TUBERCLE BACILLI IN BOVINE FÆCES.

245 The main contention of an interesting address was relapsed, and he states that at least 90 per cent. of the that the true physician must possess the gift of cases of " low back pain," lumbago," sacro-iliac The difference strain," and " sciatica " which have been referred to healing both body and mind. between the orthodox practitioner and " those him under these diagnoses are on more comprehensive others" is an equipment of traditional learning analysis instances of myofascitis, to which disorder he and ethics which not only fosters this gift but applies that overworked term " a clinical entity." enables it to be most effectively employed for the It is really due, he considers, not so much to local benefit of mankind. injury as to faulty metabolism and absorption of toxins from the large intestine, and since reaching this opinion he has treated all such cases in which no TUBERCLE BACILLI IN BOVINE FÆCES. anatomical lesion can be demonstrated by lavage of IN order to study tne incidence or tuoercie oaCllll the colon, implantation of Bacillus coli, and restricin the fæces of dairy cattle, Dr. Stenhouse Williams tion of proteins in the diet. In 40 cases which he the results are reported as from " good " to and Mr. W. A. Hoy1 examined samples taken from tabulates " 438 apparently healthy cows in five English counties. excellent," except in two in which the treatment Of these samples 337 were treated by the antiformin was not properly carried out and one other in which method and 101 by Petroff’s method ; in each case it had only just begun. In the paper which follows Dr. Albee’s in the same 1 ounce of faeces was treated and two guinea-pigs were inoculated from the sediment obtained. Neither journal (p. 534) Dr. H. Lusskin and Dr. H. Sonnenmethod completely eliminated the danger of septic " schein, of New York, reassert the reality and infections in the inoculated animals, and the test was frequency of sacro-iliac subluxation and arthritis, and not regarded as complete unless the guinea-pigs lived advocate therapeutic measures similar to those longerthan 42 days ; when possible they were kept for recommended by Dr. D. Hoyt Cox, on which we ’100 days before being killed. Of the 391 completed commented some weeks ago.l They make no allusion tests 6 (1-53 per cent.) gave positive results, living and to any treatment directed towards improving metavirulent bacilli being evidently present in the faeces. bolism, and in many ways their communication is in Nearly all the 391 samples were taken from cows that strong contrast to that which immediately procedes it. had not been tested with tuberculin ; the exceptions Like many other American surgeons they find that were 24 cows which were known to be reactors, but the application of adhesive strapping is often effi(as it turned out) had no tubercle bacilli in their faeces. cacious, but in severe and resistant cases they Examination of the records showed that five of the advocate fixative operations. They say that " all cows excreting tubercle bacilli came from four farms patients"with this form of sacro-iliac disturbance lying within a radius of three and a half miles. Since "have aggravated weak feet." On the basis of such not more than one single ounce of faecal matter from experience as has hitherto been recorded in this each cow was examined, and since later experiments country it is difficult to decide whether the latest have shown that the bacilli are excreted at irregular views of Albee, or his earlier ones, and those held by intervals, and that antiformin has a variable influence Lusskin and Sonnenschein most deserve acceptance. upon their virulence, it is probable that the tests show The sins of the human colon seem to be brought home to it with increasing emphasis as time goes on, and if too small a proportion of positive results. Dr. Albee’s last indictment results in the finding of a true bill it will furnish an additional argument for Sir William Arbuthnot Lane’s attacks upon stasis. BACKACHE. "

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IN commenting on a paper on sacro-iliac subluxation we recently remarked that orthopaedic surgeons of repute, not only in America but also in Great Britain, seemed to have had very various experience of this condition. Somewhat similar thoughts are aroused by a suggestive communication to the American Journal of Surgery (1927, N.S., iii., 523), in which Dr. F. H. Albee deals with cases that may conveniently be grouped together under the homely name of backache. As a surgeon whose name is especially associated with valuable work on autogenous bone-grafting, Dr. Albee might perhaps be expected to advocate radical operation, but in fact he recommends its restriction or abandonment in favour of gentler measures. He begins by offering a pathological explanation of many apparently dissimilar conditions which are generally labelled lumbago or sciatica or (in America) sacro-iliac strain, and which he would like to see grouped together under the name "myofascitis" which he has coined to describe To this suggestion there are, we think, them. manifest objections. In the first place, its adoption would imply the existence of an affection of musclefibres in favour of which there is no pathological or anatomical evidence, and in the second place the term fibrositis," which has been in use for a good many years, is applicable to the group of symptoms in question and is free from some of the objections offered to myofascitis." It seems a pity, moreover. to burden medical nomenclature with a new Græco-Latin hybrid unless it is absolutely necessary. Dr. Albee has become convinced that a large proportion of those cases which are by some surgeons in America diagnosed as sacro-iliac shain are in reality due to myofascitis." the chief symptom of which is pain at bony insertions elicited by tension on the involved muscle or fascia." Many of his cases had been treated for sacro-iliac relaxation and had "

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1.

1 Journal of Hygiene,

November, 1927, p. 37.

I

DIPHTHERIA CARRIERS. IT has long been recognised that diphtheria carriers may discharge bacilli intermittently, and three negative examinations are usually required before a suspect may be discharged. F. H. Thomson, E. J. Mann, and J. E. McCartney2 showed that examinations should be continued at least once a week for the first

of the disease and thereafter twice weekly for three weeks. Only when six consecutive examinations had been negative could the patient be declared free. In a recent investigation into carriers, described to the Epidemiological Section of the Royal Society of Medicine on Tan. 27th, Dr. McCartney and Dr. W. C. Harvey found it necessary to study the intermittent periods very carefully. Attempts to cure a carrier may coincide with one of these periods and convey a false impression of the result. They did not consider a carrier free unless six consecutive tests spread over six weeks were all negative, and illustrated by their charts, shown on the screen, the necessity for this rigid standard. In one carrier five examinations were negative over a period of two and a half weeks, and bacilli appeared again at the sixth test. Another patient gave four consecutive negative results, then one positive followed by eight negatives. As the tonsils were large they were removed, after which the throat cultures yielded two positive results ; then the nose gave one and then both remained clear. The work was carried on in the M.A.B. hospitals, and 350 carriers have been examined, swabs being taken twice weekly from the throat, each nostril, and, if necessary, from the ear. Loeffler’s serum medium and a modification of Pugh’s stain were used to identify the organisms, and virulence was tested by intracutaneous carrier inoculation into the guinea-pig. The term

fortnight

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1 THE LANCET, 1927, ii., 1302. 2 Annual Report, M.A.B., 1925-26, p. 130.