of 1 /1
1471 that the expense of this special training shall be placed upon men who have already devoted five or six years to the general study of their profession ; and he therefore makes the sugges- tion that the men selected for these posts as being generally well informed, skilful, and qualified for the discharge of responsible medical duties should be allowed to devote the first year after their appointment to the study of the special pathological, administrative, and clinical work required. Suggestions as to the suitable training of tuberculosis officers have already been made to the Local Government Board by the representatives of the hospitals for diseases of the chest in London, but the reply has been anything but encouraging. - SCIENTIFIC RESEARCH FOR THE LOCAL GOVERNMENT BOARD. THE President of the Local Government Board has authorised the following special researches to be paid for out of the annual grant voted by Parliament in aid of scientific investigations concerning the causes and processes of disease :- 1. A continuation of the Board’s inquiry into the Causes of Premature Arterial Degeneration, by Dr. F. W. Andrewes. 2. A continuation of the Board’s inquiries on Insects in Relation to Disease: Professor Nuttall, F.R.S., on the Life Cycle of the Body Louse and Bug; Dr. Bernstein and Mr. Hesse on the Empusa Muscse in Flies. 3. A continuation of the Board’s inquiry into Infantile Diarrhcea, by Mr. F. W. Twort and Dr. Edward Mellanby. 4. A continuation of the Board’s inquiry into the Virus of Polio- myelitis, by Dr. Andrewes and Dr. M. H. Gordon. 5. An investigation by Mr. F. W. Twort into the Character and Life- history of certain Filter-passing Micro-organisms. 6. An investi ation by Professor Leonard Hill, F.R.S., on Respiratory Exchange in Man under Varying Conditions. 7. An investigation by Mr. J. E. R. McDonagh on the Biochemistry of Syphilis. 8. An investigation by Dr. L. Rajchman into the Possibilities of Serological Diagnosis of Scarlet Fever. 9. An investigation by Dr. D. M. Alexander on the Relation between the Clinical Symptoms and the Bacteriology of the Acute Respiratory Affections. - THE LYMPHOCYTOSIS OF INFECTION. IN the acute stage of the great majority of infectious diseases there is polynuclear leucocytosis. In a few, such as typhoid fever and malaria, there is no marked change in the number of leucocytes. Occasionally infections associated with polynuclear leucocytosis show instead lymphocytosis. This phenomenon is most striking in whooping-cough, where it is so constant that some writers have regarded it as of value in differential diagnosis. In the American Journal of the Medical Soienoes for March Dr. Richard C. Cabot has called attention to the danger of confounding infections II associated with lymphocytosis with lymphatic leukaemia and giving an alarming prognosis. He has observed a group of cases in which infection, usually strepto- coccic, was associated with lymphocytosis. In one case a medical man infected his finger near the nail at a necropsy. Lymphangitis with enlargement of the axillary glands on the same side, and, to a less extent, on the opposite side, followed. For several weeks there was fever somewhat resembling typhoid fever. Through- out well-marked absolute and relative lymphocytosis was present, so that several consultants were alarmed as to the possibility of lymphatic leuksemia. Slow but complete recovery ensued. In a second case an undergraduate, aged 20 years, was seen on Nov. 15th, 1909, for boils which had persisted for six weeks. At the time of onset he was con- siderably run down. His temperature ranged from 100° F. in the morning to 102° in the evening. The leucocytes numbered 3400 per cubic millimetre, of which 82 per cent. were lymphocytes of various types. On the 19th the leuco- cytes numbered 16,400, of which 86 per cent. were lympho- cytes. By Dec. 1st he was quite well. In the third case a girl, aged 20 years, in the middle of an epidemic of streptococcic sore throats during January, 1912, began to suffer from morning headache. A week later the right axillary glands became enlarged. A week still later, on Feb. 3rd, she began to suffer from severe sore-throat with a temperature of 102°, which lasted about four days and was accompanied by swellings on each side of the neck. During the following two weeks she had frequent night- sweats. The fever ceased, but she continued to lose weight and strength. On Feb. 16th the cervical glands, both lateral and posterior, were enlarged to the size of marbles ; in the right axilla was a gland of the size of a small hen’s egg and there were smaller ones in the left axilla. The inguinal glands were also enlarged. The percussion note at both apices, especially the right, was dull. The leucocytes numbered 9000, of which 71 per cent. were lymphocytes. On the 23rd the fever had ceased and the glands were smaller but still abnormal. The leucocytes numbered 3600, of which 62 per cent. were lymphocytes. After this recovery was uninterrupted. In a fourth case, a man, aged 37 years, had a ’’ cold " in February, 1912, which left him with a cough that continued during March. On the 18th he awoke with the glands of the left side of the neck sore and swollen. After three days they subsided, but he began to have fever, and on the 22nd the temperature was 101°. For the next ten days he was in bed with slight evening fever and night sweats. On the 28th the leucocytes numbered 30,500, of which 67 per cent. were large lymphocytes and 8 per cent. small. The number of leucocytes gradually declined till May llth, when they numbered 18,000, of which 7 per cent, were large and 35 per cent. small lymphocytes. On the 23rd the number was 8200, of which 4 per cent. were large and 38 per cent. small lymphocytes. Recovery after this was uneventful. In the differential diagnosis between streptococcic or tuberculous adenitis and lymphoid leukaemia the important points are the evidence of a cause of the adenitis, the course of the disease, and the percentage of lymphocytes in the differential count. Although this was elevated in the cases reported above, it was considerably lower than in lymphoid leuksemia at the period when. patients are sufficiently ill to seek advice. In the latter disease there is usually over 90 per cent. of lympho- cytes, and many of them are broken down. It should be noted that acute lymphoid leukasmia often begins with symptoms of sore-throat, like those described in the third case. These are due to leukasmic infiltration of the tonsillar ring. - RUPTURE OF AN ABDOMINAL HYDATID CYST DURING EXAMINATION. RUPTURE of an abdominal cyst during examination is a rare accident. In the Australian Medical Journal of March 29th Mr. G. F. Hagenauer has reported the following case. A girl, aged 16 years, complained of dragging pains in the lower abdomen, and gave a history of 5 months amenorrhosa and occasional vomiting. On examination a tumour was found above the pubes rising out of the pelvis and corresponding in size to a five months’ pregnancy. The diagnosis lay between pregnancy and an ovarian cyst. She was examined under an anesthetic and the uterus was found not to be enlarged. The tumour was cystic and well defined. On an attempt being made to elevate it out of the pelvis its outline was suddenly lost and the tumour disappeared. As there was no doubt that the tumour had ruptured the patient was removed to hospital in a collapsed state. The abdomen was opened above the pelvis and found to contain a great deal of clear fluid. The omentum and coils of small intestine were much matted together by adhesions. In the omentum was found a ruptured hydatid cyst, which was removed. The abdomen was swabbed out as much as possible and closed. The wound

THE LYMPHOCYTOSIS OF INFECTION

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1471

that the expense of this special training shall be placed uponmen who have already devoted five or six years to the generalstudy of their profession ; and he therefore makes the sugges-tion that the men selected for these posts as being generallywell informed, skilful, and qualified for the discharge of

responsible medical duties should be allowed to devote thefirst year after their appointment to the study of the specialpathological, administrative, and clinical work required.Suggestions as to the suitable training of tuberculosisofficers have already been made to the Local GovernmentBoard by the representatives of the hospitals for diseases ofthe chest in London, but the reply has been anything butencouraging.

-

SCIENTIFIC RESEARCH FOR THE LOCALGOVERNMENT BOARD.

THE President of the Local Government Board has

authorised the following special researches to be paid forout of the annual grant voted by Parliament in aid of

scientific investigations concerning the causes and processesof disease :-

1. A continuation of the Board’s inquiry into the Causes of PrematureArterial Degeneration, by Dr. F. W. Andrewes.

2. A continuation of the Board’s inquiries on Insects in Relationto Disease: Professor Nuttall, F.R.S., on the Life Cycle of the BodyLouse and Bug; Dr. Bernstein and Mr. Hesse on the Empusa Muscsein Flies.

3. A continuation of the Board’s inquiry into Infantile Diarrhcea, byMr. F. W. Twort and Dr. Edward Mellanby.

4. A continuation of the Board’s inquiry into the Virus of Polio-myelitis, by Dr. Andrewes and Dr. M. H. Gordon.

5. An investigation by Mr. F. W. Twort into the Character and Life-history of certain Filter-passing Micro-organisms.

6. An investi ation by Professor Leonard Hill, F.R.S., on RespiratoryExchange in Man under Varying Conditions.

7. An investigation by Mr. J. E. R. McDonagh on the Biochemistryof Syphilis.

8. An investigation by Dr. L. Rajchman into the Possibilities ofSerological Diagnosis of Scarlet Fever.

9. An investigation by Dr. D. M. Alexander on the Relation betweenthe Clinical Symptoms and the Bacteriology of the Acute RespiratoryAffections.

-

THE LYMPHOCYTOSIS OF INFECTION.

IN the acute stage of the great majority of infectiousdiseases there is polynuclear leucocytosis. In a few, such as

typhoid fever and malaria, there is no marked change in thenumber of leucocytes. Occasionally infections associated

with polynuclear leucocytosis show instead lymphocytosis.This phenomenon is most striking in whooping-cough, whereit is so constant that some writers have regarded it as ofvalue in differential diagnosis. In the American Journal ofthe Medical Soienoes for March Dr. Richard C. Cabot hascalled attention to the danger of confounding infections IIassociated with lymphocytosis with lymphatic leukaemia

and giving an alarming prognosis. He has observed a

group of cases in which infection, usually strepto-coccic, was associated with lymphocytosis. In one

case a medical man infected his finger near the

nail at a necropsy. Lymphangitis with enlargement of

the axillary glands on the same side, and, to a less

extent, on the opposite side, followed. For several weeksthere was fever somewhat resembling typhoid fever. Through-out well-marked absolute and relative lymphocytosis waspresent, so that several consultants were alarmed as to the

possibility of lymphatic leuksemia. Slow but completerecovery ensued. In a second case an undergraduate, aged20 years, was seen on Nov. 15th, 1909, for boils which hadpersisted for six weeks. At the time of onset he was con-

siderably run down. His temperature ranged from 100° F.in the morning to 102° in the evening. The leucocytesnumbered 3400 per cubic millimetre, of which 82 per cent.were lymphocytes of various types. On the 19th the leuco-

cytes numbered 16,400, of which 86 per cent. were lympho-cytes. By Dec. 1st he was quite well. In the third casea girl, aged 20 years, in the middle of an epidemic of

streptococcic sore throats during January, 1912, began to

suffer from morning headache. A week later the rightaxillary glands became enlarged. A week still later, onFeb. 3rd, she began to suffer from severe sore-throat witha temperature of 102°, which lasted about four days andwas accompanied by swellings on each side of the neck.

During the following two weeks she had frequent night-sweats. The fever ceased, but she continued to lose weightand strength. On Feb. 16th the cervical glands, both

lateral and posterior, were enlarged to the size of marbles ;in the right axilla was a gland of the size of a small hen’segg and there were smaller ones in the left axilla. The

inguinal glands were also enlarged. The percussion note atboth apices, especially the right, was dull. The leucocytesnumbered 9000, of which 71 per cent. were lymphocytes. Onthe 23rd the fever had ceased and the glands were smallerbut still abnormal. The leucocytes numbered 3600, of which62 per cent. were lymphocytes. After this recovery was

uninterrupted. In a fourth case, a man, aged 37 years, had a’’ cold " in February, 1912, which left him with a coughthat continued during March. On the 18th he awoke with

the glands of the left side of the neck sore and swollen.After three days they subsided, but he began to have fever,and on the 22nd the temperature was 101°. For the next tendays he was in bed with slight evening fever and nightsweats. On the 28th the leucocytes numbered 30,500, ofwhich 67 per cent. were large lymphocytes and 8 per cent.small. The number of leucocytes gradually declined till

May llth, when they numbered 18,000, of which 7 per cent,were large and 35 per cent. small lymphocytes. On the

23rd the number was 8200, of which 4 per cent. were

large and 38 per cent. small lymphocytes. Recoveryafter this was uneventful. In the differential diagnosisbetween streptococcic or tuberculous adenitis and lymphoidleukaemia the important points are the evidence of a cause ofthe adenitis, the course of the disease, and the percentage oflymphocytes in the differential count. Although this waselevated in the cases reported above, it was considerablylower than in lymphoid leuksemia at the period when.patients are sufficiently ill to seek advice. In the latter

disease there is usually over 90 per cent. of lympho-cytes, and many of them are broken down. It should be

noted that acute lymphoid leukasmia often begins withsymptoms of sore-throat, like those described in the thirdcase. These are due to leukasmic infiltration of the

tonsillar ring. -

RUPTURE OF AN ABDOMINAL HYDATID CYST

DURING EXAMINATION.

RUPTURE of an abdominal cyst during examination is arare accident. In the Australian Medical Journal of

March 29th Mr. G. F. Hagenauer has reported the followingcase. A girl, aged 16 years, complained of dragging painsin the lower abdomen, and gave a history of 5 monthsamenorrhosa and occasional vomiting. On examination a

tumour was found above the pubes rising out of the pelvisand corresponding in size to a five months’ pregnancy. The

diagnosis lay between pregnancy and an ovarian cyst. Shewas examined under an anesthetic and the uterus was

found not to be enlarged. The tumour was cystic andwell defined. On an attempt being made to elevate it

out of the pelvis its outline was suddenly lost and

the tumour disappeared. As there was no doubt that thetumour had ruptured the patient was removed to hospital ina collapsed state. The abdomen was opened above the

pelvis and found to contain a great deal of clear fluid. The

omentum and coils of small intestine were much matted

together by adhesions. In the omentum was found a rupturedhydatid cyst, which was removed. The abdomen was

swabbed out as much as possible and closed. The wound