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THE PRACTITIONER AS SCIENTIST
1403 control unimmunised children. Strains maintained at these laboratories for three years retain full virulence for the mouse and remain in phase I. efficient not yet tested the sera of children immunised with such vaccines, or with vaccines prepared with rough avirulent strains. Tests of rabbit sera indicate that, in that animal, rough strains may be as efficient as smooth strains in stimulating the appearance of protective antibody. Full details of the work on which these statements are based will be published shortly in the Australian Journal of Experimental
Presumably these strains should provide as antigens as fresh strains, though we have
Biology. Naturally, these findings do not affect your conclusion that, until more information is available, vaccines for prophylactic immunisation should be prepared by methods proved to be efficient. We are, Sir, yours faithfully, ESMOND V. KEOGH, Commonwealth Serum
EDGAR A. NORTH. Laboratories, Melbourne, May 19.
THE PRACTITIONER AS SCIENTIST
biB,—it might be well to recall in reference to Lord Stamp’s address, published in your last issue, a remark of the late Sir James Goodhart, sometime
physician
to
Guy’s Hospital.
remedies, his advice was while it is still curing." I am,
Cardiff, June
9.
:
" Go
In on
speaking of new using it, my boy,
that this has been due to the above conwhich made deep infection improbable and ditions, are not to be hoped for in the case of a soldier on active service. In these cases the principle of a wideopen wound for drainage purposes cannot always be applied without sacrificing healthy structures ; the second principle, however, of absolute immobilisation is still essential and is best attained by a split plaster case, which allows for swelling of the limb and inspection if necessary. I am, Sir, yours faithfully, A. D. WALL 15. May Shanghai, I feel
sure
ACTIVATION OF MALARIA BY VACCINES
SiR,—In THE LANCET of June 3, p. 1262, I read with great interest the observation of Drs. Murgatroyd, Findlay, and MacCallum concerning a long-latent infection with Plasmodium ovale becoming manifest after yellow-fever vaccination. In 1926 I made a similar observation after the administration of another sort of vaccine. Having diagnosed ulcerative, colitis in a woman of about 30, I prescribed an autogenous vaccine.
The injections were administered by Dr. M. Hetenyi twice a week, and the first two were followed by shivering, and sometimes rigors, with fever 100-102 ° F. Pyrexia appeared four to six hours after the intramuscular injections. On the day after the third
Sir, yours faithfully, A. W. SHEEN.
CLOSED TREATMENT OF COMPOUND FRACTURES
SIR,-I have read with interest the letter of Dr. J. Raspall in your issue of April 8, in which he replies to the criticisms of Colonel E. M. Cowell and Trueta
Colonel P. H. Mitchiner on the closed treatment of compound fractures due to war wounds. My experience here in Shanghai, during the Sino-Japanese hostilities in the late autumn of 1937, tends to confirm all that Dr. Trueta claims for the method ; this in spite of the fact that the wounded had often been lying out on the battlefield for two or three days before admission to hospital and on arrival already had heavily infected wounds. I must admit, however, that gas-gangrene and tetanus were very uncommon, owing no doubt to the fact that human manure and not horse or cow manure is used by the Chinese farmer. Had these infections been common, I should have been reluctant to use the closed method. I agree with Dr. Trueta that a wide excision of all damaged tissue is essential, and that a wide and open gutter type of wound should be made, so that the path of least resistance for the discharges is towards the surface and not up the intermuscular planes. The method is most effective in the distal parts of the limb, where immobilisation by plaster is absolute, the slightest muscular movement tending to encourage the spread of infection. Most of the wounds treated were shell and bomb wounds with large areas of destroyed soft tissue ; excision of these wounds usually left the desired type of wide-open cavity for closed plaster treatment. I have had little experience of through-and-throug]3 rifle wounds, and the experience I have had has been in civil practice, with patients who have had a daily bath and clean underclothing and have been admitted to hospital within an hour of receipt of their wounds ; and, although there have been successful results,
injection chill and fever reappeared and were more intense than previously. At first the possibility of a local infection at the site of the intramuscular injection was considered, but no acute inflammation or infiltration was detected. Fortunately the temperature of 104° F. lasted only a few hours and then subsided, with copious perspiration. Two days later, however, rigor and high temperature returned, without any intervening injection of vaccine (see the accompanying chart). The patient gave no history of malaria. Blood-films, prepared during a third attack of fever, revealed the presence of the parasites of tertian malaria and the patient was cured by the regular administration of quinine. I think that there is no doubt about the activation of latent malaria by injections of vaccine. The above case is of special interest because the patient not only gave no history of previous malarial infection but, also denied ever having been in a tropical or a subtropical country. Her husband, however, had been infected with malaria in Albania in 1918, and finally cured in 1923. It is impossible to find out whether, and if so when, the husband’s malaria was transmitted
Presumably these strains should provide as antigens as fresh strains, though we have
Biology. Naturally, these findings do not affect your conclusion that, until more information is available, vaccines for prophylactic immunisation should be prepared by methods proved to be efficient. We are, Sir, yours faithfully, ESMOND V. KEOGH, Commonwealth Serum
EDGAR A. NORTH. Laboratories, Melbourne, May 19.
THE PRACTITIONER AS SCIENTIST
biB,—it might be well to recall in reference to Lord Stamp’s address, published in your last issue, a remark of the late Sir James Goodhart, sometime
physician
to
Guy’s Hospital.
remedies, his advice was while it is still curing." I am,
Cardiff, June
9.
:
" Go
In on
speaking of new using it, my boy,
that this has been due to the above conwhich made deep infection improbable and ditions, are not to be hoped for in the case of a soldier on active service. In these cases the principle of a wideopen wound for drainage purposes cannot always be applied without sacrificing healthy structures ; the second principle, however, of absolute immobilisation is still essential and is best attained by a split plaster case, which allows for swelling of the limb and inspection if necessary. I am, Sir, yours faithfully, A. D. WALL 15. May Shanghai, I feel
sure
ACTIVATION OF MALARIA BY VACCINES
SiR,—In THE LANCET of June 3, p. 1262, I read with great interest the observation of Drs. Murgatroyd, Findlay, and MacCallum concerning a long-latent infection with Plasmodium ovale becoming manifest after yellow-fever vaccination. In 1926 I made a similar observation after the administration of another sort of vaccine. Having diagnosed ulcerative, colitis in a woman of about 30, I prescribed an autogenous vaccine.
The injections were administered by Dr. M. Hetenyi twice a week, and the first two were followed by shivering, and sometimes rigors, with fever 100-102 ° F. Pyrexia appeared four to six hours after the intramuscular injections. On the day after the third
Sir, yours faithfully, A. W. SHEEN.
CLOSED TREATMENT OF COMPOUND FRACTURES
SIR,-I have read with interest the letter of Dr. J. Raspall in your issue of April 8, in which he replies to the criticisms of Colonel E. M. Cowell and Trueta
Colonel P. H. Mitchiner on the closed treatment of compound fractures due to war wounds. My experience here in Shanghai, during the Sino-Japanese hostilities in the late autumn of 1937, tends to confirm all that Dr. Trueta claims for the method ; this in spite of the fact that the wounded had often been lying out on the battlefield for two or three days before admission to hospital and on arrival already had heavily infected wounds. I must admit, however, that gas-gangrene and tetanus were very uncommon, owing no doubt to the fact that human manure and not horse or cow manure is used by the Chinese farmer. Had these infections been common, I should have been reluctant to use the closed method. I agree with Dr. Trueta that a wide excision of all damaged tissue is essential, and that a wide and open gutter type of wound should be made, so that the path of least resistance for the discharges is towards the surface and not up the intermuscular planes. The method is most effective in the distal parts of the limb, where immobilisation by plaster is absolute, the slightest muscular movement tending to encourage the spread of infection. Most of the wounds treated were shell and bomb wounds with large areas of destroyed soft tissue ; excision of these wounds usually left the desired type of wide-open cavity for closed plaster treatment. I have had little experience of through-and-throug]3 rifle wounds, and the experience I have had has been in civil practice, with patients who have had a daily bath and clean underclothing and have been admitted to hospital within an hour of receipt of their wounds ; and, although there have been successful results,
injection chill and fever reappeared and were more intense than previously. At first the possibility of a local infection at the site of the intramuscular injection was considered, but no acute inflammation or infiltration was detected. Fortunately the temperature of 104° F. lasted only a few hours and then subsided, with copious perspiration. Two days later, however, rigor and high temperature returned, without any intervening injection of vaccine (see the accompanying chart). The patient gave no history of malaria. Blood-films, prepared during a third attack of fever, revealed the presence of the parasites of tertian malaria and the patient was cured by the regular administration of quinine. I think that there is no doubt about the activation of latent malaria by injections of vaccine. The above case is of special interest because the patient not only gave no history of previous malarial infection but, also denied ever having been in a tropical or a subtropical country. Her husband, however, had been infected with malaria in Albania in 1918, and finally cured in 1923. It is impossible to find out whether, and if so when, the husband’s malaria was transmitted