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MARGARINE AND BACTERIAL INFECTION
965
Annotations. "Ne quid nimis."
A stout woman, aged 33 years, came Nov. 15th, 1915. She had been married 14 years, and had one child some years ago. Her periods were never regular ; every other month the flow was profuse, and in the intervening months scanty. The last period was on Oct. 26th. The left tube had been removed four years previously. She complained of throbbing pains in the sacral and right ovarian regions, associated with a vaginal discharge. Two weeks previously whilst walking she felt a sharp stabbing pain in the right side and a sensation as though "something burst." A brownish vaginal discharge immediately followed and had persisted ever since. During the past two weeks she had a swelling in the right side of the abdomen. On examination the uterus was found slightly retroposed, mobile, and tender. In the left ovarian region induration and tenderness were detected. No mass was felt in the pelvis, but much importance was not attached to this fact as the patient was so stout. She returned every few days and frequently reported that she had attacks of sudden severe right-sided pain followed by a brownish vaginal discharge and disappearance of the pain. Hydrops tubee profluens was diagnosed. Laparotomy showed that the left ovary was transformed into a follicular cyst about the size of a peach. The right tube was enlarged and contained fluid. Supravaginal hysterectomy, right salpingectomy, and left oophorocystectomy were performed. Gentle pressure on the excised tube caused a flow of clear watery fluid from the ostium. Uneventful recovery followed. Intermittent hydrosalpinx seems to be due to closure of the abdominal ostium of the tube by adhesions while the uterine aperture remains patulous. When the pressure of the fluid contained in the tube reaches a certain peight the flow takes place. The characteristic symptom is intermittent pain relieved by the discharge. Physical signs may be absent or a mass may be felt, according to the condition of the tube at the time of examination. In reviewing the literature of the condition in 1906 an American writer, Findley, could collect only 59 cases, including one which he reported, and some of these are He doubtful, as no operation was performed. refers to the statistics of Martin, who could find only 8 examples among 1700 cases of salpingitis.
hydrosalpinx." to hospital on
MARGARINE AND BACTERIAL INFECTION AMONGST fatty foodsjust now margarine has taken an important place in the dietary as a wholesome substitute for the more expensive butter. Before the war there was still a prejudice against this article of food, but this has now been practically removed; economic considerations have led a good many people to try margarine, and as the result of practical test it has been adopted in many households. " Bosh," the trade name first chosen for the substance, was not attractive, and the word margarine was employed, being derived from the Greek word for pearl, and adopted because of the pearly appearance of margaric acid. Under this name, however, the substance was for some time looked upon as an inferior butter substitute, the sale of which opened the way to fraud, and its use was confined to the kitchen. Whatever may have been the quality of margarine years ago there can be little doubt that its manufacture has undergone very great improvement, and the product of the present day is a triumph of the art of the refined blending of various fats, vegetable and animal, with milk. The introduction of nut and seed oils, made flavourless and neutral by cleansing processes, is a comparatively recent departure. Margarine was originally made with oleo oil or the fluid portion of beef fat, with but a trifiing proportion of vegetable fat, while now there are vegetable butters sold which are made exclusively of nut oils. Generally speaking, it may be said that the higher grades contain much more animal fat than the lower grades, and this accounts for the two classes of margarine sold at very different prices, the former commanding practically twice the price of the latter. Perhaps the existence of high and low grades of margarine is responsible for the fact that a prejudice still exists against margarine in the public mind, for this is evident from certain statements which have found their way into the lay press, suggesting that margarine contains disease organisms derived from the milk withwhich it is blended. The suspicion is ill-founded. In the first place the cream is removed from the milk by a separator, and it is well known that THE VIEWS ON PROSTITUTION OF THE SWEDISH MEDICAL SOCIETY. with the removal of this cream a very large proportion of the bacteria is withdrawn, so that in As we have shown from time to time in these this respect separated milk would contain far less the authorities in Sweden are contemcolumns, bacteria than the full cream milk from which it is radical changes in regard to prostitution obtained. Next, the skim milk before it is blended plating and venereal disease. One of the most interesting with the fats and oils is at once pasteurised, discussions on these subjects was organised by the heated, that is to say, to a temperature a little Swedish Medical Society, which devoted a series of below its boiling point. These precautions are 1911 1912 in and to these topics. In the taken by the manufacturer himself in his own meetings Svenska Läkaresällskapets Handlingar (vol. xli., interest, as unless the milk is thoroughly clean and Nr. 3. 1915) a summary of this discussion is given free from bacterial agencies there is a risk of the " by the Swedish Medicinalstyrelse (Board of resulting product being unstable, unsound, and Health). This discussion, in which leading members unpalatable. We should be surprised to find of the profession took part, not only revealed the margarine absolutely free from organisms, but we of the great complexity problems concerned, but should be equally astonished to find that it conalso showed how divergent were the views held as tained more organisms than butter. Facts all point the to best methods of regulating prostitution and to the reverse being the case. limiting venereal disease. Between the two extremes represented by the " regulationists" and " HYDROPS TUBÆ PROFLUENS. the abolitionists were the lukewarm supporters Dr. T. H. Llewellyn and Dr. T. B. Block have of regulation, who wanted the control of prostireported, in the Journat of the American Medical tutes to be exercised with more humanity than has Association of April lst, a case of the rare condition hitherto been the case. Finally, by 52 votes to 50, " termed " hydrops tubae profluens or intermittent a motion was passed emphasising the necessity "
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Annotations. "Ne quid nimis."
A stout woman, aged 33 years, came Nov. 15th, 1915. She had been married 14 years, and had one child some years ago. Her periods were never regular ; every other month the flow was profuse, and in the intervening months scanty. The last period was on Oct. 26th. The left tube had been removed four years previously. She complained of throbbing pains in the sacral and right ovarian regions, associated with a vaginal discharge. Two weeks previously whilst walking she felt a sharp stabbing pain in the right side and a sensation as though "something burst." A brownish vaginal discharge immediately followed and had persisted ever since. During the past two weeks she had a swelling in the right side of the abdomen. On examination the uterus was found slightly retroposed, mobile, and tender. In the left ovarian region induration and tenderness were detected. No mass was felt in the pelvis, but much importance was not attached to this fact as the patient was so stout. She returned every few days and frequently reported that she had attacks of sudden severe right-sided pain followed by a brownish vaginal discharge and disappearance of the pain. Hydrops tubee profluens was diagnosed. Laparotomy showed that the left ovary was transformed into a follicular cyst about the size of a peach. The right tube was enlarged and contained fluid. Supravaginal hysterectomy, right salpingectomy, and left oophorocystectomy were performed. Gentle pressure on the excised tube caused a flow of clear watery fluid from the ostium. Uneventful recovery followed. Intermittent hydrosalpinx seems to be due to closure of the abdominal ostium of the tube by adhesions while the uterine aperture remains patulous. When the pressure of the fluid contained in the tube reaches a certain peight the flow takes place. The characteristic symptom is intermittent pain relieved by the discharge. Physical signs may be absent or a mass may be felt, according to the condition of the tube at the time of examination. In reviewing the literature of the condition in 1906 an American writer, Findley, could collect only 59 cases, including one which he reported, and some of these are He doubtful, as no operation was performed. refers to the statistics of Martin, who could find only 8 examples among 1700 cases of salpingitis.
hydrosalpinx." to hospital on
MARGARINE AND BACTERIAL INFECTION AMONGST fatty foodsjust now margarine has taken an important place in the dietary as a wholesome substitute for the more expensive butter. Before the war there was still a prejudice against this article of food, but this has now been practically removed; economic considerations have led a good many people to try margarine, and as the result of practical test it has been adopted in many households. " Bosh," the trade name first chosen for the substance, was not attractive, and the word margarine was employed, being derived from the Greek word for pearl, and adopted because of the pearly appearance of margaric acid. Under this name, however, the substance was for some time looked upon as an inferior butter substitute, the sale of which opened the way to fraud, and its use was confined to the kitchen. Whatever may have been the quality of margarine years ago there can be little doubt that its manufacture has undergone very great improvement, and the product of the present day is a triumph of the art of the refined blending of various fats, vegetable and animal, with milk. The introduction of nut and seed oils, made flavourless and neutral by cleansing processes, is a comparatively recent departure. Margarine was originally made with oleo oil or the fluid portion of beef fat, with but a trifiing proportion of vegetable fat, while now there are vegetable butters sold which are made exclusively of nut oils. Generally speaking, it may be said that the higher grades contain much more animal fat than the lower grades, and this accounts for the two classes of margarine sold at very different prices, the former commanding practically twice the price of the latter. Perhaps the existence of high and low grades of margarine is responsible for the fact that a prejudice still exists against margarine in the public mind, for this is evident from certain statements which have found their way into the lay press, suggesting that margarine contains disease organisms derived from the milk withwhich it is blended. The suspicion is ill-founded. In the first place the cream is removed from the milk by a separator, and it is well known that THE VIEWS ON PROSTITUTION OF THE SWEDISH MEDICAL SOCIETY. with the removal of this cream a very large proportion of the bacteria is withdrawn, so that in As we have shown from time to time in these this respect separated milk would contain far less the authorities in Sweden are contemcolumns, bacteria than the full cream milk from which it is radical changes in regard to prostitution obtained. Next, the skim milk before it is blended plating and venereal disease. One of the most interesting with the fats and oils is at once pasteurised, discussions on these subjects was organised by the heated, that is to say, to a temperature a little Swedish Medical Society, which devoted a series of below its boiling point. These precautions are 1911 1912 in and to these topics. In the taken by the manufacturer himself in his own meetings Svenska Läkaresällskapets Handlingar (vol. xli., interest, as unless the milk is thoroughly clean and Nr. 3. 1915) a summary of this discussion is given free from bacterial agencies there is a risk of the " by the Swedish Medicinalstyrelse (Board of resulting product being unstable, unsound, and Health). This discussion, in which leading members unpalatable. We should be surprised to find of the profession took part, not only revealed the margarine absolutely free from organisms, but we of the great complexity problems concerned, but should be equally astonished to find that it conalso showed how divergent were the views held as tained more organisms than butter. Facts all point the to best methods of regulating prostitution and to the reverse being the case. limiting venereal disease. Between the two extremes represented by the " regulationists" and " HYDROPS TUBÆ PROFLUENS. the abolitionists were the lukewarm supporters Dr. T. H. Llewellyn and Dr. T. B. Block have of regulation, who wanted the control of prostireported, in the Journat of the American Medical tutes to be exercised with more humanity than has Association of April lst, a case of the rare condition hitherto been the case. Finally, by 52 votes to 50, " termed " hydrops tubae profluens or intermittent a motion was passed emphasising the necessity "
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