- Email: [email protected]
THE ACUTE VULVITIS OF LITTLE GIRLS. IS IT GONORRHŒAL?
1283 disease is to live at home, attend a school for physical defectives, and be periodically examined at a centre at a children’s hospital. I am, Sir, yours faithfully, REGINALD MILLER, M.D., F.R.C.P.
To the Editor
of THE LANCET.
a comment on Dr. Burnet’s letter, I ma3 be allowed to furnish a short account of ou] experience in Bristol. It is about six years since ou] colleagues in the school medical service began t( refer to Dr. C. E. K. Herapath and myself selected cases of doubtful or early cardiac disease discovered in the course of their routine medical inspections These children we saw in our out-patient rooms and then reported as to their fitness to attend school need for treatment, and so on. Between two and three years ago this plan was stabilised and extended by agreement between the various local authorities concerned on the one hand and certain hospital
SiB,—As
perhaps
on the other-a step which was promoted by the Cardiac Subcommittee of the Science Com-
physicians
mittee of the British Medical Association and assisted by the Medical Research Council-and since that time it has operated smoothly over an area of three counties. We trust that this work will afford a basis of data broad enough for conclusions as to means of prevention of rheumatic carditis, while at the same time we are convinced that good is already being done in bringing these children under medical care earlier, and over longer periods, than formerly. We think, moreover, that we have gained valuable experience in harmonious cooperation with our colleaguesthose of the whole-time services on the one hand, and the family practitioners on the other. It would be foolish to pretend that no difficulties have arisen, but so far it has proved possible, by relying on the goodwill of everyone concerned, to overcome all these. Valuable work of the same kind is also being done in London, Birmingham, Glasgow, and elsewhere. Those who are interested in tracing the progress of the whole movement will find some account of it in recent annual reports by the chief medical officer to the Board of Education. I am, Sir, yours faithfully, CAREY F. COOMBS.
THE ACUTE VULVITIS OF LITTLE GIRLS. GONORRHŒAL?
To the Editor of THE LANCET.
SiB,—In the contribution by Dr. H. C. Cameron in your issue of Nov. 23rd (p. 1115) several questions are raised which I feel require an answer. Dr. Cameron suggests that acute vulvitis in children may not be caused by the diplococcus found in adult infections. The following analysis, in my view, strongly supports the general belief that the organism in the two conditions is identical. Among 47 consecutive cases of gonococcal vulvovaginitis in children (bacteriologically confirmed) treated at the V.D. clinic of Guy’s Hospital, the infection in 20 cases (42’5 per cent.) was found to be present in one or other parent, although in some of the cases the parents denied symptoms. In one case, transferred from a ward where there was an epidemic of vulvo-vaginitis, no evidence of infection could be found in the parents. In 26 cases (54’5 per cent.) the examination of parents was either impossible or
bacteriological reports
were
I
SUGAR IN ASTHMA.
University Centre of Cardiac Research, General Hospital, Bristol, Dec. 9th, 1929.
IS IT
Whilst presenting these figures I do not for a. moment deny the well-known fact that organisms other than the gonococcus--for example, B. coli, the streptococcus, Jticrococcus catarrhalis, &c.-are frequently the cause of vaginal discharge in children and adults. Such cases after thorough investigation are discharged from the V.D. clinic as not venereal. Dr. Cameron suggests that the epidemic is kept up by the anxiety of those concerned in combating it and dies down only when their activities cease from exhaustion. I maintain that it is arrested by theisolation and treatment of affected cases and the Since improved prestrict enforcement of rules. ventive regulations have been carried out there has been no spread of gonococcal vulvo-vaginitis in thewards of Guy’s Hospital. The assumption that only local treatment is given by medical officers in charge of V.D. clinics is not justified. The general condition of children suffering from gonococcal vulvo-vaginitis is not ignored in these clinics and measures designed to promote thegeneral health are taken. In these cases the children generally show marked improvement in general condition and when judiciously handled do not show signs of nervous upset. At the Children’s Home, Waddon, where there ar& 37 beds for venereal disease, marked improvement in general health and gain in weight is the general rule, although local treatment is carried out daily in almost every case. Many cases of apparent recovery, under general and local treatment, are still found to be positive to bacteriological tests, sometimes months after all symptoms have disappeared. Also contacts with no symptoms are frequently found to be infected. These cases I consider to be carriers, comparable to those apparently well after general treatment only. It would be important to know the incidence of untraced infections due to this type of case. As to the question of ophthalmia, does Dr. Cameron consider it a common occurrence in adults ? I confess to have seen a case in adult or child only very rarely, excluding, of course, ophthalmia neonatorum. I consider that gonococcal infection in children is not the trivial condition which Dr. Cameron appears to imply, and that general treatment only is insufficient to effect a cure. I am, Sir, yours faithfully, MORNA RAWLINS.
inconclusive, although
clinical examination revealed extremely suspicious evidence. Among these 26 cases four were associated with the epidemic already mentioned.
I
To the Editor of THE LANCET. SIR,-In his interesting article last week (p. 1187 on Asthma in Children Dr. A. A. Osman says that as far as his experience goes " sugar is without value in the treatment of asthma in adults." May I say that only last summer a gentleman, aged 70, whom I have known many years told me that he was recently cured of asthma by eating honey for a short time, especially from the lime tree. I am, Sir, yours faithfully, R. HENSLOWE WELLINGTON. London, Dec. 9th, 1929.
SHEFFIELD
HOSPITALS.-According
to the
131st
annual report of Sheffield Royal Infirmary 6810 in-patients were treated to a conclusion, an increase of 573 ; they cost ae24s. ld. per week. The pressure upon the out-patient department may be gauged by the fact that 27,355 persons were treated in the casualty department section. A new block is being provided which will contain casualty, massage, dermatological, and dental departments, an accident theatre, pathological, physiological, and biochemical laboratories. Last year marked the completion of 50 years’ work of the Jessop Hospital for Women. The average stay of maternity patients was a small fraction in excess of 12 days ; the puerperal sepsis patients, on the other hand, remained for an average of 23 days. In the absence of the money needed toprovide research laboratories, especially for puerperal sepsis, it was hoped to convert some existing rooms for this purpose.
To the Editor
of THE LANCET.
a comment on Dr. Burnet’s letter, I ma3 be allowed to furnish a short account of ou] experience in Bristol. It is about six years since ou] colleagues in the school medical service began t( refer to Dr. C. E. K. Herapath and myself selected cases of doubtful or early cardiac disease discovered in the course of their routine medical inspections These children we saw in our out-patient rooms and then reported as to their fitness to attend school need for treatment, and so on. Between two and three years ago this plan was stabilised and extended by agreement between the various local authorities concerned on the one hand and certain hospital
SiB,—As
perhaps
on the other-a step which was promoted by the Cardiac Subcommittee of the Science Com-
physicians
mittee of the British Medical Association and assisted by the Medical Research Council-and since that time it has operated smoothly over an area of three counties. We trust that this work will afford a basis of data broad enough for conclusions as to means of prevention of rheumatic carditis, while at the same time we are convinced that good is already being done in bringing these children under medical care earlier, and over longer periods, than formerly. We think, moreover, that we have gained valuable experience in harmonious cooperation with our colleaguesthose of the whole-time services on the one hand, and the family practitioners on the other. It would be foolish to pretend that no difficulties have arisen, but so far it has proved possible, by relying on the goodwill of everyone concerned, to overcome all these. Valuable work of the same kind is also being done in London, Birmingham, Glasgow, and elsewhere. Those who are interested in tracing the progress of the whole movement will find some account of it in recent annual reports by the chief medical officer to the Board of Education. I am, Sir, yours faithfully, CAREY F. COOMBS.
THE ACUTE VULVITIS OF LITTLE GIRLS. GONORRHŒAL?
To the Editor of THE LANCET.
SiB,—In the contribution by Dr. H. C. Cameron in your issue of Nov. 23rd (p. 1115) several questions are raised which I feel require an answer. Dr. Cameron suggests that acute vulvitis in children may not be caused by the diplococcus found in adult infections. The following analysis, in my view, strongly supports the general belief that the organism in the two conditions is identical. Among 47 consecutive cases of gonococcal vulvovaginitis in children (bacteriologically confirmed) treated at the V.D. clinic of Guy’s Hospital, the infection in 20 cases (42’5 per cent.) was found to be present in one or other parent, although in some of the cases the parents denied symptoms. In one case, transferred from a ward where there was an epidemic of vulvo-vaginitis, no evidence of infection could be found in the parents. In 26 cases (54’5 per cent.) the examination of parents was either impossible or
bacteriological reports
were
I
SUGAR IN ASTHMA.
University Centre of Cardiac Research, General Hospital, Bristol, Dec. 9th, 1929.
IS IT
Whilst presenting these figures I do not for a. moment deny the well-known fact that organisms other than the gonococcus--for example, B. coli, the streptococcus, Jticrococcus catarrhalis, &c.-are frequently the cause of vaginal discharge in children and adults. Such cases after thorough investigation are discharged from the V.D. clinic as not venereal. Dr. Cameron suggests that the epidemic is kept up by the anxiety of those concerned in combating it and dies down only when their activities cease from exhaustion. I maintain that it is arrested by theisolation and treatment of affected cases and the Since improved prestrict enforcement of rules. ventive regulations have been carried out there has been no spread of gonococcal vulvo-vaginitis in thewards of Guy’s Hospital. The assumption that only local treatment is given by medical officers in charge of V.D. clinics is not justified. The general condition of children suffering from gonococcal vulvo-vaginitis is not ignored in these clinics and measures designed to promote thegeneral health are taken. In these cases the children generally show marked improvement in general condition and when judiciously handled do not show signs of nervous upset. At the Children’s Home, Waddon, where there ar& 37 beds for venereal disease, marked improvement in general health and gain in weight is the general rule, although local treatment is carried out daily in almost every case. Many cases of apparent recovery, under general and local treatment, are still found to be positive to bacteriological tests, sometimes months after all symptoms have disappeared. Also contacts with no symptoms are frequently found to be infected. These cases I consider to be carriers, comparable to those apparently well after general treatment only. It would be important to know the incidence of untraced infections due to this type of case. As to the question of ophthalmia, does Dr. Cameron consider it a common occurrence in adults ? I confess to have seen a case in adult or child only very rarely, excluding, of course, ophthalmia neonatorum. I consider that gonococcal infection in children is not the trivial condition which Dr. Cameron appears to imply, and that general treatment only is insufficient to effect a cure. I am, Sir, yours faithfully, MORNA RAWLINS.
inconclusive, although
clinical examination revealed extremely suspicious evidence. Among these 26 cases four were associated with the epidemic already mentioned.
I
To the Editor of THE LANCET. SIR,-In his interesting article last week (p. 1187 on Asthma in Children Dr. A. A. Osman says that as far as his experience goes " sugar is without value in the treatment of asthma in adults." May I say that only last summer a gentleman, aged 70, whom I have known many years told me that he was recently cured of asthma by eating honey for a short time, especially from the lime tree. I am, Sir, yours faithfully, R. HENSLOWE WELLINGTON. London, Dec. 9th, 1929.
SHEFFIELD
HOSPITALS.-According
to the
131st
annual report of Sheffield Royal Infirmary 6810 in-patients were treated to a conclusion, an increase of 573 ; they cost ae24s. ld. per week. The pressure upon the out-patient department may be gauged by the fact that 27,355 persons were treated in the casualty department section. A new block is being provided which will contain casualty, massage, dermatological, and dental departments, an accident theatre, pathological, physiological, and biochemical laboratories. Last year marked the completion of 50 years’ work of the Jessop Hospital for Women. The average stay of maternity patients was a small fraction in excess of 12 days ; the puerperal sepsis patients, on the other hand, remained for an average of 23 days. In the absence of the money needed toprovide research laboratories, especially for puerperal sepsis, it was hoped to convert some existing rooms for this purpose.