Vol. 4. No. 4. NOVEMBER, 1951

JOURNAL OFCLINICAL PATHOLOGY

EDITS ED FOR

THE ASSOCIATION OF CLINICAL PATHOLOGISTSBY

A. GORDON SIGNYHt

EDITORIAL BOARD

E. N. ALLOTT R. J. V. PULVERTAPT

J. V. DACIE DOROTHY S. RUSSELL

J. G. GREENFIELD JOAN TAYLOR

And the Editor of the British Medical Journal

S--_CA,As1951

LONDON

BRITISH MEDICAL ASSOCIATION

TAVISTOCK SQUARE, W.C.I

YEARLY SUBSCRITON (4 NUMBERS) 50S. U.S.A. $5.00 SINGLE NUIMBFRS 7s. 6d.

L-ij[[2

509

INDEX TO VOLUME IV

AABUL-FADL, M. A. M., see KING, E. J., ADUL-FADL,

M. A. M., and WALKER, P. G.Agglutination in the Coombs test, speed of, 296-- of H. pertussis, using concavity slides, 487ALEXANDER, J. G.: Evaluation of a method of estimating

the basal metabolic rate, 381ALLIBONE, E. C., and COLLINS, D. H.: Symptomatic

haemolytic anaemia associated with ovarian teratomain a child, 412

ALLINGTON, M. J., see BiGGs, R., and ALLINGTON, M. 3.p-Aminosalicylic acid, action on prothrombin time in

man, 478Anaemia, acquired haemolytic, auto-antibodies in, 253- pernicious, reticulocyte crisis after effective specific

treatment of, 207- symptomatic haemolytic, associated with ovarian tera-

toma, 412ANDERSON, K.: Aureomycin, sensitivity of 100 pathogenic

strains of Staphylococcus aureus, 355Aneurysm, unusual cardiac, in a young adult, 342Anisotropic crystals, non-silicious, in tuberculous salping-

itis, 333Antibiotics, disc technique for determining sensitivity to,

374Antibodies, heterophile, in infectious mononucleosis, 104

incomplete, proteolytic enzyme test for detecting,189

Antibody-sensitized red cells, effect of direct electric cur-rent on, 200

Association of Clinical Pathologists: 45th Scientific Meet-ing, 113

Asthma, eosinophiia and heart failure, 402Aureomycin, lingual scrapings taken during treatment

with, 393sensitivity of 100 pathogenic strains of S. aureus to,355

Auto-antibodies in acquired haemolytic anaemia, 253

BBasal metabolic rate, evaluation of a method of estimat-

ing, 381BENE, E., and KERSLEY, G. D.: Ultrafiltration of plasma

uric acid, 366BERLIN, R.: Hyperhaemolysis during the premenstrual

period (preliminary report), 286Reticulocyte crisis after the effective specific treat-ment of pernicious anaemia, 207

BERNSTOCK, L., and STERNDALE, H.: An instrument forcombined sternal biopsy and aspiration, 378

BIDMEAD, D. S.: Modified technique for determining uricacid in blood and urine, 370

BIGos, R., and ALLINGTON, M. J.: Sampling error inhaemoglobin determination, 211

-and Macfarlane, R. G.: Reaction of haemophilicplasma to thromboplastin, 445

Bleeding time in normal and abnormal subjects, 272Blood, determination of uric acid in, 370-estimating carbon monoxide in, 441-estimation of dicoumarin in, 63Bone-marrow in rheumatoid arthritis, plasmacytosis in, 47BOWLER, R. G.: Simple titration method for determining

the specific gravity on one drop of urine, 491BRZEZINSKY, A., see GUREVITCH, J., RozANSKY, R.,

WEBER, D., BRZEZINSKY, A., and ECKERLINo, B.

BUDTZ-OLSEN, 0. E.: Micro-estimation of plasma ironwith orthotolidine, 92

BUTLER, A., see MACMILLAN, R. L., EzRIN, C., andBUTLER, A.

BUTTERWORTH, E. C.: Photometric method for the estima-tion of sodium and its application to serum sodiumdetermination, 99

CCALLENDER, S. T., and LATHA, L. G.: Effect of citro-

vorum factor (folinic acid) on megaloblasts in vitro,204

Capillary method, slanting, of Rhesus blood-grouping, 464Carbon monoxide, estimation in blood with volumetric

Van Slyke apparatus, 441Cardiac aneurysm, unusual, in a young adult, 342Cell inclusion phenomenon, the lupus erythematosus, 290Cell-suspension mixer, 383Centrifugal gradocol filter, 240Cerebrospinal fluid potassium levels after death, 231Chloramphenicol, lingual scrapings taken during treatment

with, 393CHOWN, B., and LEWIS, M.: Slanted capllary method of

Rhesus blood-grouping, 464Citrovorum factor, effect on megaloblasts in vCtro, 204Clinical pathology, whither? Trends and opportunities, 129Collagen disease, diffuse, 402COLLINS, D.H., see ALLIBONE, E. C., and COLLINS, D. H.Concavity slides, agglutination of H. pertussis using, 487COOK, G. T.: Late mannitol-fermenting strain and rapidly

fermenting variant of Shisella flexnerl type Z, 427Coombs test, speed of agglutination in the, 296Cortisone, effect on experimental glomerulonephritis, 301Cover-slip container, a useful, 238

DDACIE, 3. V., and GRUCHY, G. C. de: Auto-antibodies in

acquired haemolytic anaemia, 253Death, potassium levels in cerebrospinal fluid after, 231DETLOR, M. : Agglutination of H. pertussis using con-

cavity slides, 4872:6-Dichloroquinone-chloroimid., determination of propyl-

thiouracil in urine with, 432Dicoumarin in blood, estimation of, 63Disc technique for determining sensitivity to antibiotics,

374

EECKERLING, B., see GUREVITCH, J., RozANSKY, R., WEBER,

D., BRZEZINSKY, A., and ECKERLING, B.Electric current, direct, effect on normal and antibody-

sensitized red cells, 200ELEK, S. D., and HILSON, G. R. F.: Centrifugal gradocol

filter, 240- see HILSON, G. R. F., and ELEK, S. D.ELWOOD, J. S., and WARDENER, H. E. de: Survival of

transfused erythrocytes from patients with polycyth-aemia vera, 218

Embolism, paradoxical, 316Endocarditis, Libman-Sacks, 402ENGBAEK, H. C., see TEiLUM, G., ENGBAEK, H. C..

HARBOE, N., and SIMONSEN, M.Enzyme test, proteolytic, for detecting incomplete anti-

bodies, 189

510 INDEX

Eosinophilic polyarteritis, Libman-Sacks endocarditis, andasthma with diffuse collagen disease, 402

Erythrocytes, transfused, survival from patients with poly-cythaemia vera, 218

EZRIN, C., see MACMILLAN, R. L., EZRIN, C., andBUTLER, A.

FFAIRBROTHER, R. W., and MARTYN, G.: Disc technique

for determining sensitivity to antibiotics, 374and SOUTHALL, J. E.: Determination of sensitivity

of Myco. tuberculosis to streptomycin, 183Filter, centrifugal gradocol, 240Folinic acid, effect on megaloblasts in vitro, 204Fragility test, combined, for congenital haemolytic jaun-

dice, 221Friedmann pregnancy test, modified, 107

GGILLESPIE, M., and POTELIAKHOFF, A.: Association of

eosinophilic polyarteritis, Libman-Sacks endocarditis,and asthma with diffuse collagen disease, 402

Glomerulonephritis, experimental effect of cortisone on,301

Gloyne, Stephen Roodhouse (obituary), 111GOLDSMITH, K., and HUMBLE, J. G.: Effect of a direct

electric current on normal and antibody-sensitized redcells, 200

GORRILL, R. H., see LINSELL, W. D., and GORRILL, R. H.Gradocol filter, centrifugal, 240GRUCHY, G. C. de, see DACIE, J. V., and GRUCHY,

G. C. deGUREVITCH, J., ROZANSKY, R., WEBER, D., BRZEZINSKY,

A., and ECKERLING, B.: Role of spermine in theinhibition of Staphylococcus aureus by human semen,360

HHaemagglutination reaction in tuberculosis, 158Haemoglobin determination, sampling error in, 211Haemolytic anaemia, acquired, auto-antibodies in, 253- symptomatic, associated with ovarian teratoma,

412- jaundice, congenital, combined' fragility test for, 221Haemophiliac kindred, prothrombin consumption in, 460Haemophilic plasma, reaction to thromboplastin, 445Haemophilus pertussis, agglutination of, using concavity

slides, 487Hapten, Rh, question of, 470HARBOE, N., see TEILUM, G., ENGBAEK, H. C., HARBOE,

N., and SIMONSEN, M.HAYHOE, F. G. J., and SMITH, D. Robertson Plasmo-

cytosis in the bone marrow in rheumatoid arthritis, 47Heat, effects on staphylocoagulase test, 73Heterophile antibodies in infectious mononucleosis, screen-

ing test for, 104HIGGINSON, J., and KEELEY, K. J.: Unusual cardiac

aneurysm in a young adult, 342HILSON, G. R. F., and ELEK, S. D.: Haemagglutination

reaction in tuberculosis, 158- see ELEK, S. D., and HILSON, G. R. F.

Hirsutism, benign, excretion of pregnanediol and 17-keto-steroids during menstrual cycle in, 78

Histochemistry, review of modern methods in, 1HOLMAN, S.: Lupus erythematosus cell inclusion pheno-

menon, 290HUMBLE, J. G., see GOLDSMITH, K., and HUMBLE, J. G.Hyperhaemolysis during the premenstrual period, 286

I

Instrument for combined sternal biopsy and aspiration,378

Iron, plasma, micro-estimation with orthotolidine, 92

JJaundice, congenital haemolytic, combined fragility test

for, 221JOHNSON, B. I.: Paradoxical embolism, 316

KKEELEY, K. J., see HIGGINSON, J., and KEELEY, K. J.KERSLEY. G. D., see BENE, E., and KERSLEY, G. D.

17-Ketosteroids, excretion during menstrual cycle in be-nign hirsutism, 78

KING, E. J., ABUL-FADL, M. A. M., and WALKER, P. G.:King-Armstrong phosphatase estimation by the deter-mination of liberated phosphate, 85

King-Armstrong estimation by determination of liberatedphosphate, 85

KINNEAR, A. A.: Preliminary report on a modified Fried-mann pregnancy test, 107

KLYNE, W., see MASON, J. K., KLYNE, W., and LENNOX, B.

LLAJTHA, L. G., see CALLENDER, S. T., and LAJTHA, L. G.Lamp, improved microscope, 234LENNOX, B., see MASON, J. K., KLYNE, W., and LENNOX, B.LEWIS, M., see CHOWN, B., and LEWIS, M.Libman-Sacks endocarditis, 402Lingual scrapings taken during treatment with chlor-

amphenicol and aureomycin, 393LINSELL, W. D., and GORRILL, R. H.: Effects of heat and

sodium ethyl-mercuri-thio-salicylate on the staphylo-coagulase test, 73

LOWBURY, E. J.: Improved culture methods for the detec-tion of Ps. pyocyanea, 66

LUBRAN, M.: Estimation of dicoumarin in blood, 63Lupus erythematosus cell inclusion phenomenon, 290

MMcALLISTER, R. A.: Determination of propylthiouracil in

urine with 2: 6-dichloroquinone-chloroimide, 432MCCARTNEY, J. E.: Improved microscope lamp, 234MACFARLANE, R. G., see BIoGS, R., and MACFARLANE,

R. G.MACMILLAN, R. L., EZRIN, C., and BUTLER, A.: Pro-

thrombin consumption in haemophiliac kindred, 460Mannitol-fermenting strain, late, of Shigella flexneri type

Z, 427MARTYN, G., see FAIRBROTHER, R. W., and MARTYN, G.MASON, J. K., KLYNE, W., and LENNOX, B.: Potassium

levels in the cerebrospinal fluid after death, 231MATTHEWS, G. A.: A cell-suspension mixer, 383MEADE, B. W., and SMITH, M. J. H.: Estimation of

sodium gentisate in plasma and urine, 226Megaloblasts, effect of citrovorum factor (folinic acid) on,

204Menstrual cycle in benign hirsutism, excretion of pregnane-

diol and 17-ketosteroids during, 78MERIVALE, W. H. H. Excretion of pregnanediol and 17-

ketosteroids during the menstrual cycle in benignhirsutism, 78

Metabolic rate, basal evaluation of a method of estimatingthe, 381

Micro-estimation of plasma iron with orthotolidine, 92Microscope lamp, an improved, 234Mixer, cell-suspension, 383MONCKTON, J. C.: A useful cover-slip container, 238Mononycleosis, infectious, screening test for heterophile

antibodies in, 104MORRIS, D. M., see RUBBO, S. D., and MORRIS, D. M.MORTON, J. A., and PICKLES, M. M.: Proteolytic enzyme

test for detecting incomplete antibodies, 189Mycobacterium tuberculosis, determination of sensitivity

to streptomycin, 183in sputum, streptomycin sensitivity of, 173

NNICHOLAS, J. W.: A simplified method for estimating

carbon monoxide in blood with the volumetric VanSlyke apparatus, 441

Non-silicious anisotropic crystals in tuberculous salping-itis, 333

0Obituary:

Gloyne, Stephen Roodhouse, 111Panton, Sir Philip, 109

O'BRIEN, J. R.: The bleeding time in normal and abnor-mal subjects, 272

Orthotolidine, micro-estimation of plasma iron with, 92OSBORN, D. A.: The question of the Rh hapten, 470Ovarian teratoma, symptomatic haemolytic anaemia asso-

ciated with, 412

INDEX

PPAGEL, W.: Polyarteritis nodosa and the "rheumatic"

diseases, 137Panton, Sir Philip (obituary), 109Paradoxical embolism, 316P.A.S., action on prothrombin time in man, 478PEARSE, A. G. Everson A review of modern methods in

histochemistry, 1Penicillin-resistant staphylococci In a semi-closed commu-

nity, 350Phosphatase estimation by determination of liberated phos-

phate, 85Photometric method for estimation of sodium, 99PICKLES, M. M., see MORTON, J. A., and PIcKLEs, M. M.Plasma, estimation of sodium gentisate in, 226- iron, micro-estimation with orthotolidine, 92- uric acid, ultrafiltration of, 366Plasmacytosis in the bone marrow in rheumatoid arthritis,

47Platelet count, normal, in man, 37Polyarteritis, eosinophilic, 402- nodosa and the ' rheumatic " diseases, 137Polycythaemia vera, survival of transfused erythrocytes

from patients with, 218POOLE, J. C. F., and WILLIAMS, G. C. J.: Emergency

methods for Rhesus group determination, 55Potassium levels in cerebrospinal fluid after death, 231POTELIAKHOFF, A., see GILLESPIE, M., and POTELIAKHOFF,

A.Porrs, R. E.: Non-silicious anisotropic crystals in tuber-

culous salpingitis, 333Pregnancy test, modified Friedmann, 107Pregnanediol and 17-ketosteroid, excretion during mens-

trual cycle in benign hirsutism, 78Premenstrual period, hyperhaemolysis during, 286Presidential address: Whither clinical pathology? 129Propylthiouracil, determination of, in urine, 432Proteolytic enzyme test for detecting incomplete antibodies,

189Prothrombin consumption in haemophiliac kindred, 460- time, action of p-aminosalicylic acid on, 478Pseudomonas pyocyanea, improved culture methods for

detection of, 66R

Red cells, effect of direct electric current on normal andantibody-sensitized, 200

Reticulocyte crisis after effective specific treatment ofpernicious anaemia, 207

Rhesus blood-grouping, slanted capillary method of, 464-group determination, emergency methods for, 55-hapten, question of the, 470Rheumatic " diseases, polyarteritis nodosa and the, 137

Rheumatoid arthritis, plasmacytosis in bone marrow in, 47ROZANSKY, R., see GUtEVITCH, J., RozANSKY, R., WEBER,

D., BRZEZINSKY, A., and EcCKERLINO, B.RUBBO, S. D., and MORRIS, D. M.: Slide-culture tech-

nique for determining streptomycin sensitivity of M.tuberculosis in sputum, 173

S

511

Sodium gentisate, estimation in plasma and urine, 226SOUTHALL, J. E., see FAIRBROTHER, R. W., and SOUTHALL,

J. E.Specific gravity, determination on one drop of urine, 491Spermine, role in inhibition of Staph. aureus by human

semen, 360Sputum, streptomycin sensitivity of M. tuberculosis in, 173Staphylocoagulase test, effects of heat and sodium ethyl

mercuri-thio-salicylate on, 73Staphylococci, penicillin-resistant, in a semi-closed commu-

nity, 350Staphylococcus aureus, aureomycin sensitivity of 100 patho-

genic strains of, 355role of spermine in inhibition of, 360

STEINGoLD, L., see TARNOKY, A. L., and STEINGOLD, L.Sternal biopsy and aspiration, instrument for combined,

378STERNDALE, H., see BERNSTOCK, L., and STERNDALE, H.Streptomycin, determination of sensitivity of M. tubercu-

losis to, 183- resistant tubercle bacilli, simple method for detecting,

421- sensitivity of M. tuberculosis in sputum, slide culture

for, 173

TTARNOKY, A. L., and STEINGOLD, L.: Action on p-amino-

salicylic acid on prothrombin time in man, 478TEILUM, G., ENGBAEK, H. C., HARBOE, N., and SIMONSEN,

M.: Effects of cortisone on experimental glomerulo-nephritis, 301

THOMPSON, B. A., and SCHWABACHER, H.: Incidence ofpenicillin-resistant staphylococci in a semi-closed com-munity, 350

Thromboplastin, reaction of haemophilic plasma to, 445Titration method for determining specific gravity on one

drop of urine, 491ToMASZEWSKI, W.: Findings from lingual scrapings taken

during treatment with chloramphenicol and aureo-mycin, 393

Transfused erythrocytes from patients with polycythaemiavera, survival of, 218

Tubercle bacilli, simple method for detecting streptomycinresistant, 421

Tuberculosis, haemagglutination reaction in, 158Tuberculous salpingitis, non-silicious anisotropic crystals

in, 333

UUltrafiltration of plasma uric acid, 366Uric acid, modified technique for determination in blood

and urine, 370plasma, ultrafiltration of, 366

Urine, determination of propylthiouracil in, 432specific gravity on one drop of, 491

- -- uric acid in, 370estimation of sodium gentisate in, 226

VVan Slyke apparatus, volumetric, estimation of carbonSalpingitis, tuberculous, non-silicious anisotropic crystals monoxide in blood with, 441

in, 333 VARADI, S.: Combined fragility test for congenital haemo-SCHWABACHER. H., see THOMPSON, B. A., and SCHWA- lytic jaundice, 221BACHER, H. VAUGHN, J.: A screening test for heterophile antibodies inScreening test for heterophile antibodies in infectious infectious mononucleosis, 104mononucleosis, 104

Semen, human, role of spermine in inhibition of Staph. Waureus by, 360

Serum sodium determination, photometric method for, 99 WALKER, P. G., see KING, E. J., ABUL-FADL, M. A. M.,Shigella ftexneri type Z, late mannitol-fermenting strain of, and WALKER, P. G.427 WARDENER, H. E. de, see ELWOOD, J. S., and WARDENER,SIMONSEN, M., see TEILUM, G., ENGBAEK, H. C., HARBOE, H. E. deN., and SIMoNsEN, M. WEBER, D., see GUREVITCH, J., RozANSKY, R., WEBER, D.,Slanted capillary method of Rhesus blood-grouping, 464 BRZEZtNSKY, A., and ECKERLING, B.

Slide-culture technique for determining streptomycin sensi- WHITBY, Sir L.: Whither clinical pathology? Trends andtivity of M. tuberculosis in sputum, 173 opportunities, 129SLOAN, A. W.: The normal platelet count in man, 37 Whither clinical pathology? Trends and opportunities, 129SMITH, D. Robertson, see HAYHOE, F. S. J., and SMITH, WILDY, P.: A simple method for detecting streptomycin-

D. Robertson resistant tubercle bacilli, 421SMITH, M. J. H., see MEADE, B. W., and SMITH, M. J. H. WILLIAMS, G. C. J., see POOLE, J. C. F., and WILLIAMS,Sodium, photometric method for estimation of, 99 G. C. J.Sodium ethyl mercuri-thio-salicylate, effect on staphylo- WOOTrON, I. D. P.: Factors affecting the speed of agglu-coagulase test, 73 tination in the Coombs test, 296

INDEX

INDEX TO ABSTRACTSEntries followed by the letter P in brackets (P) refer to the reports ofthe Scientific Meetings of the Association of Clinical Pathologists.

AACTH, use in poliomyelitis, 123Adamantinoma," misuse of the term (P). 115

Addison's disease, diabetes mellitus and, 387Adenolymphoma, 251Adenomatoid tumours of genital tract, 391Agranulocytosis, amidopyrin (P), 113Amidopyrin agranulocytosis (P), 113Amyloid and myeloma, 251Anaemia, haemolytic, with febrile thrombopenic purpura

and platelet thrombosis, 389--of infection, 387--pernicious, effect of thymidine on, 124

-factor inhibiting erythropoiesis in, 388-- vitamin Bt2 and extracts of duodenal mucosain, 124

Angioma, sclerosing, of skin, 252Angiosarcoma, 251Antibacterial substances, synergism and antagonism dis-

played by, 384Antibiotics in treatment of whooping cough, 499Antibodies, anti-A, haemolytic disease of newborn due to.

124-- multiple, after repeated transfusions, 248, 249Antibody producers, role of plasma cells as, 250Aortic arch bodies, tumours of, 39FAtherosclerosis, pathogenesis of, 127Auer bodies in leukaemic cells, 248Aureomycin, blood levels and urinary excretion after intra-

venous and intramuscular administration, 385effect on bacterial flora of intestinal tract, 120in infantile diarrhoea and vomiting, 121in soft tissue infections, 121

- in whooping cough, 499- susceptibility of Salmonella and Shiga strains to, 122

B

Benemid, influence on metabolism of PAS and penicillin,386

Benzoic acid derivative, influence on metabolism of PASand penicillin, 386

Biopsies in rectal disease (P), 114Blood clotting mechanism in acute leukaemia. 127

donors, dangerous universal, 249groups, multiple antibodies after repea'ed trans-

fusions, 248, 249platelet thrombosis, generalized, 125

--platelets, transfusion in thrombopathic thrombocyto-penia, 125

--vessel tumours, malignant, 251Breast, cancer, hypercalcaemia in osteolytic metastatic, 247

carcinoma, prognosis in, 392lesions complicating cirrhosis of liver, 390

Brill's disease in London, 244Brucellosis, chloramphenicol in, 501-lymph-node culture in diagnosis of, 501Burns, eosinophil and other leucocyte changes in (P), 113

C

Calcification, cystadenoma of pancreas showing, 128Cancers, multiple, 250Canicola fever, diagnosis of (P), 115Carcinoma, cylindrical-celled, presenting as nasal polypi

(P), 114of breast, prognosis in, 392

-primary, of lung. 250

Carotid body, nonhromaffin paragangliema of, 3)1Chloramphenicol in Brucellosis, 501

in H. influenzae meningitis, 498--in Shigella enteritis, 500--in surgical infections, 119

in typhoid fever, 120, 243, 498. 499--in whooping cough, 499

in vitro activity, absorption and excretion of, 243susceptibility of Salmonella and Shiga strains to. 122synthetic and fermentation tyTpe, 243. 498

Chloromycetin, see ChloramphenicolCholine, effect on haematopoiesis, 506Chorionepithelioma of testicle, 391Cirrhosis of liver, electrolyte studies on patients with, 504

lesions complicating, 390Clotting mechanism in acute leukaemia, 127Coagulation defect in thrombocytopenic purpura, 126

defects associated with premature separation ofplacenta, 250

--promoting agents in haemophilia, 127Cresyl blue, fallacies in platelet count due to use of (P),

113Cushing's syndrome and thymic carcinoma, 128Cystadenoma of pancreas showing calcification. 128- lymphomatosum, papillary, 251

D

DDS, in treatmcnt of piague, 502Diabetes insipidus associated with tes-icular tumour, 391

mellitus and Addison's disease, 3874: 4'-Diaminodiphenyl sulphone in treatment of leprosy,

502Diarrhoea and vomiting, infantile, aureomycin treatment

of, 121Diethylstilboestrol, effect on calcium, phosphorus and

nitrogen metabolism of prostatic carcinoma, 246Dysgerminoma ovarii, 252

E

Electrolyte studies on patients with cirrhosis of liver, 504Encephalitis, measles, 127Enteritis, Shigella, chloramphenicol in, 500Eosinophil changes in burns (P), 113

index in thrombocytopenic purpura, 125Ependymal tumours of spinal cord and filum terminale,

507Epididymal tumours, 391Erythrocytes, change in tendency to agg-egate, 124Erythropoiesis, inhibitory factors in pernicious anaemia,

388normoblastic and megaloblastic (P), 114

Ethyl carbamate, therapy in multiple myeloma, 124

F

Fibroblastoma. granular-cell perineural, 252Filum terminale, ependymal tumours of, 507

GGanglion nodosum, nonchromaffin paraganglioma of. 391Gastro-intestinal tract, smooth-muscle tumours of, 507Gaucher's disease in early childhood, 128

neurological form of, 128Genital tract, adenomatoid tumours of, 391Giant-celled tendon-sheath tumours, 252

512

INDEX

Glomerulonephrosis, 508Granular-cell myoblastoma, 252Granulomas caused by implantation of talcum, 127

513

NNasal polypi, cylindrical carcinoma presenting as (P), 114Neomycin, effect on bacteria, viruses, and protozoa, 123Nephritis, tubular or toxic, 508Nmhrosc-erosis. unilateral benitn and malisnant. 392Nephrosis, lower nephron, 508

Haematopoiesis, effect of choline on, 506 Normoblastic erythropo:eEis (P), 114Haemolytic disease of newborn due to anti-A antibodies,

124Haemophilia, refractoriness to coagulation-promoting 0

agents, 127 Old age, morbid anatomy of tuberculosis in, 508Haemophilus influenzae meningitis, chlorazrphenicol in, Oliguria, toxic, renal cortical ischaemia in, 508

498 Osteolytic metastatic cancer of breast, hypercalcaemia in,Haemopoietic factors in hog stomach and duodenum, 124 247Haemoglobinuria, paroxysmal nocturnal, activation of Ovary, dysgerminoma of, 252

haemolytic factor by thrombin in, 389- specific test for, 389

Harvest fever, epidemic of, 386 pH4enarin cofactor- clinical studies ann 126*svMwsrin vvWLMAUL W-aMU19s bt-wC L, 1-wHepatitis, viral, following use of irradiated plasma, 390Histiocytoma, cutaneous, 252Hog stomach and duodenum, haemopo.etic factors in, 124Hypercalcaemia in osteolytic metastatic cancer of breast,

247y-Hypergiobulinaemia, plasma protein studies in, 245

Infantile diarrhoea and vomiting, aureomycin treatment of.121

Infections, iron absorption in, 387Intestinal tract, effect of aureomycin on bacterial flora of,

120Iron absorption in infections, 387- deficiency anaemias of pregnancy (P), 117- metabolism, 503- in normal pregnancy (P), 117

storage, pathophysiology of, 503Irradiated plasma, hepatitis following injection of, 390Isoantibodies of immune type in group 0 blood, 249

Jaundice, homologous serum, associated with use of irra-diated plasma, 390

KKaposi's sarcoma, 251

varicelliform eruption (P), 114

LLeprosy, DDS in treatment of, 502Leprous material, acid-fast microorganism cultivated from,

503Leptospirosis, epidemiology of (P), 116Leucocyte changes in burns (P), 113Leukaemia, acute, blood-clotting mechanism in, 127- acute, myelocytic, with dysgerminoma ovarii, 252- relationship to polycythaemia vera, 247Leukaemic cells, Auer bodies in, 248Lipogranuloma, sclerosing, 251Liver, cirrhosis of, electrolyte studies on patients with, 504

lesions complicating, 390Lung, primary carcinoma of, 250Lymph-node culture in diagnosis of acute brucellosis, 501

Pancreas, cystadenoma of, showing calcification, 128Paraganglioma. nonchromaffin, 391Parotid salivary gland, adenolymphoma of, 251PAS, influence of new benzoic acid derivative on metabo-

lism of, 386Penicillin, accumulation in inflamed tissues (P), 115- effective concentrations for streptococc, pneumo-

cocci, and Trep. pallidum, 119- influence of new benzoic acid derivative on metabo-

lism of. 386prolongation of blood level by implantation of pro-

caine penicillin tablets, 119 385Penicillin G, use of penicillin 0 in patients hypersens.tive

to, 384, 498- 0, use in patients hypersensitive to penicillin G, 384,

498Peritoneum, squamous metaplasia of, 507Placenta, coagulation defects associated with premature

separation of, 250Plague, modern therapy of, 502Plasma cells, role as antibody producers, 250- irradiated, hepatitis following injection of, 390

potassium in surgical patients, 245- protein studies in rhyperglobulinaemia, 245Platelet count, fallacies due to use of cresyl blue (P), 113-thrombosis, febrile thrombopenic purpura with

haemolytic anaemia and, 389Pneumococci, effective concentration of penicillin for, 119Poliomyelitis, histologic study of muscles and nerves in, 252- use of AC-H in, 123Polycythacmia vera, rclationship to leukaemia, 247Polypi, nasal, cylindrical carcinoma presenting as (P), 114Potassium deficiency states (P), 117- metabolism, problems of, 386

serum and urinary, in surgical patients, 245Pregnancy, iron metabolism in (P), 117Procaine penicillin tablets, implantation of, 119, 385Prostate, lesions complicating cirrhosgs of liver, 390Prostatic carcinoma, effect of diethylstilboestrol on cal-

cium, phosphorus and nitrogen metabolism of, 246Prothrombin consumption test, one-stage, 505-- time, serum, 505Purpura, associated with bone changes, 389

febrile thrombopenic, with haemolytic anaemia andplatelet thrombosis, 389

- fulminating, with factor-V deficiency, 390- thrombocytopenic, coagulation defect in, 126-- eosinophil index in, 125

M RMeasles encephalitis, 127 Radioactive test of thyroid function (P), 118, 504Megaloblastic erythropoiesis (P), 114 Rectal disease, biopsies in (P), 114Melanoma, cutaneous and ocular, prognosis in, 506 Rectum, villous tumours of, 507Meningitis, Haemophi.'us inhfuenzae, chloramphenicol in, Renal cortical ischaemia, 508

498 - necrosis, unilateral, 392Metabolism, effect of diethylstilboestrol on, in prostatic

carcinoma, 246Metaplasia, myeloid, 248 S- squamous, of peritoneum, 507 Salivary gland, adenolymphoma of, 251Myelomd metaplasia, 248 Salmonella, infections, fatalities in, 122Myeloma, amyloid and, 251 susceptibility to chloromycetin and aureomycin, 122- multiple, urethane therapy in, 124 Salt-depletion, sodium excretion during, 247Myelomatosis, atypical flocculation tests in (P), 117 Sarcoids, talcum, 127Myoblastoma, granular-cell, 252 Sarcoma, Kaposi's, 251

514 INDEX

Sclerosing lipogranuloma, 251Serum, formation of gel in case of purpura, 389

prothrombin time, 505Shigella enteritis, chloramphenicol in, 500

susceptibility to chloromycetin and aureomycin, 122Siderosis, transfusional, 391Smooth muscle tumours of gastro-intestinal tract, 507Sodium excretion in normal and salt-depleted subjects, 247Spinal cord, tumours of, 507Squamous metaplasia of peritoneum, 507Streptococci, effective concentration of penicillin for, 119Streptomycin in whooping cough, 499Surgical infections, chloromycetin in, 120Synergism and antagonism displayed by antibacterial sub-

stances, 384Synovitis, chronic villo-nodular, 252

TTalcum, granulomas caused by implantation of, 127- sarcoids; 127Tendon-sheath tumours, giant celled, 252Terramycin, clinical observations on, 386-- in vivo and in vitro studies on, 501Terramycin hydrochloride, use of, 123Testicle, lesions complicating cirrhosis of liver, 390-malignant tumours of, 391Theca-cell tumours, 507Thigh-neck clearance test (P), 118, 504Thrombocytopenia, thrombopathic, transfusion of blood

platelets in, 125Thrombocytopenic purpura, coagulation defect in, 126

eosinophil index in, 125Thromboplastin-deficiency diseases, one-stage prothrombin

consumption test in, 505Thrombosis, generalized blood platelet, 125Thymidine, effect on pernicious anaemia, 124

Thymine desoxyriboside, effect on pernicious anaemia, 124Thymus, carcinoma, Cushing's syndrome associated with,

128Thyroid function, simplified radioactive test of (P), 118,

504Transfusion isoantibodies of immune type in group 0

blood, 249- repeated, multiple antibody response to, 248, 249Transfusional siderosis, 391Treponema pallidum, effective concentration of penicillin

for, 1 19Tuberculosis in old age, morbid anatomy of, 508Tumours, ependymal, of spinal cord and filum terminale,

507smooth-muscle, of gastro-intestinal tract, 507

- theca-cell, 507- villous, of rectum, 507Typhoid fever, chloramphenicol in, 120, 243, 498, 499

UUrethane therapy in multiple myeloma, 124Urine potassium excretion in surgical patients, 245

VVaricelliform eruption, Kaposi's (P), 114Villous tumours of rectum, 507Viral hepatitis, following use of irradiated plasma, 390Vitamin Bt2 activity in urine after oral and intramuscular

administration, 388

wWarthin's tumour of parotid salivary duct, 251Weil's disease, diagnosis of (P), 115Whooping cough, treatment with antibiotics, 499

INDEX

AUTHORS OF ARTICLES ABSTRACTED

AAckerman, G. A.. 248Alin, K., 122Allegre, G., 507Allen, F. H., 248Alston, J. M., 116Altemeier, W. A., 119Appelbaum, E., 127Aronson, S. M., 392

BBachman, M. C., 123Baggenstoss, A. H., 390Bailey, C. A., 243, 498Barnett, R. N., 390Bassen, F. A., 390Beatty, J. O., 386Benhamou, E., 499Bennett, H. S., 390Berger, J. S., 247Bernhard, W., 251Bertrand, L., 501Bethell, F. H., 124Bigger, J. W., 384Black, D. A. K., 247Blake, F. G., 386Bliss, E. A., 501Block, M., 248Blondhelm, S. H., 504Bloom, H. J. G., 392Boger, W. P., 386Bongiovanni, A. M., 504Boorman, K. E., 124Broom, J. C., 115Bryant, H. C., 251Burke, F. G., 500Butler, F. S., 250Butt, H. R., 390

CCahan, W. G., 250Caniggia, A., 506Carr, T. L., 126Chalmers, J. A., 252Chandler, C. A., 501Chow, B. F., 388Christian, R. M., 249Clark, E. A., 123Cole, J. W., 126Collins, H. S., 385Collins, J. O., 248Conley, C. L., 388Cook. C. D., 123Coriell, L. L., 123Cornely, P. B., 123CowdeUl, R. H., 507Cowen, J., 249Crome, L., 507Crosby, W. H., 389, 505Croxatto, R., 119, 385

DDahlin, D. C., 251Damashek, W., 125Dausset, J., 127Davis, J. H., 126Davis, R., 388Dearing, W. H., 120

De Muralt, G., 390De Nicola, P., 245Denst, J., 252Destaing, F., 499Dick, A., 114Discombe, G., 113Dockerty, M. B., 251Dodd, B. E., 124Dolgin, J.. 127Dolgopol, V. B., 127Duguid, J. B., 127Dukes, C., 114

EEagle, H., 119Earle, J. H. O., 117Ehrlich, L., 247Eisenmenger, W. J., 504Ellicott, C. E., 388Epstein, R. D., 127Ervin, D. M., 249Everson Pearse, A. G., 252Ewing, M. R., 507

FFavre-Gilly, J., 125Felix, A., 244Felsenfeld, O., 123, 384, 498Finch, C. A.. 503Finch, S., 503Finland, M., 385Fleischman, R., 119Flippin, H. F., 386Fluharty, R. G., 503Foote, J. B., 118, 504Fowler, W. M., 126Fox, R. A., 390French, A. J., 508Freyre, A. Vidal, 499Friou, G. J., 386Frisell, E., 121Frisk, A. R., 243Frommeyer, W. B., 127

GGarde, A., 507Gasser, C., 390Giampalmo, A., 128Giuseffi, J., 119Gocke, T. M., 385Goldenberg, P. T., 389Good, R. A., 120Gordon, H. M., 247Gormsen, H., 250Green, M. A., 125Grist, N. R., 114Gruenfeld, G. E., 127

HHahn, H., 386Haskins, D., 503Hastings, L. P., 389Haukohl, R. S., 128Hawksley, J. C., 244Hegsted, M., 503Hirsch, E. O., 125Hoch, H., 389

Holden, W. D., 126Howard, L. P., 387Hubble, D., 128Huidobro, F., 119, 385

Ishihara, S. J., 123

J

Jacobson,, L. O., 248James, G., 390Janbon, M., 501Jasinski, B., 387Johns, R. G. S., 389Johnson, J. B., 123

K

Kaplan, S. R., 125Khoo, P. S H., 391King, E. Q., 123Kinney, T. D., 503Klopper, A., 117Knight, V., 501Korns, R. F., 390Kunkel, H. G., 504

L

Laitha, L. G., 114Lang, C. A., 388Laszlo, D., 246, 247Lattes, R., 391Laurell, G., 121Leigh, E., 389Lewis, C. N., 123Lewthwaite, R., 243, 498Litzner, S., 386Logan, M. A., 121Loge, J. P., 124Long, P. H., 501Lucas, H. A., 114Lucchini, A., 119, 385Lucey, H. C., 389Lyons, J. B., 123

MMcCarthy, W. D.. 251McDermott, W., 501McGowan, 117Mackenzie, R. D., 120Maclagan, N. F.. 117, 118, 504Magnusson, J. H., 121Malone, R. H., 249Manley, E. B., 115Marrack, J. R., 389Mardn, N. H., 117Melamed, A., 128Metzger, W. I., 121Meyer, K. F., 502Meyers, M. C., 124Michael, S. R., 390Mighton, H. K., 391Mlczoch, F., 124Moragues, V., 391Muir, E., 502Murphy, L., 123Musselman, A. D., 119

515

516

NNeligh, R. B., 124Neubuerger, K. T., 252

PPack, G. T., 251Parkin, T. W., 387Pitts, F. W., 386Platt, R., 247Pool, J. L., 250Prather, G. W.. 498Prigot, A., 121

QQuatrefages, H., 501

RRace, R. R., 248Rath, C. E., 503Reid, D. E., 250Reisner, E. H., 124Rice, E. C., 500Richards, H. G., 124Robinson, E. A., 121Roby, C. C., 250Rosenthal, N., 390Rosenthal, S., 125Ross, S., 500Roth, F., 391Roulet, F., 508Ruiz-Sanchez, F., 501Rundles, R. W., 124

SSampson, M. C.. 392Sanger, R., 248

INDEX

Saphra, I., 122Schilling, A., 246Schwartz, S. O.. 125, 247Scott, R. B., 123Sevitt. S., 113Shales, W. H., 384, 498Siegel, A. C., 123Smadel, J. E.. 243, 498Smetana, H. T., 251Smith, M. H. D., 498Snavely, J. G., 390Snyder, C. D., 245Snyder, H. E., 245Sorrel, A., 499Soulier, J. P., 127Sparling, D. W., 507Spencer, H., 252Stanbury, S. W., 247Stefanini, M., 505Stevens, S., 500Stokes, E. J., 244Stokes, J., 123Swendsied, M. E.. 124Swyer, A. J., 247

TTaylor, F. H. L.. 127Taylor, I. M., 386Taylor, W. K., 113Terni, M., 503Thayer, J. E.. 389Thomas, E. D., 503Thompson, A. S., 251Thompson, B. R., 388Thompson, K. S., 115Trinick, R. H.. 124Tunevall, G., 243

UUngar, J., 115

VVentura. S., 117Volini, 1. F., 123. 384, 493

wWagner, R. R., 386Wallmark, G., 122Ward, E., 387Warth, P. T., 501Washington, J. A.. 500Watson, W. L.. 250Weiner, A. E., 250Welch, H., 123Weller, J. M., 386Wells, E. B., 385Werner, B., 121Wertheimer, P., 507West, R., 124Whimster, I. W.. 252Wright, A. W., 390Wright, C. J. E.. 506Wright, L. T., 121Wuhrmann, F.; 124. 245Wunderly, C., 124. 245Wyatt, J. P., 391

yYoung, L. E.. 249Young, V. M., 123

J. clin. Path. (1951), 4, 498.

ABSTRACTSThis section of the JOURNAL is published in collaboration with the two abstracting

journals, Abstracts of World Medicine, and Abstracts of World Surgery, Obstetrics andGynaecology, published by the British Medical Association. In this JOURNAL some ofthe more important articles on subjects of interest to clinical pathologists are selectedfor abstract, and these are classified into four sections: bacteriology; biochemistry;haematology; and morbid anatomy and histology.

BACTERIOLOGY

Use of Penicillin 0 in Patients Hyper-sensitive to Penicillin G. VOLINI,I. F., SHALES, W. H., and FELSENFELD,0. (1950). J. Amer. med. Ass., 143,794.Several workers have reported that per-

sons hypersensitive to penicillin G mayshow no reaction to some of the bio-synthetic penicillins. One of these is allyl-mercaptomethyl penicillin, or penicillin 0.The minimum inhibitory concentrations ofpenicillin 0 for Gram-positive cocci arethe same as, or double, those of penicillin G.Furthermore, penicillin 0 was found to beless toxic and less irritating than penicillin Gwhen injected subcutaneously into mice.The absorption and excretion curves of thesetwo penicillins are essentially the same.

Penicillin 0 was administered to 57patients who had clinical symptoms ofhypersensitivity to penicillin G within apreceding period of not more than 200days. Twenty of them had upper respiratoryinfections, and were given inhalations ofpenicillin-O dust, 100,000 units every 4 hoursfor 7 days. All recovered without complica-tions and showed no allergic phenomena.In 23 cases of tonsillitis and pharyngitisdue to fl-haemolytic streptococci the patientreceived 10 troches containing 3,000 unitsof penicillin 0 daily for 3 days. The resultswere excellent in 15, good in 5, and poor in3 cases. Fourteen patients received coursesof injections of penicillin 0, following whichpenicillin G was given and was well tolerated.It appears that penicillin 0 had a desen-sitizing effect. Seven of the cases arereported in detail and a further 7 in tabular

form. In every case penicillin 0 was aseffective as penicillin G.

A. W. H. Foxell.

Chloramphenicol in the Treatment ofHemophilus influenzae Meningitis.PRATHER, G. W., and SMITH, M. H. D.(1950). J. Amer. med. Ass., 143, 1405.From the Charity Hospital, New Orleans,

the authors report the treatment withchloramphenicol of 15 consecutive, un-selected cases of Haemophilus influenzameningitis. Of these 15 patients 8 wereinfants under one year. In every case H.influenza type B organisms were recoveredin culture from the spinal fluid, but fluidfrom a second puncture performed withinan average interval of 21 hours was sterile.All the patients recovered, no toxic effectsattributable to the drug being observed.On the basis of this experience the authorsrecommended immediate doses between50 and 100 mg. per kg. body weight bymouth or stomach-tube, followed by 250mg. 8-hourly for 5 or more days irrespectiveof body weight. They consider this methodof treatment to be more satisfactory thanany other known to them.

Joseph Ellison.

Synthetic and Fermentation Type Chlor-amphenicol (Chloromycetin) in TyphoidFever: Prevention of Relapses byAdequate Treatment. SMADEL, J. E.,BAILEY, C. A., and LEWTHWAITE, R.(1950). Ann. intern. Med., 33, 1.A continuation of the studies on the use

of chloramphenicol (" chloromycetin ") in

ABSTRACTS

the treatment of patients with typhoid feverindicates that the synthetic form of the drugis as efficacious as the natural antibioticobtained by the fermentation process fromStreptomyces venezuelae. The same totalamounts of either type drug are equallyeffective when given in divided doses at2- to 6-hour intervals or in larger dosesonce or twice daily.There was a definite relationship between

the duration of chloramphenicol treatmentand the occurrence of relapses in typhoidfever. Slightly more than half of thepatients who were treated for 8 days or lesshad a recrudescence of the disease whichbegan about 10 days after treatment wasstopped. No relapses occurred in thegroups of patients treated for longer periodsof time. The present data suggest that a14-day period of treatment is sufficient toprevent relapses. In spite of the dramatictherapeutic effectiveness in patients withtyphoid fever, serious complications suchas intestinal haemorrhage and perforationmay be expected in treated patients, sincethe stage is generally set for such develop-ments before therapy is instituted and timeis required for the healing of the typhoidallesion of the intestine. In the present groupof 23 patients, 2 had haemorrhage sufficientlysevere to produce shock. Two other patientssuffered intestinal perforation; the coursein one of these was further complicated bysevere haemorrhage and the disease termi-nated fatally. Neither of the patients withperforation was given surgical treatment;chloramphenicol therapy controlled or sup-pressed the usual signs of generalizedperitonitis.On the basis of the present observations,

it would appear that the adequate treatmentof typhoid fever in the adult consists of aninitial oral dose of 3 0 to 4-0 g. of chloram-phenicol, followed by 1-5 g. oral doses givenevery 12 hours during the febrile period andby single daily 15 g. doses for 7 days;thereafter the dose may be reduced to asingle 1-0 g. dose and continued until the14th day of antibiotic therapy, after whichthe drug may be discontinued. Particularattention should be given to the recognition

of intestinal perforation in treated patients.since the classical signs of this develop-ment with the ensuing generalized peritonitismay be partially masked by the anti-bacterial effect of chloramphenicol.-[Authors' summary.]

Treatment of Whooping-cough with Anti-biotics (Streptomycin, Aureomycin, andChloramphenicol). FREYRE, A. VIDAL(1950). Arch. argent. Pediat., 34, 284.Streptomycin was given in the treatment

of 20 children with whooping-cough in adose of 0 5 g. intramuscularly, repeatedevery 12 hours, to a total of from 3 to 5 g.Results are classified as very good in 4 cases,good in 9, fair in 5, and unsatisfactory in 2.In one of these failures rapid cure wasachieved with aureomycin. Chloramphenicolwas given to 5 infants and children varyingin age from 4 months to 3 i years, and to oneadult; aureomycin was given to 9 infantsand children aged from 2 months to 7 yearsof age. The dosage by mouth of chloram-phenicol was identical with that of aureo-mycin: 50 mg. per kg. body weight every6 hours for the first 2 or 3 days and every 8hours later. With aureomycin results wereexcellent in 6, good in 1, and only mediocrein the other 2. With chloramphenicol theresults were spectacular, and after the thirdor fourth dose there were practically nofurther symptoms. G. M. Findlay.

General Remarks on 300 Cases of TyphoidFever Treated with Chloramphenicoland Associated Medication. BEN-HAMOU, E., DESTAING, F., and SORREL,A. (1950). Sem. H'p. Paris, 26, 4107.The results of treating a series of 200 cases

of typhoid and paratyphoid fevers in NorthAfrica with chloramphenicol are comparedwith those obtained in a previous series of100 cases. The mortality has decreasedprogressively; of the first 100 patients 86were cured, of the second 100 patients 94,and of the last 100 cases 98. These increas-ingly good results are attributed to obser-vance of the following principles. Antibiotictreatment should be begun as soon as the

499

ABSTRACTS

clinical symptoms suggest typhoid feverand before waiting for a bacteriologicaldiagnosis. As a general rule no attemptshould be made to give a large loading doseof chloramphenicol: 3 g. in the first 2hours is quite enough for an adult and isapproximately equivalent to 50 mg. per kg.body weight. Aureomycin should be givenat the same time as chloramphenicol, as itreduces greatly the risk of collapse. A largeloading dose of chloramphenicol may,however, be given without any dangerprovided the patient's illness has lastedonly a few days. After the first week aloading dose should never be given. Adose morning and evening is usually sufficientto produce prompt improvement. Foradults 1-5 g. morning and evening, and forchildren 0-25 g. at the same time is sufficientdosage. With more effective treatment,relapses have become less common, providedthat chloramphenicol has been given indecreasing doses for 14 days after thetemperature has reached normal. In thefirst 100 cases there were 14 relapses: in thesecond 100 cases 12, and in the third 5.Relapses may occur very late in con-valescence, and in 2 cases in the presentseries developed, with positive blood culture,60 and 72 days respectively after the tem-perature had fallen to normal.

It is concluded that ordinary typhoidfever can invariably be cured by chloram-phenicol, the temperature returning tonormal in 3 days. There are, however, threecomplications which do not respond tochloramphenicol alone. These are intestinalcomplications characterized by meteorism,intestinal haemorrhage, and perforation;cardiac failure, with tachycardia and vascularcollapse; and encephalitis, with delirium,stupor, and myoclonic contractions. Someevidence is brought forward to show thatthese symptoms are caused by strains oftyphoid bacilli with a low sensitivity tochloramphenicol. The best results areobtained by giving a mixture of chloram-phenicol, aureomycin, and sometimes alsostreptomycin. [It should be noted thatchloramphenicol is now known in Franceas " tyfomycine."] G. M. Findlay.

Chloramphenicol (Chloromycetin) Therapyin Shigella Enteritis. Ross, S., BURKE,F. G., RICE, E. C., WASHINGTON, J. A.,and STEVENS, S. (1950). J. Amer. med.Ass., 143, 1459.Chloramphenicol has been used in the

treatment of 35 children, aged between 3months and 7 years, suffering from bacterialdysentery (due in 33 cases to Shigellasonnei and in 2 to Sh. flexneri). Tests ofsensitivity to the drug were made on theisolated organisms, which all proved sensi-tive to 5 jug. per ml. or less. Each casewas confirmed bacteriologically before treat-ment was started, and daily stool cultureswere made throughout the stay in hospital.In general, the dosage employed was 250mg. 4-hourly for about 8 days. In all but 2of the 35 cases stool cultures became negativewithin 12 to 36 hours of starting treatment.Of the other 2 the stools of one becamenegative in 48 hours and of the other in 6days, with a relapse 8 days after discharge.He was treated again with 500 mg. of chlor-amphenicol 4-hourly for 10 days andrecovered completely. Clinically, the diseasesubsided pari pass with the bacteriologicalfindings, much improvement usually beingseen within the first 24 hours, thoughextensive fluid therapy was needed in a fewcases, mostly in infants. Diarrhoea sub-sided within 3 days and all the patients weredischarged cured after 8 consecutive negativebacteriological reports on the stools. Side-actions seem to have been chiefly due tothe bitter taste of the drug, many of thepatients being too young to take the capsuleintact. Anorexia and vomiting wereobserved in a few cases, but were onlytransitory. In 4 female patients vulvo-vaginitis was observed about 5 days afterstarting treatment, but it cleared up whenthe drug was stopped. Comparison is madewith the results of treatment with otherdrugs. It was found that sulphadiazine,streptomycin, polymyxin B, and chloram-phenicol all produced negative bacterio-logical results within 2 days, the averagefigures being 2x0, 1-6, 1-9, and 0-76 daysrespectively, and the differences beingstatistically insignificant. There are, there-

500

ABSTRACTS

fore, four drugs now available which maybe expected to clear up bacterial dysenteryquickly and completely.

Reginald St. A. Heathcote.

Chloramphenicol in the Treatment of theAcute Manifestations of Brucellosis.KNIGHT, V., RUIZ-SANCHEZ, F., andMCDERMOTT, W. (1950). Amer. J.med. Sci., 219, 627.The authors studied 13 patients suffering

from brucellosis who were treated withchloramphenicol. In general, the dosagewas 50 to 100 mg. per kg. daily during thefebrile period, followed by 25 mg. per kg.daily up to a total period of 6 to 10 days.In 5 patients there was a rapid subsidence offever and they remained well. There was anearly improvement in symptoms in 2 patients,both with bacteriaemia and both severelyill, but fever continued after chloramphenicolwas stopped. In one of these 2 cases a secondcourse of treatment instituted immediatelyresulted in rapid and apparently permanentimprovement. In the other there was along period of low-grade fever; later therewas a prompt and beneficial response to asecond course ofthe drug. Relapses occurredin 6 cases within 1 to 8 weeks of the end ofthe treatment. These patients had receivedthe drug for periods ranging from 6 to 10days. In 3 of them the relapses were mild,but in the other 3 the symptoms were fairlysevere. In all of these patients the infectionwas adequately controlled by a furthercourse of treatment. Symptoms and signsof a drug-induced exacerbation developedin 5 patients during the first or second dayof treatment, but in no case did this causealarm. No other serious toxic effects wereencountered.The uniform manner in which all patients

improved after treatment was started, eventhough cure was not established, was astriking feature and was thought to indicatea beneficial therapeutic action. The authorsconsidered that the high relapse rate wasdue to the short period of treatment andthat a more prolonged course (even up to4 to 6 weeks) might be justified. For theaverage adult the suggested optimum dosage

is about 6 g. per day. A comparison betweenthe temperature charts of 11 patients treatedwith aureomycin and the temperature chartsof those in the present series given chloram-phenicol does not reveal any great differencein the efficacy of the two drugs.

T. Anderson.

Lymph-node Culture; a Rapid and Accur-ate Method for the BacteriologicalDiagnosis of Acute Brucellosis. JANBON,M., BERTRAND, L., and QUATREFAGES,H. (1950). Pr. med., 58, 1355.In view of the frequent enlargement of the

lymph nodes in brucellosis, the authorssuggest the removal of a lymph node understrictly aseptic conditions for rapid bacterio-logical examination as a means of diagnosis.The tissue is ground up and cultivated on" bacto " tryptose agar. After 3 days ofincubation the growth of small colonies isvisible; these colonies are translucent andhave a granular appearance and are identi-fied by direct examination and agglutination.Any culture developing before the third dayis due to contamination. Of 53 examinationsin 50 cases of brucellosis, 33 (60%) showed apositive result, 12 were negative, and 8 werecontaminated. In 18 comparative tests incases of other diseases the investigationswere negative. Franz Heimann.

Studies of Terramycin, in vivo and invitro. BLISS, E. A., WARTH, P. T.,CHANDLER, C. A., and LONG, P. H.(1950). Bull. Johns Hopk. Hosp., 87,171.A series of in vivo and in vitro tests upon

terramycin are reported, and its generalphysical properties are noted.The minimal inhibitory concentrations of

terramycin were about ' to 2 those of aureo-mycin against several strains of 12 differentgenera, except in the case of Pseudomonasaeruginosa, in which they were 1/10 to1/20. In the same way the rate of deterio-ration due to prolonged incubation andchanges in pH and temperature was studied.Filtration through a Seitz filter pad wasshown to have no effect on activity.

01

ABSTRACTS

A concentration of 20 pg. per ml. sterilizeda standard culture of Bacterium coli after atime, but if concentrations up to 10 ,g.per ml. were used a slow initial decline innumbers was always followed by growth.Organisms surviving after 4 days in 5 pg.terramycin per ml. had not become resistant,a decline in activity of the antibiotic overthis period accounting for their growth.This decline was not greater in contact withBacterium coli than in a control non-inoculated broth.Serum levels and urinary excretion were

studied in 2 normal subjects after a dose of2 g. terramycin hydrochloride by mouth.The highest serum concentration (4 to 5 pg.perml.) occurred at2 to 4 hours, and maximalexcretion at 4 hours, after ingestion.

Terramycin was more effective than aureo-mycin in protecting mice against Klebsiellapneumoniae and Haemophilus influenza,but less protective against the haemolyticstreptococci and the pneumococcus.

E. A. Brown.

Modern Therapy of Plague. MEYER,K. F. (1950). J. Amer. med. Ass., 144,982.On the basis of impressive experiences in

the laboratory and in field trials, the follow-ing modem therapy is recommended incases in which the presence of plague issuspected.

Streptomycin should be given in largedoses (4 g.) at first, but for reasons ofeconomy the dose may be reduced safelyon the third and fourth day of recovery.After the fifth day, streptomycin may bereplaced by sulphadiazine or sulphamerazine(4 g. daily), In severe septicaemia, andparticularly in pneumonic plague, the initialdaily dose of 4 g. of streptomycin should besupplemented by oral administration ofaureomycin, chloramphenicol, or terramycin(2 to 4 g.) and anti-plague immune serumglobulin (rabbit) available at the NationalInstitutes of Health. If the patient does notrespond to streptomycin and sulphonamidetreatment in 2 or 3 days, even when optimaland large initial doses have been given, theinfecting strain may be resistant to these

antibiotics. In such cases chloramphenicol,aureomycin, terramycin, aerosporin, or neo-mycin may prove beneficial.When antibiotics are not available, sulpha-

diazine or sulphamerazine in an initial doseof 4 g., followed by 1 g. every 4 hours fornot more than 10 days, has proved highlyeffective in the treatment of uncomplicatedbubonic plague.

Contacts exposed to secondary or primarypneumonic plague should be given 2 or 3 g.of sulphadiazine or sulphamerazine daily for5 days. With the onset of symptoms, inten-sive treatment with antibiotics must beinstituted.-[Author's summary.]

Preliminary Report on 4: 4'-Diamino-diphenyl Sulfone (DDS) Treatment ofLeprosy. MUIR, E. (1950). Int. J.Leprosy, 18, 299.4: 4'-Diaminodiphenyl sulphone (DDS)

is the parent substance of the proprietarysulphones and has hitherto been regardedas too toxic for human use. The drugwas given orally in a 2-5% suspension ingum-acacia in ordinary uncomplicated casesof leprosy in doses of 4 mg. per kg. bodyweight, the average dose being 0-2 g.Intolerance was indicated by anaemia, andnecessitated a smaller dose; a small dosewas also given to patients who had complica-tions or were very ill, and to those withlepra reactions. In all, 94 cases weretreated, divided into three groups: (1)advanced lepromatous cases with complica-tions such as lepromatous ulcers, blockednose, eye conditions, and lepra reaction, inwhich the earlier effects could be suitablytested; (2) uncomplicated cases in goodhealth; (3) tuberculoid cases with wide-spread lesions (5 cases). Clinical andbacteriological improvement was assessed,the latter by study of smears from fivesuitable skin points by the scraped incisionmethod. Definite clinical improvementwas obtained in 48, and considerableimprovement in 24, of the 50 cases treatedover 9 months; bacteriological improve-ment occurred in 10 of the same series ofcases. Sulphone reactions were seen, similarto lepra reactions except that the former

502

ABSTRACTS

were followed by improvement. Drugfastness was not encountered. It is con-cluded that DDS is effective, and, withproper precautions, safe; it has the greatadvantage of cheapness. J. L. Markson.

An Acid-fast Microorganism Cultivatedfrom Leprous Material. Bacteriologicaland Serological Observations. TERNI,M. (1950). Int. J. Leprosy, 18, 161.An acid-fast organism has been obtained

in culture during the course of numerousattempts to isolate leprosy bacilli in themedia of Dubos and Petragnani and in thelarvae of Galleria mellonella. Materialfrom a skin leproma was inoculated intosix larvae, and 2 days later a transfer wasmade from one larva into tubes of medium.A single colony was obtained in a tube ofPetragnani's medium after incubation for3 months. In an investigation of thecharacteristics of the organism it was foundto be acid-fast, Gram-positive, aerobic,and non-motile; it grew best at 370 C., andrequired glycerol. It was not pathogenicfor laboratory animals. Antigens preparedfrom cultures of the organism reacted incomplement-fixation tests with sera ofleprous patients up to titres of I in 320.The organisms were not lysed by bacterio-phages active against five species of myco-bacteria, and it is concluded from a reviewof their properties that they were neithertubercle bacilli nor saprophytic con-taminants. D. G. Bauer.

BIOCHEMISTRYIron Metabolism. The Pathophysiology of

Iron Storage. FINCH, C. A., HEGSTED,M., KINNEY, T. D., THOMAS, E. D.,RATH, C. E., HASKINS, D., FINCH, S.,and FLUHARTY, R. G. (1950). Blood, 5,983.This paper describes experiments carried

out on animals to elucidate questions of ironstorage and utilization. The distributionand availability of stored iron were studiedin dogs, the degree of localization of stored

iron in rats, and changes in total bodycontent of iron under various conditions inmice. In addition the organs of patientswith haemochromatosis were analysed postmortem for iron content.

Storage iron-the iron which can bemobilized from the body tissues for theformation of haemoglobin-is present intra-cellularly in the form of two similar com-pounds, ferritin and haemosiderin. Thebody of a normal man contains about5,000 mg. of iron, of which storage ironconstitutes 20%; since only a fraction of amilligram is excreted daily in the urine andfaeces, excess iron must be stored and isfound in thereticulo-endothelial or parenchy-mal cells, the liver being the most importantorgan involved. In iron deficiency anaemiathe absorption of iron is increased, but theiron is used directly for haemoglobin syn-thesis and is not stored. The iron storesthus remain depleted for a period whichmay extend over many months.The authors state that increased absorp-

tion and storage of iron may be produced inanimals by altering the composition of thediet. In such cases there is an increase inthe serum and liver iron content, and even-tually haemosiderosis develops. The distri-bution of iron is similar to that seen in casesof haemochromatosis. In animals givenintravenous injections of iron-ascorbategelatin and observed for periods up to 2 yearsmassive deposits of iron were found in thereticulo-endothelial system, whereas excessiron given by mouth or injected in smallquantities in the form of soluble salts wasstored predominantly in the liver. Whenerythrocytes labelled with radioactive ironwere injected into rats, it was found that thespleen absorbed most of the erythrocytes,whereas haemoglobin injected in solutionwas mostly concentrated in the kidneys.Iron localization after the breakdown ofblood thus depends on whether the break-down is intravascular or extravascular.Focal deposits of iron in various organs suchas the brain, lungs, and skin indicateprevious breakdown of blood in the areasinvolved. The serum iron level, althoughalways low in the presence of infection, is a

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measure of excess iron storage, while theamount of stored iron may also be deter-mined by examination of the liver or bonemarrow. No evidence was found that thestored iron in haemochromatosis differsfrom that stored when iron is injected. Indietary or idiopathic haemochromatosisthere is an excess absorption of iron, and it isstated that by giving large doses of iron anda diet of low phosphate content an increasein body iron storage may be produced.

T. M. Pollock.

Electrolyte Studies on Patients withCirrhosis of the Liver. EISENMENGER,W. J., BLONDHELM, S. H., BONGIo-VANNI, A. M., and KUNKEL, H. G.(1950). J. clin. Invest., 29, 1491.Exhaustive balance studies were carried

out on 41 patients suffering from cirrhosisof the liver. In 18 patients there was markedascites and in 10 moderate ascites; in theremaining 13 there was no ascites. Thepatients with marked ascites had Laennec'scirrhosis, and among the others were somecases of biliary or " postnecrotic " cirrhosis.Sodium and potassium content of thepatient's food, serum, urine, sweat, andfaeces were estimated by a flame photometer.The food and faeces were ashed beforeanalysis. Since some urines contained morethan three hundred times as much potassiumas sodium the question whether such largeamounts of potassium interfered with thesodium estimations was studied, but theerror was found to be small. Chloride con-centration was also estimated in the food,serum, urine, and ascitic fluid, and nitrogenbalance was estimated in some ofthe patients.

It was found that patients with severeascites excreted extremely small amounts ofsodium (their urinary excretion was usuallybelow 1 mEq. daily and never above4 mEq.), and excretion remained low evenon a high intake of sodium. Those withascites excreted by various means all thesodium they ate. Those with moder-ate ascites generally excreted less sodium intheir urine than those who had no ascites[and it must be concluded that they retained

some of the sodium they ate]. Serumsodium levels were low in patients withascites (about 140 mEq. per 100 ml.), andlow normal in the others. After paracentesisthe serum sodium level fell even lower thanbefore. If the intake of sodium was reducedto between 15 and 17 mEq. daily, the reten-tion of fluid immediately stopped in thosepatients who were suffering from ascites. Atthe same time, however, potassium andnitrogen were retained in the body. Con-versely, the serum sodium level increasedand more sodium was excreted when patientswith ascites began to improve, even beforewater balance could show that less water wasbeing retained in the body. Since the salivaand sweat of patients suffering from ascitesalso contained less sodium than normal, theauthors suggest that an overaction of theadrenal cortex may play a part in the reten-tion of sodium in cirrhosis of the liver. Thiscontention is supported by reference to somedata which are to be published later.

The Thigh-Neck Clearance: a SimplifiedRadioactive Test of Thyroid Function.FOOTE, J. B., and MACLAGAN, N. F.(1951). Lancet, 1, 868.This test is based on measurements of

radioactivity made at fixed distances (11 cm.)from the neck and thigh. A dose of 30 [Lc.of radioactive iodine (1311) is administeredorally and serial measurements are madeover neck and thigh until the maximum thighcount has been reached. Measurements overthe neck are made for a duration of 1 minute,and those over the thigh for 10 minutes.The " thigh-neck clearance " is determinedat the time of the maximum thigh count,and is defined as the rate of uptake in theneck expressed as the increase of neck countsper hour divided by the thigh count. Aseries of 100 persons was studied by this test.In 24 normal subjects the thigh-neck clear-ance ranged from 1 to 9, and in 14 patientswith definite thyrotoxicosis the values rangedfrom 21 to 108. A simple qualitative test forurinary iodide is also described. Thisproved useful in detecting patients who hadreceived treatment with iodine containing

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substances which would invalidate the radio-active test. G. Ansell.

HAEMATOLOGYThe One-stage Prothrombin Consump-

tion Test. Clinical Value in theIdentification of Thromboplastin-defi-ciency Diseases. STEFANINI, M., andCROSBY, W. H. (1950). Blood, 5, 964.The formation of a solid clot does not

represent the end-point of the intricatecomplex of reactions leading to the coagula-tion of blood or plasma. In haemophilia,acquired haemophilia-like diseases, andsevere thrombocytopenia there is alwaysimpaired activation by thromboplastin. Inthe presence of a minimal amount ofthromboplastin enough thrombin may,however, be formed eventually to clotfibrinogen, but much residual prothrombinwill be found in the serum. The purpose ofthe prothrombin consumption test is toidentify this residual prothrombin activity.The test requires deprothrombinized plasma,thromboplastin, and a standard curve ofplasma prothrombin activity. This curve isprepared by determining the prothrombintime of serial dilutions of deprothrombinizedwith normal plasma. Each mixture isassumed to possess a percentage of normalprothrombin activity corresponding to thepercentage of normal plasma it contains,and the correlation of prothrombin timewith this figure results in an exponentialcurve. Reference to this curve allows theconversion of other prothrombin time valuesinto percentages of normal prothrombinactivity. For the test, the serum from 2 ml.of clotted blood is mixed with In volume ofsodium citrate and incubated for 30 minutesto allow the neutralization of thrombin.The clotting time is then recorded afteradding, in rapid succession to a test tubekept at 370 C., 0.1 ml. of each of the follow-ing: (1) deprothrombinized plasma; (2)0.02 M calcium chloride; (3) thromboplas-tin; and (4) the serum to be tested.The serum prothrombin activity was below

10% in t normal subjects. In 2 cases ofthrombocytopenic purpura the values were87% and 63% respectively; 24 hours after

2 K

splenectomy they had fallen to 6% and0.8% respectively. Out of 7 cases ofthrombocytopenia due to leukaemia in onlyone was the value below 10% (9.8%); in oneit was 15%, in 2 between 30% and 40%, andin the remaining 3 above 60%. Similarresults were obtained in one case of aplasticanaemia (34%) and 2 cases of haemophilia(68% and 91%); in 2 cases of pseudohaemo-philia, 5 cases of hypothrombinaemia due todicoumarol treatment, and 3 cases of poly-cythemia vera the values obtained were allbelow 10%.The authors have examined the effect on

the validity of the test of the presence ofdifferent amounts of serum accelerator andconclude that it is unaffected. Thoughnormal serum has a high accelerator content,there is little prothrombin to act upon. Even100% acceleration of prothrombin activityis of no practical significance when theresidual level is only 2%. On the other hand,in a serum where there has been littleprothrombin consumption, accelerator con-tent is negligible. H. Lehmann.

Serum Prothrombin Time, a CompositeEffect. An Analysis of the FactorsInvolved. STEFANINI, M., and CROSNY,W. H. (1950). Amer. J. clin. Path., 20,1026.Quick's one-stage prothrombin consump-

tion test (Quick, Shanberge, and Stefanini, J.Lab. clin. Med., 1949, 34, 761) determines theprothrombin content of serum and is valu-able for the diagnosis of haemophilia andthrombocytopenic purpura. This paper is astudy of the influence different variablesexert on this procedure.

There are at least five coagulation factorsinvolved: (1) the concentration of uncon-verted prothrombin in the serum; (2) thethrombin content of the serum, that is, thatproportion of thrombin which has not beenabsorbed by fibrin or neutralized by thenatural antithrombin; (3) the " acceleratoreffect " of the serum; (4) the labile factor"V," plasma Ac-globulin not activatedduring coagulation; (5) (if coagulation hasbeen completed more than 2 hours beforethe serum is tested) activation ofa postulated

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prothrombin precursor. Of these five fac-tors, three can be disregarded: the thrombincan be neutralized by incubation of theserum in the presence of citrate for 15 min-utes, the concentration of labile factor canbe ignored, as it is added in excess, and theprothrombin precursor will not be activatedprovided not more than 2 hours are allowedto pass between coagulation of the plasmaand the testing of the serum. The test istherefore mainly influenced by the concen-tration of residual prothrombin and theaccelerator effect of the serum. Thus thetest reflects not only prothrombin concen-tration but also the velocity of the conver-sion of prothrombin into thrombin; it is ameasurement of serum prothrombin activityrather than of concentration. However, innormal sera where there is drastic depletionof prothrombin no accelerator effect, how-ever powerful, can compensate for thisconsumption; and since in abnormal serain which consumption of prothrombin isdefective there is only a weak acceleratoreffect, from the practical point of viewQuick's test remains a measure of pro-thrombin concentration. H. Lehmann.

The Effect of Choline on Haematopoiesis.CANIGGIA, A. (1950). Haematologica,34, 625.The effect of choline on the blood picture

was studied in 12 patients-2 with perniciousanaemia, 2 with haemolytic jaundice, 1 withpost-haemorrhagic anaemia, 1 with severehypochromic anaemia of unknown origin,and 6 with post-infective anaemia. In allcases peripheral blood and bone-marrowsmears were examined. Two patients weretreated with choline chloride 1 g. a day for12 to 20 days, 8 with 2 g. a day for 10 to25 days, and 2 with 2 g. a day for 15 daysplus 0.6 g. of iron a day as sulphate. In allcases the regimen of choline supplementsproduced marked changes in the blood andmarrow. Erythrocytes increased in number,with a moderate reticulocytosis, diminutionin mean corpuscular volume, restoration ofhaemoglobin content, and there was adiminution in the number of megaloblastsand accelerated maturation of erythroblasts.

Moderate leucocytosis and shift of Arneth'scurve to the left was noted. The addition ofiron increased the haemoglobin level andprevented the fall in mean corpuscularvolume.

It is suggested that choline has a threefoldaction: mobilizing and reducing hepaticfat; playing a part in the synthesis ofmethionine; and acting directly on the bonemarrow as a stimulant to cellular prolifera-tion. Choline should be included in anti-anaemic regimens. [There is no mention inthis paper of control observations on similarpatients.] James D. P. Graham.

MORBID ANATOMY ANDHISTOLOGY

Prognosis in Cutaneous and OcularMalignant Melanoma: A Study of 222Cases. WRIGHT, C. J. E. (1949).J. Path. Bact., 61, 507.A combined study of pathology and

survival in cases of malignant melanoma wasmade. There were 109 cases of malignantskin or mucosal tumour, 27 of doubtfulmalignancy, and 89 malignant oculartumours. The 5-year survival rate was28.6% and the 10-year rate 12.5% in the firstgroup, whereas in the cases of eye tumourthe prognosis was much better (62.5% and39.4% respectively). With tumours ofdoubtful malignancy (mostly in children andyoung adults) survival was almost indefinite.In a few cases the value of block dissectionof regional lymph nodes was shown, evenwhen they were not apparently enlarged,and in one case there was a long survivalperiod after the microscopical finding ofmelanoma in a lymph node. In the elderlyand with large tumours the prognosis gener-ally is not good. For cases of doubtfulmalignancy of course only local excision isrequired. It is finally concluded that if apatient with malignant melanoma of theskin survives 5 years after its excision withoutlocal recurrence or lymph-node involvement,there is a good chance of his remaining freeof growth; the corresponding period for eyetumours is 10 years. W. S. Killpack.

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Squamous Metaplasia of the Peritoneum,CROME, L. (1950). J. Path. Bact., 62,61.The author first reviews the scanty litera-

ture on squamous metaplasia of the peri-toneum and then describes 4 specimens ofhis own, removed surgically at St. Mary'sHospital, London, and coming from 2 casesof strangulated intestine, one of acuteappendicitis, and one of carcinoma of theuterus in which panhysterectomy had beenperformed. The peritoneum in these casesshowed tiny nodules, up to 4 cm. in diameter,of squamous epithelium together with littleislands of epithelium under the surface andvarious stages in the conversion of theseislands into cysts lined by a single layer offlattened cells. The author suggests thatgroups of serosal cells undergo metaplasiato squamous epithelium and that thisepithelium becomes buried during theorganization of fibrin deposited on theperitoneal surface. He considers thatendometriosis is also due to serosal meta-plasia and regards these findings as providingfurther indirect evidence to support hisviews on its origin. The author points outthat, if the occurrence of peritoneal meta-plasia be established, it becomes possible toview more favourably the descriptions in theliterature of various types of primaryepithelial tumour arising in the peritoneum.

Peter Harvey.

Smooth-Muscle Tumours of the Gastro-Intestinal Tract. COWDELL, R. H.(1950). Brit. J. Surg., 38, 3.Of 370 stomach tumours examined, 9

were leiomyomata or leiomyosarcomata.These tumours may be intragastric,

intramucosal, or extragastric. Histologicallythere is a variation in pattern in differentparts of the same tumour, and it is oftendifficult to decide whether a tumour isbenign or malignant, the frequency ofmitoses being the most valuable singlecriterion of malignancy.The most common symptom produced

by these tumours is haemorrhage, either intothe gastro-intestinal tract or into the

peritoneal cavity. Ulceration of a gastricleiomyoma produces symptoms of chronicpeptic ulceration. Occasionally a patientmay complain of an intra-abdominal mass.

Ependymal Tumours of the Spinal Cordand Filum Terminale. WERTHEIMER,P., ALLUGRE, G., and GARDE, A. (1950).Rev. neurol., 82, 153.Seven cases of ependymal tumour of the

spinal cord, including the filum terminate,are briefly described by the authors; histolo-gical examination had previously led to thediagnosis of neuroepithelioma, but renewedstudy revealed the true nature of theselesions. The authors distinguish betweenependymoma and ependymoglioma. Theseependymal tumours are relatively benign andcan occasionally be removed in toto.

Theca-cell Tumors. SPARLING, D. W.(1950). Amer. J. Obstet. Gynec., 59,1279.The author presents individual reports on

a series of 11 cases of theca-cell tumour.The growths varied in size from a firm,

rubbery nodule in the wall of a cyst to thatof a grapefruit. They were all unilateraland their only distinguishing feature wastheir yellow or yellowish-orange colour. Theendometrial histology was determined in 6cases, and in 3 of these showed a " Swiss-cheese" pattern of hyperoestrinism; thiswas probably due to the presence of cells ofthe granulosa type. The histological differ-entiation of these tumours from granulosa-cell tumours may be difficult, but is helpedby staining with Sudan III, which shows thefat to be intracellular in theca-cell tumoursand extracellular in granulosa-cell tumours;moreover, the cells of the thecal tumour aresurrounded by a fine connective-tissue reti-culum, whereas the granulosa cells are notso enclosed, or only in groups.The author considers these growths to be

benign, although in one patient the tumourwas associated with an adenocarcinoma ofthe fundus uteri.

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The Morbid Anatomy of Tuberculosis inOld Age. ROULET, F. (1950). Ann.Med., 51, 69.In 270 necropsies carried out at the

University of Basle on subjects over 60 yearsold, frank evidence of tuberculosis waspresent, although it was the cause of deathin only 90 cases. The active focus was foundin 245 cases around an old calcified or ossi-ned nodule in the tracheo-bronchial lymphnodes; The lungs in these cases revealedno active primary focus, though an old,calcified, inactive lesion was often discovered.It is argued that active tuberculosis in oldage is frequently caused by reactivation ofan old lesion in the lymph nodes around thebifurcation of the trachea, possibly due tothe chronic inflammation of the lowertrachea and main bronchi, which is extremelycommon in old people. Tuberculosis of thetracheo-bronchial nodes frequently leads tocomplications: of the 245 cases of tracheo-bronchial-node infection, there was alsofrank tuberculous infection of the lungs in35: in 12 cases there was a generalizedhaematogenous spread either from a focusin the tracheo-bronchial nodes or from analternative site of active infection; in 13cases there were foci both in the tracheo-bronchial nodes and elsewhere, but nogeneralized spread; and in 25 cases haema-togenous spread had occurred with tracheo-bronchial nodes as the only possible primarysource. In the remaining 160 cases theinfection was confined to the tracheo-bronchial nodes.

Speaking generally, miliary tuberculosisdevelops more rapidly in the old than atother ages. The appearances are classical,though the tubercles may be rather large-as big as a pea or a hazel nut. In the wholeseries there were 16 cases of miliary spreadamongst the 43 cases of frank pulmonarytuberculosis. Tuberculosis of the serouscavities is not uncommon in the elderly.Pulmonary tuberculosis may be of thechronic apical fibro-caseous type withcavities, or of the ulcerative caseous typeof acute tuberculosis, the frequent occur-

rence of which in old people may possiblybe due to reduced general resistance andantibody response.

Glomerulonephrosis. A MorphologicManifestation of Renal Cortical Ische-mia in Toxic Oliguria and LowerNephron Nephrosis. FRENCH, A. J.(1950). Arch. Path., 49, 43.The histopathological findings in the

kidneys of 20 specially selected cases ofglomerulonephrosis are described, specialstress being laid on the glomerular changes.This study was undertaken in the hope ofexplaining the anuria or oliguria whichaccompanies lower nephron nephrosis(" tubular " or " toxic" nephritis), in whichcondition, on physiological grounds, thereshould be polyuria if a tubular lesion alonebe present. For this purpose it was essentialto eliminate cases of primary or secondaryrenal disease, eclampsia, and cardiovascularhypertension.The changes found in the glomeruli,

tubules, and medulla in sections of thekidneys (mostly stained with haematoxylinand eosin) are tabulated. Glomerularischaemia, together with thickening of thecapillary walls, was found in every case. Thepresence of granular material staining grey-blue in the glomerular spaces and proximaltubules was noted, this being regarded as theprecursor of the protein casts seen in thedistal convoluted tubules in all except oneof these cases. R. B. T. Baldwin.

Conrections.-Dr. Varadi writes: I shall beobliged if you will print the following correctionsto my article "Combined Fragility Test forCongenital Haemolytic Jaundice " (J. clin. Path.,4, 221). On page 222 in paragraph 3 read 0.021 %instead of 0.21% NaCl, and, on page 224 para-graph 2 of the Appendix, marrow punctureinstead of culture.

We much regret that in the description of acell-suspension mixer by Dr. Matthews (J. clin.Path., 4, 383) the pipettes were described as 20 ml.and 50 ml. These should be 20 c.mm. and50 c.mm.

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