NOVEMBER, 1950

X.(JCONA!TL OAFSI ! n!x-

CLINICAL PATHOLOGY

EDITED FOR

THE ASSOCIATION OF CLINICAL PATHOLOGISTSBY

A. GORDON SIGNY

E.

J.J.

,. , 2,.

A -

EDrrORIAL Boms

N. ALLOrr R. J. V. PULVERTAPT

V. DACIE DOROTHY S. RUSSELL

G. GREENFIELD JOAN TAYLOR

And the Editor of the British Medical Journal

7t 1

- ik

sz ' LONDON

H MEDICAL ASSOCIATION

TAVISTOCK SQUARE, W.C. i xYEARLY SUBSCRIMON (4 NUMBERS) UM0S.

:

U.S.A. $5.00 SINGLE NUMBEits 7s. 6d.

I. 5. No. 4.

393

INDEX TO VOLUME III

AAberrant thyroid tissue in the trachea, case of, 48ACTH evaluation of adrenal cortical function, 87Adrenal cortical function, evaluation of, by use of adreno-

corticotrophin, 87Adrenocorticotrophin, evaluation of adrenal cortical

function by use of, 87Agar-rope technique for estimating penicillin in liquids, 51ALscHE, W. J., see JULIUS, H. W., and ALscHE, W. J.Anhydrase, carbonic, urinary excretion of, 142Antibiotic testing, simple inoculation rack and modified

technique for, 372Antibiotics, dried disc technique for determining sensitivity

to, 118Aspirated bone marrow, multiple cultures from, 157Association of Clinical Pathologists:Branch reports, 8643rd Scientific Meeting, 17544th Scientific Meeting, 374

BBacteriological media, some effects of nitrates in, 356BAILEY, N. T. J., see MARKS, J., BAILEY, N. T. J., and

GuNz, F. W.Barbiturate drugs, identification in gastric contents and

urine, 152BENNETT, A. E., see SANDERS, C., and BENNETT, A. E.

see SANDERS, C., PARRY, K. C., BENNETr, A. E., andGEISOW, J. C. H.

Bilirubin, determination of, with precipitation of the plasmaproteins, 248

-renal threshold for, 271Biotin, daily excretion by normals, 69Blood cell pipette shaker, magnetically operated, 367- cultures, microtechnique for, 74- films, a mechanical aid in making, 168

from the ear, leucocyte count in, 146pipette shaking machine, 164

--______ - mark II, 370transfusion, exchange, a two-syringe method for, 77

Bone marrow cultures, multiple, from a singie aspilate, 157- in Hutchison's syndrome, 230

red, in heart failure, 24BOOK REVIEWS:Burrows, W., Jordan-Burrows Textbook of Bacteriology,

15th ed., 1950, 294Dacie, J. V., Practical Haematology, 1950, 293Whitby, Sir Lionel, and Britton, C. J. C., Disorders of the

Blood, 6th ed., 1950, 292Wright, G. Payling, An Introduction to Pathology, 1950,

292BREWS, V. A. L., see TARNOKY, A. L., and BREWS, V. A. L.

CCarbonic anhydrase. urinary excretion of. 142CARUINFANTIM, E., and MOLLA, W.: Simple and precise

technique for the titration of haemagglutinins, 72Centrifugal filter for sterilizing small amounts of fluid, 67Coagulation, consumption of prothrombin during, 130Complement, destructive effect of traces ofzinc salts on, 363- fixation test for herpes simplex -infections, 239

COOK, G. T.: Plate test for nitrate reduction, 359and KNOX, R.: Some effects of nitrates in bacteriolo-gical media, 356

COOPER, T. V.: Case of aberrant thyroid tissue in thetrachea, 48

COXON, R. V., see KING, E. J., and COXON, R. V.Creatine and guanidoacetic acid metabolism in pituitary

disease, 345CUMINGS, J. N.: Creatine and gianidoacetic acid meta-

bolism in pituitary disease, 345

DDARK, F. A., see SELWYN, J. G., and DARK, F. A.Disc techniqLe for antibiotic sensitivity, 118Dried disc technique for determining sensitivity to anti-

biotics, 118DUDGEON, J. A.: Complement fixation test for herpes

simplex infections, 237

EEar, leucocyte count in blood from the, 146

ElectrophoBesis, estimaticn of serum protein fractions by,260

ELEK, S. D., see HILSON, G. R. F., and ELEK, S. D.Exchange blood transfusion, a two-syringe method for, 77Excretion of riboflavin, biotin, pantothenic acid, and

nicotinic acid derivatives by normals, the daily, 69

FFITZPATRICK, J., andTompsEas, S. L.: Daily excretion of

riboflavin, biotin, pantothenic acid, and nicotinic acidderivatives by normnals, 69

Fractionation of serum proteins using sodium sulphate, 266FRIEDMANN, I., see HOWELLS, G. H., and FRIEDMANN,K.

GGamma globulin, serum, simple visual turbidimetric

estimation of, 284Gastrit contents and urine, identification of barbiturate

drugs in, 152Giant cell granuloma associated with lesions resembling

polyarteritis nodosa, 220-atoai- of anterior pituitary, hypopituitarism in

male due to, 122GEISOW, J. C. H., see SANDERS, C., PARRY, K. C., BENNETTr,

A. E., and GEisow, J. C. H.GLiKIN, T., see RAPPAPORT, F., and GLIKIN, T.Globulin, serum gamma, turbidimetric estimation of, 284GoVAN, A. D. T., see MUKHERJEE, C. L., and GoVAN,

A. D. T.Granuloma, giant cell, associated with lesions resembling

polyarteritis nodosa, 220of anterior pituitary, hypopituitarism in male due to,122

Gravimetric determination of pregnanediol in urine, 287Guanidoacetic acid metabolism in.pituitary disease, 345GUNZ, F. W..see MARKS, J., BAILEY, N. T. J., and GUNZ,

F. W.

394 INDEX

HHaemagglutinins, simple and precise technique for the

titration of, 72Haemolysis, intravascular, simple test for detection of, 142Haemophilia, laboratory diagnosis of, 301

prothrombin consumption defect in, 130Heart failure, the red bone marrow in, 24Herpes simplex infections, complement fixation test for, 239HEWITT, L. F.: Simple inoculation rack and modified

technique for rapid subculturing and antibiotic testing,372

HILSON, G. R. F., and ELEK, S. D.: Centrifugal filter forsterilizing small amounts of fluid, 67

HOWELLS, G. H., and FRIEDMANN, I.: Giant cell granulomaassociated with lesions resembling polyarteritis nodosa,220

Hutchison's syndrome, bone marrow in, 230Hypopituitarism in a male due to giant cell granuloma of

anterior pituitary, 122

Inoculation rack, simple, 372

J

JUL.IUS, H. W., and ALSCHE, W. J.: Agar-rope techniquefor estimating penicillin in liquids, 51

K

KEYSER, J. W.: Serum tryptophane-perchloric acid reactionas a measure of tissue destruction, 106

KING, E. J., and COXON, R. V.: Determination of bilirubinwith precipitation of the plasma proteins, 248

KNOX, R., see COOK, G. T., and KNOX, R.

L

Larvae of Liniguatula serrata, human infestation by, 212LAWRENCE, J. S.: Plasma viscosity, 332LAZARUS-BARLOW, P.: Two-syringe method for exchange

blood transfusion, 77Leucocyte count in blood from the ear, fortuitous factors

affecting the, 146differential, multiple manual register for, 161

LEVIN, B., OBERHOLZER, V. G., and WHITEHEAD, T. P.:Serum protein fractions: a comparison of precipitationmethods with electrophoresis, 260

Simple visual turbidimetric estimation ofserum gamma globulin, 284

Linguatula serrata, human infestation by, 212LITTLEJOHN, G. T., see PERRIN, J., and LITTLEJOHN, G. T.LUCEY, H. C.: Fortuitous factors affecting the leucocyte

count in blood from the ear, 146Lymphopenia, common causes of, 321LYNCH, M. J. G.: Effect of para-amino-salicylic acid on

prothrombin time, 114

M

Magnetically operated blood cell pipette shaker, 367MALLARME, J., see PINEY, A., MALLARME, J., and Ross,

M. S.Manual register for differential leucocyte counts, multiple,

161MARKS, J., BAILEY, N. T. J., and GUNZ, F. W.: Mechanical

aid in making blood films, 168Marrow cultures, multiple, from a single aspirate, 157MARTIN, N. H., MORRIS, R., and SMITH, M.: Fractionation

of serum proteins using sodium sulphate, 266Mechanical aid in making blood films, 168Media, bacteriological, some effects of nitrates in, 356Meningeal tumours: a review, 191MERSKEY, C.: Consumption of prothrombin during

coagulation: the defect in haemophilia and thrombo-cytopenic purpura, 130Laboratory diagnosis of haemophilia, 301

Microtechnique for blood cultures, 74MOLLA, W., see CARLINFANTI, E., and MOLLA, W.

MORRIS, R., see MARTIN, N. H., MORRIS, R., and SMITH, M.MUKHERJEE, C. L., and GOVAN, A. D. T.: Nature of the

tissue fluid in the oedema of toxaemia of pregnancy, 274

Museum techniques: a review, I

NNeoplastic cells in sputum, diagnosis of, by two new

methods, 40Nicotinic acid, daily excretion by normals, 69Nitrate reduction, plate test for, 359Nitrates in bacteriological media, some eff_cts of, 356

0

OVERHOLZER, V. G., see LEVIN, B., OBERHOLZER, V. G., andWHITEHEAD, T. P.see LEVIN, B., OBERHOLZER, V. G., and WHITEHEAD,T. P.

Oedema of toxaemia of pregnancy, nature of tissue fluid inthe. 274

OELBAUM, M. H., and WAINWRIGHT, J.: Hypopituitarismin a male due to giant cell granuloma of the anteriorpituitary, 122

P

Pantothenic acid, daily excretion by normals, 69Para-amino-salicylic acid, effect on prothrombin time, 114PARRY, K. C.: Blood pipette shaking machine mark 11, 370

see SANDERS, C., PARRY, K. C., BENNETT, A. E., andGEISOW, J. C. H.

-and SIIMONDS, G. E.: Blood pipette shaking machine,164

Penicillin in liquids, agar-rope technique for estimating, 51PERRIN, J., and LITTLEJOHN, G. T.: Diagnosis of neoplastic

cells in sputum by two new methods, 40Photometer, a bridge circuit, vacuum tube, 65Photometric methods for use in the Wassermann reaction,

improved, 56PINEY, A., MALLARME, J., and Ross, M. S.: Bone marnow

in Hutchison's syndrome, 230Pipette, blood. shaking machine mark 11, 370

shaker, blood cell, magnetically operated, 367shaking machine, 164

Pituitary, anterior, hypopituitarism in male due to giantcell granuloma of, 122disease, creatine and guanidoacetic acid metabolismin, 345

Plasma proteins, determination of bilirubin with precipita-tion of, 248viscosity, 332

Plate test for nitrate reduction, 359Polyarteritis nodosa, giant cell granuloma associated with

lesions resembling, 220Precipitation methods for estimation of serum proteins, 260Pregnancy toxaemia, nature of tissue fluid in the oedema of,

274Pregnanediol in urine, gravimetric determination of, 287Protein fractions, serum: a comparison of precipitation

methods with electrtohoresis, 260precipitation, bilirubin estimation with, 248

Prothrombin consumption during coagulation, 130time, effect of para-amino-salicylic acid on, 114

PRUNTY, F. T. G.: Techniques for the evaluation of adrenalcortical function by the use of adrenocorticotrophin:a review, 87

PULVERTAFT, R. J. V.: Museum techniques: a review, I

Purpura, thrombocytopenic, prothrombin consumptiondefect in, 130

R

Rack, simple inoculation, 372RAPPAPORT, F., and GLIKIN, T.: Microtechnique for blood

cultures, 74Red bone marrow in heart failure, 24Renal threshold for bilirubin, 271Rh grouping, an easy technique for, 159Riboflavin, biotin, pantothenic acid, and nicotinic acid

derivatives, the daily excretion of, by normals, 69ROBINSON, J. R.: Urinary excretion of carbonic anhydrase:

a simple test for the detection of intravascular haemoly-sis, 142

Ross, M. S., see PINEY. A., MALLARME, J., and Ross, M. S.RUSSELL, D. S.: Meningeal tumours: a review, 191

INDEX

sSalicylate in serum, simple estimation of, 289SANDERS, C., and BENNFTr, A. E.: Multiple manual

register for differential leucocyte counts, 161PARRY, K. C., BENNETT, A. E., and GEISOW, J. C. H.:Magnetically operated blood czll pipette shaker, 367

SELWYN, J. G., and DARK, F. A.: Identification of barti-turate drugs in gastric contents and urine, 152

Sensitivity, antibiotic, dried disc technique for, 118Serum, simple estimation of salicylate in, 289

gamma globulin, simple visual turbidim-tric estima-tion of, 284

-protein fractions: a comparison of precipitationmethods with electrophoresis, 260- fractionation of, using sodium sulphate, 266tryptophane-perchloric acid reaction as a measure oftissue destruction, 106

Shaker, blood cell pipette, magnetically operated, 367Shaking machine, blood pipette, 164

blood pipette, mark II, 370SHILLINGFORD, J. P.: Red bone marrow in heart failure, 24SHILLITOE, A. J.: Common causes of lymphopenia, 321SIMMONDS, G. E., see PARRY, K. C., and SIMMONDS, G. E.SMITH, M., see MARTIN, N. H., MORRIS, R., and SMITH, M.Sodium sulphate, fractionation of serum proteins using, 266Sputum, diagnosis of neoplastic cells in, 40Sterilizing of small amounts of fluid, centrifugal filter for, 67Subculturing, simple inoculation rack and modified

technique for rapid, 372SYMMERS, W. ST. C., and VALTERIS, K.: Two cases of

human infestation by larvae of Linguatula serrata, 212

TTARNOKY, A. L., and BREWS, V. A. L.: Simple estimation

of saticylate in serum, 289THOMPSON, B. A.: Dried disc technique for determining

sensitivity to the antibiotics, 118rHOMPSON, R. B.: Multiple marrow cul.ures from a

single aspirate, 157Thrombocytopenic purpura, prothrombin consumption

defect in, 130Tissue destruction, serum tryptophane-perchloric acid

reaction as a measure of, 106Thyroid tissue, at-errant, in the trachea, 48

395

Tissue fluid in the oadema of toxaemia of pregnancy, natureof, 274

Titration of haemagglutinins, technique for, 72TOMPsETT, S. L.: Gravimetric determination of preg-

nanediol in urine, 287see FITZPATRICK, J., and ToMPSETT, S. L.

Toxaemia of pregnancy, nature of tissue fluid in theoedema of, 274

Trachea, case of aberrant thyroid tissue in, 48Tryptophane-perchloric acid reaction, serum, as measure

of tissue destruction, 106Turbidimetric estimation of serum gamma globulin. simple

viseal, 284Two-syringe method for exchange blood transfusion, 77

UUrinary excretion of carbonic anhydrase, 142Urine, gravimetric determination of pregnanediol in, 287

identification of barbiturate drugs in, 152

VVALTERIS, K., see SYMMERS, W. ST. C., and VALTERIS, K.VICKERS, H. E.: Renal threshold for bilirubin, 271Viscosity, plasma, 332

WWAINWRIGHT, J., see OELBAUM, M. H., and WAINWRIGHT, J.Wassermann reaction, improved photometric methods for

use in the, 56WHILLANS, D.: Improved photometric methods for use in

the Wassermann reaction, 56WHITEHEAD, T. P., see LEVIN, B., OBERHOLZER, V. G., and

WHITEHEAD, T. P.see LEVIN, B., OBERHOLZER, V. G., and WHITEHEAD,T. P.

WILKINSON, A. E.: D1structive effect of traces of zinc saltson complement, 363

WOOTTON, I. D. P.: Easy technique for Rh grouping, 159

zZinc salts, destructive effect on complement, 363

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.

AAbortion, septic, lower nephron nephrosis after, 391ACTH, in acute and subacute leukaemia, 387- physiologic effects in man, 384Adenoma, parafollicular cell, of thyroid gland, 188Adenomatosis, fibrosing, of the breast, 390- pulmonary, 84Adenosis, sclerosing, 390Adrenal cortical hyperfunction, salt tolerance test in, 385Agranulocytosis, cyclic, 186- cyclical, with marked improvement after splenectomy,

186- of glandular fever (P), 379Allergy and the nervous system, 188Amino-acid metabolism, problems of (P), 179Aminopterin, in treatment of leukaemia, 82, 83Amniotic fluid contents, fatal maternal embolism by (P), 180Amoebiasis in Britain (P), 377Amyloidosis, primary, 189Anaemia, chronic haemolytic, with nocturnal haemo-

globinuria, haemolysis in, 299erythropoietic effect of cobalt, 300

--haemolytic, acquired, 299hereditary nonspherocytic haemolytic, 387macrocytic, clinical association with intestinal strictureand anastomosis, 186

--megaloblastic, of infancy, vitamin B1, in, 386- of pregnancy and puerperium, vitamin B12 andfolic acid in, 386mothball (P), 177of infection, 82pernicious, pathological physiology of bone marrowin, 189- pteroyl-polyglutamic acids in treatment of, 300- vitamin B,1 in, 386sickle cell, a molecular disease, 299

Antibiotics, newer, present position of (P), 175Antibodies, incomplete anti-Rh, dextran as potentiator of

(P), 176Antihistamines in treatment of common cold, 298Anti-S, hatmolytic transfusion reaction due to, 186Anuria and oliguria (P), 378Aureomycin, assay in body fluids, 183

in herpes zoster, 296in infections with H. influenzae, Type B, 383

- in penicillin-resistant staphylococcic bacteremia, 80in typhoid fever, 79in typhus and brucellosis, 183

BBacterium coli, association of certain types with infantile

gastro-enteritis, 297Biliary cirrhosis, causation of, 189Blood and bone marrow studies in renal disease, 388- cholesterol estimations (P), 378B.O.E,A., a new coumarin substance, 387Bone marrow, after injection of nitrogen mustard, 387- granulomatous lesions in infectious mono-

nucleosis, 388in pernicious anaemia, patholdgical physiology

of, 189- studies in renal disease, 388

Breast, fibrosing adenomatosis of, 390Bronchial secretions, carcinoma cells in, 389Bronchogenic carcinoma, cytologic changes following

treatment with nitrogen mustard, 388Brucellosis, aureomycin in, 183

CCancer cells in neoplastic exudates, 389

in sputum and bronchial secretions, 389malignancy at different ages, 389

Carcinoma, developing in sebaceous cysts, 85-in situ of cervix and invasive carcinoma (P), 379Caronamide, effect on blood concentration of penicillin, 182Cervix, carcinoma in situ and invasive carcinoma (P), 379Chloramphenicol in infantile gastro-enteritis, 296

pertussis treated with, 295See also Chloromycetin

Chloride and sodium excretion after surgical operations, 185Chloromata, multiple, acute monocytic leukaemia terminat-

ing with (P), 177Chloromycetin, action on salmonella, 79

in salmonella enteritis, 296in treatment of infections, 382

- in typhoid fever, 79, 296Cholesterol, estimation in blood (P), 378

serum level in thyroid disease, 385Choroid plexus papillomas, 390Chromatography, paper partition (P), 178Cirrhosis, biliary, causation of, 189-of liver, studies in, 184Cobalt, erythropoietic effect in anaemias, 300Cold, common, antihistamines in treatment of, 298Cortisone, physiologic effects in man, 384Coumarin substance, a new, 387Coxsackie virus, epidemiology of (P), 377Cutaneous naevi and melanomas, histogenesis and clinical

significance of, 85Cystic lungs of granulomatous origin, 392

DDesoxycorticosterone acetate and sodium chloride in

Simmonds' disease, 184Dextran as plasma substitute, 81

as potentiator of incomplete anti-Rh antibodies (P),176

Diabetic acidosis and coma, 81Diarrhoea and vomiting, infantile, relation of Staphylo-

coccus pyogenes to, 297

EElectrophoretic findings in myelomatosis, 386Embolism, fatal maternal, by amniotic fluid contents (P),

180Enteritis, salmonella, chloromycetin in, 296Ependymonas and choroid plexus papillomas, 390Erythrocyte fragility, distribution curve of, 83Erythropoietic effect of cobalt in anaemias, 300Exanthem subitum, 80Exudates, pleural and peritoneal, morphology of cells in

(P), 177Eye, new techniques in laboratory examination of (P), 180

FFanconi syndrome (P), 179Flocculation tests (P), 178Folic acid antagonists, effect on acute leukaemia and other

forms of incurable cancer, 82-____- in treatment ofacute and subacute leukemia,83- in megaloblastic anaemias of pregnancy andpuerperium, 386

Follicle stimulating hormone in urine, measurements of, 81

396

INDEX

GGantrisin, a new sulphonamide, in treatment of bacterial

meningitis, 295- in treatment of urinary infections, 295

studies on solubility, absorption and excretion of, 382Gastric washings, paraffin-embedded, 388Gastro-enteritis, infantile, association of certain types of

Bact. coli with, 297chloramphenicol in, 296

Genital tract, female, correlation of histology and cytologyof(P), 181

Glandular fever, agranulocytosis of (P), 379-- in adults, 381Gram-negative organisms, clotting of human citrated

plasma by, 182Granulomatous lesions in bone marrow in infectious

mononucleosis, 388process in diffuse cystic lungs, 392

HHaemoglobinuria, cold, in vitro tests for haemolysins in

(P), 380-nocturnal, haemolysis in chronic haemolytic anaemia

with, 299Haemolysins in cold haemoglobinuria, in vitro tests for (P),

380Haemolysis in chronic haemolytic anaemia with nocturnal

haemoglobinuria, 299Haemolytic anaemia, acquired, 299- hereditary nonspherocytic, 387disease of newborn: criteria of severity, 83

- transfusion reaction due to anti-S, 186Haemophilia, laboratory investigation of (P), 379Haemophilus influenzae, Type B, aureomycin in treatment

of infections with, 383Haemorrhagic diathesis, new type of, 388- ulcerative disease, a new, 298Herpes zoster, aureomycin in, 296Hirsutism, idiopathic, excretion of 17-ketosteroids in, 385Hormonal assays, urinary, diagnostic significance of, 81Hydrocephalus, pathology of, 188Hyperparathyroidism, carcinoma of parathyroid gland

with, 390Hyperthyroidism, radioactive iodine (H131) .n diagnosis of,

184

Infantile diarrhoea and vomiting, relation of Staphylococcuspyogenes to, 297 ^gastro-enteritis, association of certain types of Bact.coli with, 297- chloramphenicol in, 296Intestinal stricture and anastomosis, clinical association of

macrocytic anaemia with, 186Iron-binding capacity of serum in man, 82

JJaundice, homologous serum, 300

K17-Ketosteroids, excretion in idiopathic hirsutism, 385- in urine, measurements of, 81Kidney, disease, blood and bone marrow studies in, 388- distribution of lymphatics of, 391

the septic abortion, 391

LLange reaction in cerebrospinal fluids, m-thods for esti-

mating (P), 178Leukaemia, acute and subacute, folic acid antagonists in

treatment of, 83- __ - use of ACTH in, 387

- effect of folic acid antagonists on, 82monocytic, terminating with multiple chloromata

(P), 177chronic lymphatic, treated with radioactive phos-phorus, 186

Lipid deposition in renal arteriolar sclerosis, 391

2D

397

Lipocalcinogranulomatosis, 187Lipoidosis, a new, 187Liver, cirrhosis of, plasma volume, plasma protein con-

centrations, and total circulating proteins in, 184-- studies in, 184

fatty, pancreatic atrophy in infants with, 190Lung, adenomatosis of, 84Lungs, diffuse cystic, of granulomatous origin, 392Lymphatics of the human kidney, 391

MMalignant cells in nose and throat (P), 376-- living, ultra-violet microscopy of, 85Mast cells, distribution in human tissues, 84Measles, pathology of (P), 375Megaloblast, problem of the, 189Megaloblastic anaemia of infancy, vitamin B12 in, 386-anaemias of pregnancy and puerperium, vitamin Bil

and folic acid in, 386Melanoma, malignant, transplacental metastasis from

mother to foetus, 187Melanomas, histogenesis and clinical significance of, 85Meningeal tumours with extracerebral metastases, 389Meningitis, bacterial, treatment with " gantrisin," 295Microscopy, ultra-violet, of living malignant cells, 85Mononucleosis, infectious, granulomatous lesions in bone

marrow in, 388-- in adults, 381Mothball anaemia (P), 177Muscle biopsy in rheumatoid arthritis, 392Myelomatosis, electrophoretic findings in, 386

NNaevi, cutaneous, histogenesis and clinical significance of,

85Necropsy hazard, pulmonary tuberculosis as (P), 176" Nec silet mors " (Presidential address) (P), 374Neomycin, a new antibiotic active against streptomycin-

resistant bacteria, 183Neoplastic exudates, examination for cancer cells, 389Neuritis after typhoid-paratyphoid vaccination, 188- peripheral, in periarteritis nodosa, 189Newborn, congenital pneumonitis in, 84-haemolytic disease of, 83Nitrogen mustard, cytologic changes in bronchogenic

carcinoma following treatment with, 388- therapy, haematological effects of, 387

Nose and throat, malignant cells in (P), 376

0Oliguria and anuria (P), 378Owren's factor V, 388

pPancreatic atrophy in infants with fatty liver, 190Papanicolaou method of cytodiagnosis (P), 181Paper partition chromatography (P), 178Papillomas of choroid plexus, 390Parafollicular cell adenoma of thyroid gland, 188Parahaemophilia (Owren), 388Parathyroid gland, carcinoma of, with hyperparathyroidism,

390Penicillin, effect of caronamide on blood concentration of,

182levels in blood and inflamed tissues (P), 175-resistant staphylococci, incidence in relation to lengthof stay in hospital, 383

Periarteritis nodosa, peripheral neuritis in, 189Peripheral neuritis in periarteritis nodosa, 189Peritoneal exudates, morphology of cells in (P), 177Pertussis treated with chloramphenicol, 295Phosphorus, radioactive, chronic lymphatic leukaemia

treated with, 186- in treatment of polycythaemia, 300

Plasma, citrated, clotting by Gram-negative organisms, 182dextran as substitute for, 81fractionation, products of, 82

Plasma-cell tumours, primary, of upper air passages andoral cavity, 190

Pleural exudates, morphology of cells in (P), 177

398 INDEX

Pneumonitis, congenital, in newborn infants, 84Polarographic serum waves in prostatic disease (P), 378Polyarteritis nodosa (P), 374Polycythaemia, control by marrow inhibition, 300Polyneuritis after typhoid-paratyphoid vaccination, 188Porphyria, acute (P), 378Potassium deficiency in diabetic acidosis and coma, 81Pregnancy and puerperium, megaloblastic anaemias of, 386Presidential address (P), 374Prostatic disease, polarographic serum waves in (P), 378Prothrombin, experimental studies on (P), 376Pteroyl-polyglutamic acids in treatment of pernicious

anaemia, 300Pulmonary adenomatosis, 84Purpura, sedormid, cause of thrombocytopenia in. 300

thrombocytopenic, coagulation defect in, 186idiopathic, 300

QQ fever, histopathologic observations in fatal case of, 392

in Great Britain, 298

RRadioactive iodine (1131) in diagnosis of hyperthyroidism,

184phosphorus, chronic lymphatic leukaemia treatedwith, 186* in treatment of polycythaemia, 300

Renal arteriolar sclerosis, role of lipid deposition in, 391- disease, blood and bone marrow studies in, 388Reticulocytes, function of, 83Rheumatoid arthritis, diagnostic value of muscle biopsy

in, 392Roseola (exanthem subitum), 80

SSaline-washed red blood cell transfusions, 387Salmonella, action of chloromycetin on, 79

enteritis, chloromycetin in, 296Salt tolerance test in patients with adrenal cortical hyper-

function, 385Sarcoidosis, clinicopathologic review of 300 cases, 188

tuberculin-neutralizing factor in serum of patientswith, 187

Sarcoma, synovial, 190Sclerosing adenosis, 390Sebaceous cysts, carcinoma developing in, 85Sedormid purpura, cause of thrombocytopenia in, 300Serological studies, present position of (P), 378Serum cholesterol level in thyroid diseases, 385-iron transport, 82Simmonds' disease, effect of desoxycorticosterone acetate

and sodium chloride, thyroxin, and testosteronepropionate in, 184

Sixth day disease" (P), 376Sodium excretion after surgical operations 185

p-aminosalicylic acid, resistance of tubercle bacilli to,80

Sputum and bronchial secretions, carcinoma cells in, 389Staphylococci, penicillin-resistant, incidence of, 383Staphylococcic bacteremia, aureomycin in penicillin-

resistant, 80Staphylococcus pyogenes, clearance from nose (P), 376

relation to infantile diarrhoea and vomiting, 297Sternal bone marrow after injection of nitrogen mustard,

387

Stomach, cytohistologic diagnosis of material aspiratedfrom, 388

Streptomycin in non-tuberculous infections, 182sensitivity testings, slide culture method for, 383

Striated muscle, histologic lesions in rheumatoid arthritis,392

Sulphonamide, a new (" gantrisin "), 295, 382Surgical operations, excretion of chloride and sodium

after, 185Synovial sarcoma and relatively benign synovioma, 190

T"TB I 698 " in surgical tuberculosis, 299Testosterone propionate in Simmonds' disease, 184Thiosemicarbazone " TB I 698 " in treatment of surgical

tuberculosis, 299Thrombocytopenia in sedormid purpura, cause of, 300Thrombocytopenic purpura, coagulation defect in, 186- idiopathic, 300Thyroid cancer, metastatic, effect of total thyroidectomy

on function of, 83gland, cholesterol serum level in disorders of, 385

parafollicular cell adenoma of, 188Thyroidectomy, total, effect on function of metastatic

thyroid cancer, 83Thyroxin in Simmonds' disease, 184Toxoplasma infection, laboratory diagnosis of (P), 176Transfusion reaction, haemolytic, due to anti-S, 186

reactions to a plasma constituent of whole blood, 387Transfusions, washed red blood cell, 387Transplacental metastasis of malignant melanoma from

mother to foetus, 187Tubercle bacilli, resistance to sodium p-aminosalicylic acid,

80Tuberculin-neutralizing factor in serum of patients with

sarcoidosis, 187Tuberculosis, non-pulmonary, distribution and frequency

of (P), 377-pulmonary, as necropsy hazard (P), 176-surgical, treatment with Thiosemicarbazone " TB

I 698," 299Typhoid fever, aureomycin and chloromycetin in, 79

chloromycetin in, 296-paratyphoid vaccination, neuri.is and polyneuritis.after, 188

Typhus, aureomycin in, 183

UUlcerative disease, a new haemorrhagic, 298Ultra-violet microscopy of living malignant cells, 85Urinary hormonal assays, diagnostic significance of, 81

infections, gantrisin in, 295Urine, measurements of 17-ketosteroids and follicle stimu--

lating hormone in, 81

VVirus, Coxsackie, epidemiology of (P), 377Vitamin B%, and folic acid in megaloblastic anaemias of

pregnancy and puerperium, 386in megaloblastic anaemia of infancy, 386

- pernicious anaemia; parenteral administration,.386

wWhooping-cough treated with chloramphenicol, 295

INDEX

AUTHORS OF ARTICLES ABSTRACTED

AAckroyd, J. F., 300Adair, F. E., 390Adams, J. M., 84Aidin, R., 376Albert, A., 384Allen, A. C., 85Allen, H. N., 295Andreas, E., 187

BBaird, J. W., 296Bakay, L., 188Bannwarth, A., 188Berk, L., 300Bilhan, N., 388Billing, B. H., 185Bishop, F. H., 388Bolton, J. H., 83Brainferd, H. D., 183Brown, A., 387Bruyn, H. B., 183Bunim, J. J., 392Burchenal, J. H., 300Burke, F. G., 296Burt, C. C., 387Buxton, P. H., 182

CCairns, H. J. F., 383Callen, I. R., 388Cameron, D. G., 186Canelas, E. Z., 295Cappio, M., 79Carpender, J. W. J., 186Carr, D. T., 80Carroll, G., 295Cartwright, G. E., 82Castellani, A., 298Castle, W. B., 300Chandler, C. A., 383Christensen, E., 389Chu Shen, S., 389Clark, M, 188Collins, H. S., 296 (2)Conway, N. S., 182Crawford, T., 375Crosby, W. H., 387Cummings, M. M., 383Cunningham, G. J., 392Cutbush, M., 83, 186

DDacie, J. V., 299, 380Dahlin, D. C., 189Dameshek, W., 83, 387Danowski, T. S., 81Darby, W. J., 386Darmady, E. M., 378Davis, L. J., 387Delaude, A., 80Discombe, G., 374Dowling, H. F., 182Drummond, M. C., 383Drymalski, G. W., 84Duane, R. T., 299Duguid, H. L. D.. 186

EEkren, H., 388Elster, S. K., 391Escamilla, R. F., 81Evans, R. S., 299

FFairbrother, R. W., 376Farber, S., 82Feldman, W. H., 80Finch, C. A., 82Finland, M., 296 (2)Finnerty, E. F., 296Fleming, J. C., 390Fluharty, R. G., 83Flynn, H., 295Foote, J. B., 378, 385Frank, E., 388Freedberg, A. S., 184Friedmann, I., 376Fruhling, L., 189Fullerton, H. W., 186

GGabrilove, J. L., 385Gaensler, E. A., 388Gerrard, J., 296Gocke, T. M.. 296Goldenberg, H., 391Gordon, C. E., 190Gray, C. H., 378Greenman, L., 81

HHarkness, J., 378Harman, J. B., 298Harper, E. M., 182Hartz, P. H., 190Hasche-Klunder, R., 299Heller, E. L., 390Hench, P. S., 384Hertz, S., 184Hewitt, W. L., 382Hill, L. F., 80Hiller, G. I., 184Hirsch, H. L., 182Hodes, H. L., 383Holland, E., 187Homburger, F., 389Hovde, R. F., 388Huffman, E. R., 184Hunter, 0. B., jun., 379

Israels, M. C. G., 300Itano, H. A., 299

JJacobs, M. D., 385Janes, J., 84Jones, A. Richardson, 378

KKarlson, A. G., 80Kass, E. H., 296Kendall, E. C., 384Kenney, F. R., 190Kernohan, J. W., 189Klaer, W., 389Knight, V., 183Koegler, S. J., 296Koets, P., 385Kreissl, L. J., 190Kubik, M., 387Kwantes, C. M. S., 300

LLawrence, J. H., 186, 300Lechevalier, H. A., 183Lees, J. C., 389Lehane, D., 300Leimbach, G., 299Lepper, M. H., 182Levey, S., 184Levy, M., 295Limarzi, L. R., 388Lovshin, L. L., 189Low-Bfer, B. V. A., 186Ludford, R. J., 85Luft, R., 184Lynch. J. P., 388

MMacCallum, F. O., 377McDermott, W., 183McDonald, J. R., 84, 389McEwen, C., 392McKay, D. G., 388Magath, T. B., 376, 377Marinelli, L. D., 83Martyn, G., 297Mason, H. L., 384Mathieson, D. R., 384Meiklejohn, G., 183Merivale, W. H. I., 385Merskey, C., 379Middleton, J. W., 298Migazzo, C., 79Mollison, P. L., 83, 186Morton, T. C. St. C., 377Muirhead, E. E., 190Muller, G., 381

NNagy, G., 185Neber, J., 387Needham, G. M., 80Nichols, D. R., 80

0

Owren, P. A., 186

p

Pagel, W., 374Park, W. W., 389Parkinson, T., 392Pauling, L., 299Payne, E. H., 295

399

INDEX

Peden, J. C., 85Perrin, T. L., 392Peters, J. H., 81Peterson, J. C., 386Pfuetze, K. H., 80Polley, H. F., 384Power, M. H., 384

QQuashnock, J. M., 81Queen, F. B., 388Quick, A. J., 186

RRannie, I., 375Rath, C. E., 82Rathbun, J. C., 81Rawson, A. J., 391Rawson, R. W., 83Reymond, A., 390Rhoads, P. S., 295, 382Rhodes, A. J., 377Rice, E. C., 296Richardson, H. L., 388Ricker, W., 188Rider, J. A., 298Ringertz, N., 390Ripy, H. W., 386Roberts, G. B. S., 375Robinson, J. A., 182Robson, H. N., 300Roger, S., 189Rogers, K. B., 296Rohr, J. H., 295, 382Ross, S., 296Ruiz-Sanchez, A., 183Ruiz-Sanchez, F., 183Russell, D. S., 188

S'Saunders, R. H., 387Scaparone, M., 183Scarzella, M., 79

Schnitz, R. C., 189Schuster, N., 374Schwartz, H. B., 383Selbie, F. R., 182Seligmann, E., 79Shanberge, J. N., 186Simon, R. D., 182Sinaiko, R. P., 189Singer, S. J., 299Sjogren, B., 184Skanse, B. N., 83Slocumb, C. H., 384Smiles, J., 85Smith, G. Stewart, 377Smith, J., 297Soffer, L. J., 385Sokoloff, L., 392Soulier, J. P., 386Spehler, H., 189Sprague, R. G., 384Stefanini, M., 186Stevens, S., 296Stewart, C. P., 185Stout, A. P., 190Summers, G. A. C., 383Sundberg, R. D., 388Svec, F. A., 295, 382Sweany, H. C., 84

TThompson, J. R., 84Thompson, R. B., 386Thomson, D. R., 300Thorsen, G., 81Tovey, G. H., 376Trunnell, J., 83

U

Ungley. C. C.. 386Upward, M. G., 300Urban, J. A., 390Ureles, A., 184

V

Vilarroel, M. S., 295

W

Waksman, S. A., 183Walker, P. G., 378Wardener, H. E. de, 390Ware, P. F., 388Washington. J. A., 296Wassermann, M., 79Watson, G. M., 186Welch, F. V., 85Wells, A. Q., 187Wells, I. C., 299Wesselow, 0. L. V. de, 390Wilens, S. L., 391, 392Wilkins, R. D., 378Wilkinson, A. W., 185WiLkinson, J. F., 300Williams, B., 382Wilson, G. S., 377Winblad, S., 389Wintrobe, M. M., 82Witts, L. J., 186Woodruff, C. W.. 386Woolner, L. B., 389Wright, H. P., 387Wyatt, J. P., 391Wylie, J. A. H., 187

yYoung. C. J., 379

zZamora, G. M., 295Zannos, L., 387Zeller, W. W., 182

400

J. clin. Path. (1950), 3, 381.

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

Clinical Observations on Infectious Mono-nucleosis in Adults. MULLER, G. (1950).Z. klin. Med., 146, 1.

From the Medical Clinic, Bremen, theauthor discusses at some length all that isat present known about glandular fever(Pfeiffer's disease). After an exhaustivehistorical resume extending from the initialdescription given by Pfeiffer in 1889 to thepresent time, with particular reference tothe angiose form (which appears to havebecome much more frequent of late), heproceeds to a minute description of theclinical and pathological findings in 37cases observed by him in 1948. It is pointedout that the faucial angina, which may bedifficult to distinguish from that of diph-theria, is due to hyperplasia of the lym-phoid tissue of the pharynx, and that thereis no one type of lesion which can beregarded as pathognomonic of glandularfever.

Points of interest from this long paperwhich may, perhaps, not be generallyfamiliar even to experts in this field maybe summarized as follows: (1) Initialsymptoms may occur for at least a weekbefore the characteristic enlargement oflymph nodes takes place. (2) Splenicenlargement is likely to be gross in abouthalf the cases and some degree will bepresent in at least two-thirds. (3) Changesin the leucocyte count are not accompaniedby an anaemia, any alteration in theerythrocytes being quite rare in glandularfever. (4) The Paul-Bunnell reaction may

2C

be positive as early as the fourth day ofthe disease and is likely to become negativeafter a month. [This finding is not the rulein the type of case lately prevalent inLondon.] (5) The sternal marrow showsa shift of myeloid cells towards theimmature side, but there is no noticeableincrease in plasma cells. From this it isdeduced that changes observed in the peri-pheral blood are due to metaplasia origin-ating in lymphoid tissue and not to analteration in the haematopoietic powers ofthe marrow; glandular fever is not a blooddisease. (6) The administration of sulphon-amides, etc., appears to be without benefit.(7) Much difficulty may be encountered indistinguishing the angina of glandularfever from that of true diphtheria espe-cially when, as not infrequently happens,diphtheria bacilli are present in the fauces.[Many cases of glandular fever are in factsent into fever hospitals as diphtheria.] Asdistinguishing features, the author men-tions absence of the typical diphtheriticfoetor and the characteristic lumpy lymph-node enlargement as contrasted with thetoxic oedema (bull-neck) of diphtheria.(8) Return to normality is stated to berapid [an observation not confirmed inGreat Britain] and the prognosis uniformlygood.

[Only a selection of points has beengiven from an elaborate clinical paperwhich seems to give the most completeaccount of glandular fever at present tohand, though it contains nothing whichcould rank as a new discovery.]

Jos. B. Ellison.

ABSTRACTS

A New Sulfonamide (Gantrisin). Studieson Solubility, Absorption and Excre--tion. SVEC, F. A., RHOADS, P. S., andROHR, J. H. (1950). Arch. intern. Med.,85, 83.

A report is presented on the solubility,absorption, and excretion of a new sul-phonamide, 3: 4 - dimethyl - 5 - sulphan la-mido-isoxazole, formerly known as " Nu445 " and now called "gantrisin." Theauthors have used this sulphonamide inthe treatment of 300 patients and have notfound any evidence of renal damage dueto the drug. It is more soluble thansulphadiazine in urine at about pH 6.3,having a solubility of 327 mg. per 100 ml.compared with 13 mg. per 100 ml. forsulphadiazine. The solubility of sulpha-diazine only approaches that of gantrisinwhen the pH is raised to 7 or 8. The freeform of gantrisin is more soluble than theacetylated form up to pH 6.6, whereas theopposite is true of sulphadiazine.

Gantrisin was given orally, intramuscu-larly, and intravenously, the dosage vary-ing from 1 to 2 g. every 4 hours. A maxi-mum total concentration in the blood of9 to 17 mg. per 100 ml. was obtained,according to the route of administration.The acetylated portion varied between28% and 35% of the total. Excretion inthe urine followed the usual pattern ofsulphonamide excretion, the major portionof the dose, 80 to 90%, being excretedwithin 48 hours. The compound wasadministered parenterally as a 40% solu-tion of the ethanolamine or diethanolaminesalts, which produced no local reactions.

R. Wien.

Chloromycetin (Chloramphenicol) in theTreatment of Infections. HEWrrr, W. L.,and WILLIAMS, B. (1950). New EDigL. J.Med., 242, 119.

Tests for bacterial sensitivity to chlor-amphenicol (" chloromycetin ") were per-formed in vitro, and from 2 to 39 strainsof each organism were employed. Themajority of the strains of Pseudomonas

aeruginosa and about half the strains ofproteus proved to be resistant, whereas themajority of the strains of streptococcus,pneumococcus, Klebsiella pneumoniae,Aerobacter aerogenes, Bacterium coli,enterococcus, and Staphylococcus aureuswere sensitive to less than 5 Mug. per ml.Therefore chloramphenicol has a widerange of in vitro bacteriostatic activityagainst pathogenic Gram-positive cocciand Gram-negative bacilli. Absorption andexcretion studies were followed by assaysin the serum and urine by a microbiologicalturbidimetric method with Shigella sonneias the test organism. A single dose of1 g. usually produced a serum concentra-tion of 10 /ug. per ml., but considerablevariations were observed. After oraladministration chloramphenicol is rapidlyabsorbed, antibacterial activity appearingin the serum within 30 minutes; but only asmall fraction (from 4 to 10%) of the doseadministered could be recovered from theurine, presumably because of the formationof inactive degradation products. In thisway chloramphenicol differs from the otherantibiotics, penicillin and streptomycin.

Chloramphenicol was tried in a widerange of clinical conditions. There were93 cases of urinary-tract infection, due toa variety of organisms, 61 being due to asingle organism and 32 to multiple organ-isms. Infections due to single organismsresponded better than those caused by amixed flora. A good clinical result wasobserved in 48 of the former and in 19 ofthe latter cases. Practically all the patientsshowed decrease in pyuria and bacilluria,even though the urine was not sterilized.In 63 cases the urine became sterile, and52 of these were followed up for a periodof at least one month, during which timethere were 13 relapses. The daily dosagevaried from 2 to 6 g. administered orally4- to 6-hourly, and the duration of treat-ment varied from 5 to 7 days. Infectionsdue to Bacterium coli also responded verywell. There were 5 patients with primaryatypical pneumonia, but the resultsobtained were equivocal. In 5 cases ofpneumococcal pneumonia, with a daily

382

ABSTRACTS

dosage of 3 g. for 5 to 8 days, there was arapid symptomatic improvement and thetemperature returned to normal within 48hours, at which time pneumococci dis-appeared from the sputum. Chloram-phenicol was used in the treatment of 4patients with herpes zoster, but the courseof the disease was not modified. Also, nomarked beneficial effect was observed inany of 5 patients with chronic ulcerativecolitis treated. Toxic side-effects wereslight and were mainly related to the gastro-intestinal tract. The frequency of theseside-reactions was related to the dailydosage; they occurred much more fre-quently in patients receiving 6 g. than inthose receiving 2 g. daily. A bitter tastein the mouth was frequently noted and wassometimes accompanied by anorexia. Dry-ness of the mouth and throat, similar tothat after atropine, was also observed.There was no evidence of renal damage orany changes in the blood picture. Drugfever was not observed, and there was onlyone case of skin rash. R. Wien.

Aureomycin in the Treatment of Experi-mental and Clinical Infections with H.influenzae,Type B. CHANDLER, C. A.,and HODES, H. L. (1950). Pediatrics,5, 267.

The relative ease of administration ofand absence of toxicity of aureomycinmake the publication of reports of itseffectiveness against bacterial invasion ofvarious kinds a matter of intense interest.In a series of six cases, in children, ofmeningitis due to Haemophilus influenzae,Type B, full recovery was obtained withaureomycin therapy in all but one, thepatient in this case being moribund onadmission. Quicker results followed thecombined use of aureomycin and sulpha-diazine than of aureomycin alone. Anaverage dosage of aureomycin for an infantwas 50 mg. intravenously and 125 mg. bymouth immediately, followed by a dailydosage of 100 mg. intravenously for 6 days,and 500 to 750 mg. orally for 14 days.Experimentally, the effectiveness of aureo-mycin against H. influenza infection in

mice was equal to that of streptomycin anddihydrostreptomycin. W. G. Wyllie.

A Slide Culture Method for StreptomycinSensitivity Testings. CUMMINGS, M. M.,DRUMMOND, M. C., and SCHWARTZ,H. B. (1950). Dis. Chest, 17, 202.The side culture method was compared

with the solid culture technique in testingsensitivity of Mycobacterium tuberculosisto streptomycin. The Muller modificationof the Pryce slide culture method, with" tween 80 " albumin medium to whichappropriate amounts of streptomycin wereadded, was employed. Results with thismethod could be read after 7 to 14 days'incubation. Specimens of sputum wereexamined before, during, and after strepto-mycin treatment. The specimen wasdivided, one-half being concentrated by theroutine method with sodium hydroxideand seeded on Loewenstein-Jensen mediacontaining 0, 1, 10, and 100 jug. of strepto-mycin and the other half being used forslide culture.

In 38% of 176 specimens positive cul-tures were obtained by both methods. Theroutine culture method revealed another19.3% of positive specimens which gavenegative results on slide culture ; on theother hand, 3.5% were positive on slideculture and negative on routine culture.Only in 8 out of the 67 cultures positiveby both methods was there disagreementin sensitivity readings, a higher degree ofresistance being revealed by the slideculture.

Slide cultures, if satisfactory, gave areading 2 weeks before the routinecultures were positive. In the case ofsputum with scanty acid-fast bacilli thelatter often fail to grow on slide culture.

E. Nassau.

Penicillin-resistant Staphylococci. Inci-dence in Relation to Length of Stayin Hospital. CAIRNS, H. J. F., andSUMMERS, G. A. C. (1950). Lancet, 1,446.Penicillin sesisitivity was studied of

strains of Staphylococcus pyogenes iso-

383

ABSTRACTS

lated from 326 in-patients, whose recordsshowed how long they had been in hospitalbefore the organism was isolated. Thestrains of Staph. pyogenes were dividedinto sensitive and resistant ones, accordingto their reaction on a penicillin gutter-platecontaining 1 unit of penicillin per ml. ofagar in the gutter. The patients weredivided into five groups and the per-centages of penicillin-resistant strainsanalysed separately for each group. Threegroups of patients all had an infection, andthe following results were obtained: of 70cases of closed infection present on admis-sion 19 yielded resistant strains and of103 cases of open infection present onadmission 43 % were resistant to penicillin,whereas in 68 cases of infection arising inhospital the percentage of resistant strainswas as high as 78. The remaining twogroups consisted of 57 patients in whomthe infection role of the staphylococcus wasdoubtful and in 46% of whom the staphylo-coccus was penicillin-resistant, and 28patients without infection (the staphylo-coccus being isolated, for example, from anasal swab) 61 % of whom yielded aresistant strain.

Further analysis of the 103 cases of openinfection showed that out of 51 cases fromwhich the swab was taken within 1 day ofadmission 25% yielded resistant strainswhereas 68% yielded resistant cultureswhen the swab was taken 8 or more daysafter admission. When these cases wereanalysed separately according to whetheror not penicillin had been given before theswab was taken, it was shown that previouspenicillin therapy did not increase the per-centage of resistant strains.

[These results clearly emphasize theimportance of hospital cross-infection inthe production of penicillin-resistantstaphylococcal infection. Since, however,19% of cases of closed infection presenton admission yielded penicillin-resistantstaphylococci it seems rather an over-statement to say that " resistant strainswould rarely emerge if cross-infection wereavoided."] Mary Barber.

BIOCHEMISTRY

Observations on the Physiologic Effects ofCortisone and ACTH in Man. SPRAGUE,R. G., POWER, M. H., MASON, H. L.,ALBERT, A., MATHIESON, D. R., HENCH,P. S., KENDALL, E. C., SLOCUMB, C. H.,and POLLEY, H. F. (1950). Arch. intern.Med., 85, 199.

The effects were studied, in a series of 33patients, of the prolonged administrationof 17-hydroxy-1 1-dehydrocorticosterone(cortisone) or pituitary adrenocortico-trophic hormone (A.C.T.H.). One of thepatients also received 17-hydroxycorti-costerone (compound F). Seventeen ofthe patients had rheumatoid arthritis and5 rheumatoid arthritis and spondylitis; 8had acute rheumatic fever; one had dis-seminated lupus erythematosus; and onepsoriasis and psoriatic arthritis. Amongthe changes produced by the administra-tion of these hormones were increase inbody weight, rounding of the facial con-tours, and the production of acne, hirsuties,keratitis pilaris, and cutaneous striae.Muscular weakness, amenorrhoea, andeuphoria were sometimes found. Theurinary excretion of corticosteroids roseabove the normal level during administra-tion of the hormones, while that of 17-ketosteroids fell rapidly at first, laterbecoming stabilized or rising again. Therewas no apparent relation between theeffects produced by the hormones on themetabolism and the clinical response ofthe arthritis. There was an increased excre-tion of creatine and of uric acid in theurine and the production of a hypochlor-aemic hypopotassaemic alkalosis. Theeffect of the hormones on sodium andchloride balance was variable, but theretended to be a retention of both in theearly stages and an increased excretionafter prolonged administration. A nega-tive nitrogen balance was produced, to-gether with significant increases in urinarycalcium and phosphorus excretion, andalso an increase in faecal phosphorus. Con-spicuous alterations in carbohydrate toler-ance were not produced; more striking

384

ABSTRACTS

changes might be expected if the hormonewere given to actual or potential diabetics.Many of the manifestations of Cushing's

syndrome were produced by protractedadministration of cortisone, and there wasevidence that cortisone is capable of de-pressing the function of the adrenal cortexin man as it does in the rat.

Geoffrey McComas.

The Value of Clinical Laboratory Tests.I. The Concentration of Cholesterol inthe Serum of Patients with Disorders ofthe Thyroid Gland. FooTE, J. B., andMERIVALE, W. H. H. (1949). Guy'sHosp. Rep., 98, 202.

In a study of the diagnostic value ofestimation of the serum cholesterol level indisorders of the thyroid, groups of 56 casesof thyrotoxicosis, 24 of myxoedema, 17 ofother thyroid diseases, and 50 normaladults were used, cholesterol estimationbeing carried out by the method of Bloor.The results in normal subjects ranged from150 to 300 mg. per 100 ml. (mean248.3 mg., S.D.±47.8). Statistical analysisof the results obtained in cases of thyro-toxicosis showed a significant lowering ofthe blood cholesterol level, but there wasconsiderable overlapping in the range ofconcentrations found with that of thenormal series, only 35% being outside thenormal range. Untreated cases of myx-oedema showed a significant rise in serumcholesterol level, with 65% of results out-side the normal range, and a return to nor-mal levels on treatment. The 17 patientswith other thyroid conditions showed nosignificant alteration in their blood chole-sterol level. F. W. Chattaway.

The Excretion of 17-Ketosteroids in Idio-pathic Hirsuitism. KOETS, P. (1949). J.clin. Endocrinol., 9, 795.

The urinary excretion of 17-ketosteroidsin normal women fluctuates between 5 and18 mg. per 24 hours. Where a masculiniz-ing tumour is the cause of hirsutism theexcretion is high or very high. From Stan-ford University School of Medicine, San

Francisco, an investigation is reported on17-ketosteroid excretion by 9 patients com-plaining of increased growth of facial andbody hair for which no cause could befound. Their ages ranged between 21 and30 years, the history from 2 to 4 years;4 were single, 5 were or had been married,and none had children. Each weekthroughout the menstrual cycle 24-hoururine specimens were analysed for 17-keto-steroids by an adaptation of the method ofRobbie and Gibson (J. din. Endocrinol.,1943, 3, 200). Two normal women wereused as controls.The average excretion level was shown

to be above normal although fluctuationsto normal occurred; there was a cyclicvariation, with the maximal excretionvalues at the approximate time of ovula-tion.For comparison, daily excretion of

ketosteroids was estimated in normal fe-male rats. The results showed a markedvariation of excretion with the maximumat mid-oestrus, a time which correspondsto ovulation in women. After ovariectomythe cyclic variation ceased and the excre-tion level fell below normal. After adren-alectomy the excretion was below measur-able levels.

It is concluded that the increased keto-steroid excretion in idiopathic hirsutism isthe result of a stimulation of the adrenalcortex by ovarian hormones. This sensi-tivity of the adrenal cortex is absent orimperceptibly small in normal women.

D. W. Higson.

Further Studies with the Salt ToleranceTest in Normal Individuals and inPatients with Adrenal Cortical Hyper-function. SOFFER, L. J., GABRILOVE,J. L., and JACOBS, M. D. (1949). J. clin.Invest., 28, Part II, 1091.

The salt tolerance test (Soffer et al., J.clin. Invest., 1944, 23, 51) was carried outon 22 normal subjects and on 15 patientswith adrenal cortex hyperfunction. In JOpatients administration of deoxycortoneacetate (DCA) resulted in a diuresis ofsodium and chloride. After x-ray treat-

385

ABSTRACTS

ment to the pituitary of one patient inwhom there had previously been saltdiuresis following DCA administration,salt retention was demonstrated. The bloodsodium concentration was measured in 9patients and was found to be considerablyincreased in 3 cases, in which the tolerancetest showed salt retention, and normal inthe others. Only in one out of the sixcases in which the blood sodium concentra-tion was normal was salt retention demon-strated. A. Schweitzer.

Electrophoretic Findings in Myelomatosis.SOULIER, J. P. (1950). Sang, 21, 37.

This is a well-documented descriptionof the electrophoretic findings in myelo-matosis.The conclusions are: (1) There is no

invariable type of electrophoretic curve inmyelomatosis. Four different electro-phoretic types have been observed, and in9 cases the curve was sufficiently charac-teristic to permit of a diagnosis. (2) Thereis no relation between the presence orabsence of proteinuria and the electro-phoretic curve in myelomatosis. In 5 cases,which did not belong to the same electro-phoretic type, proteinuria was found. Adistinction is made between the presence ofthermosoluble protein of Bence-Jones, orglobulin of small molecular weight, andnon-thermosoluble proteinuria. (3) Thereis no relation between the clinical features,the presence or absence of proteinuria, andthe histological type on the one hand andthe electrophoretic characters of the serumon the other. A. Piney.

HAEMATOLOGYVitamin B2 and Folic Acid in Megalo-

blastic Anaemias of Pregnancy and thePuerperium. UNGLEY, C. C., andTHOMPSON, R. B. (1950). Brit. med. J.,1, 919.

Six patients with megaloblastic bonemarrow (having pernicious anaemia ofpregnancy or the puerperium) were treatedwith vitamin B12 They were given an

injection of 65 to 80 jig. of the crystallinevitamin or red pigment concentrate, with-out haematopoietic or clinical responsesuntil folic acid (2.5 to 20 mg. by mouthdaily) was also given. Four also receiveda preliminary blood transfusion. Therewas no evidence of dietary deficiency inthese patients. Marked haemolysis andreticulocytosis which were noted in onecase ultimately ceased after treatment withfolic acid, but additional liver extract wasnecessary to produce complete remission.

John F. Wilkinson.

Vitamin B12 in Pernicious Anaemia:Parenteral Administration. UNGLEY,C. C. (1949). Brit. med. J., 2, 1370.

In this paper are recorded the results oftreating 73 patients with perniciousanaemia by means of single injections of1.25 to 160 [kg. of vitamin B12. A dose of1.25 ,ug. had little or no effect, but 2.5 fig.produced a small response. A dose of10 ,ug. produced on an average the " ex-pected" response in respect of increases inreticulocytes and increases in red cellsduring a 15-day period. Larger dosesproduced greater increases. Twenty-onepatients were studied for periods of 6-15months, during which time they were given10 Mug. of vitamin B12 at 2-week intervals.In 18 of these patients the blood countswere maintained at satisfactory levels.

Variable Response to Vitamin B12 ofMegaloblastic Anemia of Infancy.WOODRUFF, C. W., RIPY, H. W., PETER-SON, J. C., and DARBY, W. J. (1949).Pediatrics, 4, 723.

Three children aged 17, 9, and 12 monthswith manifestations of defective nutritionand a severe megaloblastic anaemia -Aeretreated with parenteral doses of 25, 25, and30 jug. of vitamin B12 respectively. Thefirst two cases responded satisfactorily.The third case did not respond and amegaloblastic marrow persisted. A satis-factory response, however, followed theadministration of folic acid in daily dosesof 5 mg.

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Clinical Tests of a New Coumarin Sub-stance. A Report to the MedicalResearch CounciL BURT, C. C., WRIGHT,H. P., and KUBIK, M. (1949). Brit. med.J., 2, 1250.

The treatment is discussed of 126patients suffering from various thromboticdiseases by means of a new coumarin pro-duct, bis-3: 3'-(4-oxycoumarinyl)-ethyl acet-ate (B.O.E.A.). The plasma prothrombinlevel was reduced to under 50% of thenormal within 36 hours in 100 of thepatients, and returned to over 50% ofnormal within 36 hours of cessation oftreatment. Toxic effects were slight.

The Use of ACTH in the Treatment ofAcute and Subacute Leukemia. APreliminary Note. DAMESHEK, W.,SAUNDERS, R. H., and ZANNOS, L. (1950).Bull. New Engl. med. Center, 12, 11.

This report is concerned with the re-

sponse to ACTH of 5 children with acuteor subacute lymphatic leukaemia. Remis-sions resulted, and in 4 children the bloodand bone marrow became normal or

almost normal. Remission was associatedwith an increased production of reticulo-cytes and platelets and a shrinkage ofpreviously enlarged lymph nodes, liver,and spleen. The course in two adults withsubacute myelocytic leukaemia and of anadult very ill with lymphatic leukaemiawas not influenced.The authors warn against optimism in

the use of the drug.

Transfusion Reactions to a Plasma Con-stituent of Whole Blood. Their Patho-genesis and Treatment by Washed RedBlood Cell Transfusions. DAMESHEK,W., and NEBER, J. (1950). Blood, 5, 129.

The authors describe the successfultransfusion with saline-washed red cells of11 patients who were apparently sensitiveto some factor(s) in human plasma andwho had developed reactions after thetransfusion of whole blood. The patientswere suffering from chronic haemolytic

anaemia (6 cases), leukaemia (3 cases), andmyelofibrosis and carcinomatosis (1 caseof each). The reactions were characterizedchiefly by rigors and fever and often a lackof red cell response, but haemolysis wasnot proved to be a cause.The nature of the plasma factor was not

determined; the reactions did not seem tobe due to the transfusion of iso-antibodies.

In several cases the therapeutic benefitof transfusing washed cells was strikingand even life-saving.

Hereditary Nonspherocytic HemolyticAnemia. CROSBY, W. H. (1950). Blood,5, 233.

Several members of a family sufferedfrom chronic haemolytic anaemia and alsobrachyphalangia. The anaemia was nor-mocytic; there was no spherocytosis orincrease in osmotic fragility. In the firstpatient studied porphobilinogen was foundin the urine indicating an abnormal por-phyrin metabolism. The disease was notcured by splenectomy. Transfusion studiesclearly showed that the haemolysis wasdetermined by a defect of the patient's ownred cells.

The Haematological Effects of NitrogenMustard Therapy with Special Refer-ence to the Cytology of the SternalBone Marrow. BROWN, A., and DAVIS,L. J. (1950). Glasg. med. J., 31, 93.The authors have studied in detail the

blood and bone marrows of 39 patientssuffering from various reticuloses andbronchial carcinomata who had beentreated with injections of nitrogen mustard.The total erythrocyte, leucocyte, and plate-let counts were depressed in almost all thepatients. The general reaction in the bonemarrow was that of hypoplasia of alldegrees down to almost complete aplasia.An increase in plasma cells and reticulumcells was an early sign. Evidence ofregeneration was found two to three weeksafter cessation of therapy, and during thefourth week the marrow became hyper-plastic.

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Blood and Bone Marrow Studies in RenalDisease. CALLEN, I. R., and LIMARzI,L. R. (1950). Amer. J. clin. Path., 20, 3.

In 44 patients with evidence of nitrogenretention due to renal disease, the severityof anaemia was related to the degree ofnitrogen retention. In 80% of patients thebone marrow was hypercellular. A minordegree of hypoplasia of the erythroid tissuewas observed only in patients having con-centrations of non-protein nitrogen greaterthan 150 mg. per 100 ml. of plasma.Leucopoiesis and thrombopoiesis were notdepressed.

Parahaemophilia (Owren), a New Type ofHaemorrhagic Diathesis. FRANK, E.,BILHAN, N., and EKREN, H. (1950). Actahaematol. Basel, 3, 70.

The authors describe a patient sufferingfrom a haemorrhagic diathesis due to adeficiency of Owren's factor V. VitaminK had no effect on the prolonged pro-thrombin time, but the addition in vitroof prothrombin-free plasma or pure factorV restored the prothrombin time to normal.The patient's plasma added to haemophilicplasma corrected the deficiency in thelatter, while prothrombin-free plasma froma haemophiliac corrected the defect of thepatient.

Granulomatous Lesions in the BoneMarrow in Infectious Mononucleosis.A Comparison of the Changes in theBone Marrow in Infectious Mono-nucleosis with those in Brucellosis,Tuberculosis, Sarcoidosis and LymphaticLeukemia. HovDm, R. F., and SuND-BERG, R. D. (1950). Blood, 5, 209.

Granulomatous lesions closely resemb-ling those found in the bone marrow incases of brucellosis, and which were alsonot unlike the lesions of sarcoidosis andtuberculosis, were found in 11 out of aseries of 23 cases of infectious mono-nucleosis studied- by means of marrowbiopsy.

MORBID ANATOMY ANDHISTOLOGY

Cytohistologic Diagnosis of MaterialAspirated from Stomach. Accuracy ofDiagnosis of Cancer, Ulcer andGastritis from Paraffin - embeddedWashings. RICHARDSON, H. L., QUEEN,F. B., and BISHOP, F. H. (1949). Amer.J. clin. Path., 19, 328.

The deposit of gastric washings obtainedafter an alcohol-histamine meal were fixedin picro-formol, embedded, sectioned, andstained with haematoxylin-orange G-eosin.In normal stomachs squamous cells pre-dominate, with some cubical or columnarepithelium in which small, deeply stainingnuclei are present. In gastritis, largestrands of mucosa infiltrated with leuco-cytes appear. In cancer the cells havelarge, deeply staining nuclei, usually con-taining prominent nucleoli; the cytoplasmis scanty, vacuolated, with ill-definedboundaries. Ulcers yield a fibrin masscontaining leucocytes.Of 60 patients (27 with cancer, 24 with

gastric ulcer, and 8 with gastritis) and 18normal subjects examined, a correct diag-nosis was obtained in 13 cases of cancer,20 of ulcer, and 6 of gastritis and in 11normal subjects. Two false-positive diag-noses of cancer in patients with ulcer orgastritis were made.

[This is an important paper, and shouldbe read by all concerned with the diagnosisof these diseases.] G. Discombe.

Cytologic Changes in Bronchogenic Carci-noma Following Treatment withNitrogen Mustard (Methyl-bis [/3-Chloroethyll Amine). GAENSLER, E. A.,MCKAY, D. G., WARE, P. F., and LYNCH,J. P. (1948). Arch. Path., 46, 503.

Of 8 cases studied during treatment,3 were of epidermoid carcinoma, 2 ofsquamous-cell carcinoma, and 3 of the" oat-cell " type. In the well-different;atedtypes the main changes produced by nitro-gen mustard were giant-cell formation.

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nuclear fragmentation, and a rather sur-prising increase in mitosis. On the otherhand, in the oat-cell tumours large areasof necrosis and a decrease in mitosis werefound. The maximum effect was observedin each case 5 to 8 days after treatment wasstarted. Post-mortem studies showed greatdestruction of lymphocytes and haemo-poietic tissue; also of the spermatogoniaand their products.

Studies on Effusions. II. A SimpleTechnique for the Discovery of CancerCells in Neoplastic Exudates. CHUSHEN, S., and HOMBURGER, F. (1950).Cancer, 3, 36.

The authors describe a simplifiedmethod of examining exudates for cancercells which is more rapid, and possiblymore reliable, than the Papanicolaoutechnique commonly employed. Thecentrifuged deposit from 20 ml. of defibrin-ated effusion fluid is resuspended in homo-logous or adsorbed serum and recentri-fuged. From the top layer of this finalconcentrate, 3 to 6 smears are made andstained with Wright's stain in a phosphatebuffer at pH 6.4.They used this method in examining 37

samples of fluid from 26 patients withascites, pleural effusion, or pericardialeffusion. Of 20 cases in which there wasa definite diagnosis of neoplasm, positivesmears were obtained in 17, while of 10of these cases studied by the Papanicolaoutechnique only 6 gave positive results. Nofalse-positive results were obtained in 6cases of non-cancerous effusion.

[This is a well illustrated paper andshould be read in the original by anyoneinterested.] A. Michael Davies.

Carcinoma Cells in Sputum and BronchialSecretions. A Study of 150 ConsecutiveCases in which Results were Positive.WOOLNER, L. B., and MCDONALD, J. R.(1949). Surg. Gynec. Obstet., 88, 273.

A diagnosis of bronchogenic carcinomaon the basis of positive findings in the

sputum or bronchial secretions was madein 150 out of a total of 1,600 cases. Thisdiagnosis was confirmed by means ofbiopsy, surgical exploration, radiologicalexamination, or necropsy in 145 cases.Positive smear reports were proved to befalse in 3 cases, and in 2 a final diagnosiswas not established. G. B. Forbes.

The Malignancy of Cancer at DifferentAges: A Histological Study. LEES, J. C.,and PARK, W. W. (1949). Brit. J. Cancer,3, 186.

There has been a general impressionamong clinicians that the malignancy ofcancer is greater in relatively youngpeople. The authors analysed recent litera-ture containing statistical data and did notfind in it much support for the belief. Theythen went through the records of theLaboratory of the Royal College of Physi-cians of Edinburgh and obtained a randomsample of microscopical preparations fromsubjects in three age groups and for sevensites. The following characteristics werechosen : degree of epidermoid or glandu-liform differentiation; degree of fibrosis:cell size and polymorphism; amount of" colloid " formation; mitotic frequency;general impression of malignancy. Eachfeature was assigned to one of four gradesin increasing expression. The resultantcontingency tables were analysed (the totalnumber in each age group was 105) and,with the very doubtful exception ofcarcinoma of the lung, no significant differ-ences between the age groups wererevealed. Major Greenwood.

Meningeal Tumours with ExtracerebralMetastases. CHRISTENSEN, E., KLf-R,W., and WINBLAD, S. (1949). Brit. J.Cancer, 3, 485.

A report of two cases, in males aged 38and 40 years respectively, in which theoperative removal of a meningioma fromthe Rolandic region was followed bymetastasis to remote organs.

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Ependymonas and Choroid Plexus Papil-lomas. RINGERTZ, N., and REYMOND,A. (1949). J. Neuropath. exp. Neurol.,8, 355.An account of 72 examples of ependy-

mona and 19 of chloroid plexus papil-loma, including their pathology and post-operative course. In general their featuresaccord with previous descriptions of thesetypes

Carcinoma of the Parathyroid Gland withHyperparathyroidism. DE WESSELOW,0. L. V., and DE WARDENER, H.E.(1949\.Lancet, 1, 820.The authors refer to 3 cases, recorded

in the literature, of parathyroid hyper-function with evidence of clinical andhistological malignancy and give clinicaldetails of one further case. The patientwas a woman of 35 who was firs. admittedto hospital in 1942 with classical signs andsymptoms of hyperparathyroidism. Aparathyroid tumour was removed on no

fewer than 5 separate occasions betweenthis date and 1948, and two courses ofx-ray therapy w-ere given. Symptomaticrelief and lowering of the serum calciumlevel followed these procedures. In mostof the relapses there was a sudden onsetof symptoms and an associated cardiacfailure, due probably to the high serum

calcium level. Histological section of thetumour removed at the fifth operationshowed a low degree of malignancy.

Geoffrey McComas.

Fibrosing Adenomatosis of the Breast.HELLER, E. L., and FLEMING, J. C. (1950).Amer. J. clin. Path., 20, 141.This work, reported from the University

of Pittsburgh and the Presbyterian andWomen's Hospitals, Pittsburgh, is basedupon 15 cases of fibrosing adenomatosisof the breast in women, forming 2% ofthe breast lesions examined in the patho-logy departments over a period of 5 years.The age incidence of the disease is 18 to45 years (average 34 years).

Patients have a single, painless, circum-scribed, firm, mobile mass from 0.5 to 5.0

cm. in diameter, sharply demarcated, butnot encapsulated. The cut surface isusually solid and fibrous with a delicategranularity, and often contains a few smallcysts 1 to 3 mm. in diameter. The lesionlacks the small yellow foci and the glisten-ing translucency of the mammary carci-noma. In stage I there is hyperplasia ofthe ductules, which are embedded in adense, collagenous, acellular band replac-ing the loose specialized, peri-acinar con-nective tissue. In stage II the depositionof collagen has completely replaced theperi-acinar connective tissue and thuscaused compression and distortion of theductules. At first sight the histologicalpicture may be one resembling that ofmalignant infiltration, though cytologicallythere is no evidence of malignancy. Instage III intralobular fibrosis has com-pletely destroyed the lobular structure;distorted narrow cords of acinar epithe-lium, 2 to 3 cells wide, lie in a disorderedarrangement in an abundant collagenousmatrix. The general resemblance to car-cinoma may be striking, but the cytologicalevidence of malignancy is lacking.The authors suggest that the condition is

a variant of benign cystic disease of thebreast in which the proliferation of thebasement membrane of the ductule, ratherthan of the epithelium, predominates.There has been no evidence of recur-

rence during the follow-up period. Localexcision and, occasionally, local mastec-tomy is the treatment of choice.

Peter Harvey.

Sclerosing Adenosis. URBAN, J. A., andADAIR, F. E. (1949). Cancer, 2, 625.In this paper a -detailed description is

given of the clinical picture, gross appear-ance, and morbid histology in 34 cases ofa condition described as " sclerosingadenosis " (a form of " chronic mastitis ").The difficulty in differentiating the lesionfrom cancer resides first in the fact thatthe extreme degree of fibrosis gives to thegross specimen a feel very much like thatof cancer, and histologically the ducts arecrammed with epithelial cells. Nowhere,

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however, is there true transgression ofepithelial cells into the surrounding stroma,and in most cases an alveolar pattern, or

at least spaces between the epithelial cells,are discernible under the microscope.

The Septic Abortion Kidney. WYATXr,J. P., and GOLDENBERG, H. (1950).Amer. J. Obstet. Gynec., 59, 337.

The authors describe (under the nameof " septic-abortion kidney ") 3 fatal casesof lower nephron nephrosis after septicabortion.The authors contrast lower nephron

nephrosis with the rarer (though morefrequently reported) symmetrical corticalnecrosis, and an attempt is made to explainthese two apparently diverse lesions in thelight of Trueta's recent work on the renalcirculation. The "medullary shunt" isbelieved to occur in cases of crush syn-drome, but presumably a limited circula-tion, sufficient for nutrition but not forglomerular function, continues through thecortex, except in extreme cases, in whichthe restriction of the cortical circulationproduces symmetrical cortical necrosis.On the other hand, the theory of tubularblockage by haematin casts has not beendisproved, and the true answer may bethat there is an interplay between the twofactors of anoxia and haematin precipita-tion. But, whatever its aetiology, the con-dition should be suspected in any case ofinduced abortion with oliguria.

The Role of Lipid Deposition in RenalArteriolar Sclerosis. WILENS, S. L., andELSTER, S. K. (1950). Amer. J. med.Sci.. 219. 183.

In 140 specimens obtained at necropsy,the renal arterioles of normal individualswere found to contain minute lipid de-posits, the amount becoming increased inthe later age groups. The distribution oflipid in the arteriolar wall was variable,usually occurring throughout the media,and bore no relationship to the presence

of lipid in other structures such as

glomeruli or tubules. In primary hyper-

tension and diabetes the lipid was con-siderably increased, especially in thosevessels which showed hyaline degenera-tion. Although a contrast is drawn be-tween the lesions of atherosclerosis andof arteriolar lipidosis, it is concluded thatin these two conditions lipid depositionresults from variations in blood pressurein different sets of blood vessels.

Distribution of the Lymphatics of theHuman Kidney as Shown in a Case ofCarcinomatous Permeation. RAWSON,A. J. (1949). Arch. Path., 47, 283.The distribution and arrangement of the

lymphatic channels were studied in akidney obtained at necropsy in a case ofextensive carcinoma. Microscopical ex-amination of the kidney showed that thelymphatic vessels were clearly visible anddistended by solid cords of tumour cells.One system of lymphatic channels

began as minute blind-ending vessels inclose contact with Bowman's capsules. Nolymphatic vessels were seen round theafferent or efferent arterioles of theglomeruli and none appeared to penetratethrough Bowman's capsule. The inter-lobular capillaries were also free from anylymphatic networks. The small lymphaticvessels beginning near Bowman's capsulesgradually enlarged and formed nets roundboth the arterial and venous vessels ofthe cortex. Particularly dense retworkswere observed round the large thin-walledvenous channels or " sinuses " lying in theouter half of the cortex. These lymphaticvessels round the blood vessels followsuccessively the interlobular, arcuate, andinterlobar arteries and veins, leaving thekidney at the hilus to terminate in thenodes on either side of the aorta. Smallblind-ending lymphatic capillaries alsooriginated beneath the mucosa of thepapilla, ascended in more or less straightlines through the medulla, and emptiedinto the larger lymphatic channels roundthe arcuate arteries and veins. The lym-phatic trunks round the arcuate vesselstherefore receive lymph from both medullaand cortex.

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Histopathologic Observations in a FatalCase of Q Fever. PERRIN, T. L. (1949).Arch. Path., 67, 361.In this paper are described the histo-

logical findings in a previously recordedcase. A 43-year-old cattle-worker diedafter a 15-day illness characterized byfever, cough, nasal congestion, headaches,and mental confusion. Necropsy revealeda diffuse consolidation of lungs, micro-scopy showing an essentially mononuclearexudate, with congestion and haemor-rhages, but neutrophil granulocytes werenot infrequent and there was a fibrin net-work. No rickettsiae or other micro-organisms could be found. Focal hypo-plas'ia was seen in the sternal marrow. Inthe myocardium there was fairly extensiveischaemic fibrosis due to occlusion of amajor coronary vessel. No significantchange was found in other organs. It isconcluded that the lung changes wereessentially due to the Q-fever virus andpossibly also the marrow hypoplasia ; how-ever, the cardiac condition certainly seemsto have had an unfavourable influence ina disease usually benign in the healthyadult.

Diffuse Cystic Lungs of GranlomatousOrigin. A Histological Study of SixCases. CUNNINGHAM, G. J., and PARKIN-SON, T. (1950). Thorax, 5, 43.Detailed histological studies on 6 cases

of honeycomb lungs are reported, -andbrief clinical records of the patients aregiven. All cases showed a granulomatousprocess in the walls of the cysts and in theintercystic spaces. In the acute phase thisprocess was characterized by a highlycellular histiocytic response, and in thechronic phase by widespread fibrosis. Inthe intermediate stages, foamy macro-phages were present in large numbers,sometimes being the predominant cell. Itis suggested that the cystic spaces are pro-duced by weakening of the walls of thesmaller bronchioles as a result of granulo.matous infiltration. In the present materialthe distinction between cysts of alveolar

and bronchiolar origin is impossible. Thenature of the granulomatous process isdiscussed. [Authors' summary.]

Diagnostic Value of Histologic Lesions ofStriated Muscle in Rheumatoid Arthritis.SOKOLOFF, L., WILENS, S. L., BUNIM,J. J., and McEWEN, C. (1950). Amer.J. med. Sci., 219, 174.

Biopsy or necropsy specimens or musclefrom the deltoid and gastrocnemius wereexamined by serial section in 57 cases ofrheumatoid arthritis, 10 of ankylosingspondylitis, 21 of acute rheumatism, 101of various other conditions, some involv-ing the joints, and in 13 healthy volun-teers. Focal cellular lesions similar tothose described by other workers werefound in 56% of the cases of rheumatoidarthritis, but also in 3 of the normal con-trols and in 25% of the non-rheumatoidgroup as a whole. Various other labora-tory investigations were performed, suchas determination of the erythrocyte sedi-mentation rate and estimation of the serumcontent of streptococcal agglutinins andagglutin of sensitized sheep erythrocytes.None of these threw any light on themechanism of production of the histo-logical lesions, and the authors concludethat muscle biopsy is of little value asa diagnostic procedure in rheumatoidarthritis. G. J. Cunningham.

CorrectionDr. LEVIN writes: I must apologize for

an error, which was in our typescript andwas no fault of the printers.

In the paragraph headed " Method " of"A Simple Visual Turbidimetric Estima-tion of Serum Gamma Globulin" (J. clin.Path., 3, 284) the first line should read:"Serum, 0.1 ml., is added to 2.4 ml. ofsaline ammonium sulphate solution" . . .

instead of "Serum, 0.1 ml., is added to4.9 ml. of saline ammonium sulphatesolution."

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