John Lowe

Spontaneous Thrombosis of External Carotid Artery

as a whole is very significantly higher than that of the A babies as a whole-namely, 1.11 (7,914:7,148) compared with 1.03 (6,359: 6,158). It is also worthy of note that there is a very significant shortage of A male babies compared with A mothers of male babiesnamely, 6,359 compared with 6,595. The 1924-56 and 1958 white aggregates are shown in Table Ill. Non-white Series.-In the aggregate of the two nonwhite series the sex ratio of the 0 babies as a whole is 1.20 (499:416), while that of the A babies as a whole is 0.93 (332:356)-a non-significant difference. Here, however, there are 332 A male babies compared with 326 A mothers of male babies.

Diaminodiphenylsulphone and Tinea

SIR,-My attention has been drawn to the letter of Dr. P. H. Birks (January 27, p. 191) reporting a case of tinea corporis cured with D.A.D.P.S. given orally, and I have been asked to comment on it. There is ample evidence that D.A.D.P.S. is a potent chemotherapeutic agent, being many times more active than sulphonamides against Gram-positive organisms such as the streptococcus and pneumococcus in vitro and in animals. It is widely used in veterinary medicine, but in human beings it is being used only in leprosy and in tuberculosis. A study of its action in other infections is highly desirable. For this reason, Dr. Birkss report is of interest; it is unfortunate that my experience here does not support his findings. I personally have been using oral D.A.D.P.S. for two and a half years in patients with leprosy, numbering several hundreds; in this part of Nigeria, many thousands of patients have been receiving this treatment for the last year. In these patients tinea corporis is commonly seen, and D.A.D.P.S. appears to have little or no action in preventing it or in curing it. It is perhaps worthy of note that streptococcal and pneumococcal infections are very rare in our sulphonetreated patients; in fact I have not found one. Staphylococcal infections are common as well as tinea infections: gonococcal infections also occur. The range of activity of D.A.D.P.S. is obviously limited, and this fact is likely to limit its use in medicine, but in suitable infections its activity is so great, its dose is so low, and its use is so simple and safe that it might have a sphere of usefulness apart from leprosy and tuberculosis. A dose of 100 mg. a day, which can be given at one time, appears capable of exercising the full therapeutic effect. In acute and subacute infections, daily treatment would appear desirable, and it is quite safe, for toxic effects appear usually only after weeks of continuous treatment. For long-continued administration, as in leprosy, we find that twice-weekly treatment with doses rising slowly over several weeks from 100 mg. to 400 mg. is preferable. It appears safer, better tolerated, and no less effective than daily treatment, and it is of course much simpler and cheaper. Dr. Birkss letter raises one or two points. Increasing the dose to 200 mg. a day in the second week is not always devoid of risk, particularly in ill-nourished patients such as Indian labourers. The claim that sulphone is concentrated in the skin has now been withdrawn by its author.-I am, etc.,

An Address on the Germ Theory of Disease.

prevent the public interest clashing in any way with private professional work. There is only one other point to which I beg leave to refer, and that is, the abolition of the system of apprenticeship in the medical profession. This question was well discussed, you Will remember. at a Branch meeting held at Matlock Bath some years ago; and I then advocated, as I do now, a return to a modified apprenticeship of about two years. Any medical practitioner who has been in the habit of employing assistants in his work, will bear me out in the truth of what I now say, that those men are the most useful, in the country at least (I had almost said the only useful men), who have spent some time in a surgery under experienced eyes, and are practically conversant with the details of general practice. In conclusion, gentlemen, I think you will admit that we belong to a profession which is largely unselfish, and which is doing an amount of gratuitous work amongst the poor (and also, I fear, amongst those who can afford to pay for it), the benefit of which cannot be estimated. The members of it, often regardless of remuneration, work hard by night and by day, and for what ? Wealth and position? Most emphatically, no. These rewards fall to the lot of but few of our coafreres; witness the records of the Medical Benevolent Fund and the Medical Benevolent College, two institutions which I recommend most strongly to your support. Medical men are placed daily and hourly in positions of imminent peril. A cut at a post-mortem examination, or the contraction of germs of disease, may either kill them outright, or prostrate them for weeks and months upon a sick-bed, and in the end imperil their usefulness. The late lamented Dr. Anstie, a man whom the profession could ill afford to lose, died, you will remember, six days after an injury at a post mortem examination. Notwithstanding these dangers and perils, which are always before him, the doctor never hesitates, but, like a brave and gallant soldier as he is, lie goes boldly to the front, and wages incessant war against those enemies of our race, disease and death. A wise physician, skilled otur wotunds to heal, Is more than armies to the public weal.

On Fatal Erethismus Mercurialis from Inunction.

more assimilates itself to normal skin, results. But, in persons endowed with a form of tumour-diathesis, all skin-wounds, however slight, even little points of acne, result in a small fibroma, to which we give the name of keloid. So also we find that epithelioma of the lip is in many cases attributed to the habit of smoking short clay-pipes; of the tongue, to manifold i}rritamenta; certain sarcomata are apt to form at the site of ancient, sometimes of forgotten injuries. If, then, in persons possessing the tumour-diathesis, wound or other irritation is often the local provocative of a neoplasm, the fact of traumatic tumour, therefore evidently of traumatic malignancy, is in reality already established. The only additional point in the sequence is the doctrine concerning the acute character such growth may assume. Acute or rapid formation of malignant growth is not, however, an unknown condition. Occasionally, after operations in which every part of a tumour seems to have been removed, a fresh development sometimes, in the as yet unhealed wound, will grow so rapidly, as in a few days to overwhelm and involve all the neighbouring tissues.* We cannot, therefore, refuse to believe that, when a constitutional proclivity to new growth is present, some fortuitous traumatism may set up a similar rapid development of malignancy at the site of injury. In the instances I bring before you, there must have been tumourdiathesis. The point to be remarked is this, that injury supplying the local irritation was followed immediately, not merely by a more or less slow and chronic growth of tumour; but by an acute and violent outbreak of local malignancy, such as is evidenced by the history of these cases, and more particularly is demonstrated by the condition of pleura and lung now before you. In other words, these cases-I do not see how they can be otherwise interpreted-point to the existence of an acute traumatic malignancy.