CENTRALIZED GONOCOCCUS CULTUREThe evidence presented in this paper of trichomonad infestation will not increase clinical belief in the pathogenic importance of this parasite. The very high incidence of the organism in the female genital tract without any inflammation or discharge may suggest very legitimately that its presence in inflammatory exudates is coincidental rather than causative. It may also be pointed out that the detection of Trichomonas was merely incidental to this investigation and that the specimens were not those generally considered best for the purpose. It is quite possible that in some women vaginal irritation may be caused by T. vaginalis, but to ascribe to it the importance it commonly gets because of its frequent presence in leucorrhoea is an example of post hoc ergo propter hoc reasoning which cannot be substantiated by the facts at present available. Further investigation of its occurrence in normal women is obviously desirable. The transport method described allows the investigation to be carried out more leisurely and conveniently than has hitherto been regarded possible. SummaryA method of transporting specimens for the diagnosis of gonorrhoea is described. By its use facilities for culture can be made available to all clinics within a " time distance" of 24 hours from a laboratory.The method is at the same time applicable to the detection of T. vaginalis.In the above investigation of gonorrhoea 139 positives out of 184 were found by smear examination alone and 158 by culture. The combination of smear and culture discovered 24% more positives than smear examination alone, and culture alone 10% more than smear.T. vaginalis was found in approximately 50% of women with vaginal discharges and in almost 40% of women in whom no evidence of inflammatory disorder was evident and who were examined as a test for cure cf gonorrhoea.FooTNoTE.-Since this paper was written an alteration in technique has been found necessary owing to the bactericidal action on Neisseria of certain later batches of agar used in preparing the transport medium. This property is apparently the same as that described by Ley and Mueller (1946), and is particularly prominent in the absence of nutrient material which is a feature of the medium described. The inhibitory effect can be neutralized by charcoal (Stuart, 1947), but charcoal cannot be incorporated in the medium without absorbing the methylene-blue reduction indicator. Accordingly, swabs are prepared as described above and then dipped in a 1 % water suspension of finely ground charcoal (B.D.H. blood charcoal and "norit" have been found equally suitable) before being dried and sterilized. Results from a year's experience with these charcoal-impregnated swabs are significantly better than those given above, and suggest that even when the agar is apparently free from inhibitor this alteration in technique is desirable.
INCOMPATIBILITY IN HOMOLOGOUS TRANSFUSION MEDICALJOUTNALremain after pregnancy of an Rh-negative mother bearing an Rh-positive child, this state of allergic reactivity may exist for very different periods of time, dependent on individual peculiarities and perhaps also on non-specific stimulations which the organism received in the meantime. From these considerations we do not believe that we are entitled to exclude the possibility that in our case the irregular iso-agglutinin which was responsible for the reaction following a first transfusion was an antiRh agglutinin. SummaryA severe haemolytic reaction was observed following a first transfusion of homologous blood (Group 0). Although no incompatibility was noted on cross-matching before transfusion, the patient's serum strongly agglutinated the donor's corpuscles on re-examination eight days after transfusion.While the irregular iso-agglutinogen present in the donor's corpuscles was found in 750% of 0 corpuscles examined and also in the blood of the patient's husband, the irregular isoagglutinin was apparently a peculiar feature of the patient's serum.The irregular iso-agglutinin was not identical either with anti-M or anti-N antibodies. It acted more strongly in the incubator than at lower temperatures. It had at first a relatively high titre, but weakened quickly within six weeks.The question is discussed whether the irregular iso-agglutinin observed is the same as the anti-Rh antibody. Immediate resuscitatory measures were instituted. Morphine sulphate 1/6 grain was given hypodermically and a continuous plasma infusion begun. Two hours later his condition was much improved; the temperature was 97' F., pulse 150, and B.P. 100/80. Examination, with minimal disturbance, revealed an entrance wound in the right buttock, II in. above and 1 in. posterior to the right greater trochanter. There was no exit wound. Abdominal examination left no doubt as to the presence of peritoneal irritation. He had an immobile guarded lower abdominal wall, with generalized tenderness and "release " pain. He passed 4 fl. oz. of urine. This was clear and contained no abnormality, and microscopy revealed no red blood cells. There was no evidence of injury to either the vessels or nerve trunks of the lower limbs. Examination of the whole abdomen, pelvis, and upper half of both thighs, including lateral views of the limbs, by portable x-ray apparatus, showed the presence of the bullet posterior to the left femur on a level with the lesser trochanter. No fracture of the bony pelvis was demonstrable.At 9.45 p.m. his temperature was 98.60 F., pulse 140, and B.P. 100/70. A transfusion of 450 c.cm. of plasma had now been administered, being followed by whole-blood transfusion preparatory to and during laparotomy.Operation At 10 p.m. open ether anaesthesia was induced, with atropine sulphate 1/100 grain as premedication. As the entrance wound was readily accessible without turning the patient it was decided to proceed with the laparotomy. The abdomen was opened through a right subumbilical pa...
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