CONTRACEPTIVE TECHNIQUE

1002 in the newborn. For instance, indwelling gastric tubes have to be so small that they cannot be reliable. They are tolerated variably and may produce oesophageal haemorrhage. Intravenous therapy has to be controlled on the assumption that renal function will be inefficient. The ordinary technique of two-layer anastomosis will not often be applicable. Peristalsis may be found to persist in the presence of peritonitis, and muscle-guarding to be absent under the same conditions. Experience of underlying lesions, such as errors of rotation and cystic fibrosis of the pancreas, cannot be gained from surgical treatment of adults ; and yet such lesions require diagnosis by observation at laparotomy if treatment is to be adequate. General surgical principles are the essential foundation in this as in other branches ; but the foundation alone is not enough-a superstructure of experience of the individual variations of these cases is also required. H. H. NIXON. Harrow, Middlesex. CONTRACEPTIVE TECHNIQUE

SIR,—May I correct the misapprehensions expressed by Dr. Marie Stopes (May 2) with regard to my company’s announcements on’Preceptin Vaginal Gel ’ As international manufacturers and distributors of contraceptive jellies and creams and vaginal diaphragms, we are naturally aware of the limitations of the chemical contraceptives hitherto available, when used as a sole preventive against migration of spermatozoa through the os. These limitations are due to the inability of vegetable gums and emulsified fats to adhere closely to a secreting surface and so provide the necessary " barrier " to the For this reason the " diaphragm and jelly " cervical os. technique has been accepted as hitherto the most effective measure because the diaphragm provides both a physical barrier and a means of holding a sufficient of the spermicide close to the cervix. But there are cases where the diaphragm either cannot or will not be used. Further, any means of conception control depends on intelligent use. Acceptability to the patient is no small factor in success. More than eight years’ research in the Ortho Research Foundation was concentrated on the development of a simpler method that would be at least as effective as the use of a diaphragm. The release of preceptin vaginal gel was preceded by two years’ study involving thousands of patients, and the resultant high degree of success reported in these earlier studies has since been widely confirmed in many countties. The preparation succeeds, where other chemical contraceptives have failed, because it is neither a jelly nor a cream but is compounded in a base of unique synthetic materials having the ability to adhere tenaciously to a moist secreting mucosal surface. It provides its own " barrier " when 5 ml. is deposited at the cervix. The synthetic base also has the power to release the active spermicidal system more rapidly than has been possible even with such highly spermicidal compounds as ’Ortho-gynol ’ jelly, which is compounded

quantity

in

a

vegetable

gurn base.

Mechanical devices solve only part of the vast problem of contraception. The acceptance of the mechanical barrier as the final achievement of science takes no account of such resources as those of the Ortho Research Foundation, with which my company is associated. REGINALD GEORGE High Wycombe,

Managing Director,

Bucks.

Ortho 1’liarmaceutical Pharmaceutical Ltd.

ANTICOAGULANT DRUGS

SIR,—Are anticoagulant drugs to

our

owing great

patients ?

I

a

benefit

or otherwise this question held by two of acute deep-vein

prompted to ask divergence of opinion am

to the wide schools in their treatment

thrombophlebitis. On the statistics

one

hand, the Swedish school presents

showing

a

great

diminution in the

us

with

occurrence

of embolism, and a speedy resolution of thrombophlebitis, when heparin and drugs of the dicoumarol series are employed. On the other hand, the Manchester school takes an opposite view. Professor Boyd suggests that anticoagulants have no place in the treatment of acute thrombophlebitis, and lie is of the opinion that dicou. marol is an extremely dangerous capillary poison which, when administered to patients with ischaemia, may cause eruptions of the skin followed by sloughing. He tells me that recently in six cases he has had to amputate legs which might have been saved had this drug not been given. He makes the suggestion that heparin tends to loosen recently deposited soft clots, and in support of this view states that in twenty-five years he had never found bona-fide embolism following deep vein thrombo. phlebitis, but in recent years has come across such cases in patients receiving anticoagulants. Cases of acute deep-vein thrombophlebitis in their earliest stage are treated by the Manchester school by means of paravertebral block, and all anticoagulants are anathema. This makes me ask the question-are anticoagulants our friends or our foes ? Your readers.’ views on this most important subject would be valuable. It is fully time that the treatment of deep-vein thrombophlebitis

standardised, since all will agree that crippling sequelae are all too common. The country has a vast population of patients with severe ulceration of the legs, which might well not have arisen had the antecedent condition of deep-vein thrombophlebitis been promptly and correctly treated. was

-

London, W.1.

R. ROWDEN ROWDEN FOOTE. FOOTE.

SUCKLING

SIR,—To suckle is

a

transitive verb

meaning

to

give

suck to

(Concise Oxford Dictionary). In your leader on Puerperal Mastitis (May 2)- you state that a procedure " allows the baby to suckle normally "-which is ...

of the verb. Your next sentence uses it wrong " correctly in speaking of pain on suckling " ; for suckling is what the mother who feels the’pain does. The infant feeds, takes the breast, or sucks. RONALD MAC KEITH. Guy’s Hospital, London, S.E.1 a

use

UTERINE CANCER AND VAGINAL SMEARS was surprised at the

SIR,—Like Dr. Osborn (May 2) I

misapprehensions in your leading article of April 18, and I was glad to find such support for cytology froma pathologist. We too have passed the 5000 mark; and the assessment of results of 3000 is shortly to be published. I agree with Dr. Osborn in nearly every respect. But I believe that expansion of this work, which many of us have come to regard as essential, depends on its being largely carried out by technicians, if for no other reason than that there are not enough pathologists. This has been abundantly shown in the U.S.A., and there is no doubt that it is perfectly feasible. The negative smears are screened out by technicians, who can achieve this competence in six months, and the difficult and positive ones are kept aside. The laboratory is in the-gynacology department, and we cater for the pathology in this subject for the whole region. I should have liked to see Dr. Osborn divide cancer of the uterus into its two types-cervical and corporeal. We find that our most useful contribution is in cervical cancer, where we can show just under 1% of women coming to our gynaecological clinics to have a cancer not suspected by the gynaecologist after speculum examination. But in the matter of body carcinoma, well known to be more difficult, we find it almost impossible to compete with curettage, which is usually so speedilc arranged that we contribute very little, though we have had a few discoveries. With Miss Mary Egerton I also agree-the value of the method is not assessable by the cost of working honrs. And it is usually forgotten that the 499 patients who