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Thirty years ago
TUBERCLE
236
(3) The last example is to demonstrate how, in certain cases, the E.S.R. shows a normal figure but the Index is not good. A woman (C. W.) of 28, with a minimal lung lesion, complained persistently of backache and pain in both arms. No spinal lesion could be found but a few months later, x-ray revealed spinal disease. Here again the Frimodt-M611er method showed an unsatisfactory Index in the same way as the Houghton one, whde the E.S.R. was normal.
% Neutros.
Juveniles ;~ Stabs. Segmented 57~J L) mphos. . . . . Eosinos... .. Basos. . . . . Monos. . . . . Yon Buns. . . . . E.S. rate .... H. 'Index . . . . F.M. Index ..
% ..
66.~ -'24½ I
-8 242 3 215"5 +38
Quite apart from the work done an comparing the two Indices, one very interesting feature has 'been the marked and rapid improvement shown in the blood pictures following chemotherapy with or without thoracic surgery, anajor or minor. At Grassington we have noticed a particularly satisfactory trend in the Indices following combined chemotherapy and pneumoperitoneum. The most markedly good results as reflected in the Indices are to be seen, of course, following chemotherapy and major surgery. In all I have done over i,ooo counts and compared the Houghton Index and the FrimodtM611er Index in over 3oo, and for anyone who has not the requisite laboratory help and who would like to gain the further information which an Index of this type gives, I feel that the Frimodt-M611er might be tried. Yours faithfully, The Hospital, Lomsz E. SA.~ISON, ~t.I).
Grassinglon, Wr. Skipton, Turks.
Thirty Years Ago (Extract from TUBERCLE, September r 9 2 4 Atypical Tubercle Bacilli in H u m a n and Animal Tuberculosis with Special Reference to those Occurring in Lupus, by A. Stanley Griffith, ~LD.) W h a t is the explanation of this frequent modification of the pathogenic properties of tubercle bacilli in lupus? It has been suggested that the action of
September 1954
daylight, subnormal temperature, local treatment, etc., might bring about the change. I f daylight cansed an attenuation of the virulence of tubercle bacilli in the cutaneous tissues we should expect lupus lesions which are most exposed to daylight to contain attenuated tubercle bacilli more frequently than lesions which are concealed from light. There is, however, no demonstrable relation between attenuation and the degree of exposure to light. Fully virulent h u m a n and bovine strains have been obtained from lesions on the face and neck which had been in existence m a n y )'ears. In one case a fully virulent bovine strain was obtained from facial lupus of thlrty-three years' duration. In another case of five )'ears' duration a strain from" the face was fully virulent while one from the buttock, obtained, it is true, eleven months after the face strain, was much less virulent. On the other hand, h u m a n and bovine strains with modified virulence were obtained in 12 cases in which the lesions were on the trunk and legs. Lupus is very commonly situated on the face, neck and extremities, parts of the body which are relatively cool, and the possibility cccurred to me some time ago that subnormal temperaturc might have an influence on the virulence of bacilli multiplying slowly in unfavourable surroundings. With a view to testing this hypothesis I began a passage experiment in toads. A .bovine strain h,'ls now been passed through six toads in succession and the total duration of residence in toad tissues is seven )'ears. This prolonged residence in a coldblooded host has not caused any, decrease in the virulence of the strain or alteration in cultural characteristics. T h e experiment incidentally gives no support to the view that m a m m a l i a n tubercle bacilli can be readily modified in the tissues of cold-blooded animals. Treatment of the lesions with antiseptics, Finsen light, etc., was certainly not the cause of the modifications in the majority of the cases under consideration, since the lesions filrnishing the original material had not been treated in any way. lkIoreover, lupus produced by modified tubercle bacilli is not a milder process than lupus from which fully virulent tubercle bacilli are obtained. O n the contrary', the disease in these cases is characterized by" persistence, intractability and tendency to spread. Although the tubercle bacilli have lost virulence for experimental animals there is no loss, rather is there an increase, in the virulence of the bacilli for the individual affected with lupus.
236
(3) The last example is to demonstrate how, in certain cases, the E.S.R. shows a normal figure but the Index is not good. A woman (C. W.) of 28, with a minimal lung lesion, complained persistently of backache and pain in both arms. No spinal lesion could be found but a few months later, x-ray revealed spinal disease. Here again the Frimodt-M611er method showed an unsatisfactory Index in the same way as the Houghton one, whde the E.S.R. was normal.
% Neutros.
Juveniles ;~ Stabs. Segmented 57~J L) mphos. . . . . Eosinos... .. Basos. . . . . Monos. . . . . Yon Buns. . . . . E.S. rate .... H. 'Index . . . . F.M. Index ..
% ..
66.~ -'24½ I
-8 242 3 215"5 +38
Quite apart from the work done an comparing the two Indices, one very interesting feature has 'been the marked and rapid improvement shown in the blood pictures following chemotherapy with or without thoracic surgery, anajor or minor. At Grassington we have noticed a particularly satisfactory trend in the Indices following combined chemotherapy and pneumoperitoneum. The most markedly good results as reflected in the Indices are to be seen, of course, following chemotherapy and major surgery. In all I have done over i,ooo counts and compared the Houghton Index and the FrimodtM611er Index in over 3oo, and for anyone who has not the requisite laboratory help and who would like to gain the further information which an Index of this type gives, I feel that the Frimodt-M611er might be tried. Yours faithfully, The Hospital, Lomsz E. SA.~ISON, ~t.I).
Grassinglon, Wr. Skipton, Turks.
Thirty Years Ago (Extract from TUBERCLE, September r 9 2 4 Atypical Tubercle Bacilli in H u m a n and Animal Tuberculosis with Special Reference to those Occurring in Lupus, by A. Stanley Griffith, ~LD.) W h a t is the explanation of this frequent modification of the pathogenic properties of tubercle bacilli in lupus? It has been suggested that the action of
September 1954
daylight, subnormal temperature, local treatment, etc., might bring about the change. I f daylight cansed an attenuation of the virulence of tubercle bacilli in the cutaneous tissues we should expect lupus lesions which are most exposed to daylight to contain attenuated tubercle bacilli more frequently than lesions which are concealed from light. There is, however, no demonstrable relation between attenuation and the degree of exposure to light. Fully virulent h u m a n and bovine strains have been obtained from lesions on the face and neck which had been in existence m a n y )'ears. In one case a fully virulent bovine strain was obtained from facial lupus of thlrty-three years' duration. In another case of five )'ears' duration a strain from" the face was fully virulent while one from the buttock, obtained, it is true, eleven months after the face strain, was much less virulent. On the other hand, h u m a n and bovine strains with modified virulence were obtained in 12 cases in which the lesions were on the trunk and legs. Lupus is very commonly situated on the face, neck and extremities, parts of the body which are relatively cool, and the possibility cccurred to me some time ago that subnormal temperaturc might have an influence on the virulence of bacilli multiplying slowly in unfavourable surroundings. With a view to testing this hypothesis I began a passage experiment in toads. A .bovine strain h,'ls now been passed through six toads in succession and the total duration of residence in toad tissues is seven )'ears. This prolonged residence in a coldblooded host has not caused any, decrease in the virulence of the strain or alteration in cultural characteristics. T h e experiment incidentally gives no support to the view that m a m m a l i a n tubercle bacilli can be readily modified in the tissues of cold-blooded animals. Treatment of the lesions with antiseptics, Finsen light, etc., was certainly not the cause of the modifications in the majority of the cases under consideration, since the lesions filrnishing the original material had not been treated in any way. lkIoreover, lupus produced by modified tubercle bacilli is not a milder process than lupus from which fully virulent tubercle bacilli are obtained. O n the contrary', the disease in these cases is characterized by" persistence, intractability and tendency to spread. Although the tubercle bacilli have lost virulence for experimental animals there is no loss, rather is there an increase, in the virulence of the bacilli for the individual affected with lupus.