345

there is no European or Indian neurologist or

psychiatrist with European qualifications, and inthe numerous schools and colleges throughout Indiathere is no provision for adequate instructionin nervous and mental diseases.

APPOINTMENTS TO THE MEDICAL RESEARCHCOUNCIL.

By an Order of the Committee of Privy Council,Viscount D’Abernon and Mr. A. G. Church, M.P.,have been appointed members of the Medical ResearchCouncil on the retirement of the Earl of Balfour andSir Charles Trevelyan. Lord D’Abernon will succeedLord Balfour as Chairman of the Council. Byanother Order, made after consultation with theMedical Research Council and with the President ofthe Royal Society, Dr. J. J. R. Macleod, Regiusprofessor of physiology in the University of Aber-deen, and Mr. Wilfred Trotter, honorary surgeonto University College Hospital, have been appointedmembers of the Council in succession to Prof. E. P.Cathcart and Sir Charles Sherrington, who retirein rotation on Sept. 30th.

BRONCHIECTASIS IN CHILDHOOD.

THE clinical picture of fully developed bronchiectasisis fairly obvious but the early stages are apt to passunrecognised, and this is the aspect of the diseasewhich has attracted most attention of late years.In summarising the present position Dr. EdwardThorpe points out that the exact aetiology of anessentially chronic disease of this kind is often hardto determine. So many serious infectious diseases ofearly childhood may damage the respiratory tract,and they often follow one another so surprisingly iquickly that more than one may start the earlychanges in the bronchial walls. Most observers agreein placing broncho-pneumonia first among the fore-runners, especially when it is associated with measlesor whooping-cough. The cause of this is not quiteclear, but in many such cases infection is kept up byan unhealthy condition of the nasopharynx whichis only too common at this age, and such a sequenceof events is especially prevalent among ill-nourishedchildren who have had rickets. A vicious circlemay be established so that the child is never freefrom recurrent respiratory diseases which have eitherbegun in the lungs and augmented the infection inthe upper air passages, or have started in the sinusesand tonsils and have increased the damage to thelining membrane of the bronchial walls. Saccularbronchiectasis, abscess formation, and empyema arebut natural sequelae of the primary infection.Prevention is therefore all-important. Adequateconvalescence after broncho-pneumonia should besecured wherever possible, and the public should bemade to look on measles and whooping-cough aspotentially serious diseases. Early diagnosis is by nomeans easy on clinical grounds alone and radiologicalhelp should be invoked long before the conditionhas become self-evident. A positive result is, ofcourse, evidence of disease, but negative findingsshould be accepted with reserve. In suspicious casesintratracheal lipiodol may be used; the technique isnot difficult, the risk is negligible, and the radiogramobtained will sometimes reveal an unsuspected amountof disease. The treatment of such a case is difficult;any infective focus in the nasopharynx should bedealt with, and prolonged convalescence is needed.Of recent years collapse therapy has been tried insome of these cases with good results, despite therelative mobility of the mediastinum in children.As a rule, 12 months’ treatment suffices. It is foundthat in advanced cases the results of inducing pneumo-thorax are poor, owing to the resistance to collapseoffered by the hardened walls of the bronchiectatic

1 Amer. Jour. Med. Sci., June, 1929, p. 759.

cavities. In these circumstances Thorpe advocatesrepeated bronchoscopic lavage, a measure which hasnot yet found much favour in this country, owing tothe difficulties of technique and the prolonged insti-tutional treatment required. The established diseaseis a source of distress to all concerned, but couldcertainly be prevented as a rule by adequate con-valescent treatment of its- precursors, especiallymeasles and broncho-pneumonia.

AN EPIDEMIC OF GLANDULAR FEVER.

l IN 1889 Pfeiier described a disease in children in. which there was fever, generalised swelling of the,

lymphatic glands, and enlargement of the spleen and: liver. Eighteen years later Turk found that a similar, symptom-complex was associated with well-marked, lymphocytosis, and in 1920 the epidemic nature of

the disorder was recognised in America. In thiscountry in 1921 Letheby Tidy and others described

. cases of infective mononucleosis and identified itwith the glandular fever of Pfeiffer. Since then many

, other cases have been described, the latest contri-bution to the literature being an account of anepidemic in Berne last year. Dr. E. Glanzmann 1

records that there were in all some 70 cases, 45 ofthem being distributed among 16 families, 2 to 4of whose members were affected. Analysis of thenotes he made on these cases enables him to givea clear account of the disease. The incubationperiod seems to be from seven to eight days and theearliest manifestation is a swelling of the lymphaticglands. The occipital and retro-auricular glandsenlarge first, and later the axillary and inguinalglands. The swellings are for the most partmoderately painful and sometimes the arrangementof the swollen glands about the face has suggestedmumps. The bronchial glands may also be involvedin the generalised lymphadenitis and the spasmodiccough thus caused may resemble whooping-cough.Lymphocytosis being a feature of the blood picturein both mumps and pertussis, it is easy to be ledastray in isolated cases of glandular fever simulatingeither of these disorders. In his original papersPfeiffer described an abdominal form of glandularfever with abdominal pain and enlargement of lymphglands especially in the ileocaecal region. Thepresence of an enlarged spleen and other glandularswellings help to make the diagnosis clear. Therewas a moderate fever in most of Glanzmann’s cases,lasting usually one, two, or three weeks; it was of adaily remittent type and came to an end by lysis.Relapses were not uncommon and even when thefever had gone away the glandular swellings sometimespersisted for weeks and even months. Other organswere also affected, the liver being obviously enlargedin most cases and the spleen palpable in one-third toone-half of them. Stomatitis was noted in some of thechildren, and it was usual to find the lymphoid tissueof the nasopharynx taking part in the generalisedlymphatic enlargement. In two cases a fleetingrubelliform rash was observed, whilst conjunctivitiswas another occasional manifestation. The bloodpicture in glandular fever is characteristic, and in thefirst day or first few days of the illness 80 to 90 percent. of the white blood corpuscles are mononuclear,though sometimes a polymorphonuclear reaction

occurs at first, followed later by the mononuclearpicture. The cells present are divided by Glanzmanninto three types : lymphoblasts, " lymphocytoid "cells like very large lymphocytes, and still larger" monocytoid " cells. Upon aetiology he has nothingfresh to say, except that the urine of a patient withnephritis complicating glandular fever had no effectwhen injected into a guinea-pig. For treatment herecommends quinine during the febrile stage, withapplication of ultra-violet light to such glands as

do not settle down after the acute symptoms areover.

1 Jahrb. f. Kinderh., July, 1929, p. 250.