BOXING

588

It seems possible, therefore, that bed bugs in a house infected with smallpox may be capable of transmitting the disease and may well escape the ordinary routine measures of disinfection. County Hall, Newport, Wight.

JOHN MILLS

Isle of

Medical Officer of Health.

TREATMENT OF FEMALE CYSTITIS to congratulate Mr. Bennett-Jones his excellent article of Feb. 10. It very necessarily brings notice to the existence of bladder-neck infection and obstruction in women-a condition not yet fully

SIR,-I should like

on

recognised. Having been St. Paul’s

one of Mr. Winsbury-White’s registrars at Hospital, London, I am very interested in this

---

I that

subiect.

..

agree

these patients, unless in an acute

attack,

usually have

Fig. 1-Relation of increased frequency to urine in 165

women.

sterile urines (fig. 1). The patients’ main complaint, between attacks of acute cystitis, is increased frequency of micturition. The irritation and urgency sterile are caused by infection lurking in the glands of the proximal1 urethra, with

surrounding hyperaemia of the trigone and the formation

I agree that urethral dilatation can produce dramatic results, and that it can be used diagnostically, as can the dilatation of cystoscopy. The cures resulting from a single dilatation are in early cases before the condition becomes chronic. The dilatation opens the orifices of these glands and allows free drainage-a basic principle in surgery of inflammation. I suggest the following sequence of events. Firstly, the glands of the posterior urethra become infected. If this is not treated the infection becomes chronic. This leads to upset of the sphincter mechanism and later to fibrosis and bladderneck obstruction. I would add that there may well be residual urine before there is true organic obstruction. The cases with fibrosis and true organic obstruction undoubtedly need perurethral resection. It seems unnecessary, however, to use the more major procedure of resection, no matter how expertly performed, when the minor procedure of fulguration will relieve most patients. Fulguration of the bladder-neck with a weak diathermy current does not upset the patients at all and there are no dangers. This leaves resection for the small resistant group, usually patients with longstanding infection, fibrosis, and true organic obstruction. The data in figs. 1 and 2 are taken from a survey described in paper read to the East Midlands Surgical Society. Doncaster.

a

W. MCCAUSLAND SCOTT.

BOXING Sherriff’s SIR,-Dr. arguments not do.

(March 10) simply will

Amateur boxers, certainly small boys, do not box with the deliberate object of producing cerebral concussion or other bodily damage. They box to score points. When they fight in the playground with bare fists their motives may be less pure and the results more traumatic. In any event, what is the point of trying to discriminate between deliberate and accidental trauma ? In rugby football, where trauma is presumed to be accidental, concussion is not uncommon and a broken neck not unknown. Would Dr. Sherriff also ban rugby football ? The comparison between boxing with gloves and gladiatorial combats with cesti can hardlv be taken seriouslv. Crediton, L. N.

JACKSON.

Devon.

of granulomata

and

pseudo-polyps at the

bladder-

neck. Every so

often

the infection bursts forth Fig. 2-Relation of erosion of cervix to increased from these frequency in 165 women. glands, freauentiv after intercourse, causing an acute attack of cystitis and even pyelitis. The urine then shows infection. The size of some of the polyps can only be fully seen with a Swift-Joly posterior urethroscope. The resectoscope or to their full extent. does not show them up panendoscope Mr. Bennett-Jones rightly emphasises the importance of pelvic infection and pelvic operations in this condition, but he belittles the part played by the eroded cervix. Mr. Winsbury-White showed experimentally that, when Indian ink was injected into the cervices of guineapigs, particles of this ink could be demonstrated around the bladderneck and even extended up to the kidney via the periureteric

lymphatics. 2 shows the relation of eroded cervix to increased in females from the age of 6 onwards. Unless the cervical and vaginal infection is cured it is useless to treat the bladder-neck. In fact in young women this is often all that is necessary.

Fig.

frequency

1.

Winsbury-White,

H. P. Brit. J. Urol.

1933, 5,

249.

LOW INCIDENCE OF MYOCARDIAL INFARCTION IN HEPATIC CIRRHOSIS

SiR,—It is certainly possible that a change in the oestrogen-androgen ratio may protect patients with hepatic cirrhosis against myocardial infarction, as suggested by Dr. Ivanyi (Feb. 24). It has also been speculated that the diet of alcoholics lacks atherogenic substances or that the

alcoholic liver

cannot

manufacture

cholesterol.1 Raaschou (personal communication) has suggested that the low incidence of myocardial infarction among this group of patients may be related to the infrequency of hypertension in patients with liver disease 2 3. In our paper 4 we merely wished to point out that the high mortality of cirrhosis alone could produce a decrease in the incidence of myocardial infarction at necropsy of the magnitude observed by ourselves and previous investigators. It is hard for retrospective necropsy studies to prove a negative correlation between two diseases. Prospective clinical investigations or experimental work seem much better adapted to the solution of this interesting problem.

BORIS H. RUEBNER Department of Pathology, K. MIYAI Johns Hopkins Hospital, HELEN ABBEY. Baltimore, Maryland. 1. Nutr. Rev. 1961, 19, 37. 2. Raaschou, F. Circulation, 1954, 10, 511. 3. Loyke, H. F., Cutarelli, R. Amer. J. med. Sci. 1960, 240, 346. 4. Lancet, 1961, ii, 1435.