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ABDOMINAL MYOMECTOMY
585 and those who want additional certificates will have pass at least the first part of the general examination. to
THE ONION AGAIN
LAST year Haggard and Greenberg1 of Yale, investigating the cause of the socially disastrous odour that persists in the breath of those who have eaten onion or garlic, concluded that this smell arises solely from the presence of alliaceous particles retained in the mouth, and to cure it they confidently recommended a mouth-wash containing chloramine. According to Blankenhorn and Richards2 of Cincinnati, those who put their faith in such a mouthwash are living in a fool’s paradise ; it is true that 1 per cent. solution of chloramine will mask the odour for perhaps an hour, but it will then return and persist for 18 hours or more. They attribute their predecessors’ errors to the use of a chemical rather than an olfactory test for the smell of onions, and so far from believing that the odour originates in alliaceous particles lingering in the mouth, they have shown that it can be detected in the breath of one fed with garlic or onion by a route other than the mouth. Thus a patient with complete occlusion of the oesophagus due to carcinoma was fed, through a gastrostomy opening, first with garlic soup, and secondly with an infusion of onions. On both occasions the tell-tale odour appeared in the breath. Another patient, whose larynx had been removed for carcinoma and who breathed through a tracheotomy fistula, was fed with a garlic and onion salad. Three and four hours later, even when his nose was pinched shut, the odour could be detected in the breath exhaled through the fistula. A third patient, a boy
no higher than that of hysterectomy, and has thereby successfully laid a ghost. After the operation fibroids
in 4-8 per cent. of cases, and in 80 per cent. menstruation returns to normal. Of the patients who are likely to conceive after operation about a quarter become pregnant, and not more than 2 per cent. of these have abnormal labours ; rupture of a scar is extremely rare. Myomectomy during labour is, however, a dangerous procedure, and hysterectomy is to be preferred in such circumstances. These conclusions are reached from an analysis of some hundreds of cases. They are very encouraging and will further the cause of conservative surgery. recur
THE COLONIAL MEDICAL SERVICE
a
with a laryngeal stricture who was breathing through a tracheal fistula, was given a capsule containing the essential oil of garlic which he swallowed whole. By closing his mouth and nose, it was made necessary for him to exhale completely through the fistula ; yet three, six, and even twelve hours later the odour of garlic was apparent to three separate observers in the air thus expired. Blankenhorn and Richards would have us return to the old theory that alliaceous odours come from the blood by way of the lungs. ABDOMINAL MYOMECTOMY
Alexander of Liverpool, in 1898, was the first in this country to publish a series of cases of abdominal myomectomy, and in the August issue of the Journal of Obstetrics and Gyncecology of the British Empire Prof. Arthur Gemmell, also of Liverpool, has produced one of the most comprehensive surveys of the indications, risks, and benefits of this method of treating fibroids. Victor Bonney, in a Hunterian lecture that we printed in 1931, made out a strong claim for the operation, and maintained that it is usually no more risky than a total hysterectomy. Its advan-
tage is that the uterus is conserved, and this may be of incalculable importance to a woman in the childbearing period. Prof. Gemmell, who supplements the experience of the Liverpool school with a wide reference to recent writings and the results of a questionnaire to professors of gynaecology throughout the world, is able to reach several definite and important conclusions. The mortality of abdominal myomectomy lies, he says, between 1’3 and 5 per cent., being about the same as that of total hysterectomy; he has also established that the morbidity-rate is 1 Haggard, H. W., and Greenberg, L. A. : Jour. Amer. Med. Assoc., 1935, civ., 2160 ; see THE LANCET, 1935, ii., 316. 2 Blankenhorn, M. A., and Richards, C. E. : Jour. Amer. Med. Assoc., August 8th, 1936, p. 409.
IN 1934 the Colonial Medical Service was constituted as a separate branch of the Colonial Service. The first Colonial Medical Service List,l which has just been published, contains the regulations governing the composition of the new Service and the appointments, promotion, transfer, and practice of its members. There are two schedules: the first gives offices whose holders automatically became members of the Service in 1934 ; the second includes the amendments since that date. Finally there is the alphabetical list of officers with a record of their qualifications and appointments, past and present. THE following medical appointments have been made to the household of the Duke and Duchess of York:-To be physicians-in-ordinary : Dr. G. F. Still, Sir John Weir, Dr. H. L. Tidy, and Dr. D. T. Davies. To be surgeons-in-ordinary: Sir Lancelot Barrington-Ward and Mr. A. E. Porritt.
Major-General E. W. C. Bradfield, surgeon-general with the Government of Bombay, has been selected to succeed Major-General Sir Cuthbert Sprawson as director-general of the Indian Medical Service when he retires. General Bradfield is hon. surgeon to the Viceroy of India and was formerly professor of surgery at the Medical College, Madras. He was appointed assistant director of medical services in 1932. Sir Walter Burford Johnson is about to retire from his post of director of the Nigerian medical and sanitary services which he has held since 1929. Sir Walter took part in the work of the Yellow Fever Commission in 1913 and in the tsetse-fly investigation in Nigeria in 1921. WE regret to learn the death of Lady Moynihan which occurred on August 31st, suddenly, at Carr Manor, Meanwood, Yorkshire.
She
was
Isabella
Wellesley, daughter of the late Prof. a distinguished surgeon in Leeds and
T. R. Jessop, the first professor of surgery in what was then the Yorkshire College, now the University of Leeds.
Lieut.-Colonel S. P. James, F.R.S., has retired from his position as medical officer and adviser on tropical disease to the Ministry of Health. Leaving the Indian Medical Service at the end of the late war he joined the staff of the Ministry (then the Local Government Board) in 1918, and has since devoted most of his time to the problem of malaria. Abroad he has done important work on the League of Nations Malaria Commission and other bodies, while at home he has added much to our knowledge of the disease by his observations on infections induced in the course of malariotherapy. 1 London: H.M. Stationery Office.
1936.
Pp. 66.
1s.
THE ONION AGAIN
LAST year Haggard and Greenberg1 of Yale, investigating the cause of the socially disastrous odour that persists in the breath of those who have eaten onion or garlic, concluded that this smell arises solely from the presence of alliaceous particles retained in the mouth, and to cure it they confidently recommended a mouth-wash containing chloramine. According to Blankenhorn and Richards2 of Cincinnati, those who put their faith in such a mouthwash are living in a fool’s paradise ; it is true that 1 per cent. solution of chloramine will mask the odour for perhaps an hour, but it will then return and persist for 18 hours or more. They attribute their predecessors’ errors to the use of a chemical rather than an olfactory test for the smell of onions, and so far from believing that the odour originates in alliaceous particles lingering in the mouth, they have shown that it can be detected in the breath of one fed with garlic or onion by a route other than the mouth. Thus a patient with complete occlusion of the oesophagus due to carcinoma was fed, through a gastrostomy opening, first with garlic soup, and secondly with an infusion of onions. On both occasions the tell-tale odour appeared in the breath. Another patient, whose larynx had been removed for carcinoma and who breathed through a tracheotomy fistula, was fed with a garlic and onion salad. Three and four hours later, even when his nose was pinched shut, the odour could be detected in the breath exhaled through the fistula. A third patient, a boy
no higher than that of hysterectomy, and has thereby successfully laid a ghost. After the operation fibroids
in 4-8 per cent. of cases, and in 80 per cent. menstruation returns to normal. Of the patients who are likely to conceive after operation about a quarter become pregnant, and not more than 2 per cent. of these have abnormal labours ; rupture of a scar is extremely rare. Myomectomy during labour is, however, a dangerous procedure, and hysterectomy is to be preferred in such circumstances. These conclusions are reached from an analysis of some hundreds of cases. They are very encouraging and will further the cause of conservative surgery. recur
THE COLONIAL MEDICAL SERVICE
a
with a laryngeal stricture who was breathing through a tracheal fistula, was given a capsule containing the essential oil of garlic which he swallowed whole. By closing his mouth and nose, it was made necessary for him to exhale completely through the fistula ; yet three, six, and even twelve hours later the odour of garlic was apparent to three separate observers in the air thus expired. Blankenhorn and Richards would have us return to the old theory that alliaceous odours come from the blood by way of the lungs. ABDOMINAL MYOMECTOMY
Alexander of Liverpool, in 1898, was the first in this country to publish a series of cases of abdominal myomectomy, and in the August issue of the Journal of Obstetrics and Gyncecology of the British Empire Prof. Arthur Gemmell, also of Liverpool, has produced one of the most comprehensive surveys of the indications, risks, and benefits of this method of treating fibroids. Victor Bonney, in a Hunterian lecture that we printed in 1931, made out a strong claim for the operation, and maintained that it is usually no more risky than a total hysterectomy. Its advan-
tage is that the uterus is conserved, and this may be of incalculable importance to a woman in the childbearing period. Prof. Gemmell, who supplements the experience of the Liverpool school with a wide reference to recent writings and the results of a questionnaire to professors of gynaecology throughout the world, is able to reach several definite and important conclusions. The mortality of abdominal myomectomy lies, he says, between 1’3 and 5 per cent., being about the same as that of total hysterectomy; he has also established that the morbidity-rate is 1 Haggard, H. W., and Greenberg, L. A. : Jour. Amer. Med. Assoc., 1935, civ., 2160 ; see THE LANCET, 1935, ii., 316. 2 Blankenhorn, M. A., and Richards, C. E. : Jour. Amer. Med. Assoc., August 8th, 1936, p. 409.
IN 1934 the Colonial Medical Service was constituted as a separate branch of the Colonial Service. The first Colonial Medical Service List,l which has just been published, contains the regulations governing the composition of the new Service and the appointments, promotion, transfer, and practice of its members. There are two schedules: the first gives offices whose holders automatically became members of the Service in 1934 ; the second includes the amendments since that date. Finally there is the alphabetical list of officers with a record of their qualifications and appointments, past and present. THE following medical appointments have been made to the household of the Duke and Duchess of York:-To be physicians-in-ordinary : Dr. G. F. Still, Sir John Weir, Dr. H. L. Tidy, and Dr. D. T. Davies. To be surgeons-in-ordinary: Sir Lancelot Barrington-Ward and Mr. A. E. Porritt.
Major-General E. W. C. Bradfield, surgeon-general with the Government of Bombay, has been selected to succeed Major-General Sir Cuthbert Sprawson as director-general of the Indian Medical Service when he retires. General Bradfield is hon. surgeon to the Viceroy of India and was formerly professor of surgery at the Medical College, Madras. He was appointed assistant director of medical services in 1932. Sir Walter Burford Johnson is about to retire from his post of director of the Nigerian medical and sanitary services which he has held since 1929. Sir Walter took part in the work of the Yellow Fever Commission in 1913 and in the tsetse-fly investigation in Nigeria in 1921. WE regret to learn the death of Lady Moynihan which occurred on August 31st, suddenly, at Carr Manor, Meanwood, Yorkshire.
She
was
Isabella
Wellesley, daughter of the late Prof. a distinguished surgeon in Leeds and
T. R. Jessop, the first professor of surgery in what was then the Yorkshire College, now the University of Leeds.
Lieut.-Colonel S. P. James, F.R.S., has retired from his position as medical officer and adviser on tropical disease to the Ministry of Health. Leaving the Indian Medical Service at the end of the late war he joined the staff of the Ministry (then the Local Government Board) in 1918, and has since devoted most of his time to the problem of malaria. Abroad he has done important work on the League of Nations Malaria Commission and other bodies, while at home he has added much to our knowledge of the disease by his observations on infections induced in the course of malariotherapy. 1 London: H.M. Stationery Office.
1936.
Pp. 66.
1s.