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FLUORIDATION AND CANCER
199
INJECTION OF TRH SIR,-Dr Blum and Dr Pulini (July 5, p. 43) describe sensa;;ons noted by their female patients after injection of thyroid releasing hormone. When I received an injection of this hormone, I experienced a sensation in my penile urethra which L:ave me the impression that I was either about to ejaculate or pass water. This feeling was not accompanied by an erection; 11 lasted for about a minute; it prompted a precautionary dash to the lavatory, but no emission of either semen or urine SENSATIONS AFTER
(SMRS)*
AND OBSERVED STANDARDISED MORTALITY RATIOS NUMBERS OF DEATHS FROM CANCER IN BIRMINGHAM AND SOLIHULL AND IN THE NON-FLUORIDATED PARTS
OF
THE WEST
MIDLANDS CONURBATION
occurred. Department of Pathology, Royal Victoria Hospital, Bournemouth BH1
P.
4JG
J. GREEN
TIME OF FERTILISATION AND SEX OF INFANTS
SIR,-James’ has demonstrated an U-shaped regression of ratio on cycle day of insemination, on the basis of direct and indirect data. He suggests that sex may be determined by the maternal gonadotrophin level when the zygote is formed. This hypothesis could explain the low sex ratio and high dizygotic twinning rate of Negroes with higher maternal gonadotrophin production. If this hypothesis is true the sex ratio should show a characteristic seasonality because of the changing monthly pattern of gonadotrophin production. A correlation between daylight and gonadal stimulation through pituitarv gonadotrophin secretion has been shown.2 However, there is no seasonality of sex ratio in Hungarian data, evaluated by the method of Edwards3 (see figure), though a seasonality of sex
*All SMRs were based on sex and 5-year age-group specific national rates for the two periods 1959-63 and 1969-73 combined. tfluoridated in 1964. $If the County Borough of Warley, which was only created in 1966 and which receives some fluoridated water, is excluded, the SMR becomes 107.22, based on 11 692 deaths, a rise of 8.9.
in the Registrar General’s analysis of cancer mortality by area of residence.’ As mentioned in the Royal College of Physicians report (Fluoride, Teeth and Health; p. 60) mortality from cancer has risen more in the non-fluoridated parts of the conurbation than in the fluoridated areas of Birmingham and Solihull. It is, of course, not difficult to find parts of England in which cancer mortality has risen less than in Birmingham. The areas we have compared are, however, in our opinion the most appropriate for this purpose as they are geographically close and of similar residential and industrial character. Department of Regius Professor of Medicine, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE
L.
Medical Services Study Group, King’s Fund Centre, London NW1
C. A. CLARKE
Green College, Oxford
R. DOLL
J. KINLEN
CIMETIDINE, DELAY IN DIAGNOSIS, AND CARCINOMA OF THE STOMACH
SiR,—Your May 24 editorial
of birth with true undescended testis not of sex ratio at birth (1977-79).
Seasonality
(1970-76)
but
birth with true undescended testis (i.e., testis or testes not in the scrotum at the age of one year) was found. The role of gonadotrophins is well-known in the descent of testes. Thus the impact of seasonal changes of gonadotrophin secretion can be proved in the undescended testes but not in the sex ratio of the newborn. of Human Genetics, National Institute of Hygiene,
Department
ANDREW CZEIZEL
Badapest, Hungary
FLUORIDATION AND CANCER
SIR,-Our attention has been drawn
to
the
publicity given
by Dr Dean C. Burk that mortality from cancer has risen especially rapidly in Birmingham since it was fluoridated in 1964. BX’e have, therefore, examined the changes in cancer mortality in the West Midlands conurbation recorded
to statements
1. James WH. The fertilisation and sex ratio of infants. Lancet 1980; i: 1124-26 2. Clark W E, McKeown T, Zuckerman S. Visual pathways concerned in gonadal stimulation in ferrets. Proc Roy Soc B 1939; 126: 449-68. 3. Edwards JH Seasonal incidence of congenital disease in Birmingham. Ann Hum Genet1961, 25: 89-93.
stresses the importance of of gastric carcinoma. The relevance of its message is well illustrated by recent experience on this unit.
early and
accurate
diagnosis
From August, 1979, to May, 1980, 29 patients (22 males), between the ages of 51 and 89 years, have been treated on this unit for adenocarcinoma of the stomach. In 12 of these patients, delays of between 2 and 12 months had occurred (mean 6.6 months) from the time of presentation with symptoms strongly suggestive of gastric neoplasm, and its diagnosis. 8 of these 12 (all men over the age of 57), had been treated with cimetidine and antacids for 6 to 12 months before surgical referral. Only 2 had a barium meal and none had a gastroscopy before starting treatment. 26 of the 29 patients underwent laparotomy. 5 out of 8 patients with unresectable tumours had delayed referral and had been treated with cimetidine. 16 of the 29 patients have died. 12 died from carcinomatosis 3-19 weeks after operation, and half of these had received cimetidine. The importance of repeat endoscopy where a gastric carcinoma is suspected is well illustrated by 3 patients. 1 presented with dysphagia; a barium swallow and meal was reported as showing achalasia and only on the third endoscopy 1.
Registrar General. Statistical reviews of England and Wales: part I, mortality 1957-63 and 1969-73..The figures for Solihull before it became a county borough were supplied by the Office of PopulatIOn Censuses and Survevs.
INJECTION OF TRH SIR,-Dr Blum and Dr Pulini (July 5, p. 43) describe sensa;;ons noted by their female patients after injection of thyroid releasing hormone. When I received an injection of this hormone, I experienced a sensation in my penile urethra which L:ave me the impression that I was either about to ejaculate or pass water. This feeling was not accompanied by an erection; 11 lasted for about a minute; it prompted a precautionary dash to the lavatory, but no emission of either semen or urine SENSATIONS AFTER
(SMRS)*
AND OBSERVED STANDARDISED MORTALITY RATIOS NUMBERS OF DEATHS FROM CANCER IN BIRMINGHAM AND SOLIHULL AND IN THE NON-FLUORIDATED PARTS
OF
THE WEST
MIDLANDS CONURBATION
occurred. Department of Pathology, Royal Victoria Hospital, Bournemouth BH1
P.
4JG
J. GREEN
TIME OF FERTILISATION AND SEX OF INFANTS
SIR,-James’ has demonstrated an U-shaped regression of ratio on cycle day of insemination, on the basis of direct and indirect data. He suggests that sex may be determined by the maternal gonadotrophin level when the zygote is formed. This hypothesis could explain the low sex ratio and high dizygotic twinning rate of Negroes with higher maternal gonadotrophin production. If this hypothesis is true the sex ratio should show a characteristic seasonality because of the changing monthly pattern of gonadotrophin production. A correlation between daylight and gonadal stimulation through pituitarv gonadotrophin secretion has been shown.2 However, there is no seasonality of sex ratio in Hungarian data, evaluated by the method of Edwards3 (see figure), though a seasonality of sex
*All SMRs were based on sex and 5-year age-group specific national rates for the two periods 1959-63 and 1969-73 combined. tfluoridated in 1964. $If the County Borough of Warley, which was only created in 1966 and which receives some fluoridated water, is excluded, the SMR becomes 107.22, based on 11 692 deaths, a rise of 8.9.
in the Registrar General’s analysis of cancer mortality by area of residence.’ As mentioned in the Royal College of Physicians report (Fluoride, Teeth and Health; p. 60) mortality from cancer has risen more in the non-fluoridated parts of the conurbation than in the fluoridated areas of Birmingham and Solihull. It is, of course, not difficult to find parts of England in which cancer mortality has risen less than in Birmingham. The areas we have compared are, however, in our opinion the most appropriate for this purpose as they are geographically close and of similar residential and industrial character. Department of Regius Professor of Medicine, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE
L.
Medical Services Study Group, King’s Fund Centre, London NW1
C. A. CLARKE
Green College, Oxford
R. DOLL
J. KINLEN
CIMETIDINE, DELAY IN DIAGNOSIS, AND CARCINOMA OF THE STOMACH
SiR,—Your May 24 editorial
of birth with true undescended testis not of sex ratio at birth (1977-79).
Seasonality
(1970-76)
but
birth with true undescended testis (i.e., testis or testes not in the scrotum at the age of one year) was found. The role of gonadotrophins is well-known in the descent of testes. Thus the impact of seasonal changes of gonadotrophin secretion can be proved in the undescended testes but not in the sex ratio of the newborn. of Human Genetics, National Institute of Hygiene,
Department
ANDREW CZEIZEL
Badapest, Hungary
FLUORIDATION AND CANCER
SIR,-Our attention has been drawn
to
the
publicity given
by Dr Dean C. Burk that mortality from cancer has risen especially rapidly in Birmingham since it was fluoridated in 1964. BX’e have, therefore, examined the changes in cancer mortality in the West Midlands conurbation recorded
to statements
1. James WH. The fertilisation and sex ratio of infants. Lancet 1980; i: 1124-26 2. Clark W E, McKeown T, Zuckerman S. Visual pathways concerned in gonadal stimulation in ferrets. Proc Roy Soc B 1939; 126: 449-68. 3. Edwards JH Seasonal incidence of congenital disease in Birmingham. Ann Hum Genet1961, 25: 89-93.
stresses the importance of of gastric carcinoma. The relevance of its message is well illustrated by recent experience on this unit.
early and
accurate
diagnosis
From August, 1979, to May, 1980, 29 patients (22 males), between the ages of 51 and 89 years, have been treated on this unit for adenocarcinoma of the stomach. In 12 of these patients, delays of between 2 and 12 months had occurred (mean 6.6 months) from the time of presentation with symptoms strongly suggestive of gastric neoplasm, and its diagnosis. 8 of these 12 (all men over the age of 57), had been treated with cimetidine and antacids for 6 to 12 months before surgical referral. Only 2 had a barium meal and none had a gastroscopy before starting treatment. 26 of the 29 patients underwent laparotomy. 5 out of 8 patients with unresectable tumours had delayed referral and had been treated with cimetidine. 16 of the 29 patients have died. 12 died from carcinomatosis 3-19 weeks after operation, and half of these had received cimetidine. The importance of repeat endoscopy where a gastric carcinoma is suspected is well illustrated by 3 patients. 1 presented with dysphagia; a barium swallow and meal was reported as showing achalasia and only on the third endoscopy 1.
Registrar General. Statistical reviews of England and Wales: part I, mortality 1957-63 and 1969-73..The figures for Solihull before it became a county borough were supplied by the Office of PopulatIOn Censuses and Survevs.