1258 JUNE 17, 1939 CORRESPONDENCE
MEDICAL JOURNAL
had leucocyte counts of 2,000 or more, with more than 5 per
cent. granulocytes, and only one of these died. Of those who
had a total leucocyte count of less than 1,000 the mortality
was 55 per cent.; thirty of these had a total count of below
500, and seventy-four had complete agranulocytosis. Of
sixteen cases recorded in the Lancet and British Medical
Joiurnal from July, 1934, to July, 1936, only three recovered
(one of these three owed his recovery to the spontaneous
evacuation of toxic material from a nasal sinus); the mortality
was 82 per cent. In the majority of these cases the diagnosis
was made too late for effective treatment. Three were only
diagnosed shortly before death upon admission to isolation
hospitals as supposed cases of diphtheria.
At the present time agranulocytosis is more often
recorded when resulting from treatment of acute bacterial
infections by sulphanilamide or one of its derivatives,
though the number of cases is still relatively very small
in comparison with the number treated. In a case recorded
quite recently (Lancet, 1939, 1, 1208) the recommendation
is made that " since agranulocytosis cannot be definitely
diagnosed without a white cell count, frequent blood
examinations should be made in all cases where the drug
is continued for more than a week and large doses are
given." All would agree with the soundness of this advice,
and since the new chemotherapeutic treatment has given
such startlingly successful results there seems to be every
probability that it will to a great extent supersede other
methods of treatment, with a possible increase in the
number of cases of agranulocytosis.
Surely it would be of the greatest advantage if every
medical practitioner were competent to conduct a thorough
blood examination and were willing to spend the time
required. Why should not medical students be instructed
to undertake complete blood examinations and include
them in the notes of every case allotted to them as clinical
clerks? Many would find it an interesting and fascinating
occupation.-I am, etc.,
HERBERT H. BROWN, M.D., F.R.C.S.
Worthing, June 5.
The After-coming Head in Breech Delivery
SIR,-1 do not propose to discuss the causes and pre-
vention of impaction of the after-coming head, but in two
recent -cases of breech presentation with extended legs to
which I was called this emergency occurred during delivery
under my supervision. In each case I was fortunate
enough to prevent death of the foetus by means of a
manceuvre which I cannot find mentioned in any of the
few books I have searched. In my opinion the cause of
death in this condition is usually (1) the cord being com-
pressed, thus cutting off placental " respiration," and
causing inspiratory efforts by the increase of carbon
dioxide in the child's blood-respiratory movements are
also stimulated by exposure of the baby's wet body to
the air unless the usual precautions are taken; (2) respira-
tory efforts are useless as the child's face is smothered by
the soft tissues of the maternal perineum; (3) if the child
manages to expand its lungs they fill with amniotic fluid
or blood, and death ensues from drowning.
The procedure I adopted, after failing to get the head
through by abdominal pressure, forward and upward
traction, and so on, was to insert two fingers of the left,
or free, hand between the child's face (as far as the mouth)
and the mother's perineum and separate the fingers, thus
allowing foetal fluids to run out and, still more important,
providing an air-way to the baby's mouth. In each of
these two cases the abortive attempts at inspiration by the
baby were changed at once into full, useful expansion of
the lungs and lusty crying. In each case it was eventually
THE BRITISH
necessary to apply forceps to effect delivery, and I am
sure that without this manceuvre the inspiratory efforts of
the two infants would have come to an untimely end.-
I am, etc.,
Herne Bay, June 5. QUENTIN F. EVANS.
Xenopus Test for Pregnancy
SIR,-Professor F. A. E. Crew in his article on biological
pregnancy diagnosis tests in your issue of April 15
(p. 766) proposes that the xenopus test should be known
as the " Hogben test," and states that it was in Professor
L. Hogben's laboratory in Capetown that it was first shown
that this anuran might with advantage be used for this
test. He refers to a note by Hogben to the Royal Society
of South Africa in March, 1930. In this communication-
" Some Remarks on the Relation of the Pituitary Gland to
Ovulation and Skin Secretion in Xenopus laevis "-an
important contribution to the comparative physiology of
reproduction is made by showing that injection of extracts
of the anterior lobe of the pituitary of the ox into the
female Xenopus laevis produces extrusion of the ova
through the cloaca within eighteen hours. There is no
suggestion, however, that xenopus might be used as a test
animal for the presence of an anterior-pituitary-like
hormone found in the urine of pregnancy.
In 1933 xenopus was first shown to be a suitable animal
for pregnancy diagnosis by Drs. H. A. Shapiro and H. J.
Zwarenstein in the Physiological Laboratory at Capetown,
long after Professor Hogben had left South Africa. The
results were communicated to the Royal Society of South
Africa in October, 1933. Further papers by these authors
appeared in Nature (1934, 133, 762) and the South
African Medical Journal (March 23, 1935). In the latter
paper the technique of the test is very fully described.
The authors look on this xenopus test as a modification
of the Aschheim-Zondek test, and have not considered it
necessary to label it with any name. If, however, Pro-
fessor Crew wishes to bring the nomenclature of this test
into line with that of the mouse and the rabbit tests, it
should obviously be referred to as the " Shapiro-Zwaren-
stein test."
Although the name of Hogben is associated with a great
deal of valuable research on xenopus, there is no justifica-
tion whatever for attaching it to this pregnancy test.
Since there seems to be considerable misconception about
the history of this test it is necessary to make the position
unequivocally clear in the interests of scientific accuracy.
-I am, etc.,
University of Capetown, June 2. J. W. C. GUNN.
Reconstruction in Vaginal Atresia
SIR,-In your issue of May 27 (p. 1113) Mr. H. P.
Pickerill joins issue with Dr. V. S. Counseller of the
Mayo Clinic for describing as new a method of recon-
struction of the congenitally absent vagina which he
himself claims to have performed in 1922. Mr.
Pickerill is quite correct in stating that I suggested the
particular technique of the method used by Dr.
Counseller, but he is wrong in feeling that either of
us ever claimed priority for the use of Thiersch grafts in
this situation. If Mr. Pickerill will refer to the articles
by the late Mr. J. Bright Banister and myself in the
Journial of Obstetrics and Gynaecology of the British
Empire (45, No. 3, 490) and Zentralblatt fur Gyna-
kologie (1939, 63, No. 1) he will see that priority for