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PENICILLIN FOR SYPHILIS
129 and that in fact pressure by the clavicle the first rib is often a prime factor in the production of injuries thereto. Thus : " If in another- subject the outer end of the clavicle be forced backwards, so that it rests upon the first rib outside its tubercle, being separated from it by the scalenus medius, and a heavy blow be struck horizontally backwards on its padded outer extremity, in some rare cases the inner end of the clavicle is dislocated forwards, but in the large majority of cases the first rib is fractured at the point of impact. The facility with which this fracture of the first rib is produced is remarkable, and if one compares the relative thickness and strength of the first rib and clavicle and the mechanical advantage of the action of the clavicle upon the first rib, one would not be surprised to find this fracture occur not uncommonly during lifetime." (Lane, W. A. Guy’s Hosp. Rep. 1885).
insupportable, on
.
a much non-nursery children throughout the country. For this the Federation will seek the cooperation of medical officers of health in many areas. The purpose of the investigation is to obtain evidence which may have a bearing on the value of day nurseries, at least in so far as the health of the children is concerned, and which to that extent may be of assistance in determining future policy regarding day nurseries. JANET CAMPBELL, President. KATHERINE M. HIRST, Chairman, Medical Women’s Federation. Day Nursery Committee.
to the evidence of respiratory larger number of nursery and .
PENICILLIN FOR SYPHILIS SIR,—The introduction of penicillin into syphilo-
therapy recalls the years immediately following the last war when what was then the new, potent, and quickThe essential feature in deliberate assessment of the acting antisyphilitic remedy-neoarsphenamine--often truth of the various claims made is to realise that Lane failed to confer immunity from relapse where it was used was studying the whole of the anatomy of the spine, sternum, ribs, and ligaments, and their interplay, and without a supporting heavy metal. Relapse was far more frequent with neoarsphenamine in those days than meant by first rib " first rib plus its cartilage " ; whereas it is with penicillin today ; but it might not be unprofitmany studies based on radiography alone (and I believe Alderson’s to be such) are incomplete,- because they fail able to have in mind the experiences of earlier times when seeking to use to the best advantage this new drug to reveal or to take sufficient cognisance of the whole that is so lethal to the treponema, so harmless to the of the first rib (and the sternum) and deal only with the host. of the first rib. bony portion In your leading article of Dec. 30, 1944, favourable There is, I think, abundant evidence that fracture of comment- was made on the combined use of arsenic and the first rib " unit " is probably much commoner than penicillin. One would ask if there are objections to the Alderson has shown. It results from violence applied for there are use of bismuth along with penicillin ; to clavicle, sternum, or (under certain conditions) theoretical grounds for suggesting that, if not antagoncervical spine, being frequent in collision accidents. istic to the action of penicillin, bismuth is a more logical It certainly occurs, somewhat rarely, solely as a result to adjuvant than arsenic. During the 8-10 days of penimuscular action. But I maintain that no evidence cillin administration it should be possible to give a whatsoever has been adduced to justify the description number of injections of bismuth metal, or of one of the of " stress fracture " of the first rib. I strongly urge that, in order that the true nature of relatively insoluble bismuth salts, the therapeutic action " of which would be maintained for many weeks. This stress " or " fatigue " fracture shall be clearly understood, and the literature not obscured either by reports might achieve better results than by supplementing penicillin, .which is excreted within a few hours, with of fractures of violence or examples of pseudo-fraeture, arsenic, the effect of which is generally regarded as the terms be .not used unless there is real evidence that: (a),the bone affected is not diseased ; (b) no violence has lasting only a few days. One has every sympathy with the clinician who occurred which could have accounted for fracture ; and (c) the patient has been subjected to repeated sub- naturally wishes to ascertain what penicillin by itself can accomplish, without assistance from ’either of the threshold stresses, which, either by the frequency of remedies. Better results, however, older-established some other their repetition, or being superimposed upon for the intensive courses of oxophenarsine stress, might reasonably be shown to cause infraction were claimed when bismuth was added ; and a little bismuth might at the site under discussion. Meanwhile, there seems to go a long way towards making permanent in more nearly be no authoritative work to be placed against Lane’s 100% of cases the brilliant early results of the penicillin exhaustive studies which led him to the belief that treatment of svnhilis. more than was first rib were of the fractures common ROBERT FORGAN. Dagenham, Essex. supposed, and that they were of traumatic origin. J. BLAIR HARTLEY. Manchester. MALIGNANT MELANOMA HEALTH OF CHILDREN IN WAR-TIME SIR,—I should like to defend Miss Tod’s statement DAY NURSERIES about the " incompetent treatment." Is it realised that most pigmented moles which are treated are removed by attention to some Nov. drew 25, 1944, you SIR,—On the hairdresser by electrolysis at 6d. per treatment ? of the doubts that have been expressed about the value of day nurseries to the health and well-being of young H. M. DENHOLM-YOUNG. Farningham, Kent. children, mentioning - particularly the criticisms raised by Dr. Helen Mackay and Dr. Marjorie Back at a meeting CARE OF LABORATORY ANIMALS of the Medical Women’s Federation. The Federation, SIR,—Last year we wrote to all holders of the Home realising the importance of this subject in relation to Office licence asking them to send us information for use post-war planning for child welfare, has not allowed the in the forthcoming UFAW handbook on the care of matter to rest. Is day-nursery life beneficial in the animals. Thanks to valuable help from long run to the health of young children or is it not ? laboratory and also in America, Russia, and Opinion is divided and recorded evidence is scanty. It workers initBritain has been possible to discuss the care of most elsewhere, be of make known a to scheme may interest, therefore, if not all the smaller laboratory animals, but we are of research which is being organised by the Medical anxious to get into touch with those who have been Women’s Federation into the health of children in wartime day nurseries compared with children of similar successful in maintaining healthy stocks of the larger species-cats, dogs, and the smaller ungulates and priages not in nurseries. mates. These species will not be dealt with in detail in The scheme falls into two parts. One part comprises but we should like to include references to an investigation by a whole-time clinician covering a the handbook, accounts of methods of maintaining healthy published comparatively small number of children but extending and contented stocks, and also to mention laboratories over a, period of a year. This is already being carried at which advice on the subject can be given at first hand. out by Dr. Margaret McLaughlin, on behalf of the Medical Women’s Federation, in Birmingham, and we We should be grateful if those who could help in either of these ways would get into touch with us as soon as are greatly indebted to the medical officer of health and his staff in that city for making it possible to undertake possible, at 284, Regent’s Park Road, London, N3. C. W. HUME. the work. In the second part it is intended to compare Universities Federation F. JEAN VINTER. the results of a single examination (relating especially for Animal Welfare. ,
-
infection) of
insupportable, on
.
a much non-nursery children throughout the country. For this the Federation will seek the cooperation of medical officers of health in many areas. The purpose of the investigation is to obtain evidence which may have a bearing on the value of day nurseries, at least in so far as the health of the children is concerned, and which to that extent may be of assistance in determining future policy regarding day nurseries. JANET CAMPBELL, President. KATHERINE M. HIRST, Chairman, Medical Women’s Federation. Day Nursery Committee.
to the evidence of respiratory larger number of nursery and .
PENICILLIN FOR SYPHILIS SIR,—The introduction of penicillin into syphilo-
therapy recalls the years immediately following the last war when what was then the new, potent, and quickThe essential feature in deliberate assessment of the acting antisyphilitic remedy-neoarsphenamine--often truth of the various claims made is to realise that Lane failed to confer immunity from relapse where it was used was studying the whole of the anatomy of the spine, sternum, ribs, and ligaments, and their interplay, and without a supporting heavy metal. Relapse was far more frequent with neoarsphenamine in those days than meant by first rib " first rib plus its cartilage " ; whereas it is with penicillin today ; but it might not be unprofitmany studies based on radiography alone (and I believe Alderson’s to be such) are incomplete,- because they fail able to have in mind the experiences of earlier times when seeking to use to the best advantage this new drug to reveal or to take sufficient cognisance of the whole that is so lethal to the treponema, so harmless to the of the first rib (and the sternum) and deal only with the host. of the first rib. bony portion In your leading article of Dec. 30, 1944, favourable There is, I think, abundant evidence that fracture of comment- was made on the combined use of arsenic and the first rib " unit " is probably much commoner than penicillin. One would ask if there are objections to the Alderson has shown. It results from violence applied for there are use of bismuth along with penicillin ; to clavicle, sternum, or (under certain conditions) theoretical grounds for suggesting that, if not antagoncervical spine, being frequent in collision accidents. istic to the action of penicillin, bismuth is a more logical It certainly occurs, somewhat rarely, solely as a result to adjuvant than arsenic. During the 8-10 days of penimuscular action. But I maintain that no evidence cillin administration it should be possible to give a whatsoever has been adduced to justify the description number of injections of bismuth metal, or of one of the of " stress fracture " of the first rib. I strongly urge that, in order that the true nature of relatively insoluble bismuth salts, the therapeutic action " of which would be maintained for many weeks. This stress " or " fatigue " fracture shall be clearly understood, and the literature not obscured either by reports might achieve better results than by supplementing penicillin, .which is excreted within a few hours, with of fractures of violence or examples of pseudo-fraeture, arsenic, the effect of which is generally regarded as the terms be .not used unless there is real evidence that: (a),the bone affected is not diseased ; (b) no violence has lasting only a few days. One has every sympathy with the clinician who occurred which could have accounted for fracture ; and (c) the patient has been subjected to repeated sub- naturally wishes to ascertain what penicillin by itself can accomplish, without assistance from ’either of the threshold stresses, which, either by the frequency of remedies. Better results, however, older-established some other their repetition, or being superimposed upon for the intensive courses of oxophenarsine stress, might reasonably be shown to cause infraction were claimed when bismuth was added ; and a little bismuth might at the site under discussion. Meanwhile, there seems to go a long way towards making permanent in more nearly be no authoritative work to be placed against Lane’s 100% of cases the brilliant early results of the penicillin exhaustive studies which led him to the belief that treatment of svnhilis. more than was first rib were of the fractures common ROBERT FORGAN. Dagenham, Essex. supposed, and that they were of traumatic origin. J. BLAIR HARTLEY. Manchester. MALIGNANT MELANOMA HEALTH OF CHILDREN IN WAR-TIME SIR,—I should like to defend Miss Tod’s statement DAY NURSERIES about the " incompetent treatment." Is it realised that most pigmented moles which are treated are removed by attention to some Nov. drew 25, 1944, you SIR,—On the hairdresser by electrolysis at 6d. per treatment ? of the doubts that have been expressed about the value of day nurseries to the health and well-being of young H. M. DENHOLM-YOUNG. Farningham, Kent. children, mentioning - particularly the criticisms raised by Dr. Helen Mackay and Dr. Marjorie Back at a meeting CARE OF LABORATORY ANIMALS of the Medical Women’s Federation. The Federation, SIR,—Last year we wrote to all holders of the Home realising the importance of this subject in relation to Office licence asking them to send us information for use post-war planning for child welfare, has not allowed the in the forthcoming UFAW handbook on the care of matter to rest. Is day-nursery life beneficial in the animals. Thanks to valuable help from long run to the health of young children or is it not ? laboratory and also in America, Russia, and Opinion is divided and recorded evidence is scanty. It workers initBritain has been possible to discuss the care of most elsewhere, be of make known a to scheme may interest, therefore, if not all the smaller laboratory animals, but we are of research which is being organised by the Medical anxious to get into touch with those who have been Women’s Federation into the health of children in wartime day nurseries compared with children of similar successful in maintaining healthy stocks of the larger species-cats, dogs, and the smaller ungulates and priages not in nurseries. mates. These species will not be dealt with in detail in The scheme falls into two parts. One part comprises but we should like to include references to an investigation by a whole-time clinician covering a the handbook, accounts of methods of maintaining healthy published comparatively small number of children but extending and contented stocks, and also to mention laboratories over a, period of a year. This is already being carried at which advice on the subject can be given at first hand. out by Dr. Margaret McLaughlin, on behalf of the Medical Women’s Federation, in Birmingham, and we We should be grateful if those who could help in either of these ways would get into touch with us as soon as are greatly indebted to the medical officer of health and his staff in that city for making it possible to undertake possible, at 284, Regent’s Park Road, London, N3. C. W. HUME. the work. In the second part it is intended to compare Universities Federation F. JEAN VINTER. the results of a single examination (relating especially for Animal Welfare. ,
-
infection) of