TUBERCULOUS ABSCESS AT THE SITE OF INJECTIONS

709 cancer

of the

cervix, but instead to take

up radium

therapy." The passing years are proving the wisdom of this protest, and many of those younger surgeons, whom he has trained, are finding that with hands less skilful than the hands which taught them they are able to perform the Bonney-Wertheim hysterectomy with a very low mortality. These results are made possible by team-work, improved anaesthesia, specific chemotherapy, and improvements in preoperative preparation and postoperative care. In that same Hunterian lecture Mr. Bonney stated that " the truth of the matter probably is that in certain cases surgery, and in others radium, would give the best chance of cure." Believing that until a specific cure for cancer was found the hope for the future, as far as carcinoma of the cervix was concerned, rested in a closer combination of both radiation and surgery, I have in my department advocated and practised the BonneyWertheim operation, after a full Stockholm course of radium, on suitable cases. That this procedure is logical will be explained in a subsequent publication giving details of the series, which though small is now growing To date only 20 patients have been treated more rapidly. in this way. There have been no operative or postoperative deaths, no nstulse, and no serious complications. Moreover the fact has been established that if the operation is performed a week after the last application of radium no technical difficulties result from the preliminary radiation. At the follow-up clinic these patients are unbelievably well six weeks after the operation. It is too early to assess end-results, but if they prove encouraging it is to be hoped that with the regional development of medicine patients with cancer of the cervix will be given the benefit of treatment in departments where radiotherapists and gynaecological surgeons, trained to perform the necessary radical surgery, will work in the closest harmony. If future results justify the combined method of treatment, and by so doing bring life and health to many at,present condemned to die, it must not be forgotten that the man who made these results possible by his courageous and brilliant pioneer work was Mr. Victor Bonney, a British surgeon, an international teacher, and a supreme master of surgical technique. JOHN STALLWORTHY. Oxford.

because in the deaths from vagal inhibition I have been called to see, death had always taken place long before I saw the body. R. BRUNEL HAWES. London, S.’V.1. CARDIOSPASM SiB,—With reference to the article by Sir Adolphe Abrahams (April 2) and Dr. Magonet’s letter (April 9), I suggest that difficulty in swallowing from emotional causes has no relation to cardiospasm but is due to cricoideus spasm-a condition I described some years 1

ago.

The dysphagia of disappointment extremely severe. I remember well

can be young mother who had been unable to take any solids for a week. The sight of her infant gave me a clue, and I soon discovered that the source of her distress was that she wanted a boy and had got a girl! The symptoms cleared up almost at once, though I have not heard whether she was luckier next time. In my experience it is not necessary to hypnotise these patients to make a diagnosis. Treatment is less easy, especially where the source of trouble is beyond the patients’ cbntrol ; but in most cases, once they have got rid of the fear of cancer, they learn to disregard the symptom until it disappears. E. WATSON-WILLIAMS. Bristol. or

sorrow

a

TUBERCULOUS ABSCESS AT THE SITE OF INJECTIONS SiR,-Dr. Elek, writing in your issue of April 9, bases his argument against the haematogenous origin of tuberculous abscesses following penicillin injections on the failure to discover other tuberculous lesions in the few cases so far reported. By a coincidence I have, through the courtesy of Mr. C. H. Gray, just seen an instance of a similar condition, although penicillin was not used. The patient, a married woman of 34, received last December an injection of Novutox ’ into the left buttock for sciatic pain. Two weeks later she sustained an accidental blow on the site of the injection, and this was followed two days later by a swelling at the injection site. She was admitted to Wellhouse Hospital under the care of Mr. Gray, who found a gluteal abscess with - much brawny induration and a flexion deformity of the left hip. The abscess was incised and found DEATHS FROM VAGAL INHIBITION to be a typical tuberculous abscess. I was asked to see her and found that although she had no chest symptoms, there 2 of Dr. Keith article SiR,-The interesting April by in fact, a lesion in the chest. X-ray examination revealed Simpson recalled an incident many years ago in a was, bilateral infiltration, probably active, with calcified lesions when one of the in the East district spectators country at the left apex. of my treatment of a man who had fainted was a In my opinion, there is no doubt that this patient, Japanese instructor in jujitsu. This man afterwards demonstrated to me the technique he taught of reviving who is suffering from heematogenous pulmonary tubera man who had apparently been killed by a blow used culosis, developed a tuberculous abscess of buttock by in this method of fighting. haematogenous infection of a locus minoris resistentice, The blow in question was delivered with the ulnar border thus supporting the view I have previously maintained of the hand against the opponent’s neck to the side of the in your columns (Lancet, 1946, ii, 617). larynx ; I forget which side was considered the most effective. A. G. HOUNSLOW. Clare Hall Hospital, If the blow was successful and it was considered politic to South Mimms, Barnet. restore the

and

at the

life, he was instantly seized by the shoulders sitting posture with his back to the operator,

to a

instant gave him a hard blow with his knee in the region of the 2nd-6th thoracic vertebrae. If no signs of life appeared immediately, the two hands were rapidly placed below the victim’s breasts, the skin was gripped with the fingers, and a sudden jerk made as if to tear the skin apart, at about the same time giving a hard kick with the side of the foot just above the sacrum. The instructor used his internal malleolus with as much force as he could muster in his cramped position. Maybe, as these deaths so often happen in places where no drugs or other means of resuscitation are available, and any treatment to be effective must be given within a, matter of half-seconds, someone might like to try this necrologic operation, which can at least do no further harm. The Japanese method is, I think, preferable to another that I once encountered, which was taught in a primitive community ; the instructions were to grasp the testicles of the patient and pull them with a sudden jerk. Unfortunately I cannot speak from personal experience for the effectiveness of either of these two methods,

who

d

man

pulled into

THE UNDESCENDED TESTICLE

same

SiR,-Many

physicist why

years ago,

the

F.R.S.

an eminent given for clinical

when I asked was

never

work, he replied : " You doctors don’t discuss like scientists : you dispute like theologians." The remark stung and it stuck ; I have had more and more to admit to its justice. Consider Dr. Simpson’s statement (April 2) : "

Clinical

diagnosis

can

be sound whether

not his

or

new

anatomy should replace the older." This is very like much theological argument, but can anyone imagine a chemist saying ’’ My results are sound, whether or not the substances I was working with were what I thought them to be " ? The letters from Dr. Simpson and Dr. Spence (April 9) express very well the almost invariable reaction of anatomists, surgeons. and physicians to the half-dozen papers I have published querying the correctness or the completeness of the sacred books of anatomy. No professor, no senior surgeon, and no physician has ever come to me to say " This is interesting : can you really -

1. A

Lump in the Throat.

Bristol med.-chir. J. 1937, 54, 279.