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ŒSTRIN IN TOXIC GOITRE
1302 ŒSTRIN IN TOXIC GOITRE To the Editor of THE LANCET
SiR,—In
your issue of Nov. 21st Dr. Foss stresses for massive doses of oestrin to obtain results. In particular he mentions the excessive doses he has used for the affection of the skin known " as kraurosis vulvse, much larger doses than normally used in human therapy." It would appear from experimental work on animals that the injection of crystallised folliculin and its salts stimulates the development of cancer, and that carcinoma of the uterine cervix, mammary cancer, and cancer of the prostate gland have all been produced in this way in animals. Can the risk of stimulating a cancerous neoplasm be entirely dismissed when such injections are given to the human subject, more especially if the subject is predisposed Dermatologists have seen in the past the disastrous results of a variety of skin remedies ; to mention only two, thallium acetate in the treatment of tinea capitis, X rays in the treatment of lupus vulgaris. In these the risks were only recognised after the event. In the case of cestrin there seems to be definite experimental proof in advance.
the
necessity
hospitals.. But the fear of chloroform-for the greater part, unnecessary fear-has militated against the training of pupil midwives in their use. Midwives are allowed to use bromides, chloral, and opium, and chloroform capsules are no more dangerous. With a short training in their use and attention to the simple rules they can, I am sure, be employed with safety and advantage. I
am.
Sir.
faithfullv. W. D. HAYWARD,
vours
Lieut.-Col. I.M.S. (retd.).
London, W., Nov. 19th.
UVEOPAROTITIS
of THE
To the Editor
LANCET
SIR,-The important by the authors of the paper on uveoparotitis published in your last issue merit the consideration of ophthalmologists and physicians alike. Even if these conclusions appear to be vague, they will achieve good in emphasising the fallacy of regarding this disease as essentially tuberculous. Admittedly, some observers have a presented strong thesis in favour of this assumption, yet a different type of case is met with which one would be very hesitant to label tuberculous. In two examples that I have followed up since my report in THE LANCET of 1934, to which these authors refer, the patients have remained in good health, and these certainly appear to belong to the latter varietv. I am. Sir. vours faithfullv. C. B. V. TAIT. Windsor, Nov. 24th. conclusions drawn
preparations are being recommended with increasing frequency, and it is a singular paradox that in the midst of a widespread campaign against cancer the use of remedies which are potentially carcinoThese
is extending. Should not a woman be informed of the possible risk to which she is to be exposed and her consent to the treatment be obtained before injections are given, in the same manner in which the risks of any surgical procedure are explained and consent obtained for the operation’? I am, Sir, yours faithfully, ELIZABETH HUNT. Welbeck-street, W., Nov. 21st.
genic
To the Editor
of
THE LANCET
SiR,—The question of whether uveoparotitis is of tuberculous origin has been raised again, and I think that various points arise in the paper by Lewis, Raines, and Stewart, published in THE LANCET last week, which require an answer. In recording a new case of uveoparotitis these authors suggest that this syndrome " may not be due to any one specific infection," but to my mind they produce no evidence to refute the contention of Thomson and myself that this condition is always of tuberculous origin. They state that " tubercle bacilli have never been demonstrated in this condition " ; but this is incorrect and they apparently realise this in the later statement that " guinea-pig inoculations have nearly always been negative." The demonstration of the tubercle bacillus is extremely difficult in this type of tuberculosis, but Cavara (Boll. d’oculist., Firenze, 1928) succeeded in producing tuberculosis in a guinea-pig inoculated with portions of an affected lacrymal gland ; the inoculation experiments failed in three rabbits and two guinea-pigs before a positive result was obtained. In our second paper (THE LANCET, 1934, ii., 743) Thomson and I recorded a case previously under the care of Mr. Lawson of Leicester. This case was recorded a second time (Brit. Med. Jour., 1934, ii., 1041) by Tanner and McCurry, who by this time had succeeded in demonstrating tubercle bacilli in sections from an affected parotid gland. Turning to the new case record, there can be no doubt that this is an example of uveoparotitis with the unusual development of a scotoma, this finding only once being noted before (Souter, W. C.: Trans. Ophth. Soc. U.K., 1929, xlix., 113). The Mantoux test was strongly positive but we are not told whether or not there was any focal reaction, the presence of which would be of paramount importance. The blood sedimentation-rate is not recorded and no mention is made of the heart, though it appears to be enlarged in the radiograms. We have, therefore,
always
*** Reference
to the possible risk of inducing with cestrin will be found in our report of last week’s discussion at the section of obstetrics and gynaecology of the Royal Society of Medicine (p. 1269).-ED. L. cancer
CHLOROFORM CAPSULES To the Editor of THE LANCET
SIR,-May I add my testimony to that of Lieut.Col. T. Hunter in his letter to THE LANCET of Oct. 24th In a on the safety of chloroform as an anaesthetic. long period of service in India I used chloroform almost entirely, without any fatality attributable to the anaesthetic. Other methods and other anaesthetics have their advantages, but chloroform has still its own advantages and uses, and it is a mistake to decry its usefulness and to exaggerate its dangers for all occasions, as it is the custom to do nowadays. After my retirement I took up the suggestion for the use of chloroform by midwives as an analgesic in childbirth and, with the help and interest of the National Birthday Trust Fund, crushable capsules (brisettes) of 20 minims of cbloroform were tried out in maternity hospitals, and in many hundreds of cases with success, with few if any bad results. I in that as shown in annotation hospitals, agree your in the same issue (p. 992), Dr. Minnitt’s or some other gas-and-air apparatus may be preferred. But I am sure that those mothers who are attended by midwives in their own homes, as is the case with 60 per cent. of the births in this country, can be more easily given safe relief from the pains of childbirth by thet Instructions and rules for use of these capsules. their use were drawn up, and were followed in the investigation and trial of the capsules in maternity ,
,
-
.
SiR,—In
your issue of Nov. 21st Dr. Foss stresses for massive doses of oestrin to obtain results. In particular he mentions the excessive doses he has used for the affection of the skin known " as kraurosis vulvse, much larger doses than normally used in human therapy." It would appear from experimental work on animals that the injection of crystallised folliculin and its salts stimulates the development of cancer, and that carcinoma of the uterine cervix, mammary cancer, and cancer of the prostate gland have all been produced in this way in animals. Can the risk of stimulating a cancerous neoplasm be entirely dismissed when such injections are given to the human subject, more especially if the subject is predisposed Dermatologists have seen in the past the disastrous results of a variety of skin remedies ; to mention only two, thallium acetate in the treatment of tinea capitis, X rays in the treatment of lupus vulgaris. In these the risks were only recognised after the event. In the case of cestrin there seems to be definite experimental proof in advance.
the
necessity
hospitals.. But the fear of chloroform-for the greater part, unnecessary fear-has militated against the training of pupil midwives in their use. Midwives are allowed to use bromides, chloral, and opium, and chloroform capsules are no more dangerous. With a short training in their use and attention to the simple rules they can, I am sure, be employed with safety and advantage. I
am.
Sir.
faithfullv. W. D. HAYWARD,
vours
Lieut.-Col. I.M.S. (retd.).
London, W., Nov. 19th.
UVEOPAROTITIS
of THE
To the Editor
LANCET
SIR,-The important by the authors of the paper on uveoparotitis published in your last issue merit the consideration of ophthalmologists and physicians alike. Even if these conclusions appear to be vague, they will achieve good in emphasising the fallacy of regarding this disease as essentially tuberculous. Admittedly, some observers have a presented strong thesis in favour of this assumption, yet a different type of case is met with which one would be very hesitant to label tuberculous. In two examples that I have followed up since my report in THE LANCET of 1934, to which these authors refer, the patients have remained in good health, and these certainly appear to belong to the latter varietv. I am. Sir. vours faithfullv. C. B. V. TAIT. Windsor, Nov. 24th. conclusions drawn
preparations are being recommended with increasing frequency, and it is a singular paradox that in the midst of a widespread campaign against cancer the use of remedies which are potentially carcinoThese
is extending. Should not a woman be informed of the possible risk to which she is to be exposed and her consent to the treatment be obtained before injections are given, in the same manner in which the risks of any surgical procedure are explained and consent obtained for the operation’? I am, Sir, yours faithfully, ELIZABETH HUNT. Welbeck-street, W., Nov. 21st.
genic
To the Editor
of
THE LANCET
SiR,—The question of whether uveoparotitis is of tuberculous origin has been raised again, and I think that various points arise in the paper by Lewis, Raines, and Stewart, published in THE LANCET last week, which require an answer. In recording a new case of uveoparotitis these authors suggest that this syndrome " may not be due to any one specific infection," but to my mind they produce no evidence to refute the contention of Thomson and myself that this condition is always of tuberculous origin. They state that " tubercle bacilli have never been demonstrated in this condition " ; but this is incorrect and they apparently realise this in the later statement that " guinea-pig inoculations have nearly always been negative." The demonstration of the tubercle bacillus is extremely difficult in this type of tuberculosis, but Cavara (Boll. d’oculist., Firenze, 1928) succeeded in producing tuberculosis in a guinea-pig inoculated with portions of an affected lacrymal gland ; the inoculation experiments failed in three rabbits and two guinea-pigs before a positive result was obtained. In our second paper (THE LANCET, 1934, ii., 743) Thomson and I recorded a case previously under the care of Mr. Lawson of Leicester. This case was recorded a second time (Brit. Med. Jour., 1934, ii., 1041) by Tanner and McCurry, who by this time had succeeded in demonstrating tubercle bacilli in sections from an affected parotid gland. Turning to the new case record, there can be no doubt that this is an example of uveoparotitis with the unusual development of a scotoma, this finding only once being noted before (Souter, W. C.: Trans. Ophth. Soc. U.K., 1929, xlix., 113). The Mantoux test was strongly positive but we are not told whether or not there was any focal reaction, the presence of which would be of paramount importance. The blood sedimentation-rate is not recorded and no mention is made of the heart, though it appears to be enlarged in the radiograms. We have, therefore,
always
*** Reference
to the possible risk of inducing with cestrin will be found in our report of last week’s discussion at the section of obstetrics and gynaecology of the Royal Society of Medicine (p. 1269).-ED. L. cancer
CHLOROFORM CAPSULES To the Editor of THE LANCET
SIR,-May I add my testimony to that of Lieut.Col. T. Hunter in his letter to THE LANCET of Oct. 24th In a on the safety of chloroform as an anaesthetic. long period of service in India I used chloroform almost entirely, without any fatality attributable to the anaesthetic. Other methods and other anaesthetics have their advantages, but chloroform has still its own advantages and uses, and it is a mistake to decry its usefulness and to exaggerate its dangers for all occasions, as it is the custom to do nowadays. After my retirement I took up the suggestion for the use of chloroform by midwives as an analgesic in childbirth and, with the help and interest of the National Birthday Trust Fund, crushable capsules (brisettes) of 20 minims of cbloroform were tried out in maternity hospitals, and in many hundreds of cases with success, with few if any bad results. I in that as shown in annotation hospitals, agree your in the same issue (p. 992), Dr. Minnitt’s or some other gas-and-air apparatus may be preferred. But I am sure that those mothers who are attended by midwives in their own homes, as is the case with 60 per cent. of the births in this country, can be more easily given safe relief from the pains of childbirth by thet Instructions and rules for use of these capsules. their use were drawn up, and were followed in the investigation and trial of the capsules in maternity ,
,
-
.