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ORAL CONTRACEPTION
524
sclerotic area, is apparent. Changes in pyogenic osteomyelitis usually progress rapidly, and new bone is often produced. Bony ankylosis of the diseased vertebrae may develop later. When the infection is subacute or chronic the radiographic changes are usually distinct, but may resemble those of a tuberculous infection or even a simple degenerative process. The leucocyte-count is seldom raised except in the acute lesion, and blood-culture is rarely positive. Serological tests for staphylococcal infection may be of value in the subacute or chronic case. The anti-oc. hsemolysin is probably the commoner test, and readings greater than 2 units are rarely found in the absence of staphylococcal infection, although Towers and Gladstone8 noted that two-thirds of their cases of osteomyelitis had a value lower than this on admission. A further test of probably greater value is the anti-Panton-Valentine leucocidin titre,9 and a combination of these two tests can be used both for diagnosis of infection and for assessment of
activity. SCHOOL DENTAL SERVICE IN DANGER
THE first group of " dental auxiliaries " to be trained under the General Dental Council’s experimental scheme will be leaving the School for Dental Auxiliaries at New Cross this summer, to work in the local-authority dental services. If they are a success, the scheme will continue; other training schools will no doubt be set up elsewhere, and the number of trained auxiliaries will be increased as rapidly as possible. Soon they should be bringing considerable help to the school dental service, which is chronically undermanned. The degree to which the local-authority services lack staff varies from place to place. In many industrial areas, such as parts of South Wales, there are so few dentists that the service may break down. In Glamorgan, helped by a few practitioners employed part-time, two dental officers are trying to cope with the dental ills of 130,000 children. In Monmouthshire things are little better. The situation is made more serious by a shortage of dentists in the general dental service as well, which means that priority groups cannot easily get treatment from local practitioners when it is not to be had from the local-authority service. This injustice might be partly redressed if the local authorities which are hardest hit were given first claim on the services of the newly qualified dental auxiliaries; but these young women are no more likely to be attracted to the industrial areas than are dentists and doctors. At present, girls accepted as student dental auxiliaries are reasonably sure they will be found jobs with local authorities near their homes, and any hint that, after training, they might be directed " to less agreeable parts of the country would undoubtedly hinder recruitment. On the other hand, no objection could be taken to the principle of reserving the majority of places at the training school for suitable candidates who live in areas where there is the greatest shortage of dentists--on the understanding that when they finished their training they would take up appointments with local authorities near their homes. A survey of the distribution of dental manpower would establish where the shortage is most serious, and training places could then be allocated on this basis. It "
8. 9.
Towers, A. G., Gladstone, G. P. Lancet, 1958, ii, 1192. Towers, A. G. J. clin. Path. 1961, 14, 161.
might even be thought expedient to undertake active recruiting of student auxiliaries in the localities where school dentists are scarcest. Though these measures offer a prospect of partially restoring the dental services, this cannot happen overnight. For some years to come, a great many people will have to accept a highly unsatisfactory state of affairs, in which they can expect little dental attention beyond emergency treatment for the relief of toothache-simply because they live in the wrong parts of the country.
ORAL CONTRACEPTION
FOR nine years Dr. Edris Rice-Wray worked in Puerto Rico, where she was responsible for the first large trial of an oral progestational agent in contraception. The women involved in this trial (with norethynodrel) have now been followed up for six years; no harmful long-term effects have yet appeared. Last Monday Dr. Rice-Wray described further work in Mexico to a meeting in London of the International Planned Parenthood Federation. In this trial in Mexico, ’Orthonovum ’, which contains both norethynodrel and an oestrogen, has been given to 364 women over 39 menstrual cycles, and has proved reliable. (Norethynodrel alone was found to cause a high incidence of menstrual irregularity-" break-through " bleeding and missed menstruation.) Cervical mucous and vaginal cells were examined to check whether ovulation had occurred. It was found to be consistently suppressed while the pills were taken conscientiously. " Dr. Rice-Wray has observed 42 intentional" pregnancies after orthonovum had been taken for a time. There were no evident ill effects: notably, no female infant showed signs of virilisation. Further, she cited figures which suggested that, once the tablets were withdrawn, fertility was greater than after a similar time in which local contraceptive methods were used, The tablets were found to diminish or suppress lactation in 1 woman in 3. Where economics may render breast-feeding urgently necessary, this is a serious matter. Once the risk was appreciated, it was explained to the mother, and the choice was hers. If she wished it, orthonovum was re-started some thirty days after the birth of the child. Where breast-feeding then continued successfully, no ill effects were seen in the infant. No estimates have yet been made of the concentrations of the hormones in the milk. Dr. Rice-Wray touched on the possible carcinogenic role of the oestrogens. A cervical smear was taken from every woman in the trial, before she started taking the tablets. In 2 cases, doubtful cytological changes were found at this stage. Check smears were repeated at twelve-monthly intervals in all the women: no further positive results were obtained. Biochemical tests-blood-counts, erythroctye-sedimentation rates, and liver function tests-remained consistently normal, as did 17-ketosteroid-excretion rates in 30 women chosen at random from the series. Dr. Rice-Wray emphasised that the oral contraceptives are no solution to the great population problems of the
developing countries. They are still expensive, and they be given under medical supervision, which cannot be available in remote areas. But her experience with must
them enabled her afraid at all."
to
say:
"
I
am not
afraid of them-not
sclerotic area, is apparent. Changes in pyogenic osteomyelitis usually progress rapidly, and new bone is often produced. Bony ankylosis of the diseased vertebrae may develop later. When the infection is subacute or chronic the radiographic changes are usually distinct, but may resemble those of a tuberculous infection or even a simple degenerative process. The leucocyte-count is seldom raised except in the acute lesion, and blood-culture is rarely positive. Serological tests for staphylococcal infection may be of value in the subacute or chronic case. The anti-oc. hsemolysin is probably the commoner test, and readings greater than 2 units are rarely found in the absence of staphylococcal infection, although Towers and Gladstone8 noted that two-thirds of their cases of osteomyelitis had a value lower than this on admission. A further test of probably greater value is the anti-Panton-Valentine leucocidin titre,9 and a combination of these two tests can be used both for diagnosis of infection and for assessment of
activity. SCHOOL DENTAL SERVICE IN DANGER
THE first group of " dental auxiliaries " to be trained under the General Dental Council’s experimental scheme will be leaving the School for Dental Auxiliaries at New Cross this summer, to work in the local-authority dental services. If they are a success, the scheme will continue; other training schools will no doubt be set up elsewhere, and the number of trained auxiliaries will be increased as rapidly as possible. Soon they should be bringing considerable help to the school dental service, which is chronically undermanned. The degree to which the local-authority services lack staff varies from place to place. In many industrial areas, such as parts of South Wales, there are so few dentists that the service may break down. In Glamorgan, helped by a few practitioners employed part-time, two dental officers are trying to cope with the dental ills of 130,000 children. In Monmouthshire things are little better. The situation is made more serious by a shortage of dentists in the general dental service as well, which means that priority groups cannot easily get treatment from local practitioners when it is not to be had from the local-authority service. This injustice might be partly redressed if the local authorities which are hardest hit were given first claim on the services of the newly qualified dental auxiliaries; but these young women are no more likely to be attracted to the industrial areas than are dentists and doctors. At present, girls accepted as student dental auxiliaries are reasonably sure they will be found jobs with local authorities near their homes, and any hint that, after training, they might be directed " to less agreeable parts of the country would undoubtedly hinder recruitment. On the other hand, no objection could be taken to the principle of reserving the majority of places at the training school for suitable candidates who live in areas where there is the greatest shortage of dentists--on the understanding that when they finished their training they would take up appointments with local authorities near their homes. A survey of the distribution of dental manpower would establish where the shortage is most serious, and training places could then be allocated on this basis. It "
8. 9.
Towers, A. G., Gladstone, G. P. Lancet, 1958, ii, 1192. Towers, A. G. J. clin. Path. 1961, 14, 161.
might even be thought expedient to undertake active recruiting of student auxiliaries in the localities where school dentists are scarcest. Though these measures offer a prospect of partially restoring the dental services, this cannot happen overnight. For some years to come, a great many people will have to accept a highly unsatisfactory state of affairs, in which they can expect little dental attention beyond emergency treatment for the relief of toothache-simply because they live in the wrong parts of the country.
ORAL CONTRACEPTION
FOR nine years Dr. Edris Rice-Wray worked in Puerto Rico, where she was responsible for the first large trial of an oral progestational agent in contraception. The women involved in this trial (with norethynodrel) have now been followed up for six years; no harmful long-term effects have yet appeared. Last Monday Dr. Rice-Wray described further work in Mexico to a meeting in London of the International Planned Parenthood Federation. In this trial in Mexico, ’Orthonovum ’, which contains both norethynodrel and an oestrogen, has been given to 364 women over 39 menstrual cycles, and has proved reliable. (Norethynodrel alone was found to cause a high incidence of menstrual irregularity-" break-through " bleeding and missed menstruation.) Cervical mucous and vaginal cells were examined to check whether ovulation had occurred. It was found to be consistently suppressed while the pills were taken conscientiously. " Dr. Rice-Wray has observed 42 intentional" pregnancies after orthonovum had been taken for a time. There were no evident ill effects: notably, no female infant showed signs of virilisation. Further, she cited figures which suggested that, once the tablets were withdrawn, fertility was greater than after a similar time in which local contraceptive methods were used, The tablets were found to diminish or suppress lactation in 1 woman in 3. Where economics may render breast-feeding urgently necessary, this is a serious matter. Once the risk was appreciated, it was explained to the mother, and the choice was hers. If she wished it, orthonovum was re-started some thirty days after the birth of the child. Where breast-feeding then continued successfully, no ill effects were seen in the infant. No estimates have yet been made of the concentrations of the hormones in the milk. Dr. Rice-Wray touched on the possible carcinogenic role of the oestrogens. A cervical smear was taken from every woman in the trial, before she started taking the tablets. In 2 cases, doubtful cytological changes were found at this stage. Check smears were repeated at twelve-monthly intervals in all the women: no further positive results were obtained. Biochemical tests-blood-counts, erythroctye-sedimentation rates, and liver function tests-remained consistently normal, as did 17-ketosteroid-excretion rates in 30 women chosen at random from the series. Dr. Rice-Wray emphasised that the oral contraceptives are no solution to the great population problems of the
developing countries. They are still expensive, and they be given under medical supervision, which cannot be available in remote areas. But her experience with must
them enabled her afraid at all."
to
say:
"
I
am not
afraid of them-not