718

relation between difference in chromosome constitution anddiscordance for normal and abnormal traits.

JOHANNES NIELSEN.

The Cytogenetic Laboratory,Aarhus State Hospital,Risskov, Denmark.

A NEW KLINEFELTER’S SYNDROME KARYOTYPE

SIR,-We have found an unusual type of mosaicism in achild with Klinefelter’s syndrome.The patient, born April 23, 1967, was discovered in a

programme of sex-chromatin examinations in a maternity hos-pital. He is the first-born of a mother aged 17 and a fatheraged 20, of Caucasian extraction. There is no history of con-sanguinity. The pregnancy was normal, with no history of drugingestion, radiation, or previous miscarriages.

Buccal smear showed 20% chromatin-positive cells initially,and 9% on repetition. Two cultures of capillary blood forchromosome culture yielded unsatisfactory results. A peri-pheral-blood culture yielded seventy-two analysable cells-twowith 45 chromosomes, eleven with 46 chromosomes, and fifty-nine with 47 chromosomes. The cells with 47 chromosomeshad 5 chromosomes in the G group, 1 of which correspondedto the Y, and 16 chromosomes in the C group, with a karyotypeof 47 XXY. The cells with 46 chromosomes were of two types:six of the cells had 4 chromosomes in the G group and 16chromosomes in the C group, with a 46 XX karyotype: theother five cells had 5 chromosomes in the G group, and 15 inthe C group, with a 46 XY karytype. The cells with 45chromosomes seemed to have random losses. A blood-smearshowed five typical drumsticks in a hundred and eighteenneutrophils.The child seems completely normal physically. His penis

and testes are soft and of normal size for a child of three months.His growth and development have been normal up to now.We explain this unusual mosaicism by an aberration in the

early somatic mitoses of the embryo. Reports of similar caseswould be welcomed.

M. ASPILLAGAL. CROSBY.

Department of Genetics,Luis Calvo Mackenna Hospital,

360 Antonio Varas,Santiago, Chile.

BANTU

SiR,-Except for the fact that Dr. Gordon (Aug. 5, p. 312)questions my statements directly, I would not have entered thisdiscussion again. The term " Bantu " is actually used by thepeople it is supposed to define and it simply is not offensive tothem. " Bantu " is used by the Zulu author, VusamazuluMutwa, in his book on the history of the Black man in Africaas it is known to themselves in legends and rituals.l Theancestral tribe was known to them as " Batu " or " Bantu "." Negro " and " Bantu " are indicated in their language by" Old People " and " Young People ", and Mutwa suggeststerms such as " Greater Bantu " and " Lesser Bantu " forNegro and Bantu respectively.l

" Bantu" was introduced by Dr. Bleek for the purelyscientific reason of classification of the 25% of world languagesspoken by 10% of the world’s population living on this secondlargest land mass on earth-Africa. With some 3000 world-

languages, the formidable task he undertook was greatlysimplified by the grouping together of Bantu-speaking tribes.

In Africa, however, political boundaries intersect languageand cultural boundaries. The term " African " came into ageneral use after the 1939-45 war. In its literal meaning itwould have the same significance as " Asian " or " European ",but the limited definition proposed is politically inspired andis undesirable because it divides people on skin colour alone;it implies an exclusive privilege to the possession of a continentshared by many who occupied some parts of it long before theadvent of the Bantu; and the term moreover does not define

1. Mutwa, V. C. Indaba, my Children. Johannesburg, 1964.

or embrace all inhabitants of Africa and therefore is misleading,incorrect, and unscientific, regardless of the extent to which itis commonly used.

I am in full agreement with Dr. Lewis and his colleagues(July 1, p. 46) that " scientific literature can do withoutclassifications which are now chiefly political ", but the choiceof classification must be scientifically motivated and not

dictated by arguments as to common world usage, false senti-ment, and biased reasoning. I think this can be done for theterm

" Bantu ", but not for the term " African ".If Dr. Gordon had read my reply he would have learnt that

history proves that the Whites in Southern Africa are not11 newcomers " but were here before the Bantu migrationreached this part of Africa. So far as his genetic studies areconcerned, I am in full agreement with his views, but evenskin colour is genetically endowed, and therefore his studies donot allow the conclusion that my contention is no longer valid.His own studies concern Bantu only; no Negroes were

included.

H. P. WASSERMANN.

Department of Internal Medicine, C.S.I.R.Pigment Metabolism Research Unit,

University of Stellenbosch, P.O. Box 53,Bellville, South Africa.

IMPETIGO ON THE INCREASE ?

SIR,-In recent months there has been an increase in thenumbers of patients with impetigo attending this hospital. Thisimpression has been confirmed by comparing the number ofpatients with impetigo admitted in the three-month periods,June, July, and August, last year and this year: six cases in1966, and eighteen this year.

I should be interested to know whether there has been asimilar increase in the number of cases seen in other parts ofthe countrv.

D. B. BROOKES.

Manchester and Salford Hospitalfor Skin Diseases,Manchester 3.

CUTANEOUS ANTHRAX

SiR,ŇI was interested in the article by Dr. Taylor andDr. Carslaw 1 and in the subsequent correspondence. In threeof their four patients it was not possible to grow Bacillusanthracis on admission to hospital. This suggests that manycases may be missed. With the increasing use of animal-product fertilisers by gardeners, it is probable that more caseswill be seen in town and suburban practice, rather than inspecialised industrial and agricultural practice. I have recentlyseen such a case in a 44-year-old engine-driver. Althoughbacteriological confirmation could not be obtained, the clinicalpicture satisfied the criteria of Dr. Taylor and Dr. Carslaw.

_

The patient presented on April 20, 1967, four days afterhaving been bitten in the right posterior triangle of the neck bya gnat. At the time of the bite he was liberally using a mixedanimal and chemical fertiliser containing 10% hide meal.After the bite he complained of malaise and increasing swellingof his neck and anterior chest wall. He gave a past history oflocalised hypersensitivity reaction to insect bites. He hadreceived no treatment before admission to hospital, when hehad a temperature of 103°F (39-5°C) and was toxic. On theright side of his neck there was a small red area next to anunruptured clear bulla. The area around was red, indurated,and not tender. Beyond the induration oedema fluid spreadon to the face, back, anterior chest wall, and down the rightarm, and formed a tight collar around the neck. There was nolymphadenopathy. The initial small bulla became necroticand was later surrounded by several haemorrhagic bullie (seeaccompanying figure).The patient was treated initially with ampicillin, 500 mg.

t.d.s., and later penicillin, 2 megaunits 4-hourly; he was given1. Taylor, L., Carslaw, R. W. Lancet, 1967, i, 1214.

719

Original necrotic bulla surrounded by haemorrhagie butlae andgross cedema.

intravenous fluids. In addition, because of the gross oedemaand the danger to his airway, 100 mg. hydrocortisone intra-muscularly was given 8-hourly, and later changed to oralprednisolone, 15 mg. 6-hourly.

Investigations were as follows: a negative blood-culture(before antibiotic therapy); a white-cell count of 21,300 with89% neutrophils; a smear from the original bulla revealedgram-positive cocci, and gram-positive bacilli, not definitelyidentifiable as B. anthracis; on culture Staphylococcus pyogenesonly was obtained. B. anthracis could not be isolated in theremainder of the fertiliser. A specimen of serum was kindlyexamined by Mr. F. C. Belton who reported " no specificanthrax antibody could be detected by either the agar diffusionplate or the toxin neutralisation method 3 ". Negativeserology does not exclude the diagnosis.The patient’s recovery was stormy and complicated by hypo-

tension, oliguria, and uraemia (blood-urea 432 mg. per 100 ml.);a similar complication was reported by Lamb.4 His temperaturefell over 4 days. The oedema slowly disappeared over 3 weeksand the bullae healed. After 6 weeks a small skin scar 0-5 X0-25 cm. was all that remained, and after 3 months the site ofthe lesion was barely visible.

It is possible that the gross oedema in this patient may havebeen partly due to hypersensitivity. Tahernia 5 has reportedon six cases of facial cutaneous anthrax complicated by grossoedema in South Iranian children, and advocates treating suchpatients with penicillin and steroids. Steroids should probablybe considered in all patients with cutaneous anthrax complicatedby severe local oedema.

I should like to thank Dr. P. I. Reed for permission to report thiscase and for his helpful advice, and Mr. D. Griffin for the photograph.

N. A. P. EVANS.Wexham Park Hospita

Slough, Bucks.

NODULES OF THE EAR

SIR,-I cannot agree with the suggestion in your annota-tion (Sept. 16, p. 602) that surgical excision is the treatmentfor persistent painful nodules. Curettage and cautery werefavoured by Cramer 6; and Cohen 7 observes that local injec-tions of triamcinolone may be the treatment of choice.The proponents of surgery point out that resolution fol-

lowing local injections of steroid may not be permanent.Surgical removal of areas of chondrodermatitis nodularischronica helicis, however, is not without its share of recur-rences ; and if the excision includes a sliver of cartilage, as itshould, some degree of deformity of the pinna is inevitable.Triamcinolone particles, being insoluble, have a depot effect

and cause regression of the lesions with the least inconvenience.I can recall only two failures in the past ten patients or so I havetreated with intra-lesional triamcinolone (25 mg. per ml.).Both were in men in their sixth decade, with the nodule on theright ear, who have been nodule-free for nearly three years2. Thorne, C. B., Belton, F. C. J. gen. Microbiol. 1957, 17, 505.3. Belton, F. C., Henderson, D. W. Br. J. exp. Path. 1956, 37, 156.4. Lamb, R. Lancet, 1958, ii, 151.5. Tahernia, A. C. Archs Dis. Childh. 1967, 42, 181.6. Cramer, J. E. Aust. J. Derm. 1964, 7, 141.7. Cohen, E. L. in Modern Trends in Dermatology, 3 (edited by R. M. B.

MacKenna); p. 305. London, 1966.

since a second injection of triamcinolone; and neither they norI can be sure that the " recurrence " was not the developmentof a new, adjacent nodule.

Unless you have some information which I have missed I

prefer to accept Cohen’s opinion on the present-day treatmentof this terribly named common condition.

RONALD CARRUTHERS.

Department of Dermatology,General Hospital,

Launceston, Tasmania.

BILHARZIASIS AND BLADDER CANCER

SIR,-Dr. Macieira-Coelho (July 15, p. 156) infers thatPrates proved that an association existed between bladdercancer and chronic urinary bilharziasis. The publicationhe cites proves nothing that was not known before: it proves,firstly, that in endemic bilharzial regions bladder cancer is

sufficiently common to make one suspect the association, and,secondly, that the malignant process occurs at an earlier agethan in non-endemic bilharzial regions. Our approach, asdescribed in our article,2 is entirely different.

MICHAEL GELFAND.University College of Rhodesia,

Salisbury, Rhodesia.

SEX CHROMATIN IN FEMALE BREAST CANCER

SIR,-The report by Dr. Soost and Dr. Knote (Sept. 9,p. 570) of their failure to confirm the findings of Stanley et al. 3of abnormalities in the frequency of chromatin-positive nucleiin buccal smears from women with breast cancer prompts us torecord our own findings.Two groups of patients were studied. The first consisted of

262 consecutive female admissions to the radiotherapy wardsof this hospital: 71 were women with breast cancer, and the

TABLE I-FREQUENCY OF CHROMATIN-POSITIVE NUCLEI IN 139 PATIENTSWITH BREAST CANCER AND 191 CONTROL PATIENTS

TABLE II-DISTRIBUTION OF FREQUENCIES OF CHROMATIN-POSITIVE

NUCLEI IN PATIENTS WITH BREAST CANCER AND CONTROL PATIENTS

remaining 191 served as controls. The second group consistedof 68 patients selected for study because they had breast cancer:11 were examined after simple mastectomy but before under-going radiotherapy and in this respect were identical to thepatients in the first group; the remaining 57 patients had beentreated by surgery and radiotherapy 1-22 years before.

Buccal smears obtained in the usual way were fixed imme-

diately in polyethylene glycol and stained with cresyl-violet.The slides were coded and counted blind by three observers.200 suitable nuclei were scored in each case. No significantdifferences were found between the counts of differentobservers. No difference in the frequency of chromatin-1. Prates, M. D. Acta Un. int. Cancr. 1962, 18, 643.2. Gelfand, M., Weinberg, R. W., Castle, W. Lancet, 1967, i, 1249.3. Stanley, M. A., Bigham, D. A., Cox, R. I., Kirkland, J. A., Opit, L. J.

ibid. 1966, i, 690.