P. Lesley Bidstrup

Paralysis following poisoning by a new organic phosphorus insecticide (mipafox); report on two cases.

The disease resembles a non-icteric form -of Weils disease and may prove to be caused by a leptospire. Its prevalence along river banks and estuaries in North Korea during autumn months, the presence of a suitable rodent carrier in vast numbers, and its general clinical course, with special emphasis upon renal involvement, are all suggestive of such an infection despite the absence of positive proof by laboratory demonstration. Weils disease has a case mortality of 3% for the age group 16-30 (Broom, 1951), our mortality was 1 in 40 (2.5%), but diagnosis was possibly made more often in milder cases owing to its epidemic quality. All agglutination tests for leptospirosis were negative. As renal failure in this disease follows a period of hypotension it may be due to anoxia, which Darmady and his colleagues (1944) suggest is the causative mechanism in Weils disease; the pathological picture of the kidney is one of cortical pallor and medullary hyperaemia, suggesting an alteration in the distribution of blood flow in the kidney which may short-circuit the glomeruli, as has been shown in rabbits by Trueta et al. (1947). Paralysis of the sympathetic nerves by high spinal anaesthesia was not attempted in our cases. The hypothalamic and pituitary lesions possibly have far-reaching effects upon the hormonal control of urinary secretion and upon the autonomic control of the vascular system, and may be responsible in part for the tendency to inversion of sleep rhythm noted in some of our cases. Adrenal cortical damage may be responsible for the prostration and electrolyte imbalance seen early in the disease and for the delayed water excretion and apparent lack of concentrating power of the kidneys in the later phases.

Carcinoma of the lung in workmen in the bichromates-producing industry in Great Britain.

The chromates-producing industry provides the basic chromates, sodium and potassium dichromate or monochromate, from which metallic chromium and the chromium compounds used in industry are obtained. The process involves extraction of chromium from the ferrous ore known as chromite or chrome ironstone, FeO.Cr,O, which contains 40 to 50% chromium and small amounts of alumina and silica. The ore is dried, crushed, mixed with limestone and the carbonate either of sodium or potassium and heated in a rotary furnace to convert the insoluble oxide to soluble monochromate. The monochromate is extracted from the furnace roast by repeated washing with water and treated with sulphuric acid to form dichromate, with sodium sulphate as a by-product. Carcinoma of the lung in employees in the chromates-producing industry has been investigated and recognized as an occupational hazard in Germany (Pfeil, 1935; Alwens, Bauke, and Jonas, 1936; Teleky, 1936; Gross and K6lsch, 1943) and more recently in the United States of America (Machle and Gregorius, 1948; Baetjer, 1950a, b; Mancuso and Hueper, 1951; Gafafer, 1952). An investigation has been in progress in the industry in Great Britain since 1948 and the results are reported in this paper. One of us has previously published the results of a clinical and radiographic investigation of men employed in the chromates-producing industry in Great Britain (Bidstrup, 1951). Seven hundred and twenty-four workmen were interviewed and radiographed and among these one was found to have carcinoma of the lung, from which he died during the survey. It was obviously not possible to