Blast Perforation of Ear-drums
BMJ (Clinical Research Edition)
along the bodies, of the' organisms. This feature is more obvious in older specimens. Myco. smnegmatis is decolorized and takes up a greyish-green colour, losing some of its Grampositive character when treated with acetone. Thus urine sediments or pus from the urinary tract are suitable for examination by this staining method. Gram-positive organisms such as pneumococci and staphylococci appear violet-black, as in the usual Gram stain; while Gram-negative organisms such as N. catarrhalis -and
... catarrhalis -and Friedlander's bacillus a;e grass-green in colour. The background of fibrin, mucus, and debris takes up a light-green tint, while cells vary somewhat according to their type and age. Thus epithelial cells show bluish-green nuclei with a light yellowish-green cytoplasm. Polymorph leucocytes, if not degenerate, show a deeper staining of both nuclei and cytoplasm, the latter being paler. Old degenerate pus cells take up a more uniform pale-green stain with more or less differentiation between nuclei and cytoplasm. Lymphocytes show a deep bluish-green nucleus, while endothelials appear more mottled, with a paler cytoplasm. As in the ordinary Gram stain, old degenerate Gram-positive organisms take up the counterstain and appear Gram-negative. Incidentally, auramine green counterstain has been found useful in the direct Ziehl-Neelsen technique in place of methylene blue, and also in Gram's method in place of neutral red or safranine, both for pus smears and films from culture. The colour is restful to the eye (as noted by Mackie and McCartney (1942) for malachite green in the former method). In my opinion, however, the cellular appearances are rather clearer when methylene blue is used, and where this feature is of importance the latter stain is recommended. The following short notes on 60 cases of blast perforation of the ear-drums occurring simultaneously among Indian troops in the Middle East following a land-mine explosion may be of enough topical interest to merit publication. HISTORY OF CASES All these men were within fifteen yards of the mine, and some as near as five yards. Casualties were admitted to hospital within three hours of the explosion, and the ears of all 82 immediate survivors were examined, when 60 were found to have traumatic perforation of one or both tympana. In all, 100 drums were perforated, 50% in the antero-inferior quadrant, the remainder showing either a posterior perforation or a horseshoe perforation involving the greater part of the membrane. Tuning-fork tests revealed a middle-ear deafness in each case, and, although sepoys are not very suitable subjects for such tests, the majority of them showed a diminution of absolute bone conduction also for several days after the accident. Preliminary treatment in all cases consisted in the insufflation of sulphanilamide powder, followed by packing the car with sterile gauze. Nine ears were occluded with wax and were left severely alone until three weeks after the injury. Only three of these nine drums showed a perforation at the end of that time. Of the two cases in which syringing was employed to remove wax both became infected, although they dried up subsequently within a fortnight. The proportion of drums infected was 38%, four of which were classed as severe infections, while two of these required a cortical mastoid operation two weeks after the accident. In both these cases the drum and the post-auricular wound were dry and had healed five weeks after operation. All infected cases received sulphapyridine, 1 gramme 4-hourly for five days, and many of the cases were put on sulphapyridine for their other injuries. All but four drums were dry within four weeks; but as it was impossible to keep all the patients in hospital until their drums had healed the percentage of complete recovery is not available; 45% were healed within four weeks. CONCLUSIONS The antero-inferior quadrant is the commonest site of injury. The proportion of infection to be expected under the most ideal conditions is 35 to 40%. Insufflation of sulphanilamide powder is probably of value in preventing infection. Deafness is of the middle-ear type, superimposed upon a temporary nerve-deafness. The subsequent damage to hearing is not marked. on a course of lectures by Dr. A. V. M. Anderson at Melbourne University. (Pp. 78. 5s.) Melbourne: Published by Ramsay (Surgical) Pty., Ltd., 340, Swanston Street. Obtainable at all booksellers. This modest volume may certainly be commended to the junior practitioner as he enters on the responsible duties of his profession. It offers information and advice relative to positions which are met but imperfectly in the technical medical curriculum but are none the less important in the doctor's life and conduct as these are related to his colleagues, to his patients, and to the State. The advice in all the circum-, stances contemplated is excellent in itself and is based throughout on the recognized traditions of the profession. The author's persuasive style gives the book an attractive literary quality. If the subject offers little opportunity for originality in substance the manner in which the teaching is presented is both pleasing and effective. There is no attempt to cover all the situations included in the department of forensic medicine. Rather the purpose is to explain and justify professional obligations which arise less from. rigid rules than from personal opportunities and seemly customs and courtesies. In this respect the book is both comprehensive and well balanced. If we may suggest an addition it would be a paragraph on the value of personal insurances as a wise protection against the risks and con-tingencies which are part of the common lot. -The author acknowledges his indebtedness to the well-known, textbook of the late Dr. Saundby, but he is mistaken when he. suggests that there are not more recent counsellors in the: field. Two limitations may be noted. First, po.t all legislation, affecting medical practice in Australia-for example, the com-, pulsory notification of venereal disease applies in Great Britain; and, secondly, the book wants, and the anxious inquirer desires, an index.