- Email: [email protected]
RADIATION CANCER OF THE PHARYNX
683 of vitamin A (Moore and Sykes 1940). The in which a vitamin-A deficiency may affect the normal production of the C.S.F. presents a problem which Since the must remain for the present unanswered. vitamins must profoundly influence cellular metabolism, it is not difficult to suppose that a vitamin imbalance or deficiency may disorganise the production of the C.s.r. by the cells of the choroid plexuses.
supplements manner
RADIATION CANCER OF THE PHARYNX RONALD W. RAVEN O.B.E., F.R.C.S. SURGEON, WESTMINSTER HOSPITAL TEACHING GROUP ; SURGEON, ROYAL CANCER HOSPITAL, LONDON
V. B. LEVISON M.B. Lond., F.F.R.
Conclusions and Comment
SENIOR
The experimental finding of hydrocephalus in stillborn and late foetal rabbits from dams subjected to prolonged vitamin-A deficiencies makes it possible to extend earlier observations on the effects of a maternal deficiency of vitamin A on the offspring. The hydrocephalus in these young is undoubtedly congenital, but the exact cause remains obscure. The available evidence supports the view that the primary cause is excessive production of C.S.F.
Considerable caution must be exercised in the application of observations made on laboratory animals suffering from vitamin deficiencies to human pathology. Gross vitamin-A deficiency in maternal diets must, in modern circumstances, arise but rarely. The possibility remains, nevertheless, that absorption of the vitamin by the mother may be interfered with by diseases affecting the intestinal tract, or that, even in the presence of normal absorption, there may be an inability to store or to use the vitamin
efficiently.
Congenital hydrocephalus in late fcetal and stillborn offspring of female rabbits subjected to prolonged vitamin-A deficiency before mating and during pregnancy has been investigated. The primary cause of this hydrocephalus has not yet been determined, but the evidence suggests that the determining factor may be an overproduction of c.s.F., combined with a relative insufficiency of the cerebral aqueduct. The observations are discussed in relation to the production of congenital abnormalities by vitamin dietary deficiencies and to current views on the aetiology of
hydrocephalus. The results of the experiments reported here confirm earlier observations of hydrocephalus in young rabbits from does - deficient in vitamin A and show that it is possible for the hydrocephalus to be already established at birth. This finding raises many questions about both the ætiology of congenital forms of hydrocephalus in man and the factors influencing the development of abnormalities in general.
(J. W. M. and D. H. M. W.) gratefully acknowledge
grant from the Nuffield Foundation in support of this work ; and one of us (G. E. L.) was, during a part of this work, a a
member of the research staff of the Agricultural Research Council. We wish to thank Prof. J. D. Boyd and Dr. J. Hammond for their advice and encouragement ; Miss M. Ellington for technical assistance ; and Mr. T. R. L. Brooks for the photographs. REFERENCES
Andersen, D. H. (1949) Amer. J. Path. 25, 163. Benda, C. E. (1954) J. Neuropath. exp. Neurol. 13, 14. Bonnevie, K. (1934) J. exp. Zool. 67, 443. Cornfield, D., Cooke, R. E. (1952) Pediatrics, 10, 33. Davis, L. E. (1924) J. med. Res. 44, 521. Hale, F. (1933) J. Hered. 24, 105. Kahn, E. A., Luros, J. T. (1952) J. Neurosurg. 9, 59. Lamming, G. E., Woollam, D. H. M., Millen, J. W. (1954) Brit. J. Nutrit. (in the press). Mellanby, E. (1941) J. Physiol. 99, 467. Millen, J. W., Woollam, D. H. M., Lamming, G. E. (1953) Lancet,
ii, 1234.
Moore,
L. A., Sykes, J. F. (1940) Amer. J. Physiol. 130, 684. B. L., Whitley, J. R., Hogan, A. G. (1948) Proc. Soc. Biol., N.Y. 69, 272. Warkany, J. (1947) Advanc. Pediat. 2, 1. Nelson, R. C. (1941) Anat. Rec. 79, 83. — Schraffenberger, E. (1944) J. Nutrit. 27, 477. Wolbach, S. B., Bessey, O. A. (1941) Arch. Path. 32, 689. Woollam, D. H. M., Millen, J. W. (1953) Brain, 76, 104.
O’Dell, —
RADIOTHERAPY
DEPARTMENT,
CAMBRIDGE
FoR many years it has been recognised that cancer develop in certain parts of the body after exposure to irradiation from radium and X rays. According to the first case was Hueper (1942) reported by Frieben Before the (1902), a malignant lesion of the skin. necessity for adequate protection was realised, persons exposed to radiation during their work developed. malignant disease. Rolleston (1930) cited Krause (1911), who referred to the deaths of 54 radiologists from this disease, and Ledoux-Lebard (1922), who estimated that 100 radiologists had died from this cause. This country was the first to insist on adequate protection, in can
1920. We
report here a case of cancer of the hypopharynx following radiotherapy for thyrotoxicosis. Case-record
spinster, aged 46, was seen on June 12, 1952, because of dysphagia and dyspneea. In 1929 she had consulted he another surgeon because she had Graves’s disease ; advised against surgical treatment, and she was treated by radiotherapy. Eight months ago she developed dysphagia for solids ; this became progressively worse until she could only swallow fluids taken from a spoon. There was also considerable regurgitation. During the last two weeks her breathing had become difficult and her voice husky. She had lost 2 stone in weight in six months. On examination she was pale and thin and had dyspnoea, stridor, and mild exophthaimos. There was a wide band of telangiectasis in the skin over the anterolateral aspects of the lower half of the neck, where the skin was thickened and scarred and had lost its elasticity. The hypopharynx and larynx were wider than normal but mobile, and the thyroid gland was indurated. The cervical lymph-nodes were not enlarged. Pharyngoscopy showed a postcricoid carcinoma, which was confirmedby biopsy. Operations.-A gastrostomy was made with a view to building up the patient’s general condition to undergo laryngo-oesophago-pharyngectomy. It was also decided that it would be necessary to transplant skin from the acromiopectoral region. A month later the neck was explored, but the carcinoma was found to have extended into the retropharyngeal tissues and to be necrotic and inoperable. Tracheotomy was done and the patient returned home after eleven days. She died four months later. Radiotherapy.-The following are the details of the X irradiation given to the patient in 1929 : Coolidge tube, 120 kV, 2-5 mA, aluminium filter 4 mrn. thick, focus-skin distance 23 em., right and left thyroid fields (8 cm. circle). Twelve treatments were given, starting on Aug. 9, 1929, at first fortnightly and later monthly until April 24, 1930. The length of treatment at one session varied from 12 to 20 minutes, and the total treatment given to each field lasted The exact rontgen dose corresponding to this 170 minutes. 170 minutes’ treatment is unknown but by calculation is thought to be 8000r ± 10%. This would have given 10,000r ±10% in the pharynx, where the carcinoma developed. A
Summary
Two of us
REGISTRAR,
ADDENBROOKE’S HOSPITAL,
exp.
-
Discussion
reviewed by Goolden (1951), and the, subject has been compiled. by us from the table accompanying case-records he cited and the present case. There are 10 patients, 9 females and 1 male, whose average age is 5&-2 7 had received radiotherapy for goitre, years. and 3 for tuberculous adenitisthe average interval between radiotherapy and the development of pharynWhen our patient’s neck geal cancer was 25 years. This
was
684 RADIATION CANCER OF THE PHARYNX
No. of Reference
Part affected
Age Sex (yr.))
years before
Original disease
Condition of skin of neck
cancer
developed Kruchen (1937) Kindler (1943) den Hoed (1946) Goolden (1951)
Ogilvie (1951) Present
case
65 59 43 41 69 50 76 49 54 46
F F M F F F F F F F
Posterior wall of hypopharynx Post-cricoid
Goitre
Aryepiglottic fold Aryepiglottic fold Pyriform fossa
Tuberculous adenitis Tuberculous adenitis
Post-cricoid Post-cricoid Posterior wall Post-cricoid Post-cricoid
Thyrotoxloosia Thyrotoxicosis Thyrotoxicosis
20 20 27 28 26 30 28
Thyrotoxicosis Thyrotoxicosis
23
Thyrotoxicosis
Tuberculous adenitis
explored, the cancer was found to be extensive and inoperable, having infiltrated through the posterior pharyngeal wall and extended widely in the prevertebral
Severe Severe
Necrotic nlcpr Necrotic ulcer
’I’elangicctasis with subcutaneous fibrosis Grafted area of skin Grafted area of skin Grafted area of skin Fibrosis and pigmentation Telangiectasis with subcutaneous fibrosis
30 18
Summary
was
tissues. Radiation Dosage.-In our patient it is calculated that a dose of about 8000r was delivered to the thyroid gland and 10,000r to the post-cricoid region of the pharynx. Goolden (1951) and Ogilvie (1951) do not state the dosages given to their patients. We have read the original papers of the other workers cited in the table but have In spite of the found few precise details of dosages. lack of this information it is fair to assume that a high dosage-rate was given to these patients, as is shown by the fact that changes were produced in the skin of the neck. den Hoed’s patient, aged 43, received a total dose of 20,000r in ten months. Other Varieties of Radiation Cancer.—We do not intend to develop this aspect of the subject, but we refer briefly to certain other cases which have been published. Kindler (1943) reported the case of a man, aged 54, who developed a carcinoma in the left lobe of the thyroid gland twenty-four years after radiotherapy for tuberculous cervical adenitis. Beck (1922) described 3 cases of malignant disease in bone at the site of previous radiotherapy for benign lesions, and we have studied 17 others published up to 1945. Of these patients 15 had received radiotherapy for tuberculous arthritis, and the average interval between radiotherapy and the development of malignancy in the whole group was 71/2 years. Cahan et al. (1948) reported 11 other cases in which malignancy developed after the irradiation of either benign bone tumours or of normal bone. It is well known that cancer of the skin may follow irradiation, -and many cases are reported in which malignancy has supervened in a benign skin lesion after radiotherapy. The subject has been investigated experimentally. Hueper (1942) stated that Bloch (1924) was the first to produce X-ray carcinoma in the skin of the rabbit’s ear. Burrows et al. (1937) produced inflammatory foci in the groins of 12 rabbits and then exposed them to X rays, each area receiving a single dose of 600r. Of 9 rabbits thus treated and surviving for two years or more tumours developed in 6 in the irradiated tissues, and in 4 these were metastasising sarcomas. Lacassagne and Vinzent (1929) irradiated an experimentally produced abscess close to the femur of a rabbit with a dose of 1200r, and an osteogenic sarcoma developed several months later. Lacassagne (1945) cited Hellner’s experiments in animals irradiated with radium in the knee-joint region for two years with doses of 2500-3000 mg. hr. ; in 3 animals an osteosarcoma developed after two years, three years, and three years and two months. Lacassagne stated that irradiation in doses as small as 600r could under certain conditions initiate malignancy in tissue after a latent period of from six months to four years. Hueper (1942) believed that the initial sclerotic and porotic irradiation reactions in bone, which are called radiation osteitis, represented an early stage in malignant transformation. ’
telangiectasis telangiectasis
A case of radiation cancer of the pharynx is described. Reference is made also to other varieties of radiation cancer.
We
are
to Prof. J. S. Mitchell for
grateful
permission
to
publish. REFERENCES
Beck, A. (1922) Munch. med. Wschr. 69, 623. Bloch, B. (1924) Schweiz. med. Wschr. 54, 867. Burrows, H., Mayncord, W. V., Roberts, J. E. (1937) Proc.
roy.
Soc B, 123, 213.
Cahan, W. G., Woodard, (1948) Cancer, 1, 3.
H. Q.,
Higinbotham, N. I., Stewart, F. W.
den Hoed, D. (1946) Acta radiol. Stockh. 27, 20. Frieben, A. (1902) Fortschr. Röntgenstr. 6, 106. Goolden, A. W. G. (1951) Brit. med. J. ii. 1110. Hueper, W. C. (1942) Occupational Tumors and Allied Diseases. Springfield, Ill. Kindler, K. (1943) Z. Krebsforsch. 54, 153. Krause, P. (1911) Z. Röntgentiefentherap. 13, 256. Kruchen, C. (1937) Strahlentherapie, 60, 466. Lacassagne, A. (1945) Les cancers produits par les rayonnements electromagnétiques. Paris. Vinzent, R. (1929) C. R. Soc. Biol. Paris, 100, 247. Ledoux-Lebard, R. (1922) Paris med. 12, 299. Ogilvie, C. M. (1951) Brit. med. J. ii, 1464. Rolleston, H. (1930) Quart. J. Med. 24, 101. —
ERYTHROMYCIN IN NON-SPECIFIC URETHRITIS* R. R. WILLCOX M.D. Lond. DEPARTMENT OF VENEREAL
CONSULTANT, ST.
MARY’S HOSPITAL,
DISEASES,
LONDON
non-specific urethritis the soorally administered antibiotics, oxytetracycline (terramycin) and chlortetracycline (aureomycin), have so far proved to be the most successful drugs (Harkness 1953, Willcox 1953). Recently a new antibiotic, erythromycin, prepared from Streptomyces erythreus, has become available. In venereology, erythromycin has been shown to give varying results in gonorrhoea : successful if 20 g. or more is given in a period of 24 hours or less (Gable et al. 1953, Manning et al. 1954), but unsuccessful if a daily dose smaller than this is spread over several days (Alexander and Schoch 1954). Erythromycin has been shown to be potent against syphilis (Keller and Morton IN the treatment of called broad-spectrum,
1953, Alexander and Schoch 1954) ; but both successful and Cohen 1953) and unsuccessful (Alexander and Schoch 1954) results have been reported in granuloma inguinale. Alexander and Schoch also stated that the drug had no action against lymphogranuloma venereum. Of particular interest is the report by Keller and Morton (1953) that pleuropneumonia-like organisms are highly resistant to erythromycin. These organisms have from time to time been incriminated as a possible cause of non-specific urethritis-for example, by Harkness (1950). The fact that those antibiotics which have been
(Robinson
*
Presented
at
a
symposium on non-specific urethritis, against the Veneral Diseases, Monaco,
International Union Sept. 23-24. 1954.
supplements manner
RADIATION CANCER OF THE PHARYNX RONALD W. RAVEN O.B.E., F.R.C.S. SURGEON, WESTMINSTER HOSPITAL TEACHING GROUP ; SURGEON, ROYAL CANCER HOSPITAL, LONDON
V. B. LEVISON M.B. Lond., F.F.R.
Conclusions and Comment
SENIOR
The experimental finding of hydrocephalus in stillborn and late foetal rabbits from dams subjected to prolonged vitamin-A deficiencies makes it possible to extend earlier observations on the effects of a maternal deficiency of vitamin A on the offspring. The hydrocephalus in these young is undoubtedly congenital, but the exact cause remains obscure. The available evidence supports the view that the primary cause is excessive production of C.S.F.
Considerable caution must be exercised in the application of observations made on laboratory animals suffering from vitamin deficiencies to human pathology. Gross vitamin-A deficiency in maternal diets must, in modern circumstances, arise but rarely. The possibility remains, nevertheless, that absorption of the vitamin by the mother may be interfered with by diseases affecting the intestinal tract, or that, even in the presence of normal absorption, there may be an inability to store or to use the vitamin
efficiently.
Congenital hydrocephalus in late fcetal and stillborn offspring of female rabbits subjected to prolonged vitamin-A deficiency before mating and during pregnancy has been investigated. The primary cause of this hydrocephalus has not yet been determined, but the evidence suggests that the determining factor may be an overproduction of c.s.F., combined with a relative insufficiency of the cerebral aqueduct. The observations are discussed in relation to the production of congenital abnormalities by vitamin dietary deficiencies and to current views on the aetiology of
hydrocephalus. The results of the experiments reported here confirm earlier observations of hydrocephalus in young rabbits from does - deficient in vitamin A and show that it is possible for the hydrocephalus to be already established at birth. This finding raises many questions about both the ætiology of congenital forms of hydrocephalus in man and the factors influencing the development of abnormalities in general.
(J. W. M. and D. H. M. W.) gratefully acknowledge
grant from the Nuffield Foundation in support of this work ; and one of us (G. E. L.) was, during a part of this work, a a
member of the research staff of the Agricultural Research Council. We wish to thank Prof. J. D. Boyd and Dr. J. Hammond for their advice and encouragement ; Miss M. Ellington for technical assistance ; and Mr. T. R. L. Brooks for the photographs. REFERENCES
Andersen, D. H. (1949) Amer. J. Path. 25, 163. Benda, C. E. (1954) J. Neuropath. exp. Neurol. 13, 14. Bonnevie, K. (1934) J. exp. Zool. 67, 443. Cornfield, D., Cooke, R. E. (1952) Pediatrics, 10, 33. Davis, L. E. (1924) J. med. Res. 44, 521. Hale, F. (1933) J. Hered. 24, 105. Kahn, E. A., Luros, J. T. (1952) J. Neurosurg. 9, 59. Lamming, G. E., Woollam, D. H. M., Millen, J. W. (1954) Brit. J. Nutrit. (in the press). Mellanby, E. (1941) J. Physiol. 99, 467. Millen, J. W., Woollam, D. H. M., Lamming, G. E. (1953) Lancet,
ii, 1234.
Moore,
L. A., Sykes, J. F. (1940) Amer. J. Physiol. 130, 684. B. L., Whitley, J. R., Hogan, A. G. (1948) Proc. Soc. Biol., N.Y. 69, 272. Warkany, J. (1947) Advanc. Pediat. 2, 1. Nelson, R. C. (1941) Anat. Rec. 79, 83. — Schraffenberger, E. (1944) J. Nutrit. 27, 477. Wolbach, S. B., Bessey, O. A. (1941) Arch. Path. 32, 689. Woollam, D. H. M., Millen, J. W. (1953) Brain, 76, 104.
O’Dell, —
RADIOTHERAPY
DEPARTMENT,
CAMBRIDGE
FoR many years it has been recognised that cancer develop in certain parts of the body after exposure to irradiation from radium and X rays. According to the first case was Hueper (1942) reported by Frieben Before the (1902), a malignant lesion of the skin. necessity for adequate protection was realised, persons exposed to radiation during their work developed. malignant disease. Rolleston (1930) cited Krause (1911), who referred to the deaths of 54 radiologists from this disease, and Ledoux-Lebard (1922), who estimated that 100 radiologists had died from this cause. This country was the first to insist on adequate protection, in can
1920. We
report here a case of cancer of the hypopharynx following radiotherapy for thyrotoxicosis. Case-record
spinster, aged 46, was seen on June 12, 1952, because of dysphagia and dyspneea. In 1929 she had consulted he another surgeon because she had Graves’s disease ; advised against surgical treatment, and she was treated by radiotherapy. Eight months ago she developed dysphagia for solids ; this became progressively worse until she could only swallow fluids taken from a spoon. There was also considerable regurgitation. During the last two weeks her breathing had become difficult and her voice husky. She had lost 2 stone in weight in six months. On examination she was pale and thin and had dyspnoea, stridor, and mild exophthaimos. There was a wide band of telangiectasis in the skin over the anterolateral aspects of the lower half of the neck, where the skin was thickened and scarred and had lost its elasticity. The hypopharynx and larynx were wider than normal but mobile, and the thyroid gland was indurated. The cervical lymph-nodes were not enlarged. Pharyngoscopy showed a postcricoid carcinoma, which was confirmedby biopsy. Operations.-A gastrostomy was made with a view to building up the patient’s general condition to undergo laryngo-oesophago-pharyngectomy. It was also decided that it would be necessary to transplant skin from the acromiopectoral region. A month later the neck was explored, but the carcinoma was found to have extended into the retropharyngeal tissues and to be necrotic and inoperable. Tracheotomy was done and the patient returned home after eleven days. She died four months later. Radiotherapy.-The following are the details of the X irradiation given to the patient in 1929 : Coolidge tube, 120 kV, 2-5 mA, aluminium filter 4 mrn. thick, focus-skin distance 23 em., right and left thyroid fields (8 cm. circle). Twelve treatments were given, starting on Aug. 9, 1929, at first fortnightly and later monthly until April 24, 1930. The length of treatment at one session varied from 12 to 20 minutes, and the total treatment given to each field lasted The exact rontgen dose corresponding to this 170 minutes. 170 minutes’ treatment is unknown but by calculation is thought to be 8000r ± 10%. This would have given 10,000r ±10% in the pharynx, where the carcinoma developed. A
Summary
Two of us
REGISTRAR,
ADDENBROOKE’S HOSPITAL,
exp.
-
Discussion
reviewed by Goolden (1951), and the, subject has been compiled. by us from the table accompanying case-records he cited and the present case. There are 10 patients, 9 females and 1 male, whose average age is 5&-2 7 had received radiotherapy for goitre, years. and 3 for tuberculous adenitisthe average interval between radiotherapy and the development of pharynWhen our patient’s neck geal cancer was 25 years. This
was
684 RADIATION CANCER OF THE PHARYNX
No. of Reference
Part affected
Age Sex (yr.))
years before
Original disease
Condition of skin of neck
cancer
developed Kruchen (1937) Kindler (1943) den Hoed (1946) Goolden (1951)
Ogilvie (1951) Present
case
65 59 43 41 69 50 76 49 54 46
F F M F F F F F F F
Posterior wall of hypopharynx Post-cricoid
Goitre
Aryepiglottic fold Aryepiglottic fold Pyriform fossa
Tuberculous adenitis Tuberculous adenitis
Post-cricoid Post-cricoid Posterior wall Post-cricoid Post-cricoid
Thyrotoxloosia Thyrotoxicosis Thyrotoxicosis
20 20 27 28 26 30 28
Thyrotoxicosis Thyrotoxicosis
23
Thyrotoxicosis
Tuberculous adenitis
explored, the cancer was found to be extensive and inoperable, having infiltrated through the posterior pharyngeal wall and extended widely in the prevertebral
Severe Severe
Necrotic nlcpr Necrotic ulcer
’I’elangicctasis with subcutaneous fibrosis Grafted area of skin Grafted area of skin Grafted area of skin Fibrosis and pigmentation Telangiectasis with subcutaneous fibrosis
30 18
Summary
was
tissues. Radiation Dosage.-In our patient it is calculated that a dose of about 8000r was delivered to the thyroid gland and 10,000r to the post-cricoid region of the pharynx. Goolden (1951) and Ogilvie (1951) do not state the dosages given to their patients. We have read the original papers of the other workers cited in the table but have In spite of the found few precise details of dosages. lack of this information it is fair to assume that a high dosage-rate was given to these patients, as is shown by the fact that changes were produced in the skin of the neck. den Hoed’s patient, aged 43, received a total dose of 20,000r in ten months. Other Varieties of Radiation Cancer.—We do not intend to develop this aspect of the subject, but we refer briefly to certain other cases which have been published. Kindler (1943) reported the case of a man, aged 54, who developed a carcinoma in the left lobe of the thyroid gland twenty-four years after radiotherapy for tuberculous cervical adenitis. Beck (1922) described 3 cases of malignant disease in bone at the site of previous radiotherapy for benign lesions, and we have studied 17 others published up to 1945. Of these patients 15 had received radiotherapy for tuberculous arthritis, and the average interval between radiotherapy and the development of malignancy in the whole group was 71/2 years. Cahan et al. (1948) reported 11 other cases in which malignancy developed after the irradiation of either benign bone tumours or of normal bone. It is well known that cancer of the skin may follow irradiation, -and many cases are reported in which malignancy has supervened in a benign skin lesion after radiotherapy. The subject has been investigated experimentally. Hueper (1942) stated that Bloch (1924) was the first to produce X-ray carcinoma in the skin of the rabbit’s ear. Burrows et al. (1937) produced inflammatory foci in the groins of 12 rabbits and then exposed them to X rays, each area receiving a single dose of 600r. Of 9 rabbits thus treated and surviving for two years or more tumours developed in 6 in the irradiated tissues, and in 4 these were metastasising sarcomas. Lacassagne and Vinzent (1929) irradiated an experimentally produced abscess close to the femur of a rabbit with a dose of 1200r, and an osteogenic sarcoma developed several months later. Lacassagne (1945) cited Hellner’s experiments in animals irradiated with radium in the knee-joint region for two years with doses of 2500-3000 mg. hr. ; in 3 animals an osteosarcoma developed after two years, three years, and three years and two months. Lacassagne stated that irradiation in doses as small as 600r could under certain conditions initiate malignancy in tissue after a latent period of from six months to four years. Hueper (1942) believed that the initial sclerotic and porotic irradiation reactions in bone, which are called radiation osteitis, represented an early stage in malignant transformation. ’
telangiectasis telangiectasis
A case of radiation cancer of the pharynx is described. Reference is made also to other varieties of radiation cancer.
We
are
to Prof. J. S. Mitchell for
grateful
permission
to
publish. REFERENCES
Beck, A. (1922) Munch. med. Wschr. 69, 623. Bloch, B. (1924) Schweiz. med. Wschr. 54, 867. Burrows, H., Mayncord, W. V., Roberts, J. E. (1937) Proc.
roy.
Soc B, 123, 213.
Cahan, W. G., Woodard, (1948) Cancer, 1, 3.
H. Q.,
Higinbotham, N. I., Stewart, F. W.
den Hoed, D. (1946) Acta radiol. Stockh. 27, 20. Frieben, A. (1902) Fortschr. Röntgenstr. 6, 106. Goolden, A. W. G. (1951) Brit. med. J. ii. 1110. Hueper, W. C. (1942) Occupational Tumors and Allied Diseases. Springfield, Ill. Kindler, K. (1943) Z. Krebsforsch. 54, 153. Krause, P. (1911) Z. Röntgentiefentherap. 13, 256. Kruchen, C. (1937) Strahlentherapie, 60, 466. Lacassagne, A. (1945) Les cancers produits par les rayonnements electromagnétiques. Paris. Vinzent, R. (1929) C. R. Soc. Biol. Paris, 100, 247. Ledoux-Lebard, R. (1922) Paris med. 12, 299. Ogilvie, C. M. (1951) Brit. med. J. ii, 1464. Rolleston, H. (1930) Quart. J. Med. 24, 101. —
ERYTHROMYCIN IN NON-SPECIFIC URETHRITIS* R. R. WILLCOX M.D. Lond. DEPARTMENT OF VENEREAL
CONSULTANT, ST.
MARY’S HOSPITAL,
DISEASES,
LONDON
non-specific urethritis the soorally administered antibiotics, oxytetracycline (terramycin) and chlortetracycline (aureomycin), have so far proved to be the most successful drugs (Harkness 1953, Willcox 1953). Recently a new antibiotic, erythromycin, prepared from Streptomyces erythreus, has become available. In venereology, erythromycin has been shown to give varying results in gonorrhoea : successful if 20 g. or more is given in a period of 24 hours or less (Gable et al. 1953, Manning et al. 1954), but unsuccessful if a daily dose smaller than this is spread over several days (Alexander and Schoch 1954). Erythromycin has been shown to be potent against syphilis (Keller and Morton IN the treatment of called broad-spectrum,
1953, Alexander and Schoch 1954) ; but both successful and Cohen 1953) and unsuccessful (Alexander and Schoch 1954) results have been reported in granuloma inguinale. Alexander and Schoch also stated that the drug had no action against lymphogranuloma venereum. Of particular interest is the report by Keller and Morton (1953) that pleuropneumonia-like organisms are highly resistant to erythromycin. These organisms have from time to time been incriminated as a possible cause of non-specific urethritis-for example, by Harkness (1950). The fact that those antibiotics which have been
(Robinson
*
Presented
at
a
symposium on non-specific urethritis, against the Veneral Diseases, Monaco,
International Union Sept. 23-24. 1954.