Frank Ellis

Treatment of papilloma of bladder with radioactive colloidal gold Au198.

This report describes an investigation designed to compare vaccination with B.C.G. and vole bacillus vaccines, and records the preliminary results after one and two years. The B.C.G. was given in the routine intradermal manner and the vole vaccine by multiple puncture to those of 5 years and over and intradermally to those under 5 years. Vaccination by the multiplepuncture method is probably slower than by intradermal injection, but it is considered to be the method of choice and is simpler and more certain in young children. The rate of conversion after vole vaccination is a little slower than after B.C.G., but the percentages95% after six weeks and 100% after twelve weeksare very satisfactory, and compare closely with those obtained with B.C.G. We believe that vaccination with vole bacillus has certain advantages because of the milder clinical course and the smaller rate of reversions. The periodic surveys showed that induration developed in a substantial proportion of the cases receiving vole vaccine by the multiple-puncture method, and that, later, lupoid reactions occurred in the vaccination area. These later complications were noted in 5% and 15% of the cases inspected after the first and second years. The discovery of lupoid reactions at the second yearly inspection in arms regarded as healed at the first yearly inspection was unexpected and unfortunate, and we regard the rate of these reactions to be too high to permit of the routine use of the vaccine until these difficulties have been overcome.

INTRODUCTION TO RADIATION BIOLOGY

Cytochemistry: A Critical Approach. By Professor J. F. Danielli. Biological Research Series. (Pp. 139; illustrated. £1 12s.) New York: Wiley and Sons, Inc. London: Chapman and Hall. 1953. Cytochemistry is a very recent offshoot from the main tree of biological research. As the author of this monograph points out, it has little in common with the essentially morphological approaches of cytology and histology, since the aim of the zytochemist is not to exhibit structure but rather to demonstrate the loci of specific chemical reactions normally taking place within the cell, and, furthermore, to measure their reactions in as qtiantitative a manner as possible. In this brilliant little book Professor Danielli begins with a general analysis of the possibilities of artifacts arising at various stages in the techniques used; he then proceeds to a description of recent work, a.great deal of which is his own, on the localization of phosphatase activity, a form of activity which, to judge by the work cited, would appear to be at the basis of all secretory processes. The Feulgen reaction, which demonstrates the. presence of deoxyribose nucleic acid, thereby permitting the staining of chromosomes during mitosis, relies on the conversion of the deoxyribose to an aldehyde; again, aldehyde would appear to be concerned in fat metabolism. Consequently the whole subject of the cytochemistry of aldehydes is of great practical importance, and the author devotes a chapter to this problem. The relationship between synthesis of protein and nucleic acids is a theme running through most recent cytochemical studies. In the present monograph there is a valuable assessment of the recent work of Brachet and Caspersson among others. According to the author the claim that nucleic acids are concerned in protein eynthesis is well grounded, and he puts forward the suggestion that the nucleic acids can influence or determine the folding of the newly synthesized protein chains, thereby imparting their specific characteristics. In a final chapter the future outlook in cytochemistry is briefly reviewed. The author points out that biochemistry, concerned as it is with homogenates, pulped tissues, and tissue extracts, is very indiscriminating in that all cells of an organ are usually treated as equal, whereas the cytochemist is well aware of the wide differences in chemical composition that often exist among cells of apparently the same histological type. He expresses the hope that the combination of the present indiscriminating approach of biochemists, and the more perceptive but undeveloped techniques of the cytologist, will be richly rewarding. Written by a brilliant investigator, whose original contributions to the science of living matter have carried him into the very front rank of modern biologists, this monograph, by virtue of its critical yet imaginative approach, may justly be regarded as a masterpiece that will guide for years to come present and future investigators in this new branch of biology. HUGH DAVSON.

Herpes Zoster after Irradiation

Since 1935 one of us (F. E.) has been of the opinion that clinically typical zoster occurring in patients who had received radiotherapy probably resulted from the treatment. The numerical incidence of zoster generally in the population is not known, so that statistically the point is difficult to prove; we believe, however, that there is presumptive evidence of such correlation. Although the virus nature of zoster is now accepted, there is still a considerable difference of opinion on the importance of various factors predisposing to attack by the virus. Apart from the idiopathic type of disease occurring especially in adults, the infection may also arise after contact with a case of varicella, during the course of acute or chronic infections-e.g., influenza, pneumonia, or tabes-as a result of trauma to the skin (Klauder, 1947) or injury to the spine, and following poisoning by certain drugs-e.g., arsenic, mercury, or benzol. In addition, there is some association between zoster on the one hand and various forms of reticulosis and cancer, and possibly radiotherapy, on the other. The discussion and analysis of cases which follow are an attempt to clarify this latter connexion. Pathology of Zoster

Treatment by Oestrogens of Pulmonary Metastases from Breast Cancer

cases. There was no clear association between length of history and gland involvement. The various methods of treatment are discussed. Simple surgery was undertaken in 229 cases, more than half of which were treated by simple excision of the tumour. Radical mastectomy was done in 338 cases, and the modified radical operation in 167.. Radium treatment without surgery was used in 149 cases, and x rays alone in 114. Forty-seven cases were not treated. Of the cases treated surgically, about two-thirds were also given irradiation. This type of treatment became more frequent towards the end of the period, and at the same time x rays tended to replace radium, particularly in combination with simple surgery. Fiveand ten-year survival rates, adjusted for variations in age distribution, are calculated for different clinical stages and treatment groups. The adjusted rates for all treated Sases in stage I were as follows: five-year, 72% ; ten-year, 51 %. The corresponding figures for stage II were: 39% and 26%. The rates for the individual treatment groups showed no appreciable departure from these figures despite the fact that simple surgery consisted merely of local excision in more than half the cases; nor did the addition of irradiation affect the rates, although it is possible that selection of cases may have concealed some of the benefits of radiotherapy. Attention is drawn to the lower survival rates in the cases assessed clinically to be in stage II but with axillary glands pathologically free, compared with stage I cases with glands involved. The mortality of radical mastectomy was 1.2%. Oedema of the arm occurred after radical surgery in 14% of cases, compared with 5% after simple surgery, and was almost twice as frequent when the radical wound gave rise to complications as in those with primary healing. There seemed to be fewer local recurrences following radical surgery than other types of surgery, but the addition of radiotherapy appeared to make no difference in this respect. It was concluded from a general discussion that where efficient radiotherapy is available radical mastectomy should be abandoned in favour of conservative surgery.

GRENZ-RAY THERAPY

This is essentially a continuation of the great work on British Surgical Practice edited by the same authors and brings that work up to date. It consists of three sections: original articles, critical surveys, and abstracts. They are all of a very high order, and either describe or provide access to the latest achievements of surgery. The first article, by Rodney Maingot, is perhaps the most arresting. He describes in detail the injuries which may occur to the bile ducts and the results which may follow, often unfortunately as the result of surgical procedures. He explains how such mistakes may arise, and how they might have been prevented by a more accurate knowledge of the abnormalities which may occur and by more accurate technique. There follows an admirable account of the methods which have been evolved for the repair of such injuries, sometimes the most difficult problem with which a surgeon can be faced. The article by Poole-Wilson on injuries of the urethra and bladder, fortunately of less common occurrence, is clear and the result of wide experience. It will be welcomed by all who have to deal with these difficult conditions. That by Paul Brand, of Vellore, on reconstruction of the hand in leprosy, is of far wider appeal than to his own special field, and all who have to deal with the restoration of the functions of the hand after nerve injuries will appreciate the value of his work. Pelvic viscerectomy for advanced cancer is the subject of an article by Sir Stanford Cade, and is an example of the extraordinary lengths to which modem surgery can go. Such operations can, of course, be justified only in desperate cases and when undertaken by surgeons of quite exceptional skill and wide experience. But he shows that with these conditions they are fully justified and may give relief which can be obtained in no other way. The article by G. A. Hay and F. W. Spiers on the application of electronics to clinical practice shows how dependent the surgeon of the future may be on physical science. One only hopes that it will be his servant and not his master. After all, one can use a microscope quite effectively without knowing anything about spherical aberration. The critical surveys include several articles of value. Those on antibiotics and on blood transfusion show important progress in these fields. On carcinoma of the oesophagus Ross Robertson gives a full and well-illustrated account of what can be done with the resources of modern surgery. That many surgeons now question whether such operations are worth while in no way detracts from the value of the article. Norman Tanner gives an excellent account of the present position of carcinoma of the stomach and the encouraging results of modern technique. The abstracts furnish a brief account of progress in a large number of fields and afford ready access to the literature for those who desire to explore these subjects further, We would like to congratulate the editors on the high level of material, and the publishers on the standard of production maintained throughout the volume.

X-RAY SIEVE THERAPY

has achieved much in lowering the incidence and mortality of tuberculosis, and it is highly important in Britain that the treatment of tuberculosis under the National Health Service shall be closely co-ordinated with the preventive work of the local authorities. Epidemiologists are unlikely to agree with the contention on p. 185 that a study of mortality curves over 150 years shows-that tuberculosis began to decrease before any specific measures had been taken against the disease. Reliable figures of the mortality from all forms of tuberculosis in England and Wales first became available since the decennium 1851-60, and do show a marked decline. Since 1848, however, environmental hygiene has greatly improved, especially for the poor. There has been a higher standard of living, more institutional segregation of the highly infective patient, cessation of indiscriminate expectoration, and, as a consequence of these things, less exposure of the public to massive infection. Furthermore, the direct attack on tuberculosis must have exerted a beneficial effect. Yet tuberculosis is still a killing disease, and this book should help to stimulate further endeavour, especially as regards co-operation of the public in preventive measures.

Periodic Medical Examination

velvety appearance of the anal mucosa and lower third of the rectum. Above this area the surface was normal. Some form of self-infliction was-suspected, and close observation was kept for several weeks without result. All this time the patient was kept in bed on a milk diet. It might be mentioned that he was most oo-operative in treatmert, grateful for all that was being done, and often expressed a profound wish to get better. He was alert, intelligent, and an ardent book reader. At length the mystery was solved. While the patient was in the theatre for a final proctoscopy an intensive search, one of many, was being made of his bed and belongings. Concealed in the binding of a library book were found two pieces of twisted wire, 2 to 3 inches in length,-with the ends set apart at one extremity-designed to createtrauma and haemorrhage. The wire had a faecal odour. Confirmatory examination by microscope and speptroscope revealed blood cells, B. coli, and a haemoglobin absorption band. From this moment the patient rapidly got well.