safety in the swimming-pool
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suggested some return of nasal allergy ; for 4 had someeosinophils present and were considered to be borderline,and 1, which contained numerous eosinophils, wasconsidered to be allergic.We are indebted to Dr. R. F. Ogilvie and Dr. A. C. P.
Campbell for their reports on the nasal sections ; and toDr. I. Simson Hall for advice and criticism.
--. - - T T T?TEdinburgh.Dundee.
T. J. REID.R. B. HUNTER.
SiR,In connexion with Mr. Gibberds letter ofFeb. 26, I should like to mention that in 1937 Dr. H.Staub and I published a paper 1 on the action of colloidalcarbohydrates on the circulating-plasma volume. Com-mon starch, gum-arabic, and glycogen were assayed.Experiments made in dogs showed that glycogen (thepreparations of Roche and Merck were used) in waterycolloidal solution (20%), in doses of 0.25 g. per kg. givenintravenously, raised the circulating plasma volume onthe average by 21-7%. We believed that the colloidalnature of solutions containing glycogen would assuretheir retention in the blood-vessels. In another paper 2I reported clinical observations on 4 cases treated withintravenous injections of 50-150 ml. of 20% glycogendissolved in physiological salt solution ; perfect tolerancewas observed.
I suggest that more clinical trials should be made withglycogen solutions (20%). The solutions may be of valueas a ineans of temporarily maintaining blood-volume.Glycogen is inexpensive, non-toxic, and possibly inaddition supports the general detoxifying function ofthe liver.CUP Pharmacological Department,
Bogot-Colombia S.A.KALMAN MEZEY.
SPONTANEOUS ALVEOLAR RUPTURE
SiR,I read with great interest the two articles inyour issue of May 28, on Spontaneous Pneumo-mediastinum in Pregnancy by Mr. D. J. MacRae and onAcute Mediastinal and Subcutaneous Emphysema byDr. L. Fridjohn and Dr. P. G. Azzopardi. The impressionleft on the reader is that the authors of both papersregard Hamman 3 as the first to describe the aetiologyand development of spontaneous interstitial emphysemain human pathology, although a few earlier writers arebriefly quoted. May I therefore remark that I publishedfour papers on this subject before Hamman, in thefirst of which, entitled the Symptomatology of Spon-taneous Alveolar Rupture and its Consequences,4 4 Ithoroughly discussed the aetiology and symptomsobserved in infants. I have never, however, claimedany priority in the description of the syndrome, for Iknew that spontaneous alveolar rupture and its con-sequences were well known to Rokitansky,5 the pioneerViennese pathologist, as long ago as 1847. Roger, aFrench paediatrician, observed and published cases ofspontaneous rupture of the alveoli in 1862,6 whileRauchfuss, the leading Russian psediatrician- of his time,described very well the aetiology and symptomatology ofspontaneous alveolar rupture, in the first German hand-book of paediatrics in 1876-82.7 In 1888 Friedrich Mller,8of Munich, gave a full account of the peculiar crunchingsounds over the heart area. Dr. Fridjohn and Dr. Azzo-pardi say that " the first description of the peculiarcrunching sound is credited to Mller (McGuire and Bean1939) ... " but add that " its full significance wasrecognised by Hamman (1937)."1. Rev. md. Suisse rom. 1937, 57, 480.2. Congrs de la Diurese, Vittel, 1939.3. Hamman, L. Trans. Ass. Amer. Phys. 1937, 52, 311.4. Z. Kinderheilk. 1924, 38, 479.5. Quoted by Mller (rep. 6).6. Arch. gn. Md. 1862, 2, 129.7. Gerhards Handbuch fr Kinderkrankheiten. Tbingen, 1877-81.8. Berl. Klin,. Wschr. 1888, no. 11. p. 205.
My further contributions appeared in 1928 and 1930.9-11In my last paper I mentioned that Guillot had observedtwo cases in early infancy in 1853-82.12 My own contribu-tions, since I am a paediatrician, dealt with alveolarrupture in infancy, and I observed that in prematurelyborn infants the function of the elastic fibres of thelungs may be impaired and the alveoli may thereforerupture during attacks of cough. Alveolar rupture innewborn babies following artificial respiration shouldnot of course be considered spontaneous alveolar rupture.As to the heart, I described in infants weakness of theheart sounds due to interposition of air between the heartand thoracic wall in the anterior mediastinum ; thecrunching sounds described by Muller could not be heard.As the mechanism and aetiology of the so-called spon.
taneous alveolar rupture in infants and in adults areidentical or at least similar, I feel entitled to send youthe above information.
Department of Pediatrics,College of Medicine,
University of the Philippines.EUGENE STRANSKY.
SAFETY IN THE SWIMMING-POOL
SIR,-I read with interest your leading article ofJune 18 and Dr. Lawss letter of July 16. I have found,however, from personal experience, that chloramines(produced by the action of hypochlorites and amides)can be used very effectively in the bacteriological controlof swimming-baths, especially those in the open air.The one in most common use is chloramine B.P.or chloramine-T (sodium p-tolueneslphonchloroamide),which in salt-water baths is an excellent steriliser becauseof the interaction of the sodium chloride and the chlor-amine. If used in fresh-water baths the addition ofcommon salt adds creativ to its efficiency.
North British Laboratories,Samlesbury, Lanes.
SiR,-As a general practitioner I hesitantly offer thefollowing comments on the case of fulminating apyrexialpostpartum streptococcal peritonitis reported by Drs.L. N. and M. H. Jackson in your issue of July 30.
(1) A four-hourly record of the (mouth) temperaturewould probably have shown pyrexia in the earlier stagesof the illness. The pulse-rate was then only 80 or less.
(2) Abdominal rigidity is often absent or indefinitein puerperal peritonitis. The signs on the whole may beindefinite in the earlier stages.
(3) It seems unwise to rely solely on the sulphonamidesin puerperal infection. On the first suspicion of infection,start penicillin therapy as well. Incidentally, this isgood for the medical attendants peace of mind, evenif subsequent events prove his fears to have beenill-founded.
Birmingham. W. M. CHESNEY.
SiR,-In the case reported by L. X. and M. H. Jacksonthe patient survived for 21/z days after labour withoutthe temperature being raised on any of the numerousoccasions on which it was recorded.From 1906 to 1936 the London Hospital had an
isolation unit for severe cases of puerperal sepsis, andduring the last ten years of its existence I saw themajority of the cases admitted. During this period ofthirty years, which ended shortly before the introductionof modern methods of chemotherapy, just over 1000cases were dealt with by this unit and the over-allmortality was 25%. The absence of pyrexia was rare,being encountered in a few cases of fulminating gas-gangrene infection, and sometimes as a terminal event,
9. Mschr. Kinderheilk. 1928, 39, 104.10. Ibid, 1930, 46, 109.11. Rev. fran. Pdiat, 1930, 6, 761.12. Arch. gn. Md. 1853, 2, 151.