Book Review The Clinical Study of the Early Symptoms and Treatment of Circulatory Disease in General Practice . By R. M. Wilson, M.B., Ch.B., late Assistant to Sir James Mackenzie; late Cardiologist War Office, Trench Fever Committee; Consulting Physician, Ministry of Pensions. With a Foreword by Sir James Mackenzie. Cloth, illustrated, pp. 245. London: Henry Frowde and Hodder & Stoughton. 1921
1922
Boston Medical and Surgical Journal
briefly describe the effect of gastric juice on the tubercle bacillus and reach the following conclusions : 1. Gastric juice removed from the stomachs of persons free from gastro-intestinal disease, at various intervals of time after an oatmeal test meal, showed very little power of destroying (a) tubercle bacilli in sputum which had been exposed to it for ninety minutes, and (b) tubercle bacilli in mouth washes which had been exposed to it for ninety and one hundred and eighty minutes
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... ely. In one case a total acidity of 62, in another of 54.1, and in a third of 24, failed to destroy the bacillus. 2. The gastric secretion may possibly have destroyed the tubercle bacilli in a very weak emulsion to which it was exposed under similar conditions, but the number of bacilli used (100) was so small that it cannot be considered a fair test, and even the control test with this weak emulsion proved negative in a guinea-pig. 3. The protection against the tubercle bacillus afforded by the gastric secretion is apparently by no means perfect. But it must be remembered that the dilution of contents and the motor activity of the stomach probably play a large part in this mechanism of protection, and these latter factors cannot be satisfactorily experimented upon in vitro. These results are in general agreement with the conclusions arrived at by Allan Macfadyen under different conditions and with bacteria other than B. tuberculosis as long ago as 1887. 4. In the four cases examined the untreated gastric juice contained no tubercle bacilli as judged by the inoculation test. We know of no records which show whether or no tubercle bacilli have been found in gastric juice in persons not suffering from clinical tuberculosis. This point may have important bearing on the portals of entry of the .bacillus. [J. B. IL] Congenital IIypertrophic Pyloric Stenosis. Gray and Reynolds (British Medical Journal, November 26, 1921) present an analysis of 50 operations for congenital hypertrophie pyloric stenosis. Their conclusions are as follows : 1. Accumulating evidence supports Pirie's hypothesis, that hyperadrenalism causes pyloric hypertrophy, which is to be regarded as one of its manifestations. 2. Pancreatic and biliary insufficiency, also resulting from hyperadrenalism, accentuate the pyloric closure and influence the mortality. 3. The sex preponderance is of similar importance. 4. Gas and oxygen amestbesia will nearly eliminate operative fatalities, both immediate and delayed. 5. Operation should never be undertaken as an emergency. 6. Systematic preparation for operation by lavage and infusion is essential. Even moribund cases can he so rendered operable, and make a good recovery. 7. Such preparation should never exceed four days at the outside. 8. Now that the operation mortality has been so greatly reduced by the employment of gas and oxygen, operation is indicated as soon after the diagnosis as the necessary preparatory treatment will permit. 9. The possible risk of performing an avoidable operation is negligible when compared with the prej-
doi:10.1056/nejm192204061861405
fatcat:a7e2edrnonhqvpsh6bltnhnqcu
