586 CARDROOM WORKERS’ ASTHMA

so as to ensure a supply of progesterone from thelatter. There is strong circumstantial evidence forthe production of progesterone by the placenta inincreasing amounts as pregnancy proceeds, 7 butmight this not be linked up with the increasingexcretion of oestrogen 7 It now seems certain thatthe placenta secretes some non-oestrogenic substancewhich is different from anything produced by theanterior pituitary, and a name will have to be foundfor it. But animals differ so widely in the details oftheir endocrine management of pregnancy that,while the existence of a hormone ensuring an adequatesupply of progesterone may be probable, the timedoes not yet seem ripe for assuming that a universalfunction of the placenta is to produce such a hormonewhich is at once non-oestrogenio and sufficiently welldefined to deserve a name.

CARDROOM WORKERS’ ASTHMA

AT last it seems that some justice is to be done tothe workers in the Lancashire cotton mills who becomedisabled by respiratory disease as a consequence oftheir exposure to the dust produced in the processesof cleaning and carding the cotton. It has been along story, however, for three-quarters of a centurylie between the observations of Leach 8 in 1863 andthe present report of the Departmental Committee onCompensation for Cardroom Workers, issued by theHome Office.9 And it is a story on which a greatindustrial organisation will hardly look back withpride. Environmental conditions in the mill havevastly improved since the days (not so very longago) when strippers and grinders were continuallyenveloped in a cloud of dust-conditions which aprevious committee described as intolerable. Exhaustsystems of ventilation and vacuum stripping, installedmainly in the pre-war years, changed that, but it hascontinued to be a moot point whether or no an

occupational risk remained in the carding processitself. In a report to the Industrial Health ResearchBoard Bradford HillO showed that in 1923-27 thecardroom workers over 30 suffered two to three timesas much from respiratory illness as workers in a lessdusty part of the mill. Thus the previous evidence ofdamage was reaffirmed and a numerical estimate givento its scale. On the other hand, before the age of 30no striking difference between the two groups wasto be seen.

This latter observation, apparently, was the rockthat wrecked the subsequent attempts of the opera-tives and employers to reach agreement on a scheme

. of compensation. The employers, conscious of theimproved machinery, maintained that the absenceof excess sickness from respiratory causes amongstthe younger persons, who had been exposed onlyto the modern conditions of work, was evidence thatthe risk had been removed. The operatives, thoughadmitting the improvement in environment, weresatisfied that fresh cases were continuing to arise andwould, even under the improved conditions, continueto do so indefinitely. The failure of the two sides toreach agreement on this point led to the appointmentof the committee whose report has just been published.In addition to hearing witnesses the committee wentstraight to the issue by means of a fresh survey ofsickness incidence, which was carried out by oneof its members, Mr. P. N. Harvey, the deputyGovernment actuary, and related to a period roughly

7. Browne, J. S. L., Henry, J. S., and Venning, E.N., J. clin.Invest. 1937, 16, 678.

8. Leach, J., Lancet, 1863, 2, 648.9. London: H.M. Stationery Office. 1939. Pp. 32. 6d.

10. Hill, A. B., Rep. industr. Hlth Res. Bd, Lond. No. 59, 1930.

ten years later than that of Bradford Hill’s figures.Mr. Harvey’s statistics are clear and his inferencesfrom them well founded. He finds that improve-ments in working conditions have not removed thegross excess of respiratory sickness amongst the olderworkers who were exposed to the dusty environmentin the past, but that there is now a smaller excess atthe middle range of ages, which is justly attributableto the improved conditions, and may well diminishstill further with the passage of time. At the sametime he observes a heavy excess of respiratoryillness even at the younger ages among workers inthe cotton and blowing room (where the cotton iscleaned before carding) and he does not anticipate anymaterial improvement in their respiratory sickness-rate without an alteration in their working conditions.Such an improvement is foreshadowed in a referenceto new exhaust machinery, but meanwhile the com-mittee is satisfied that it must evolve a scheme ofcompensation to cover new as well as old cases. Itsuggests that a scheme similar to that which dealswith silicosis should be adopted, with a speciallyqualified medical board to examine applicants forcompensation. It will be a matter of regret to somethat it feels compelled to limit applicants to workerswho (a) have been employed for not less than 20 yearsin the cotton, blowing and/or card rooms, (b) are stillengaged in that employment or have left it not morethan a year previously, and (c) claim to be sufferingfrom " byssinosis " and to be totally incapacitatedthereby. If he surmounts these formidable fencesand receives an affirmative certificate it is proposedthat the workman shall be entitled to claim com-pensation as if the disease were a personal injury byaccident arising out of and in the course of hisemployment.

Half a loaf is better than none and it is to be

hoped that these proposals will be speedily imple-mented. For those disabled in the " bad old times "a payment of 10s. a week is envisaged, an amountwhich can hardly be quarrelled with on the groundsof extravagance. The committee also suggests thata medical examination at entry to the industrywould be advisable, and for that purpose would liketo see further investigations made into the questionof special skin-tests for supersensitiveness to cottondust, as suggested by Prausnitz.ll

CHEMOTHERAPY OF INFECTIVE ENDOCARDITIS

SuBACUTE bacterial endocarditis is comparativelyuncommon, so that some time must necessarily elapsebefore the effect of new drugs can be assessed orobserved in anything like a large series. So far therehave been very few records of cases treated with2-sulphanilyl-aminopyridine (M. & B. 693), the

drug which offers the greatest promise as having,according to Maegraith and Vollum,12 the mostdefinite inhibitive action on the growth of Strepto-coccus viridans. Of the three cases which Whitby i3treated he was satisfied that in two life was prolongedand there was improvement in general health andcomfort and in the secondary features such as aneamia.The most prominent effect was, however, upon thefever, which fell dramatically. Ellis 14 described twocases which responded in much the same manner,the temperature falling immediately the drug wasbegun and in one case remaining subnormal for three

11. Prausnitz, C., Spec. Rep. Ser. med. Res.Coun., Lond. No. 212,1936.

12. Maegraith, B. G., and Vollum, R. L., Brit. med. J. 1938,2, 985.

13. Whitby, L., Lancet, 1938, 2, 1095.14. Ellis, G. R., Ibid, p. 1521.

587DENTISTRY AT GUY’S

days. Ravina 15 has now published a sixth case’

The patient developed infective endocarditis due toStr. viridans last June. At the end of Novembershe was given a course of M. & B. 693 lasting eightdays, 2-5 grammes being given on the first day,1.5 g. daily for the next three days and then 1 g.daily for four days. The patient’s temperature,which had been oscillating between 101° and 102° F.,fell to 99° F. on the first day of treatment and remainedthere during the course, after which it slowly roseagain. Another day’s treatment was given a monthlater but this produced nausea and vomiting andsevere joint pains and no more could be given for afortnight. From the middle of December, when thepatient’s temperature was going up to 105° F., shewas given 1-5-2-5 g. of M. & B. 693 daily for five orsix days at a time with a few days’ rest between thecourses and a daily injection of 2 g. of the sodiumsalt of M. & B. 693. On this treatment her tempera-ture remained below 100° F., and when Ravina’spaper was written in the second week of Januaryshe was feeling better and stronger with an improvedappetite. As Ellis remarked, it is too much to hopethat M. & B. 693 can reach the streptococci embeddedin the cardiac vegetations, but at least it seems torelieve the symptoms of this distressing disease ina way that no other drug has hitherto done.

DENTISTRY AT GUY’S

IT is fifty years since the far-sighted activity ofMr. F. Newland-Pedley and the late Sir CooperPerry led to the foundation of a dental school atGuy’s Hospital, and though the official jubilee celebra-tions will not take place until later in the year theannual clinical meeting on March 4, which wasattended by about 500 old students, gave visitors anopportunity of estimating the progress of theirenterprise. The school now has 367 students, is thelargest in the Empire, and provides a quarter of thenames added to the Dentists Register each year. The

improvement in the status of dental surgery, which isthe joint achievement of the schools, the Royal Colleges,the universities, and the British Dental Association,is intimately linked with the close relationship thatexists in this country between dental surgery and otherbranches of medicine ; and in setting up a dentalschool in connexion with a medical school of finetraditions the governors of Guy’s undoubtedly playeda large part in determining the character of dentaleducation here and the attitude of dental practitionersto general medicine. Fears have been expressedthat the proportion of time devoted in the dentalcurriculum to the broader aspects of medicine andpathology-a proportion which though far from largeis much greater than in some other countries-mightlead to insufficient technical instruction and practice,and at one time there was probably ground for sucha criticism. It was therefore reassuring to note atthis clinical meeting the number and quality of thepurely technical demonstrations. There is no doubtthat the steady advance in this respect is partly dueto the policy of appointing whole-time professorsin these subjects. Research still occupies a ratherinconspicuous position in dental schools, but theactivity of the research laboratory at Guy’s and thepending appointment there of a dental researchfellow (a biochemist) show that it is beginning toreceive more support. This impression was borneout by the display of slides and specimens in thelaboratory illustrating recent investigations on the

15. Ravina, M. A., Bull. Soc. méd. Hôp. Paris, Jan. 30, 1939,p. 40.

absorption and replacement of enamel, dentine,cementum, and bone ; on the altered structure of thedentine matrix in osteogenesis imperfecta ; and on acomparison of the quality of enamel formed beforeand after birth as assessed by the petrological micro-scope. Like so many others the Guy’s school is,however, handicapped by out-of-date buildings andlack of adequate equipment, and in his speech atthe press luncheon which traditionally accompaniesthese meetings, Mr. T. J. Evans, the dean, appealedfor a jubilee fund of E50,000 to rebuild and re-equipthe school in keeping with its prestige.

RADIATION DOSAGE FOR UTERINE CANCER

THE rapid development of radiotherapy has beengreatly helped by its efficacy in carcinoma of thecervix uteri, but the very success of the Paris andStockholm methods has perhaps tended to hinderlocal improvements in technique. A not uncommon

complication with either method is ulceration of themucous membrane of portions of the bowel lying nearthe uterus. Such ulceration is usually attributed tooverdosage, but where the carcinoma is widelyinfiltrating, or where a loop of bowel is adherent tothe uterus, radionecrosis of the mucosa may beunavoidable if the growth is to be given an adequatedose. Corscaden, Kasabach, and Lenz i have latelyreported 15 cases of these intestinal injuries ; theradium dosage was 7000 mg.-hr. given in 40 hours,followed by a course of X rays extending over eighteendays : since giving the same radium dosage over alonger time (100 hours) and an X-ray dose about athird greater but extending over forty-nve days,they have had no further cases of intestinal injury.In this country chief reliance has been placed oncareful packing of the vagina when the radium isinserted and on confining the subsequent X-irradiationto the parametria, the central anteroposterior planeof the pelvis being protected by a lead strip 3-5 cm.wide on the skin.Hurdon 2 and more recently Todd 3 have suggested

that rectal ulceration is not necessarily due to localoverdosage of its mucous membrane, but may becaused by endarteritis of the blood-vessels lying inthe paracervical fascia. Tod and Meredith 4 ofManchester have accordingly taken the tolerance ofthe normal tissues in the paracervical fascia as thebasis of a dosage system for the irradiation of carci-noma of the cervix uteri. The vaginal applicatorsare ovoid and are made in three sizes for the large,medium, and small pelvis ; the intra-uterine tubemay similarly be long, medium, or short. Rules forthe loading of the different sizes of applicator aregiven, such that the dose in the paracervical fascia isuniform for any size of tube and paired ovoids. Atthe Christie Hospital the time spacing for cases

treated with radium only is two applications of48 hours, with an interval of five days between theremoval of the radium and its reinsertion ; this givesan almost uniform dose in the paracervical fascia of7200 r in nine days-a dose which, it is believed,approaches the maximal tissue tolerance. Withdosage expressed in milligramme-hours without refer-ence to the size of the pelvis or to the homogeneityof the distribution of the radiation it is impossible tocorrelate the effects on the tissues with the dose ofradiation delivered ; hence it is to be hoped that

1. Corscaden, J. A., Kasabach, H. H., and Lenz, M., Amer.J. Roentgenol. 1938, 39, 871.

2. Hurdon, E., at a meeting of the Society of Radiotherapists,October, 1936.

3. Todd, T. F., Surg. Gynec. Obstet. 1938, 67, 617.4. Tod, M. C., Meredith, W. J., Brit. J. Radiol. 1938, 11, 809.