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UMBILICAL-CORD BLOOD
827 of elastic fibres, with disappearance of these elements in and clumping and fragmentation of the elastic in other There was no evident pigmentation and no obvious areas. local change in the blood-vessels.
places,
Though only single estimations of ketosteroid excretion possible, the change in the 20-ketosteroid values while the 17-ketosteroid excretion remained practically stationary appears highly significant. Increased production of glucocorticoids is thought to mobilise glucose from the body proteins. The skin is the largest organ of the body, and represents about 16% of the total weight of an adult. It therefore seems reasonable to suppose that the skin supplies much of the protein used for gluconeogenesis, is weakened thereby, and becomes more liable to injury. Increased tension on skin so affected, due either to posture, as described
were
by Hurford and Snell,1
or to the accommodation of of subcutaneous fat or a space-occupying lesion, such as an intra-abdominal tumour, may well produce the histological features of striæ cutis distensae. The normal glucose-tolerance curve seems to confirm Simpson’s suggestion4 that increased adrenal cortical output is balanced by a secondary hyperinsulinism. This may be a factor in determining the gain in weight.
deposits
indebted to Mrs. A. M. Robinson for the ketosteroid to Dr. R. J. R. Cureton for histological I am also grateful to Dr. H. C. examination of the skin. Aston, of Bethnal Green Hospital, for permission to publish the case, and to Dr. E. F. Scowen for criticism and advice. I
am
estimations ; and
St. Bartholomew’s Hospital, London.
D’ALMERO KOK.
GERMAN MEASLES IN GIRLS’ SCHOOLS
SIR,—Recently my youngest child, a girl of 61/2, developed rubella. The attack upset the child mildly for a day or two, and at the end of 10 days she returned to school. (I understand that the latest Ministry circular recommends 7 days’ exclusion from school from the appearance of the rash.) Apparently her return was too early to be in accordance with the " regulations," and she was told to keep away from the other girls. I feel that enough is already known about the effects of rubella on the foetus in early pregnancy to warrant revision of such " regulations as these. For my part, I am thankful that in years to come my daughter is unlikely to present me with a maimed grandchild, consequent upon an attack of rubella in early pregnancy. It seems a pity that the " regulations " prevent her from conferring this great boon on her school-friends. It "
may well be that in time to come deliberate infection of girls with rubella during their school-days will be offered along with vaccination, diphtheria immunisation, and the rest. General Hospital, South Shields.
TEKENCE G. ROBINSON.
SIR,—Dr. Lehmann’s letter earlier this year,5 on the disturbance of prothrombin-time estimations by cleaning the glassware with soapless detergents, demonstrated the value of communications on purely technical matters in your correspondence columns. It is with this letter in mind that I record a finding that may be of assistance to workers in the field of rhesus blood-groups. Occasionally samples of umbilical-cord blood are contaminated with an undue amount of Wharton’s jelly. W’hile this is usually removed by simple washing, as in the Coombs test, rarely the clumping of the test cells in suspension due to this viscous connective-tissue litucin is not overcome by washing ; occasionally also a rapid slide-test is called for. When the phenomenon 5.
Simpson, S. L. Post.-grad. med. J. 1950. 26, Lehmann, H. Lancet, 1950, i, 1133.
PYREXIAL TREATMENT OF ULCERATIVE COLITIS
SIR,—In the early days of treatment of general paralysis of the insane by artificial pyrexia, a male general paretic was admitted to one of my wards at the County Mental Hospital, Rainhill. In view of his very poor general condition, complicated by long-standing ulcerative colitis, it was at first thought inadvisable to attempt pyrexial therapy ; but at the insistent request of his wife a modified course of’Pyrifer’ was given. It was observed with surprise that after the fourth intraFrom that time venous injection the diarrhoea ceased. onwards the stools showed satisfactory formation and there was no further evidence of colitis. Unfortunately the patient died a few months later as a result of his cerebral disease, and no conclusions could be drawn from the short period of apparent cure of the ulcerative colitis. It was then brought to my notice that a male patient in another section of the hospital was suffering from ulcerative colitis of nearly two years’ duration, and it was decided to study the effects of pyrifer. The following notes have been extracted from his case-sheet :
1934.—May 19 : taken ill with diarrhoea, stools containing blood and mucus; afebrile. May 26: Flexner organisms isolated from stools ; case notified to medical officer of health June 12 : passing blood and mucus as bacillary dysentery. in stools : general condition failing. June 14 : stools still show blood and mucus ; no organisms of dysentery group now isolated ; febrile, 99-103°F ; general condition poor. June 28 : Bowel condition as before ; commonly febrile in evening ; slight improvement in general condition. 1935.-April 26 : diagnosed as chronic colitis ; average of six motions daily, often containing blood and mucus. 1936.-March : condition unchanged. April 4 to May 11 : course of twelve injections of pyrifer, producing on all occasions (except the third injection) temperatures of 103-104°F. No blood or mucus found in the stools after the third intravenous injection. 1937.—Feb. 17 : no further diarrhoea ; no change in mental state.
1941.-Nov. 12 : reported diarrhoea. Nov. 14 : Schmitz organisms isolated;Chinosol’ exhibited for one month (details not given). 1942.-Jan. 15 : clinically and bacteriologically clear;no evidence of colitis. 1947.-lVIarch 28 :
stools ;
presumably
attack of acute
vomiting ; occult blood in gastritis (no evidence of active
colitis). 1948.-April
UMBILICAL-CORD BLOOD
4.
has been encountered in this laboratory we have found that the addition of a small amount of a commercial preparation of hyaluronidase (one drop of a solution containing 1 mg. in 10 ml. of saline to tube or slide) will prevent the clumping, which interferes with the interpretation of tests. It has been found, further, that much higher concentrations of hyaluronidase do not interfere with any routine blood-grouping procedures. King Edward Memorial Hospital, W. S. KILLPACK. Ealing, London, W.13.
417.
13 : reported to have loose stools. April 14 : stools contained Sonne dysentery organisms, but no blood or mucus; treated with phthalylsulphalthiazole emulsion. May 28 : six swabs have been negative (no evidence of active
colitis). 1950.—May
31 :
no
clinical
signs
of colitis.
In the ten years after leaving Rainhill Hospital in 1938 I was able to use this therapy in a few cases in another hospital. The results were reasonably good, but they were complicated by the fact that the pyrifer available during the war years produced less fever. The ampoules had all been filled before September, 1939, and their potency, in my opinion, decreased with time. Using the fresh supplies obtained in recent years, the previous pyrexial response has been observed. I can draw no definite conclusions from the small number of cases of chronic ulcerative colitis which I have been able to treat in the course of mental-hospital
places,
Though only single estimations of ketosteroid excretion possible, the change in the 20-ketosteroid values while the 17-ketosteroid excretion remained practically stationary appears highly significant. Increased production of glucocorticoids is thought to mobilise glucose from the body proteins. The skin is the largest organ of the body, and represents about 16% of the total weight of an adult. It therefore seems reasonable to suppose that the skin supplies much of the protein used for gluconeogenesis, is weakened thereby, and becomes more liable to injury. Increased tension on skin so affected, due either to posture, as described
were
by Hurford and Snell,1
or to the accommodation of of subcutaneous fat or a space-occupying lesion, such as an intra-abdominal tumour, may well produce the histological features of striæ cutis distensae. The normal glucose-tolerance curve seems to confirm Simpson’s suggestion4 that increased adrenal cortical output is balanced by a secondary hyperinsulinism. This may be a factor in determining the gain in weight.
deposits
indebted to Mrs. A. M. Robinson for the ketosteroid to Dr. R. J. R. Cureton for histological I am also grateful to Dr. H. C. examination of the skin. Aston, of Bethnal Green Hospital, for permission to publish the case, and to Dr. E. F. Scowen for criticism and advice. I
am
estimations ; and
St. Bartholomew’s Hospital, London.
D’ALMERO KOK.
GERMAN MEASLES IN GIRLS’ SCHOOLS
SIR,—Recently my youngest child, a girl of 61/2, developed rubella. The attack upset the child mildly for a day or two, and at the end of 10 days she returned to school. (I understand that the latest Ministry circular recommends 7 days’ exclusion from school from the appearance of the rash.) Apparently her return was too early to be in accordance with the " regulations," and she was told to keep away from the other girls. I feel that enough is already known about the effects of rubella on the foetus in early pregnancy to warrant revision of such " regulations as these. For my part, I am thankful that in years to come my daughter is unlikely to present me with a maimed grandchild, consequent upon an attack of rubella in early pregnancy. It seems a pity that the " regulations " prevent her from conferring this great boon on her school-friends. It "
may well be that in time to come deliberate infection of girls with rubella during their school-days will be offered along with vaccination, diphtheria immunisation, and the rest. General Hospital, South Shields.
TEKENCE G. ROBINSON.
SIR,—Dr. Lehmann’s letter earlier this year,5 on the disturbance of prothrombin-time estimations by cleaning the glassware with soapless detergents, demonstrated the value of communications on purely technical matters in your correspondence columns. It is with this letter in mind that I record a finding that may be of assistance to workers in the field of rhesus blood-groups. Occasionally samples of umbilical-cord blood are contaminated with an undue amount of Wharton’s jelly. W’hile this is usually removed by simple washing, as in the Coombs test, rarely the clumping of the test cells in suspension due to this viscous connective-tissue litucin is not overcome by washing ; occasionally also a rapid slide-test is called for. When the phenomenon 5.
Simpson, S. L. Post.-grad. med. J. 1950. 26, Lehmann, H. Lancet, 1950, i, 1133.
PYREXIAL TREATMENT OF ULCERATIVE COLITIS
SIR,—In the early days of treatment of general paralysis of the insane by artificial pyrexia, a male general paretic was admitted to one of my wards at the County Mental Hospital, Rainhill. In view of his very poor general condition, complicated by long-standing ulcerative colitis, it was at first thought inadvisable to attempt pyrexial therapy ; but at the insistent request of his wife a modified course of’Pyrifer’ was given. It was observed with surprise that after the fourth intraFrom that time venous injection the diarrhoea ceased. onwards the stools showed satisfactory formation and there was no further evidence of colitis. Unfortunately the patient died a few months later as a result of his cerebral disease, and no conclusions could be drawn from the short period of apparent cure of the ulcerative colitis. It was then brought to my notice that a male patient in another section of the hospital was suffering from ulcerative colitis of nearly two years’ duration, and it was decided to study the effects of pyrifer. The following notes have been extracted from his case-sheet :
1934.—May 19 : taken ill with diarrhoea, stools containing blood and mucus; afebrile. May 26: Flexner organisms isolated from stools ; case notified to medical officer of health June 12 : passing blood and mucus as bacillary dysentery. in stools : general condition failing. June 14 : stools still show blood and mucus ; no organisms of dysentery group now isolated ; febrile, 99-103°F ; general condition poor. June 28 : Bowel condition as before ; commonly febrile in evening ; slight improvement in general condition. 1935.-April 26 : diagnosed as chronic colitis ; average of six motions daily, often containing blood and mucus. 1936.-March : condition unchanged. April 4 to May 11 : course of twelve injections of pyrifer, producing on all occasions (except the third injection) temperatures of 103-104°F. No blood or mucus found in the stools after the third intravenous injection. 1937.—Feb. 17 : no further diarrhoea ; no change in mental state.
1941.-Nov. 12 : reported diarrhoea. Nov. 14 : Schmitz organisms isolated;Chinosol’ exhibited for one month (details not given). 1942.-Jan. 15 : clinically and bacteriologically clear;no evidence of colitis. 1947.-lVIarch 28 :
stools ;
presumably
attack of acute
vomiting ; occult blood in gastritis (no evidence of active
colitis). 1948.-April
UMBILICAL-CORD BLOOD
4.
has been encountered in this laboratory we have found that the addition of a small amount of a commercial preparation of hyaluronidase (one drop of a solution containing 1 mg. in 10 ml. of saline to tube or slide) will prevent the clumping, which interferes with the interpretation of tests. It has been found, further, that much higher concentrations of hyaluronidase do not interfere with any routine blood-grouping procedures. King Edward Memorial Hospital, W. S. KILLPACK. Ealing, London, W.13.
417.
13 : reported to have loose stools. April 14 : stools contained Sonne dysentery organisms, but no blood or mucus; treated with phthalylsulphalthiazole emulsion. May 28 : six swabs have been negative (no evidence of active
colitis). 1950.—May
31 :
no
clinical
signs
of colitis.
In the ten years after leaving Rainhill Hospital in 1938 I was able to use this therapy in a few cases in another hospital. The results were reasonably good, but they were complicated by the fact that the pyrifer available during the war years produced less fever. The ampoules had all been filled before September, 1939, and their potency, in my opinion, decreased with time. Using the fresh supplies obtained in recent years, the previous pyrexial response has been observed. I can draw no definite conclusions from the small number of cases of chronic ulcerative colitis which I have been able to treat in the course of mental-hospital