797

ments will have to be conducted in England, since theplaces where Dr. Schiotz did his work are for the timebeing in German hands.

THE HABITATS OF CLOSTRIDIUM WELCHII

WITHIN recent years anaerobic bacteria which intheir general characters are indistinguishable fromClostridium welchii have been found to be a cause ofcertain animal diseases, notably acute entero-toxæmiasaffecting lambs and sheep. The first of these is lamb

dysentery-the name is self-explanatory-the secondis "struck," an acute infection of sheep first dis-covered in the Romney marshes of Kent and sincethen in Wales, and the third an acute entero-toxaemiaof sheep first reported from Australia and associatedin lambs with an infection called "pulpy-kidneydisease." The clostridia isolated from these variousinfections were found to differ from strains of Cl.welchii isolated from human infections in that an

antitoxin to the latter did not neutralise the toxins ofthe animal-infecting strains. From a study of thetoxin-antitoxin relationships of these various strainsWilsdon found that they could be divided into fourdistinct types, which he called type A, the classicalhuman Cl. welchii, type B, the lamb-dysenterybacillus, type C, associated with " struck " and calledby MacEwen Bacillus paludis, and type D or B.

ovitoxicus, the type isolated by Bennetts and othersfrom sheep with entero-toxaemia and pulpy-kidneydisease. Following up this work, Glenny and his

colleagues showed that types B, C and D produced atoxin or toxins additional to that derived from typeA, as indicated in the accompanying table.

TOXICS OF THE CL. WELCHII GROrp

+ toxin produced ; — not produced ; ± nm invariablyproduced.

Some years ago W. S. Gordon detected the toxinof Cl. ivelclzii type D in, and recovered the associatedorganism from, the intestinal contents of a few horsessuffering from grass-sickness. In attempts to assessthe significance of these findings Gordon and his col-leagues at the Moredun Institute have carried outdifferent investigations, the latest of which is an

inquiry into the distribution of the various types ofCl. welchii in farm soil and in the intestines of manand domesticated animals. Their findings will interestthe medical man because little is known about thenatural habitats of Cl. uelcltii, which as the principalcause of gas gangrene is often in our minds these days,and because there is some resemblance between theentero-toxasmias of sheep and non-specific infantile diar-rhoea. These workers found that 196 strains of C1.we1chiiisolated from forty-three samples of soil belonged with7 exceptions to type A (the remaining 7 were type Dand three of the four soil samples yielding these typeswere from fields on which cases of grass-sickness hadoccurred) ; 161 strains from twenty-five human bowelspecimens obtained post mortem were all type A,

1. Taylor, A. W. and Gordon, W. S. J. Path. Bact. March, 1940,p. 271.

while all but 13 (3 type B and 10 type D) of 986 strains from the intestines of various animal species-cattle, sheep, pigs, dogs, cats, rabbits, guineapigsand poultry-were also type A. Obviously, therefore,type A is the predominant type in soil and in theanimal intestine, so that the risk of types other thanA being causally connected with gas gangrene in manis minimal-an important point in the prophylaxisand treatment of this infection with specific antitoxin.

STOMACH LAVAGE IN THE DIAGNOSIS OF

PHTHISIS

IT is forty years since Meunier 1 demonstrated theefficacy of stomach lavage in the diagnosis of tubercu-losis, but his work lay forgotten until Armand-Delille 2in France, Poulsen 3 in Denmark, Collis and Brocking-ton in England and Wallgren in Sweden drewattention to it. The method was first applied tochildren and in them tubercle bacilli in the sputumcan often be found in this way in para-tuberculousconditions previously thought to be closed. Kayne andHounslow and Stadnichenko and his colleagues havenow applied the method to adults, and have been ableto detect tubercle bacilli in cases where other methodshad failed. In the investigation by Stadnichenko, outof 511 patients over the age of ten years in a muni-cipal sanatorium whose sputum was always foundnegative by routine methods, 249 gave positive resultswhen sputum was obtained by stomach lavage, andhe concludes that " it should be adopted as the ulti-mate standard for absolute negativity or apparentcure of patients having had or suspected of havingtuberculosis." It is not suggested that this elaborateprocedure should be employed in all cases: there isno point in using it when tubercle bacilli are-found bysimple sputum examination. No clinician can, how-ever, afford to overlook the possibilities of this " courtof appeal" for suspected phthisis in adults and para-tuberculous lesions in children.

Dr. JOHN TATE, medical officer of health for theadministrative county of Middlesex, died on April 21.

1. Meunier, H. Pr. méd. 1898, 2, 81.2. Armand-Delille, P. F. Amer. J. Dis. Child. 1927, 34, 547.3. Poulsen, V. Ibid, 1929, 37, 900.4. Collis, W. R. F. and Brockington, C. F. Lancet, 1933, 1, 127.5. Wallgren, A. Amer. J. Dis. Child. 1931, 41, 816.6. Kayne, G. G. and Hounslow, A. G. Brit. med. J. 1939, 1, 1170.7. Stadnichenko, A., Cohen, S. J. and Sweaney, H. C. J. Amer.

med. Ass. Feb. 24, 1940, p. 634.

ImsH HOSPITAL SWEEPSTAKES. — Mr. Ruttledge,Minister for Local Government and Public Health,stated in the Dáil that over £4 million of the E14million collected by the sweepstakes had been earmarkedfor hospitals controlled by local public authorities.Large regional hospitals were to be erected in Galway,Limerick, and Cork. The sum available for voluntaryhospitals was approximately £6 million. Money hadto be set aside for endowment. The four big generalhospitals to be established in Dublin would cost over£2 million, while the Dublin children’s hospital andfever hospitals would absorb at least another £1 million.As our Irish correspondent announced last week (p. 753),Hospital Trust Ltd. has gone into voluntary liquidation,but it is believed that arrangements are being made fora second series of sweepstakes. Owing to the difficultyof establishing communications with all countries overseas,it is probable that during the war the sale of tickets willbe confined to Ireland, and it is not expected that therevenue will do more than meet the annual deficits ofthe voluntary hospitals.