982

columns of figures do not allow for what is perhaps thedecisive (and least understood) factor in the prognosisof an individual case-the rate of growth of the cancer.

This collective survey reveals no striking advance inthe results of treatment over the past 30 years. But it is bystandard methods of staging and by careful follow-up,as in this study, that the first signs of a break-through willbe recognised.

ST. JOHN’S HOSPITAL

St. John’s Hospital for Diseases of the Skin, withwhich is associated the University of London’s post-graduate Institute of Dermatology, is celebrating the

centenary of its foundation with a reception at the RoyalCollege of Physicians and the publication of the hospital’shistory. 1

John Laws Milton, its founder, was at first its solemedical officer, but he was joined in 1864 by ErasmusWilson, Tilbury Fox, and J. Mill Frodsham. Unfortu-

nately a dispute occurred, and the three soon felt com-pelled to resign, but the activities of the hospital con-tinued to grow slowly. At first situated in Church-street,now Romilly-street, it soon moved to the west side of

Leicester-square, to the building now occupied by theAutomobile Association. In its first 60 years the hospitalfaced many vicissitudes, including at one time near-

ostracism as far as professional relationships were con-cerned. But in 1923 Dr. James H. Stowers, Sir MalcolmMorris, and other eminent dermatologists between themmanaged to break the barrier between St. John’s Hospitaland the teaching hospitals, and a number of physiciansattached to their dermatological departments were

appointed to the staff at St. John’s Hospital.The London School of Dermatology was formed in

1923, and in 1936 the hospital moved to its present sitein Lisle-street. The Institute of Dermatology took overthe London School of Dermatology in 1946, and in 1948St. John’s Hospital was designated a teaching hospital.In 1959 the Institute of Dermatology was recognised asa federated institute of the British Postgraduate MedicalFederation, and in 1961 a chair in dermatology wasestablished.The hospital and institute are at present seriously

hampered by lack of space and the separation of theinpatient department at Homerton from the outpatientbuilding in Leicester-square; but some 10 years or morewill have to pass before inpatients, outpatients, research,and teaching can be brought under one roof within theproposed new postgraduate centre of hospitals andinstitutes at Chelsea.

A NEW ANTISEPTIC

THE isolation from hospital patients of bacteria resistantto most if not all of the available antibiotics is becomingincreasingly common. These bacteria are often found assecondary invaders in superficial lesions such as bedsores,trophic ulcers, and burns, especially in chronically ill ordebilitated patients and in patients with chronic ulceratingconditions of the skin. In hospital, lesions of this typecan form reservoirs of antibiotic-resistant organisms fromwhich more serious systemic infections may arise not onlyin the patient harbouring the organism but also by cross-infection to others. Treatment with systemic antibiotics1. St. John’s Hospital for Diseases of the Skin 1863-1963. By BRIAN RUSSELL.

Edinburgh: E. & S. Livingstone. 1963. Pp. 70. 27s. 6d.

may help to localise the lesion but often merely results ininfection by a more resistant organism, while topicalapplication of antibiotics favours the emergence of resis-tant variants during treatment besides carrying an appre-ciable risk of sensitising the patient.

Before the discovery of antibiotics, the usual form oftreatment of this type of lesion was local application ofgermicidal substances, and a return to this practice seemsjustified in many cases. Many of these substances, how-ever, are of limited value. Those whose activity dependson the presence of halogen are rapidly inactivated in thepresence of organic material such as purulent debris,serum, or blood; phenolic disinfectants are too toxic; andquaternary ammonium compounds are much less activeagainst gram-negative than against gram-positive organ-isms, Pseudomonaspyocyanea being particularly resistant. 1-3Consequently the search for new germicidal substanceswith a wider spectrum of antibacterial and antifungalactivity continues.,

Promising results have been reported with Poly-noxylin’, a condensation product of formaldehyde andurea,4 5 which is active against a wide variety of gram-positive and gram-negative organisms as well as certainpathogenic fungi. How this substance acts has not beenestablished, but the absence of irritant properties suggeststhat activity is probably not due to the liberation of freeformaldehyde.5 The reported studies do not make clearthe rate and degree of killing produced by polynoxylin orthe effect of organic material on its activity. The manyinherent difficulties in the testing of chemical disinfect-ants 6-8 may lead to over-optimistic claims of activity:8The importance of estimating the degree of killing by achemical disinfectant, and the limitations of the theoret-ical assumptions involved, are well shown by cases ofpoliomyelitis occurring after vaccination with certaincommercial lots of vaccine,9 which had been preparedaccording to specifications regarded as safe. Neverthe-

less, the promising results so far obtained with polynoxy-lin seem to justify further investigation of its germicidalproperties and clinical worth.

POISONING IN THE HOME

AT a plenary session of the Third International Meetingin Forensic Immunology, Medicine, Pathology, and

Toxicology, which ended in London last week, the discus-sion on poisoning in the home centred on incidence andprevention rather than on treatment. Among figuresproduced to illustrate this worldwide problem, those fromthe United States showed that more children were killed

by accidental poisoning than by a number of infantdiseases put together. The public were still not sufficientlyaware of the dangers, and more propaganda was needed,especially about the safe keeping of noxious agents andthe dangers of a number of domestic substances, includinginsecticides. Already some places had preventive pro-grammes for the laymen, and there were informationcentres where people could get advice by phone; but moreeffort was needed along these lines.The idea of poison information centres was discussed,

1. Lowbury, E. J. L. Brit. J. industr. Med. 1951, 8, 22.2. Anderson, K., Keynes, R. Brit. med. J. 1958, ii, 274.3. Plotkin, S. A., Austrian, R. Amer. J. med. Sci. 1958, 235, 621.4. Haler, D., Aebi, A. Nature, Lond. 1961, 190, 734.5. Haler, D. ibid. 1963, 198, 400.6. Wyss, D. Ann. Rev. Microbiol. 1948, 2, 413.7. Phillips, C. R., Warshowsky, B. ibid. 1958, 12, 525.8. Williams, R. E. O., Blowers, R., Garrod, L. P., Shooter, R. A. Hospital

Infection: Causes and Prevention. London, 1960.9. Meier, P. Science, 1957, 125, 1067.