UNDULANT FEVER.

1067 has since been stated by Heller and Holtz,! and tion for this lies in the development of dilatation of also by Jeffcoate,2 that solutions of crystalline the colon which may assume considerable proportions. cestrin exert no synergic effect of the kind described. Concerning the blood picture, cases of Addisonian We have also examined the effect of crystalline pernicious anaemia in children have indeed been cestrin (which was not available in 1928), and we described, but, so far as we are aware, no associated wish to state that we confirm Heller and Holtz, and dwarfism has been recorded though a somewhat similar blood picture may occur with idiopathic Jeffcoate. steatorrhcea and dwarfism. We are, Sir, yours faithfully, ALECK BOURNE, A case recorded in 1920 by Dr. H. L. Tidy is quoted J. H. BURN. by Drs. Hampson and Shackle in their original paper. London, May 5th, 1932. The blood picture described in this case is quite unlike that found in Addisonian pernicious anaemia, since UNDULANT FEVER. large numbers of immature white cells were found in the peripheral blood. The picture is, however, Editor To the of THE LANCET. similar to that found in erythroblastic anaemia, SIR,—Dr. C. P. Beattie points out in your last issue of which we have studied two cases associated with (p. 1002) that in Scotland the routine examinations the other symptoms of idiopathic steatorrhcea. of Widal sera reveal a certain number of unsuspected These cases are to be published. ErythroOur experience in this blastic anaemia shortly cases of undulant fever. is characterised by megalocytosis part of Wales is the same. Since 1928 we have added and high variability of the red cells, large numbers Br. abortus to the list of organisms to which we test of nucleated red cells, and sometimes primitive white the agglutinating power of Widal bloods and have cells in the blood. Its association with found 4 out of 143 gave a titre of 1 in 250 or more. bone lesions peripheral was first described by Cooley in 1927.i All four bloods proved to be from typical cases of Dr. himself suggests that the bone lesions undulant fever. On the other hand, all the others in his Tidy case were secondary to the disturbances of were negative in 1 in 25. We also tested the haematopoiesis. In view of modern knowledge it is of 1325 Wassermann sera, and of more agglutinating power likely that the two conditions are dependent these 6 gave partial agglutination in 1 in 40 and one upon failure to absorb essential factors, as are the agglutinated up to 1 in 50. It is clear therefore other symptoms of the disease. that the generally accepted titre of 1 in 100 can be We are, Sir, yours faithfully, taken as diagnostic. Again our findings regarding JANET M. VAUGHAN, average cow’s milk are the same as those of Dr. DONALD HUNTER. Beattie and others ; 76 routine samples of mixed London Hospital, Whitechapel, E., May 9th, 1932. milks were examined for Br. abortus my

specially colleague Mr. J.

by

H.

Sugden,

and of these 28-

i.e., 37 per cent.-were shown to be positive by guinea-

DEEP X RAYS IN THE TREATMENT OF

inoculation. OSTEO-ARTHRITIS. It is significant of the little interest taken in this To the Editor of THE LANCET. subject that it is unusual for me to be asked to examine Widal bloods for undulant fever, although SIR,—In your leading article (April 30th, p. 941) the clinical note sent with the specimens seldom points on the economic aspect of the rheumatic diseases definitely to enteric fever. no specific mention was made of deep X rays. I am, Sir, yours faithfully, it This is has little in the value treatment, true, WM. PARRY MORGAN. of rheumatism, in the ulnar polyarticular variety Institute of Preventive Medicine, Cardiff, May 7th, 1932. defection of the fingers and constitutional disturbance, generally known in this country as rheumatoid arthritis, but in the case of osteo-arthritis of hyperCŒLIAC DISEASE AND DWARFISM. thymic type which occurs in middle-aged people To the Editor of THE LANCET. who otherwise appear to be in good health, the effect SIR,-Statements by Dr. J. W. Shackle in a letter of properly applied X ray treatment is often remarkwhich you published on May 7th seem to us still able. Function as well as pain is beneficially affected, further to support our view that the case in dispute and the economic aspect therefore becomes of was one of idiopathic steatorrhoea with associated importance. Moreover, the treatment of osteobone deformities and a megalocytic anaemia. He arthritis by X rays can be carried out very largely I have now states that he does not regard the case as one by making use of existing hospital facilities. of renal dwarfism. In the original description no had personal experience of this work for three years, mention is made of the character of the stools nor of both in hospital and private practice, but most of a chemical estimation for the percentage of fats and my cases have so far been of the hospital type, and, fatty acids. It is a common experience that patients unfortunately, all suffering from an advanced form suffering from idiopathic steatorrhoea may present of the disease with osteophytes and destruction of at times no diarrhoea. Dr. Shackle states that the the intra-articular cartilages. What can be done for these cases ?’? In ascending symptoms " would have needed to be fairly severe to produce the degree of dwarfism that existed." On order : (1) By the relief of pain the patients become the contrary in adolescent patients severe cceliac less troublesome in their homes, and their relatives rickets with dwarfism is commonly unassociated with have more time and freer minds to deal with their diarrhoea, though indeed the stools are pale and own work. (2) Function may improve sufficiently porridgy and contain a large excess of split fats. for an almost helpless patient to get about the house In such cases the past history of diarrhoea may be and attend to himself. (3) A patient who has been obtained only on interviewing the parents, the able to walk a few hundred yards only may be patient having forgotten its occurrence. The explana- enabled to return to light employment. (4) In a

pig

2

1 Jour. Physiol., 1932, xliv., 134. Jour. Obst. Gyn. Brit. Emp., 1932, xxxix., 67.

1 Cooled, T. B., Witwer, E. R., and Lee, P.: Amer. Jour. Dis. Child., 1927, xxxiv., 923.

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