Josephine Barnes

Inhibition of Lactation by Synthetic Oestrogens.

The hormone control of lactation was reviewed by Nelson (1936). He concluided that the ovarian hormones, which are present in enormously increased amounts in pregnancy, are necessary for the development of the breasts, but inhibit the secretion of milk. The initiation and maintenance of lactation depend on the anterior lobe of the pituitary. After parturition the oestrogenic hormone ceases to be produced in large amounts, and with this release of control lactation begins. A further factor in the maintenance of lactation is the stimulus of suckling, the mechanism of which is obscure; nor is it known how the oestrogenic hormones inhibit lactation, though it is assumed that they do so by inhibiting the action of the anterior lobe. Folley (1936) showed that when the oestrogenic hormone was administered to the lactating cow, lactation was inhibited and the milk yield was reduced. This effect was temporary and depended on obtaining a high level of oestrogen in the blood. Folley and Kon (1936) studied the effect of sex hormones on lactation in the rat. They found that oestradiol caused a marked inhibition in intact rats, and a definite though less well marked effect in rats ovariectomized on the day after parturition. Testosterone propionate also caused pronounced inhibition, but progesterone and androsterone had no effect. On the basis of these and similar findings it was suggested that oestrogenic hormones might be used for the inhibition of lactation in puerperal women, and numerous reports of this use of the naturally occurring oestrogens have appeared. Foss and Phillips (1938) obtained satisfactory results in 62 cases with oestradiol (progynon B, Schering), giving a total dose of 10,000 I.U. They found that oestrogenic hormone was also useful for flushed and engorged breasts, relieving the symptoms without interfering with lactation. Lehmann (1938) used progynon B oleosum. He found that 100,000 units given by injection in the first 24 hours post partum inhibited lactation in 91% of cases. Inhibition of established lactation was pbtained in 89% of cases with 200,000 units, but in only 50% with 150,000 units. Jeffcoate (1939) gave oestrone by mouth in doses of 2 to 6 mg., gradually decreasing the dose over 3 to 6 days. He found that,it was usually necessary to supplement this by 1 to 2 mg. of oestradiol benzoate by injection.

Oral Treatment of Trichomonas Vaginitis with Aminitrozole

and Conclusion Eighty patients with acute respiratory infection of mixed bacterial origin either per se or complicating other conditions were treated with chloramphenicol, 2 g. daily for five days. Clinical improvement resulted in 77, three being totally unaffected. Relapse occurred in three patients within one week. The infection was controlled in 73 patients for periods varying from one to eight months after treatment. Seventy-five patients were quite free from side-effects; dry mouth was observed in three, a mild skin rash in one, and slight transient diarrhoea in one. No blood dyscrasias of any kind were detected. The potential toxicity of chioramphenicol has been overstressed. If it is given in short courses of 10 g. over five days to patients with acute and severe respiratory infections a satisfactory and prompt response is obtained, with a very low failure and relapse rate, and with negligible toxicity. Chloramphenicol has therefore a definite place in the treatment of such cases, but should not be employed in prolonged dosage or for trivial infections. It may well be that the avoidance of its extensive use in recent years has had the advantage of enabling us to deal effectively with organisms now frequently resistant to the other antibiotics more commonly employed.

Dienoestrol for Menopausal Symptoms

in hospital do not seem to respond to strapping. The cases of umbilical hernia I selected for injection had necks the smallest diameter of which was one-third of an inch or less. Most of the cases had been sent to me because strapping had failed. Technique of Injection Treatment An anaesthetic is not essential for young infants; a little ethyl chloride anaesthesia, however, is very helpful, because voluntary movements are controlled, but the sac still remains distended, so that it can be avoided. I have used up to 4.5 c.cm. of 5°, phenol in almond oil at one injection. The solution is injected into the subcutaneous tissue as near the neck as possible without risk of puncture of the peritoneum. At a subsequent injection, it this is required, it is much harder to inject the solution. After injection it is essential to keep the hernia reduced. A small round pad of gauze is held in position by elastoplast applied right round the body like a belt at the level of the umbilicus. This support should be continued after the injections have ceased, because the scar tissue produced by the sclerosing fluid becomes more strain-resistant as time progresses. Animal experiments (Crohn, 1937) have shown that the phenol solution produces tihy areas of necrosis, which are later followed by more intense fibrous reaction than that seen when other solutions have been tried. I would like to emphasize the method of applying elastoplast as a complete belt. Beadnell (1942) has suggested applying elastoplast to one half of the abdomen as far as the midline while the nurse pushes the other half of the rectus muscle towards the middle. Beadnell admits that his method produces a fold of skin in the midline, so there will be no effective antero-posterior support and very little pull on the two rectus muscles when the child cries or strains. The belt method of application keeps the hernia effectively reduced without any skin-chafing, and it will give much more support to the hernia owing to fixation from the lumbar spine. Mothers of babies with umbilical hernia nearly always state that they have noticed that the baby has cried less than before, and the belt method has certainly not reduced the babys appetite or increased its liability to vomit. I strongly recommend this method of support, even for the youngest babies, as soon as umbilical hernia is noticed. The ordinary binder slips either up or down and it has to be removed daily for bathing, so the hernia is not kept permanently reduced.

Post-partum Maternal Collapse

For the purpose of this article it is proposed to limit discussion to those cases in which sudden collapse of the mother occurs within a few minutes or hours after delivery. Such a condition may arise at any time during pregnancy or during the puerperium, but the varieties most commonly encountered in practice occur mainly during the immediate post-partum period. A full discussion of these conditions would involve a survey of all the general medical and surgical conditions, to say nothing of those of obstetrical origin, which can lead to sudden collapse or shock. Broadly, they can be divided into conditions directly due to pregnancy and childbirth-that is, to obstetrical conditions-and those due to general medical or surgical diseases which are acutely exacerbated by the process of labour.

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Female Reproductive Tract.

Most of this monograph is on the cytological appearances of the normal epithelia of the female reproductive tract. Dr. Papanicolaou is world-famous for his studies in this field and his present collaborators have been associated with him in much of his work. The monograph is a triumph of transcontinental collaboration, since almost half-way through the ten years devoted to collecting material Dr. Traut left Cornell University to become professor of obstetrics and gynaecology in the University of California. Discussion of all the normal epithelia from the ovary to the vagina occupies 48 -pages. Every one of them is packed with detailed information, not only on the cytology of the tissues but on the correlation of the changes which take place throughout the female genital tract as a whole at the different phases of the menstrual cycle and in the menopausal woman. It is clearly shown that all the epithelia take part in these cyclical changes and that the changes in the Fallopian tubes, cervix, and vagina, though less well known than those in the ovaries and endometrium, are nevertheless completely characteristic to the eye of the expert cytologist. The illustrations are beautifully produced and lend the highest distinction to the work as a whole. Most are in colour; they consist of photomicrographs of admirable clarity and excellent drawings by Hashime Murayama. No doubt the high quality of the production is reflected in the price, though it is difficult to produce work of this kind, which depends so largely on accurate illustration, on a less lavish scale. This monograph will prove an admirable companion to that published five years ago by Dr. Papanicolaou and Dr. Traut on the diagnosis of uterine cancer by the vaginal smear. Their pioneer work in this field is too well known to need further comment, but anyone who wishes to learn this difficult but fascinating method of gynaecological investigation will find these two monographs indispensable. There is no doubt that the vaginal smear will very soon be universally recognized as a routine procedure in gynaecology. The absence of an index is to be regretted, especially in a work where so many cross-references are to be found. The chart given at the end of the book, however, affords an admirable summary of the changes in the menstrual cycle to be seen not only in the epithelia but in the basal-temperature chart and the hormone-excretion levels. It also serves to emphasize again the main theme, which is that of correlation of cytological changes with function.