THE MEDICAL REGISTER

1303 whose father died of pulmonary an attack of slight general ill health in 1926, a lung illness of somewhat doubtful origin in 1934, an attack of uveoparotitis with pyrexia in 1935, and a strongly positive tuberculin reaction in 1936. Yet although the authors advance no alternative theory based on facts, they are unable to agree that tuberculosis forms the basis of the uveoparotitis in this case. Their statement that " in previously reported cases a period of malaise has been described before the " does not contain the onset of frank uveoparotitis whole truth. In the 47 cases reviewed by Thomson and myself prodromal symptoms had occurred in 20 only. But I think one of the most important points raised in their paper is the statement that "the presence of a round-celled infiltration, even together with giant cells, is not always necessarily a proof of a tuberculous infection " ; this statement, of course, must be admitted, but I think it is of the greatest significance that all the biopsies performed either on the iris, parotid, or lacrymal gland in this syndrome have shown identical microscopic appearances, and the pathologist concerned has unhesitatingly labelled the section tuberculous. Further, in the new cases recorded by Thomson and myself, as well as in Souter’s case and others subsequently recorded from Reading and Leicester, the sections have been examined by Prof. M. J. Stewart; there has never been any question about the identity of the condition, and while admitting that round cells and giant cells do not necessarily mean tuberculosis I shduld like to know if there is any proof that any other condition can produce the characteristic picture which has occurred in all these sections. To say that " even if miliary tuberculosis supervened it might be argued that the uveoparotitis itself was not necessarily tuberculous," is to my mind no argument at all. Here we have a syndrome in which all affected biopsy material shows the histological appearance of tuberculosis and in which four persons have died ; one of these died of pernicious anaemia, and the pathologist concerned did not consider this to be associated with the uveoparotitis, which had healed; the three remaining cases all died of miliary tuberculosis, and showed the characteristic microscopical changes in the affected parotid glands. I maintain that there is nothing to suggest the presence of another allergen operating in these three cases. Finally I suggest that the latest case to be recorded, far from throwing doubt on the universal tuberculous setiology of this syndrome, rather lends support to this theory. I am. Sir. vours faithfullv. HUGH G. GARLAND. Leeds, Nov. 23rd.

the

case

of

a man

tuberculosis, who had

"

ÆTIOLOGY OF ACUTE RHEUMATISM

To the Editor

of THE LANCET SrR,-Dr. Poynton’s request for opinions on the current nomenclature of streptococci will, I hope, lead to some authoritative pronouncement on the subject. Since I took an active part in the work recorded

in Coburn’s paper in your issue of Oct. 31st I may be able to contribute a little information, and this can ’best be accomplished by referring to a specific case quoted by him. The history reported on p. 1029 is that of a boy who contracted follicular tonsillitis on Feb. 17th, 1935. Clinically this was a straightforward streptococcal sore-throat. The predominant organism, also present in other members of the

family, was a haemolytic streptococcus belonging to Group A (Lancefield) Type 13 (Griffith). In common terms it was Streptococcus pyogenes. This particular type is a common epidemic strain-hence it may be classified S. epidemicus. It can produce scarlet fever, and is entitled to be named S. scarlatinae. Otitis media and puerperal sepsis are frequently due to it, and and I have seen Type 13 pyaemia, septics&mia, Thus to S. vel pneumonia. pyogenes, epidemicus, vel scarlatinae, vel rheumaticus we can add a number of qualifying adjectives. We add nothing to our knowledge ! By retaining a term which is in common use we shall, in time, realise that the ordinary Streptococcus pyogenes is a villain playing many parts. One of his minor rôles is in the pathogenesis of acute rheumatism. What part he plays in this act, and how, is as yet unknown ; it is certainly not by the mechanism which justifies the ,qualification "pyogenes," and the qualification " rheumaticus " is also doubtfully deserved. We may find some practical value in qualifying the classification of hsemolytic streptococcus by the addition of a serological type number. Although we do not yet know the significance of the fact that this boy’s organism was Group A, Type 13, we have a reasonable chance of recognising and identifying a similar organism obtained from another source. I am, Sir, yours faithfully, W. H. BRADLEY. Department of Medicine, University of Cambridge, Nov. 23rd. THE MEDICAL REGISTER To the Editor of THE LANCET SIR,-I am directed by the President of the Council to say that he would be glad if you could publish this intimation that any orders for the office edition of the Medical Register, 1937, published by the Council at the special price of 10s. a copy, post free, must be received, with a remittance, at the office of the Council not later than Dec. 31st, 1936. The office edition differs from the ordinary edition of the Register to the extent that it does not contain reprints of the Medical and Dentists Acts and other preliminary matter, and is printed on more inexpensive paper and bound in boards. It includes, however, the same entries relating to registered medical practitioners as are included in the ordinary edition, and is therefore equally serviceable to public authorities and others who find it necessary to ascertain whether particular persons are registered medical practitioners or not. I am to take the opportunity of stating that the Council also prepare monthly lists of names added to, and removed from, the Register, and that particulars of the terms and conditions upon which copies of these lists may be made available can be obtained on application to the office of the Council. I am, Sir, yours faithfully,

MICHAEL

HESELTINE,

Registrar, General Medical Council. 44, iiauam-street, Jr’oruand-piaoe, London, W.1, Nov. 19th.

Mr. Hugh Lett will deliver the Bradshaw lecture to the Royal College of Surgeons of England on Thursday, Dec. 3rd, when he will speak on the early diagnosis and the treatment of renal tuberculosis. A week later on Dec. 10th Dr. George W. Corner, professor of anatomy in the University of Rochester, will address the College on Salernitan surgery in the twelfth century when he gives the Thomas Vicary lecture. Both lectures will take place at the College at 5 P.M.