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CANCER OF THE UTERUS IN YOUNG WOMEN.
290 cated1
for the protection of the public, but a method stated to be more reliable is now recommended in a circular issued by the Ministry of Health. The brush should be : (a) thoroughly washed with soap and warm water containing a little washing soda and then allowed to stand for half an hour in warm water containing a little soda; (b) placed in a warm solution of formaldehyde (1 part of 40 per cent. formalin and 16 parts of water-a 2 per cent. solution of formaldehyde) for half an hour; (c) allowed to dry. It is, however, pointed out that complete sterilisation of brushes is impracticable; the method mentioned above frees the exposed part of the hair from infection, but does not affect spores embedded in the handle of the brush. The following figures have been supplied by the Medical Inspector of Factories with regard to the results of various forms of treatment in 800 cases of cutaneous anthrax (excluding the erysipelatous form) in Great Britain :-
It is also stated that in general the best treatment for case of anthrax is physiological rest of the part affected, combined with intravenous injection of antianthrax serum; and that there is always difficulty in estimating the efficacy of different methods of treatment of a malady such as anthrax, which is capable of a
undergoing spontaneous
cure.
THE VENTILATION OF SUBMARINES. THIS subject has been little discussed in the medical press, which makes more welcome the paper by Lieutenant-Colonel (Surgeon-Commander) R. Marantonio, of the Italian Navy, in Annali di Medicina Navale (1920, ii., 467). A small submarine, 100ft. long and 10 ft. broad, displacing when fully submerged 200 tons, has a crew of 12, and takes down with her some 200 cubic feet of respirable air per man. This air is deteriorated not only by respiration, but by gases given off by the accumulators ; as, however, not all parts of the boat are equally occupied, some parts retain a better atmosphere than others, and an equalising system of 4-inch trunks is installed to collect on the starboard side the used air by the help of a Sirocco fan, and discharge it, mixed, on the port side. This circulation does nothing to improve the air supplied, though the motion imparted makes it pleasant and cooling, but the air drawn through soda-lime can, if preferred, be granules, which remove carbonic acid and water vapour. Also, two steel cylinders of oxygen are carried as a reserve. When the boat comes to the surface, where its stay may be short, it is important at once to renew the air within it. That is not invariably easy, as the hatches are small and near the water, still it is managed by help of the Sirocco fan and the previously mentioned ventilation system. The valves on the trunks are set differently, air is sucked out of the ends of the boat, out of the latrine, out of the accumulators, and is driven overboard through an 8-inch trunk abaft the conning-tower, replacement occurring by drift through the hatches, or, if these are closed, through a second 8-inch trunk before the conning-tower. These trunks have their upper ends 8 ft. above the water and are closed by shutters and screws. In larger submarines (150 ft. long, 15 ft. wide, and displacing 474 tons submerged) ventilation is differently arranged The gases from the and air purifiers are not used. accumulators are the chief problem, and the exhaust air from the crew spaces is taken out through the accumulator chambers and pumped overboard to the 1
THE LANCET,
1920, i.,
108.
nearer escape, of which there are two, one one aft. When the oil-motors are air boat on the surface, the from the crew spaces, while the used air is overboard, but there are always a ventilator remove that air
forward, running, the
required
being
is taken
discharged leakages, and to
is fitted ("smoke") at the after end of the engine-room. But this ventilator has to be at once closed if the boat begins to submerge, so that as she submerges the engine-room always wants a blow through. When submerging the openings are all firmly sealed and water is run into the ballast tanks, displacing the air there contained, air that has always a very unpleasant smell, and the barometric pressure increases to 31 in. From all which we learn there are unpleasantnesses in the submarine service as well as risks, and the call for equanimity is as clear as that for courage. ------
UTERUS IN YOUNG WOMEN. ACCORDING to Dr. Gordon Gibson,l of the Long Island College Hospital, who records six cases in women aged from 25-28, cancer of the cervix under 30 is not so rare In 500 cases of cancer of the as is generally supposed. uterus recently reported by Petersen 23, or 4’8 per cent., occurred under 30. Dr. Gibson’s percentage is higher, being 6 in 61 cases, or 9’9 per cent. It is noteworthy that 4 of his cases had married early-namely, at 19, 17, 16, and 17 respectively. Of the 5 who had borne children 4 developed the cancer comparatively soon after pregnancy -namely, 16 months, 3 years, 4 years, and 5 months. In young women the growth, which is usually an epithelioma, is much more rapid than in older women, and it is only when it is seen in the first three months that a radical operation can be done. The extension is particularly rapid when the parametrium becomes involved and death takes place comparatively soon. In only three of Dr. Gibson’s cases was the radical operation carried out, and in them the disease had given rise to symptoms for a comparatively short time-namely, three months, two months, and two months respectively. In the others, in whom the symptoms had been present from four to six months, only palliative measures, such as curetting and cauterisation, were possible, and all of them died shortly afterwards. CANCER OF THE
THE FORM OF MERCURY FOR INUNCTION. IN the British Jonrnal
of Derviatology and Syphilis December, 1920, there appears an interesting article on the absorption and elimination of mercury by Dr. Svend Lomholt, head of the Venereal Clinic of
for
the Royal Danish Marine Hospital, Copenhagen. The author has made a careful analysis of the fseces and urine of patients under various forms of mercurial treatment, and daily charts of the rapidity of elimination of mercury have thus been obtained. Before dealing with the therapeutic conclusions arising from this work, Dr. Lomholt discusses the question whether mercury in the infected body acts directly upon the spirochsetes, or indirectly by stimulating the bactericidal forces of the body. Eighteen examinations of blood from patients under full mercurial treatment or severely intoxicated with this metal have shown that the average content of mercury amounts only to 1-2 mg. per litre, and never exceeds 3 mg. The concentration is so feeble that it appears improbable that a direct bactericidal effect takes place. This conclusion is reinforced by experiments conducted in company with Dr. A. Kissmeyer, in which it was found that a colony of spirochaetes grew well in horse serum containing 5-10 mg. of HgC12 per litre. Dr. Lomholt concludes with a review of the various methods of administration of mercury considered from the point of view of absorption and elimination. He is of opinion that the salicylate of mercury is not absolutely reliable, on the one hand, because its chemical composition makes it decomposable only with difficulty, and, on the other hand, because of its extremely rapid elimination. Metallic mercury has 1 The American Journal of Obstetrics and Gynæcology, December, 1920.
for the protection of the public, but a method stated to be more reliable is now recommended in a circular issued by the Ministry of Health. The brush should be : (a) thoroughly washed with soap and warm water containing a little washing soda and then allowed to stand for half an hour in warm water containing a little soda; (b) placed in a warm solution of formaldehyde (1 part of 40 per cent. formalin and 16 parts of water-a 2 per cent. solution of formaldehyde) for half an hour; (c) allowed to dry. It is, however, pointed out that complete sterilisation of brushes is impracticable; the method mentioned above frees the exposed part of the hair from infection, but does not affect spores embedded in the handle of the brush. The following figures have been supplied by the Medical Inspector of Factories with regard to the results of various forms of treatment in 800 cases of cutaneous anthrax (excluding the erysipelatous form) in Great Britain :-
It is also stated that in general the best treatment for case of anthrax is physiological rest of the part affected, combined with intravenous injection of antianthrax serum; and that there is always difficulty in estimating the efficacy of different methods of treatment of a malady such as anthrax, which is capable of a
undergoing spontaneous
cure.
THE VENTILATION OF SUBMARINES. THIS subject has been little discussed in the medical press, which makes more welcome the paper by Lieutenant-Colonel (Surgeon-Commander) R. Marantonio, of the Italian Navy, in Annali di Medicina Navale (1920, ii., 467). A small submarine, 100ft. long and 10 ft. broad, displacing when fully submerged 200 tons, has a crew of 12, and takes down with her some 200 cubic feet of respirable air per man. This air is deteriorated not only by respiration, but by gases given off by the accumulators ; as, however, not all parts of the boat are equally occupied, some parts retain a better atmosphere than others, and an equalising system of 4-inch trunks is installed to collect on the starboard side the used air by the help of a Sirocco fan, and discharge it, mixed, on the port side. This circulation does nothing to improve the air supplied, though the motion imparted makes it pleasant and cooling, but the air drawn through soda-lime can, if preferred, be granules, which remove carbonic acid and water vapour. Also, two steel cylinders of oxygen are carried as a reserve. When the boat comes to the surface, where its stay may be short, it is important at once to renew the air within it. That is not invariably easy, as the hatches are small and near the water, still it is managed by help of the Sirocco fan and the previously mentioned ventilation system. The valves on the trunks are set differently, air is sucked out of the ends of the boat, out of the latrine, out of the accumulators, and is driven overboard through an 8-inch trunk abaft the conning-tower, replacement occurring by drift through the hatches, or, if these are closed, through a second 8-inch trunk before the conning-tower. These trunks have their upper ends 8 ft. above the water and are closed by shutters and screws. In larger submarines (150 ft. long, 15 ft. wide, and displacing 474 tons submerged) ventilation is differently arranged The gases from the and air purifiers are not used. accumulators are the chief problem, and the exhaust air from the crew spaces is taken out through the accumulator chambers and pumped overboard to the 1
THE LANCET,
1920, i.,
108.
nearer escape, of which there are two, one one aft. When the oil-motors are air boat on the surface, the from the crew spaces, while the used air is overboard, but there are always a ventilator remove that air
forward, running, the
required
being
is taken
discharged leakages, and to
is fitted ("smoke") at the after end of the engine-room. But this ventilator has to be at once closed if the boat begins to submerge, so that as she submerges the engine-room always wants a blow through. When submerging the openings are all firmly sealed and water is run into the ballast tanks, displacing the air there contained, air that has always a very unpleasant smell, and the barometric pressure increases to 31 in. From all which we learn there are unpleasantnesses in the submarine service as well as risks, and the call for equanimity is as clear as that for courage. ------
UTERUS IN YOUNG WOMEN. ACCORDING to Dr. Gordon Gibson,l of the Long Island College Hospital, who records six cases in women aged from 25-28, cancer of the cervix under 30 is not so rare In 500 cases of cancer of the as is generally supposed. uterus recently reported by Petersen 23, or 4’8 per cent., occurred under 30. Dr. Gibson’s percentage is higher, being 6 in 61 cases, or 9’9 per cent. It is noteworthy that 4 of his cases had married early-namely, at 19, 17, 16, and 17 respectively. Of the 5 who had borne children 4 developed the cancer comparatively soon after pregnancy -namely, 16 months, 3 years, 4 years, and 5 months. In young women the growth, which is usually an epithelioma, is much more rapid than in older women, and it is only when it is seen in the first three months that a radical operation can be done. The extension is particularly rapid when the parametrium becomes involved and death takes place comparatively soon. In only three of Dr. Gibson’s cases was the radical operation carried out, and in them the disease had given rise to symptoms for a comparatively short time-namely, three months, two months, and two months respectively. In the others, in whom the symptoms had been present from four to six months, only palliative measures, such as curetting and cauterisation, were possible, and all of them died shortly afterwards. CANCER OF THE
THE FORM OF MERCURY FOR INUNCTION. IN the British Jonrnal
of Derviatology and Syphilis December, 1920, there appears an interesting article on the absorption and elimination of mercury by Dr. Svend Lomholt, head of the Venereal Clinic of
for
the Royal Danish Marine Hospital, Copenhagen. The author has made a careful analysis of the fseces and urine of patients under various forms of mercurial treatment, and daily charts of the rapidity of elimination of mercury have thus been obtained. Before dealing with the therapeutic conclusions arising from this work, Dr. Lomholt discusses the question whether mercury in the infected body acts directly upon the spirochsetes, or indirectly by stimulating the bactericidal forces of the body. Eighteen examinations of blood from patients under full mercurial treatment or severely intoxicated with this metal have shown that the average content of mercury amounts only to 1-2 mg. per litre, and never exceeds 3 mg. The concentration is so feeble that it appears improbable that a direct bactericidal effect takes place. This conclusion is reinforced by experiments conducted in company with Dr. A. Kissmeyer, in which it was found that a colony of spirochaetes grew well in horse serum containing 5-10 mg. of HgC12 per litre. Dr. Lomholt concludes with a review of the various methods of administration of mercury considered from the point of view of absorption and elimination. He is of opinion that the salicylate of mercury is not absolutely reliable, on the one hand, because its chemical composition makes it decomposable only with difficulty, and, on the other hand, because of its extremely rapid elimination. Metallic mercury has 1 The American Journal of Obstetrics and Gynæcology, December, 1920.