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1. Lancet, 1962, ii, 649.2. Buescher, E. L., Parkman, P. D., Arnstein, M. S., Halstead, S. B.
Fed. Proc. 1962, 21, 466.3. Parkman, P. D., Arnstein, M. S., McCown, J., Buescher, E. L. ibid.
p. 466.4. Sever, J. L., Schiff, G. M., Traub, R. G. J. Amer. med. Ass. 1962,
suggests that, in some of the reported instances of longsurvival after hepatic secondaries have been seen at
operation, the secondaries were, in fact, larval granulomas.In his other 2 cases there was some evidence that larvalnodules were at least partly responsible for symptomstypical of cholecystitis and chronic pancreatitis. This isthe first hint that disseminated linguatulid larvx mayproduce symptoms in man.Drury found fibrous nodules of similar structure in
the livers of 18 adults at postmortem examination. More-
over, he found incidental larval granulomas (besidesother indeterminate nodules) in the liver and spleen at12 of 3000 necropsies conducted in the Greater Londonarea. By no means all those infected had a history ofresidence abroad. Apparently, therefore, at least 0-4%of the London population carries these parasites; the truefrequency of infestation may be much higher, but solittle larval debris remains in the lesions that diagnosis isdifficult. Surgeons working in this country must, there-fore, encounter this type of visceral granuloma fairlyregularly. They would do well to bear the possibility inmind and to sacrifice, where necessary, panache for
accuracy in the identification of multiple hepatic nodules.And, since larval nodules may yet be proved to causesymptoms, dog-lovers might be wise to discourage intheir pets too slobbery a devotion.
WE have already referred to an important advance inthe investigation of rubella virus by workers at the WalterReed Army Institute.2 3 A new agent, designated RA,was recovered from 19 of 28 military recruits who hadrubella. Although RA produced no cytopathic changewhen inoculated into African green-monkey kidney-cellmonolayers, its presence could be detected because of itsblocking effect on superinfection with ECHO 11 virus.Isolation of RA enabled serological studies to be made onoutbreaks of rubella at other military camps, and thesefindings, too, suggested that this agent was implicated inrubella.
In another careful study, in which the technique usedpreviously 3 was slightly modified, Sever et al. haveisolated a similar agent (which they call RV) from 10 of 13recruits and 13 of 15 children, all of whom had typicalrubella. As a control, men in the same recruit populationas those with rubella, who reported sick with non-infectious complaints, were also examined for RV, butnone was found. Tests carried out on acute and convales-cent specimens of serum from five different rubellaoutbreaks showed that neutralising antibodies developedin over 90%. ·
Specimens for isolation of RV came from four geo-graphically distinct regions, but, to judge from theneutralisation tests with prototype rabbit sera and cross-agglutination tests, only one strain of virus was involved.The virus was 320-260 m in size, was ether-sensitive,and had no hxmagglutinating, hsemadsorbing, or comple-ment-fixing properties. Of two rhesus monkeys, whichhad had very little human contact, and which wereinoculated with RV in its third tissue-culture passage, one
developed fever, lymphocytosis, and leukopenia but no
1. Archibald, R. McL., Oakley, A. F. Trans. Ass. industr. med. Offrs, 1962,12, 93.
rash or lymphadenopathy, and both developed neutralisingantibody. Finally 10 volunteers received cultures of virus,and rubella developed only in the 2 without antibodies intheir serum.These results appear to confirm those of the Walter
Reed workers, and it now seems certain that the causalagent of rubella has been isolated. Rubella is a particularproblem in pregnancy on account of its teratogenic effects,but there is now hope that in the foreseeable future weshall be able to determine serologically the state of a
patient’s immunity to rubella and to offer immunisationwhen it is needed.
AFTERMATH OF DISASTER
IN March, 1958, a cage containing 44 miners fell thirtyfeet to the bottom of a shaft at Brookhouse Colliery inYorkshire. Dr. Archibald and Dr. Oakley,! who attendedthe casualties at the colliery and saw to their evacuation,describe the medical handling of the emergency and thesocioeconomic consequences for the miners, as seen threeyears later.The injuries, as might be expected from the relatively
short fall, were confined to the legs, and ranged fromfractures and dislocations of the femur, tibia, and os calcisto bruises and sprains of the ankle and heel. There wereno patients with multiple injuries, and blood-transfusionwas not required. This greatly simplified the task of themine doctors, who, after assessing the extent of the
injuries, could devote themselves mainly to applyingtemporary splints, relieving pain, and organising the
despatch of the injured men to hospital. In the space ofa few hours, the hospital in Sheffield had to make overmore than half its male beds to the victims. Only severalmonths later was the last patient discharged, and many ofthe miners were disabled for much longer.At the end of three years, 11 of the original 44 had
returned to their own work (including the 7 who had hadrelatively light injuries). 15 had returned to alternativework on the surface and 4 to alternative work under-
ground ; 9 had left coalmining, 1 had retired, 1 had foundwork at another colliery, and 3 were still absent from work.Contrary to popular belief, the general worker under-ground commands only a moderate wage, and work onthe pit top is often more arduous than work underground-except of course at the coalface. But wherever theminer works, perfect function of the knee-joint is essential,and in this kind of accident the knee-joint is most likely tobe affected. The injury benefits paid to the men weresubstantially lower than their pre-accident earnings; andthe social worker who visited them found, not surprisingly,that they were worried about their hire-purchase pay-ments and commitments on their housing. But with the
cooperation of the hospital almoners, the Coal IndustrySocial Welfare Organisation, and the colliery managementthey were helped to restore their situation to some degree.
Fortunately, accidents on this scale are uncommon inthis country. This one seems to have been handledexpeditiously with a reasonably successful outcome.
Prof. J. W. HowiE has been appointed director of thePublic Health Laboratory Service in succession to Sir GrahamWilson, who retires in September.
Dr. J. ST. C. ELKINGTON, physician in charge of the neuro-logical department of St. Thomas’ Hospital, died on Jan. 21.