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THE " IRON LUNG "
1380
PERCUTANEOUS ABSORPTION OF MALE HORMONE
Therefore, it seems doubtful whether the threshold be raised by such means, and one would hesitate to induce convulsions in epilepsy except to dispel the psychic equivalents. The therapeutic range of convulsion therapy is by no means limited to cases of schizophrenia, but it would be mifortunate if the public, or perhaps even the profession, came to believe that every case, whatever its type or duration, could be cured by the induction of fits. can
I am,
Sir,
yours
London, W., Dec. 5th.
faithfully,
H. PULLAR STRECKER.
work, and so forth, that appears to me also to require special study. These uses were well recognised by the American pioneers, the brothers Drinker. I am sure Sir Henry is right to insist upon the care of these " life or deathinstruments, and the need for trained assistants. T
of THE
LANCET
SIR,-YOur leading article of Oct. 22nd is rather
disturbing to anyone who has had reason to believe efficacy of prophylactic inoculation against
in the colds. It is
impossible for the general practitioner to state categorically that a patient acquires immunity aftera course of vaccine, but it is possible to say that many patients previously extremely susceptible to colds appear to resist infections after such a course, for periods of eighteen months to two years, and this has been my experience during eighteen years of practice in South Africa, Rhodesia, and Kenya. I always use the Compound Coryza Vaccine prepared by the South Afiican Institute for Medical Research in Johannesburg, and have found that in some 70-80 per cent. of cases immunity, or apparent immunity, is conferred. It is rather disappointing to think that such effects are post not propter hoc. I cannot believe that these results are merely psychological, particularly as in one of my successful cases previous prophylactic vaccines in England had failed. I am, Sir, yours faithfully, G. DUNDERDALE. Nanyuki, Kenya Colony, Nov. 30th. THE " IRON LUNG "
To the Editor
of
THE LANCET
SiR,—I read with interest Sir Henry Gauvain’s letter on the lron Lung and support his comments. In the Daily Telegraph of Nov. 26th I recalled that in 1934, through the generosity of the Imperial Chemical Co., and acting under the advice of Dr. T. E. Stowell and Dr. G. P. Crowden, I obtained for the Hospital for Sick Children, Great Ormond-street, the first English-made "lung." The makers (the Siebe Gorman firm) gave us every help with technical advice and we had the assistance of the skilled sister of my ward, Miss Magall. It was an interesting experience, confirming my belief in the high intelligence of the British, and the virile courtesy of our profession. The lay committee thought I was dealing with some new form of mechanism for providing drinks, and with some difficulty a certain number of students, nurses, and a few doctors were collected to hear an excellent demonstration by Dr. Crowden and Mr. Gorman Davis. The press also showed interest. The immediate object of this letter, however, is to give my opinion-knowing something of the pathology of polio-encephalitis-that we cannot expect very much. If the outlying zone of the lesions are in question, then the " lung " will help, but I have seen serious lesions near the vital centres recover without such help because the respiratory apparatus was only threatened and not killed. Diphtheritic paralysis, provided the heart is not too much damaged, is more encouraging. It is the use of the lung in fires, partial electrocution, drowning, gas poisoning, mine
Pir
’BTfI111’>!
f!1.itJrfnlhr
F. JOHN POYNTON.
Bath, Dec. 2nd.
PERCUTANEOUS ABSORPTION OF MALE HORMONE
To the Editor
INOCULATION AGAINST COLDS
To the Editor
o/m
of THE
LANCET
SIR,-Dr. Alfred A. Loeser has drawn my attention to the fact that in a letter to THE LANCET of May 14th, 1938 (p. 1134), he mentioned briefly that he had treated cases of thyrotoxicosis in women by percutaneous application of an alcoholic solution of He said that the pertestosterone propionate. cutaneous dose corresponds to the dose given intramuscularly ; also, he madebrief mention of this application at the Congress of Obstetrics and Gynaecology in Amsterdam on May 8th. I must ask Dr. Loeser to accept my apologies for omitting this reference in my paper. In your annotation (p. 1308) discussing the possi. bilities of oral therapy with testosterone and the more recent derivatives-methyl testosterone and ethinyl testosterone-it is pointed out that the species difference in rats and rabbits of oral therapy with methyl testosterone has given rise to some ambiguity as to their efficacy by this route and their possible application to human therapy. In preliminary experiments with testosterone by mouth I have produced slight potency in a eunuch by giving 100 mg. daily, divided into ten hourly doses of 10 mg. (4x2-5 mg. tablets). Although at present this is an extremely wasteful method, in view of its apparent activity I hope to increase the doses given and to try methyl testosterone and ethinyl testosterone. I have found that progesterone has almost as much androgenic activity by injection in the eunuch as testosterone propionate, and it would be extremely interesting to discover whether anhydro-oxy-progesterone, although apparently non-androgenic in laboratory animals, is active by mouth in man, in view of the marked increase in cestrogenic activity of the ethinyl derivative of oestradiol when given
orally.
I am,
Sir, yours faithfully, G. L. Foss.
Bristol, Dec. 5th.
SPONTANEOUS HÆMOTHORAX To the Editor
of
THE LANCET
SIR,-In your issue of Oct. 8th (p. 831) Dr. Kenneth Perry says that in spontaneous haemothorax " the patient will be shocked and show evidence of internal hsemorrhage." This statement is undoubtedly supported by almost all the reports on such cases. How. ever, a case which I published in the Klinische oc6sc7M’ of June 20th, 1936 (p. 906), shows that occasionally the symptoms may be very mild. That patient, from whose pleura more than 300 c.cm. of pure blood had been extracted, was never shocked, had only moderate pain which did not prevent him from walking about in his room, and did not show any signs of internal haemorrhage. I am, Sir, yours faithfully. ERIC G. VIO, Assistant Superintendent of Hospitals, Nov. 5th.
Shanghai Municipal Council.
PERCUTANEOUS ABSORPTION OF MALE HORMONE
Therefore, it seems doubtful whether the threshold be raised by such means, and one would hesitate to induce convulsions in epilepsy except to dispel the psychic equivalents. The therapeutic range of convulsion therapy is by no means limited to cases of schizophrenia, but it would be mifortunate if the public, or perhaps even the profession, came to believe that every case, whatever its type or duration, could be cured by the induction of fits. can
I am,
Sir,
yours
London, W., Dec. 5th.
faithfully,
H. PULLAR STRECKER.
work, and so forth, that appears to me also to require special study. These uses were well recognised by the American pioneers, the brothers Drinker. I am sure Sir Henry is right to insist upon the care of these " life or deathinstruments, and the need for trained assistants. T
of THE
LANCET
SIR,-YOur leading article of Oct. 22nd is rather
disturbing to anyone who has had reason to believe efficacy of prophylactic inoculation against
in the colds. It is
impossible for the general practitioner to state categorically that a patient acquires immunity aftera course of vaccine, but it is possible to say that many patients previously extremely susceptible to colds appear to resist infections after such a course, for periods of eighteen months to two years, and this has been my experience during eighteen years of practice in South Africa, Rhodesia, and Kenya. I always use the Compound Coryza Vaccine prepared by the South Afiican Institute for Medical Research in Johannesburg, and have found that in some 70-80 per cent. of cases immunity, or apparent immunity, is conferred. It is rather disappointing to think that such effects are post not propter hoc. I cannot believe that these results are merely psychological, particularly as in one of my successful cases previous prophylactic vaccines in England had failed. I am, Sir, yours faithfully, G. DUNDERDALE. Nanyuki, Kenya Colony, Nov. 30th. THE " IRON LUNG "
To the Editor
of
THE LANCET
SiR,—I read with interest Sir Henry Gauvain’s letter on the lron Lung and support his comments. In the Daily Telegraph of Nov. 26th I recalled that in 1934, through the generosity of the Imperial Chemical Co., and acting under the advice of Dr. T. E. Stowell and Dr. G. P. Crowden, I obtained for the Hospital for Sick Children, Great Ormond-street, the first English-made "lung." The makers (the Siebe Gorman firm) gave us every help with technical advice and we had the assistance of the skilled sister of my ward, Miss Magall. It was an interesting experience, confirming my belief in the high intelligence of the British, and the virile courtesy of our profession. The lay committee thought I was dealing with some new form of mechanism for providing drinks, and with some difficulty a certain number of students, nurses, and a few doctors were collected to hear an excellent demonstration by Dr. Crowden and Mr. Gorman Davis. The press also showed interest. The immediate object of this letter, however, is to give my opinion-knowing something of the pathology of polio-encephalitis-that we cannot expect very much. If the outlying zone of the lesions are in question, then the " lung " will help, but I have seen serious lesions near the vital centres recover without such help because the respiratory apparatus was only threatened and not killed. Diphtheritic paralysis, provided the heart is not too much damaged, is more encouraging. It is the use of the lung in fires, partial electrocution, drowning, gas poisoning, mine
Pir
’BTfI111’>!
f!1.itJrfnlhr
F. JOHN POYNTON.
Bath, Dec. 2nd.
PERCUTANEOUS ABSORPTION OF MALE HORMONE
To the Editor
INOCULATION AGAINST COLDS
To the Editor
o/m
of THE
LANCET
SIR,-Dr. Alfred A. Loeser has drawn my attention to the fact that in a letter to THE LANCET of May 14th, 1938 (p. 1134), he mentioned briefly that he had treated cases of thyrotoxicosis in women by percutaneous application of an alcoholic solution of He said that the pertestosterone propionate. cutaneous dose corresponds to the dose given intramuscularly ; also, he madebrief mention of this application at the Congress of Obstetrics and Gynaecology in Amsterdam on May 8th. I must ask Dr. Loeser to accept my apologies for omitting this reference in my paper. In your annotation (p. 1308) discussing the possi. bilities of oral therapy with testosterone and the more recent derivatives-methyl testosterone and ethinyl testosterone-it is pointed out that the species difference in rats and rabbits of oral therapy with methyl testosterone has given rise to some ambiguity as to their efficacy by this route and their possible application to human therapy. In preliminary experiments with testosterone by mouth I have produced slight potency in a eunuch by giving 100 mg. daily, divided into ten hourly doses of 10 mg. (4x2-5 mg. tablets). Although at present this is an extremely wasteful method, in view of its apparent activity I hope to increase the doses given and to try methyl testosterone and ethinyl testosterone. I have found that progesterone has almost as much androgenic activity by injection in the eunuch as testosterone propionate, and it would be extremely interesting to discover whether anhydro-oxy-progesterone, although apparently non-androgenic in laboratory animals, is active by mouth in man, in view of the marked increase in cestrogenic activity of the ethinyl derivative of oestradiol when given
orally.
I am,
Sir, yours faithfully, G. L. Foss.
Bristol, Dec. 5th.
SPONTANEOUS HÆMOTHORAX To the Editor
of
THE LANCET
SIR,-In your issue of Oct. 8th (p. 831) Dr. Kenneth Perry says that in spontaneous haemothorax " the patient will be shocked and show evidence of internal hsemorrhage." This statement is undoubtedly supported by almost all the reports on such cases. How. ever, a case which I published in the Klinische oc6sc7M’ of June 20th, 1936 (p. 906), shows that occasionally the symptoms may be very mild. That patient, from whose pleura more than 300 c.cm. of pure blood had been extracted, was never shocked, had only moderate pain which did not prevent him from walking about in his room, and did not show any signs of internal haemorrhage. I am, Sir, yours faithfully. ERIC G. VIO, Assistant Superintendent of Hospitals, Nov. 5th.
Shanghai Municipal Council.