659

Fig. 2-Pancreas of monkey No. 3 (X 800)

sections 7µ thick were stained with Heidenhain’s iron-hæmat-oxylin or with Heidenhain’s

" azan

" stain. In some of thecells in the islet of Langerhans the cytoplasm was homo-geneous while in others it contained vacuoles. The nucleiwere pyknotic. Granules were - absent from most of thecells (fig. 2).

It will thus be seen that after a single intravenousinjection of alloxan (300 mg. per kg. body-weight) 3 ofthe 6 monkeys died in hypoglycaemia, while the other3 did not develop hypoglycaemia but neverthelessbecame diabetic. On examination of one of the diabeticmonkeys cellular changes were found in the islet ofLangerhans. An insufficient dose of alloxan mayexplain the absence of degeneration of the malignantislet cells in a case of islet-cell carcinoma observed byBrunschwig et al.

REFERENCES

Bailey, C. B., Bailey, O. T. (1943) J. Amer. med. Ass. 122, 1165.Brunschwig, A., Allen, J. G., Owens, F.M., Thornton, T. F. (1944)

Ibid, 124, 212.Dunn, J. S., Kirkpatrick, J., McLetchie, N. G. B., Telfer, S. V.

(1943) J. Path. Bact. 55, 245.Dunn, J. S., McLetchie, N. G. B. (1943) Lancet, ii, 384.Hagedorn, H. C., Jensen, B, N. (1923) Biochem. Z. 137, 92.Hughes, H., Ware, L. L., Young F. G. (1944) Lancet, i, 148.Jacobs, H. R. (1937) Proc. Soc. exp. Biol., N.Y. 37, 407.

FATAL CORONARY SCLEROSISIN A BOY OF TEN YEARS

E. JOKL, M D J. GREENSTEIN, M BSOUTH AFRICAN POLICE MEDICOLEGAL LABORATORIES,

JOHANNESBURG

FATAL coronary arteriosclerosis in children is rare.

In a study of coronary disease in youths, based on therecords of 100 cases in persons under 40 years, Glendy,Levine and White (1937) did not encounter a singleexample under 20 years and only 8 between 20 and29 years of age. Master, Dack and Jaffe (1939) analysed500 case-histories of coronary- occlusion ; their youngestsubject was 27 years old. French and Dock (1944), whoreported on 100 fatal cases of coronary arteriosclerosisin soldiers, did not find the disease in subjects under 20,though a large number of younger men are serving withthe forces.A white boy, aged 10 years, collapsed and died five minutes

after a boxing match lasting three rounds. He had receiveda number of blows against chest and abdomen but was notknocked down, nor did he seem to be unduly distressed atany time during the fight.At autopsy the left descending branch of the coronary

artery was blocked for a distance of about an inch, beginningt inch from the orifice. Above and below the occlusion wereslight atheromatous changes in the intima. Histologicalexamination of the diseased portion of the coronary arteryrevealed an almost complete occlusion. The intima was

considerably thickened and hyalinised and a well-organisedthrombus occupied almost the whole lumen of the vessel.

There was well-marked cellular activity inside the thrombus.Several plaques’of calcium were deposited between intimaand media and the surrounding tissues were infiltrated witherythrocytes. The internal elastic layer was disrupted andcompletely absent in parts. No other abnormalities werefound in the arterial system. A special effort was made tostudy the boy’s family and previous history, but no light couldbe thrown on the origin of the condition.We cannot give an opinion as to the cause of the

coronary disease in this case. Nor is it possible to saywhether the fist blows which the boy received a fewminutes before he died contributed to his fatal collapse.This latter possibility is suggested by previous observa-tions of injury to the heart in boxing (Jokl 1941).Nelson (1941) as well as French and Dock (1944) havepointed out that physical activity increases the risk ofbleeding into the hypertrophied intima or into athero-matous or calcified plaques in diseased coronary arteriesand that such haemorrhages may expedite fatal collapsesin persons thus affected. We therefore feel that thepresence of recently extravasated blood in the intima ofour young patient’s coronary artery is significant. Inspite of the fact that the boy’s left coronary artery wasalmost completely occluded, he had been capable ofstrenuous physical effort immediately before he died

REFERENCES

French, A. J., Dock, W. (1944) J. Amer. med. Ass. 124, 1233.Glendy, R. E.; Levine, S. A., White, P. D. (1937) Ibid, 199, 1775.Jokl, E. (1941) The Medical Aspect of Boxing, Pretoria.Master, A. M., Dack, S., Jaffe, H. L. (1939) Arch. intern. Med. 64, 767.Nelson, M. G. (1941) J. Path. Bact. 53, 105.

Reviews of Books

Infectious Anemias

Due to Bartonella and Related Red Cell Parasites. DAvIDWEINMAN, parasitologist to the 1937 Harvard Expedi.tion to Peru. (Transactions American PhilosophicalSociety, vol. 23, part III. Pp. 243-339.$1.25.)

THE first part of this comprehensive review deals withhuman bartonellosis. There are two apparently un-related syndromes : a severe, often fatal, infectiousanaemia, known as Oroya fever, and a benign skin erup-tion called verruga peruana. Oroya fever, which isneither -contracted nor endemic in the city of Oroya,got its name because in 1870 there was an epidemic witha high fatality-rate among the workmen building theLima-Oroya railway ; the first thorough description wasgiven by Odriozola in 1898 and the causative organismwas described by Barton in 1905. The parasites invadethe erythrocytes of the host and reproduce by binaryfission ; they can be transferred by cell-free media. Sofar, the disease is only found in some parts of westernSouth America, a narrow strip of country comprisingthe western and central Cordilleras in Peru, Ecuador,and Colombia from 13°S to 3°N latitude. Weinmangives a.full description of the clinical and pathologicalfindings in the two forms of human disease and reviewsall that is known of the protistology of the parasite. Ithas been shown that man is the only important mam-malian reservoir, and the vectors are arthropods-one or more species of phlebotomus (sandfly). Appar-ently healthy persons carry the bartonella parasites andso- increase the reservoir. There is unfortunately noknown effective treatment for Oroya fever ; NAB is

effective against the allied infections in mice, but doesnot control the human disease. Part II deals with therelated organisms that infest the erythrocytes of otheranimals : 21 species of haemobartonella have been’named so far. Part III gives present knowledge of theeperythrozoon, a related blood parasite affecting animals;human infection with this organism has not been estab-lished. Often the parasite appears in the blood onlyafter splenectomy. The organisms described in parts IIand III are widespread in animals and their possiblepresence in laboratory animals must always be considered.A final short section deals with epidemiological aspects.Bartonellosis can be very dangerous, and there is someevidence that it is extending ; during a recent outbreakin an area of Colombia, in which the disease was previ-ously absent, there were 4000 deaths in a total popula-tion of 100,000. Its control does not seem to be easy.

660

Year Book of Eye, Ear, Nose and Throat, 1943LOUIS BOTHMAN, MD ; SAMUEL J. CROWE, MD. (YearBook Publishers; Lewis. Pp. 580. 19s.)

THE past year has been one of consolidation ratherthan outstanding discovery in both specialties coveredby this volume. A special article summarises the ocularchanges in acute and chronic stages of malaria. Thisdisease has been a major scourge during the present war,and in many localities it has been a good rule to suspectmalaria in any case of PUO. Anything from lacrimationto optic atrophy may be found, and these complicationshave been noted in 10-20% of all cases of malaria andconstitute the second commonest complication in thedisease after splenomegaly. Many of the manifestationsare transitory, some are periodic and synchronise with.the somatic involvement, some respond to quininetherapy, others result in permanent changes. There isapparently a tendency in America to operate on con-genital cataract with fair vision, and the optimum ageis given as 3-4 years. There are a number of referencesto operations on the ocular muscles, but the objectionto all such operations is the virtual impossibility ofexactly gauging how much change the immediate cor-rection will undergo when the final stage of healing isreached. A few more temporal bones of Meniere’sdisease have been examined histologically, and dilata-tion of most of the endolymphatic system, with theconstant exception of the semicircular canals, was aroutine finding. These variations in dilatation of thedifferent portions is possibly due to the variations inthickness of the walls. The cause is ascribed to raisedpressure in the system, perhaps produced within it,since the perilymphatic space is -always normal inappearance. No inflammatory changes were found.Portmann’s operation of opening the endolymphaticsac is perhaps more physiological than, but apparentlynot yet as effective as, Dandy’s division- of the vestibular

New Inventions

A NEW LARYNGOSCOPE

THE laryngoscope illustrated differs in a number ofways from those hitherto in use. -The handle whichcarries the electric battery is sloped backwards at anobtuse angle to the blade, so that the wrist of the useris abducted and he is discouraged from exerting leverage

’ about the upper teeth of the patient, as described in ourarticle on p. 651. Also the handle is placed well to theleft side of the blade. This facilitates manipulationsthrough the tubular part, since the user’s hands are notin a line with each other.

There are three sizes of blade, which can be sterilisedand fitted to the handle at will, and which are kept in

Fig. 1—Handle and three blades. Each blade carries its own lighting bulb.

nerve. Treatment of laryngeal disease by irradiationreceives some notice and progress has been made, butthe same cannot yet be said for carcinoma of the wso-phagus. There are a number of reviews of the resultsof penicillin treatment, but the precise fields of this andof the sulphonamide drugs have not yet been mappedout. More knowledge of sulphonamide sensitivity isaccumulating. The book is as clearly printed as ever,and the editorial comment as sapient.Reaction to Injury

WILEY D. FORBUS, MD, professor of pathology, Duke-University. (Bailliere. Pp. 797. 50s.)

Forbus has planned a " pathology for students ofdisease " which retlects the trend of modern teaching.The subject is built up from basic principles, and thereaction of tissues is studied as the natural response toinjury-physical, chemical, bacterial, fungoid, virus-or to what Forbus calls " obligate cellular parasitism."In his preface he says : The central idea of the chosentheme is that disease is a matter of the abnormal out-come of a constantly changing relation between theultimate biological unit, the cell, and its environment."He admits in his preface that be did not realise themagnitude of. his theme until he set about the arrange-ment of 800 pages of text and some 530 pictures ; andthis is but the first half of his study, for a second volumewill deal with the " submissive type of reaction " and the" reaction of adaptation." In this first volume para-graphs on the immediate results of plain physical traumaare brief; and blast and crush syndrome, trauma andneoplasia, allergy, blood-transfusion "injuries," vitamindefects, and toxicology are not mentioned. No doubtthe second volume will make good such omissions.

Professor Forbus has had vision in conceiving thiswork. In many ways it justifies itself, but it is too bigfor the student, though it is just the kind of teaching herequires. Firm editing could have reduced its bulk.

position by means of a set screw (fig. 1). The bladeshave been designed with curves whose object is to pickup the epiglottis easily and without injury to the pharynx.The illumination is by one of the twin lighting bulbs ofthe Negus instrument. This is carried in a small tunnelon the left side of the blade, and fits into a socket on thehandle alongside that’of the blade (fig. 2). The bulbs canbe boiled so. that the blade and bulb forms a sterilisableunit. They do,not become hot when the lamp is in use.We have designed this laryngoscope primarily for

anaesthetists, and have found it convenient and easy touse. It is just as applicable, however, to laryngologicalpurposes, and a Negus type of bronchoscope can bepassed through it. It has been made for us by theGenito-Urinary Manufacturing Co. Ltd.We have to thank Prof. R. R. Macintosh for permitting

his technical staff to make our experimental models ; Mr. R.Salt for most of this work ; Mr. V. E. Negus for permitting usto incorporate his lighting system ; and Mr. R. Schranz of theGenito-Urinary Mfg. Co. for suggestions for the final design.

R. G. MACBETH, B M OXFD, FRCSEFREDA B. BANNISTER, MD LPOOL