was there 1. Edmunds. V., Proter, R. J. Brit. med. J. 1952, ii, 668; Going, C. H. Ibid, p. 777. 2. Steiner, H. Radiology, 1943, 40, 175.