Norman R. Grist

Enteroviral etiology of the paralytic poliomyelitis syndrome.

Virological investigations of patients in Scotland with poliomyelitis-like paralysis showed near-disappearance of paralytic poliovirus infections after general vaccination and persistence of a few paralytic infections with other enteroviruses. Coxsackieviruses, especially of type A7, were mainly involved, but no enterovirus had presented a serious or increasing threat. Because of occasional importation of virulent poliovirus and some continued circulation of virus in the population, it remains important to continue surveillance and maintain vaccination at a high level.

Serological epidemiology of poliomyelitis in Central Scotland.

T H A S L O N G B E E N R L A L I S E D that the extent of poliomyelitis infection in human populations greatly exceeds that of recognisable, notifiable disease. Infections with poliomyelitis viruses give rise to measurable antibodies, the frequency and distribution of which reflect the past infective experience of the population and indicate its current immune status. The present report describes the distribution of such naturallyacquired antibodies among children in Scotland before the introduction of prophylactic immunisation. The study was primarily undertaken in order to discover children without antibody who could take part in the Medical Research Councils trials of British poliomyelitis vaccines, but the opportunity was taken to record sufficient information about each child to permit a study of the association of certain factors with immunity to poliomyelitis.

Q fever in South-West Scotland.

IN V EST I GAT ION of Q fever in Glasgow began in 1950 with serological examinations of pneumonia patients (Grist et al., 1952). Although the results indicated that Q fever was an uncommon infection of man in this area, the discovery of antibodies in the sera of a few patients prompted a search for possible sources of infection. This paper presents evidence of infection of man, sheep and cattle.

Q fever endocarditis.

Q fever endocarditis is described in a man aged 48 years, known to have had a rheumatic fever-like illness in 1960. He had evidence of aortic valve disease when seen with mumps infection in 1963. He was again seen in 1966 with suspected subacute bacterial endocarditis, but later, Q fever infection was shown to be present by serological tests. He survived for just over one year from the presumed onset of Q fever, in spite of prolonged intensive antibiotic therapy. Necropsy examination showed chronic congestive cardiac failure with pleural and pericardial effusions, and calcific aortic stenosis with tiny vegetations along the edges of the cusps. Rickettsia burneti was isolated only from the damaged aortic valve, and histology revealed colonies of cocco-bacillary bodies between the collagen bundles. Immuno-fluorescence studies suggested that the rickettsiae were heavily coated with 7S gamma globulin (presumably the patients own specific antibody). It is important to consider Q fever endocarditis in all cases presenting as bacterial endocarditis.

Poliomyelitis: A laboratory study during two seasons.

THIS report presents the results of laboratory investigations of 465 cases of notified or suspected poliomyelitis. The study was carried out as part of a national survey arranged by the Medical Research Council during field trials of poliomyelitis vaccines in Britain. The patients examined were those admitted to hospitals of the Eastern and Western Regions of Scotland during the period of 20 months from May 1956 to December 1957, which includes the seasons of prevalence of poliomyelitis of both years. Preliminary reports based mainly on the results of attempted virus isolations have already appeared (MacGregor et al., 1958; Grist et al., 1958). This information has now been completed by serological tests for prevalent enteroviruses. It is thus possible to present a comprehensive account of the virus infections encountered during the study and to evaluate some of the laboratory methods employed.

The serological diagnosis of influenza in infancy.

I T I S G ENE R ALL Y A G R E E D that the most satisfactory laboratory test for the routine diagnosis of influenza is the complement fixation test with soluble antigen. This test is preferred to the haemagglutinationinhibition test because the same typespecific soluble antigen, differing from that common to influenza B strains, is shared by all the A strains, whereas the haemagglutination-inhibition test is largely specific for the particular antigenic subtype of virus used as antigen; the complement fixation test is also more convenient for testing large numbers of sera. Serological diagnosis in young children is complicated by the highly strain-specific antibody response of these immunologicallyinexperienced individuals and by the defective immune-response of infants. During the past four years laboratory tests for influenza have been applied to young children as part of a general study of virus infections of the respiratory tract and in conjunction with clinical and epidemiological investigations at Ruchill Hospital of acute respiratory disease in infancy. This paper describes the results of these tests and certain modifications of technique which have improved their efficiency.

Hepatitis Hazard in Clinical Laboratories

Hepatitis Hazard in Clinical Laboratories N. R. Grist, F.R.C.P.ED., F.R.C.PATH......... 788 Changes in Lung Capillary Permeability in Renal Failure P. D. Snashall, M.R.C.P ................... 788 Gastric Ulcer after Highly Selective Vagotomy R. Hall, F.R.C.S ......................... 789 AHF-Related Protein and Precipitation Reactions H. Ekert, and others ........ ............ 789 Trapped Nerves R. Cilento, F.R.C.S ....................... 789 Mixed Connective Tissue Disease B. I. Hoffbrand, D.M ..................... 790 Poisoning Treatment Centres A. A. H. Lawson, F.R.C.P.ED., and I. Mitchell, M.R.C.P. .............................. 790 Herpes Simplex Encephalitis L. S. Illis, M.D., and Flora M. Taylor ...... 790 Causes of Failure in Antibiotic Treatment A. V. Pollock, F.R.C.S.; Jacqueline S. Cargill, M.B. .................................. 790 Infertility after the Pill B. Eton, F.R.C.O.G ....................... 791 General Knowledge of Cancer 0. A. N. Husain, F.R.C.PATH ............... 791 Corticosterolds in Retroperitoneal Fibrosis A. Apalakis, M.D., and J. K. McCollum, F.R.C.S . ....................791 Pulmonary Aspiration after Fibre-endoscopy W. Sniper, F.F.A. R.C.S ...791 Delay in Labour P. M. Lewis, F.R.C.S ..................... 792 Carcinoembryonic Antigen in Urine of Cancer Patients M. Al-Sarraf, F.R.C.P.(C)., and K. Kithier..792 Methylceliulose in Diverticular Disease A. Z. Almeida, F.R.C.S ................... 792 Use of Surgical Beds J. H. L. Ferguson, F.R.C.S ................. 792 Radioactive Bromide Partition Test in Tuberculous Meningitis J. Shafar, F.R.c.P., and F. D. Hollanders,M.B. 792 Insulin Abuse by a Drug Addict S. Retsas, M.D ......................... 792 Adhesive Patches for Theatre Linen J. W. Dickson, F.R.C.S ................... 793 Thymectomy for Myasthenia Gravis A. D. Korczyn, M.D ..................... 793 Malaria in Pregnancy A. M. Smith, F.R.C.S.ED ................. 793 Malaria Mortality in Children Cicely D. Williams, F.R.C.P ........... 793 Radioactive Bromide Partition Test R. J. Fallon, M.D ....................... 794 Temperature Change and Multiple Sclerosis W. I. McDonald, F.R.A.C.P., and T. A. Seas, B.SC., PH.D . ................. 794 Drugs in Infertllity I. D. Cooke, M.R.C.o.G ................... 794 Intramuscular Injection and Coagulation Defects T. Dyk, M.D ........................... 795 Asthma Deaths H. G. J. Herxheimer, M.D ................. 795 Fracture of Lippes Loop J. R. Lang, M.B ......................... 795 Radiology of Swallowed Earthworm T. Healey, D.M.R.D ..................... 795 Trichuris trichiuria Infestation M. F. J. Lowry, M.R.C.P . ...........795 Acute Dystonia due to Phenothiazines X. G. Okojie, F.I.C.S ..................... 796 Thrombus Formation in Dialysis Membranes E. N. Wardle, M.R.C.P ................... 796 Reorganization of the B.M.A. W. E. Lewis, M.R.C.G.P . ............ 796 Plight of Uruguayan Doctors W. Norman-Taylor, M.D ............ 796

Viruses and chronic bronchitis.

TH ERE are several ways in which viruses might be important in the initiation, maintenance or exacerbation of chronic bronchitis. Initiation might result from damage by a single acute infective episode, possibly in early life. For obvious practical reasons this hypothesis would be very difficult to test. Alternatively an acute infection might become persistent and provide the basis of chronic disease. Acute exacerbations of chronic bronchitis might result from periodic reactivations of a chronic, latent virus infection, or from intercurrent acute infections with common respiratory viruses. These latter hypotheses are open to investigation by conventional virological methods, e.g. by attempted virus isolation, or by serological tests for fourfold-or-greater rising antibody levels (evidence of acute infection) or abnormally high titres or greater prevalence of antibodies in chronic bronchitis as compared with controls suggesting abnormally high frequency or persistence of the corresponding infections in the bronchitics. Several investigations on these lines have now been reported, including studies in the Glasgow area, and are briefly reviewed and discussed in this paper.

Asian Influenza in the Glasgow Area, 1957-58.

cases investigated showed serological evidence of influenza infection, separated by the months of November and December 1957 when little influenza was detected. Table II shows the serological findings during these two periods of influenzal prevalence in relation to clinical diagnosis. Results are shown separately for the group of young children in baby pneumonia wards of Ruchill Hospital. During August to October 1957, laboratory confirmation of influenza infection was thus found in most cases of influenza-like illness. If recent infections (evidenced by C.F. titres of 16 or over) are included, serological evidence of influenza was also shown by the majority of cases of pneumonia and other respiratory diseases which occur as complications of o