of 1 /1
413 by lumbar puncture was removed and replaced by air ; the amount varied from 75 to 155 c.cm. After this an X ray appearance that he considered normal was obtained in eight cases ; and in these most of the air had disappeared within 24 hours. In four eases there was pronounced dilatation of the ventricles and subarachnoid spaces, especially in the region of the Pacchionian bodies, and repeated pictures showed persistence of the air, in one case up to 216 hours later-a phenomenon which Notkin is inclined to associate with the ventricle dilatation. In the five remaining cases there was evidence of other patho- logical changes, such as asymmetry of the ventricles or leptomeningitic adhesions, pointing to inflammatory, or possibly neoplastic, processes, which were apparently not active. It is probable that further study along these lines would lead to results of high value ; and this indeed is indicated in the consequent successful therapy claimed by Temple Fay. But a procedure such that no one has so far attempted to apply it to a series of healthy people should be approached with caution. Notkin is careful to inform us that none of the patients died as a consequence of the procedure ; but one died five weeks later from a severe convulsion, and another eight weeks later from an unexplained haemoptysis. All the patients had severe headaches for 48 hours after the operation, together with rigidity of the neck, profuse per- spiration, vomiting, and tachycardia, which sub- sequently gave place to a pronounced slowing of the I, pulse. He is inclined to think that some of these symptoms might be obviated if the volume of air introduced were rather less than that of the fluid withdrawn. INFANT DEATHS AND VITAMIN STARVATION THE North Kensington Medical Society has circulated among its members an analysis of the causes of the 180 deaths of infants under one year which occurred in the borough during the year 1928. The report is the work of three practitioners, Dr. H. E. Barrett, Dr. A. Keith Gibson, and Dr. Eleanor M. Reece, and their conclusions are worthy of close scrutiny, as they differ appreciably from those usually reached in an inquiry of this kind. In each case investigated an attempt was made to classify the various environmental factors as " good," " fair," or " bad," these factors including housing, income, antenatal and postnatal maternal employment, feeding, maternal care, foster care, size of family, and the proximity of open spaces. In nearly 40 per cent. of the cases the family income was unsatisfactory, and an analysis of other factors in the group, taken as a whole, showed that environment deteriorated in direct proportion to the decrease of family income. In homes where the income was small, therefore, they assume that death was probably the result of several unsuitable environmental factors, or, in other words, that poverty was the real cause behind a number of these deaths. It was found, however, that bronchitis and broncho-pneumonia were no respecters either of houses or incomes. Among the children between six months and a year in age who died as a result of these respiratory diseases it was found that a large proportion had shown signs of rickets. The incidence of breast-feeding in this group, however, was high ; out of 55 deaths from respiratory infections 30 infants were.. com- pletely and 18 partially breast-fed. The investiga- tors point out that those foods which contain vitamin D also contain vitamin. A, and that a child who is showing signs of rickets must therefore be receiving a diet defieient in both these vitamins. Recent experiments on the resistance conferred against infection by vitamin A lead them to conclude that a deficiency of this vitamin would be sufficient to account for the occurrence of broncho-pneumonia associated with rickets in children between 6 and 12 months old. Even during the period from the second to the sixth month they consider a deficient diet may be responsible for deaths from respiratory infections, and claim that great improvement has been seen in cases of bronchitis and broncho-pneumonia when vitamin preparations have been administered along with the ordinary remedies. Deaths under one month from these conditions may be due, they suggest, to an innate tendency to infection, due to faulty diet and environ- ment of the mother during pregnancy. Anticipating that the high proportion of breast-feeding in this group may be quoted as an argument against their theory, the investigators point out that it is now well established that the quality of breast milk and its vitamin content depend on the food of the mother ; any deficiency in her diet will be reflected in the diet of the infant. It is admittedly by no means rare to find well-established rickets in a breast-fed infant. They make the bold suggestion that in many cases a good brand of dried milk may be better for the infant than breast milk of the quality it is receiving. Inquiry into deaths due to causes other than respiratory disease seemed to show that most of the marasmus and some of the enteritis and prematurity cases occurred where the environment was bad, and that often the parents of those infants appeared to be of poor stock, with little physical or mental ability. The investigators suggest a series of simple experiments on infant and maternal feeding which might be carried out at welfare centres, to decide how far the customary diet of pregnant and nursing women is complete in those materials essential to the child. FRIEDMANN’S TURTLE VACCINE. EVER since its first appearance in Germany the Friedmann turtle tubercle vaccine 1 has been a trial to the serious worker in the immunological field. It has produced a large mass of clinical records, called forth at least one government report, stimulated the appearance of a competing vaccine made from a rival strain (the Piorkowsky bacillus), and finally produced a lawsuit. But in spite of all this publicity, inquiries into the purely biological properties of the bacillus have never been as thorough as they might have been. M. A. Saenz 2 has at last removed this reproach by making-we hope once and for all-a detailed investigation. The organism was first isolated by Friedmann in 1903 from the lungs of two sea- turtles captured off Italy and removed to the Berlin aquarium. Since its isolation it has undergone many vicissitudes and, as always with a strain passed from laboratory to laboratory, the purity of culture has frequently been called in question. Sea-turtles with pulmonary tuberculosis do not come the way of bacteriologists every day in the week, and laboratories have been unable, therefore, to check the original findings. Saenz has made a careful study of three cultures of the bacillus which he has obtained, and in the Annales of the Pasteur Institute sets forth in full detail the morphological characters, cultural properties, and pathogenic action of the organism. 1 See report of discussion by Tuberculosis Association, THE LANCET, 1929, ii., 36. 2 Bull. Acad. de Méd., 1931, cv., 853 ; Ann. Inst. Pasteur, July, 1931, p. 4.

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Page 1: INFANT DEATHS AND VITAMIN STARVATION

413

by lumbar puncture was removed and replaced byair ; the amount varied from 75 to 155 c.cm. Afterthis an X ray appearance that he considered normalwas obtained in eight cases ; and in these most of theair had disappeared within 24 hours. In four easesthere was pronounced dilatation of the ventricles andsubarachnoid spaces, especially in the region of thePacchionian bodies, and repeated pictures showedpersistence of the air, in one case up to 216 hourslater-a phenomenon which Notkin is inclined toassociate with the ventricle dilatation. In the five

remaining cases there was evidence of other patho-logical changes, such as asymmetry of the ventricles orleptomeningitic adhesions, pointing to inflammatory, orpossibly neoplastic, processes, which were apparentlynot active. It is probable that further study along theselines would lead to results of high value ; and thisindeed is indicated in the consequent successfultherapy claimed by Temple Fay. But a proceduresuch that no one has so far attempted to apply itto a series of healthy people should be approachedwith caution. Notkin is careful to inform us thatnone of the patients died as a consequence of theprocedure ; but one died five weeks later from a

severe convulsion, and another eight weeks later froman unexplained haemoptysis. All the patients hadsevere headaches for 48 hours after the operation,together with rigidity of the neck, profuse per-spiration, vomiting, and tachycardia, which sub-

sequently gave place to a pronounced slowing of the I,pulse. He is inclined to think that some of thesesymptoms might be obviated if the volume of airintroduced were rather less than that of the fluid

withdrawn.

INFANT DEATHS AND VITAMIN STARVATION

THE North Kensington Medical Society hascirculated among its members an analysis of thecauses of the 180 deaths of infants under one yearwhich occurred in the borough during the year 1928.The report is the work of three practitioners, Dr.H. E. Barrett, Dr. A. Keith Gibson, and Dr. Eleanor M.Reece, and their conclusions are worthy of close

scrutiny, as they differ appreciably from those

usually reached in an inquiry of this kind. In eachcase investigated an attempt was made to classifythe various environmental factors as

"

good," " fair,"or " bad," these factors including housing, income,antenatal and postnatal maternal employment, feeding,maternal care, foster care, size of family, and theproximity of open spaces. In nearly 40 per cent. ofthe cases the family income was unsatisfactory, andan analysis of other factors in the group, taken as awhole, showed that environment deteriorated indirect proportion to the decrease of family income.In homes where the income was small, therefore,they assume that death was probably the result ofseveral unsuitable environmental factors, or, in otherwords, that poverty was the real cause behind anumber of these deaths. It was found, however,that bronchitis and broncho-pneumonia were no

respecters either of houses or incomes. Among thechildren between six months and a year in agewho died as a result of these respiratory diseasesit was found that a large proportion had shownsigns of rickets. The incidence of breast-feeding inthis group, however, was high ; out of 55 deathsfrom respiratory infections 30 infants were.. com-

pletely and 18 partially breast-fed. The investiga-tors point out that those foods which contain vitaminD also contain vitamin. A, and that a child who isshowing signs of rickets must therefore be receiving

a diet defieient in both these vitamins. Recent

experiments on the resistance conferred againstinfection by vitamin A lead them to conclude that adeficiency of this vitamin would be sufficient to accountfor the occurrence of broncho-pneumonia associatedwith rickets in children between 6 and 12 months old.Even during the period from the second to the sixthmonth they consider a deficient diet may be responsiblefor deaths from respiratory infections, and claim thatgreat improvement has been seen in cases of bronchitisand broncho-pneumonia when vitamin preparationshave been administered along with the ordinaryremedies. Deaths under one month from theseconditions may be due, they suggest, to an innatetendency to infection, due to faulty diet and environ-ment of the mother during pregnancy. Anticipatingthat the high proportion of breast-feeding in this

group may be quoted as an argument against theirtheory, the investigators point out that it is now wellestablished that the quality of breast milk and itsvitamin content depend on the food of the mother ;any deficiency in her diet will be reflected in thediet of the infant. It is admittedly by no means rareto find well-established rickets in a breast-fed infant.

They make the bold suggestion that in many cases agood brand of dried milk may be better for the infantthan breast milk of the quality it is receiving. Inquiryinto deaths due to causes other than respiratorydisease seemed to show that most of the marasmusand some of the enteritis and prematurity cases

occurred where the environment was bad, and thatoften the parents of those infants appeared to be ofpoor stock, with little physical or mental ability. The

investigators suggest a series of simple experimentson infant and maternal feeding which might becarried out at welfare centres, to decide how far thecustomary diet of pregnant and nursing women is

complete in those materials essential to the child.

FRIEDMANN’S TURTLE VACCINE.

EVER since its first appearance in Germany theFriedmann turtle tubercle vaccine 1 has been a trialto the serious worker in the immunological field.It has produced a large mass of clinical records, calledforth at least one government report, stimulated theappearance of a competing vaccine made from arival strain (the Piorkowsky bacillus), and finallyproduced a lawsuit. But in spite of all this publicity,inquiries into the purely biological properties of thebacillus have never been as thorough as they mighthave been. M. A. Saenz 2 has at last removed this

reproach by making-we hope once and for all-adetailed investigation. The organism was first isolatedby Friedmann in 1903 from the lungs of two sea-turtles captured off Italy and removed to the Berlinaquarium. Since its isolation it has undergone manyvicissitudes and, as always with a strain passed fromlaboratory to laboratory, the purity of culture hasfrequently been called in question. Sea-turtles withpulmonary tuberculosis do not come the way ofbacteriologists every day in the week, and laboratorieshave been unable, therefore, to check the originalfindings. Saenz has made a careful study of threecultures of the bacillus which he has obtained, andin the Annales of the Pasteur Institute sets forth infull detail the morphological characters, cultural

properties, and pathogenic action of the organism.

1 See report of discussion by Tuberculosis Association,THE LANCET, 1929, ii., 36.

2 Bull. Acad. de Méd., 1931, cv., 853 ; Ann. Inst. Pasteur,July, 1931, p. 4.