37

All but 1 of the non-puerperal patients were of child-bearing age. The oldest patient (case 4) had severe dia-betes, and this may well have been relevant to the devel-opment of particularly extensive necrosis in her case. Inall 8 patients with anaerobic breast abscess, and thepatient from whom no organisms were isolated, the abs-cess was subareolar; this seems to be a feature of anaer-obic breast abscesses.3 Staphylococcal abscesses were notsubareolar. Anaerobic breast abscesses tend to be recur-rent, as in 4 of our patients from whom anaerobes wereisolated and the case with a sterile culture. Indeed case8 had five documented recurrences before being curedby surgery. Caswell and Burnett5 described a patientwho had had recurrent subareolar abscesses for twentyyears. Inverted or retracted nipples are important in thepathogenesis of this infection5 and 7 of our 8 patientswith anaerobic abscesses and the patient with sterile pushad this feature. Inverted nipples were not a feature ofthe staphylococcal abscesses.

Habif et al.,6 in a largely histological study of 152 pa-tients with subareolar abscesses, concluded that most ofthese abscesses in the non-puerperal woman were causedby infection in ducts that are lined with squamous epith-elium and filled with keratin plugs. This feature wasnoted in the 2 patients in our series in whom formal ductexcision was undertaken. Habif et awl. emphasised thatsurgery to the underlying duct abnormality was the keyto successful therapy and this is well illustrated by pa-tient 8 who had had recurrent abscesses until duct exci-sion was performed. The essential role of surgery in thiscondition has been mentioned more recently byHughes. 7

Whilst appropriate surgery is clearly the only treat-ment for those patients with recurrent subareolar breastabscess, attempts should be made to isolate the patho-gen(s) from the pus and the clinician should be aware ofthe importance of anaerobes. Ampicillin, often an inap-propriate drug, was the most commonly prescribed anti-biotic in our series, particularly by G.P.s.The presence of a subareolar breast abscess with a

retracted nipple should alert the clinician to the probabi-lity of anaerobes; a foul discharge or foul pus on

drainage confirms their presence. Gram-stained films areuseful not only in confirming the absence of staphylo-cocci but also in demonstrating gram-negative bacilli

typical of bacteroides, and G.L.C., where available, pro-vides further immediate confirmation. If an antibiotic isto be given at the time of drainage, a drug such asmetronidazole with predictable anti-anaerobic activitycan be confidently prescribed. In our experience, mostsurgeons, if they prescribed an antibiotic for a patientwith a breast abscess, would choose a specifically anti-staphylococcal drug, assuming the pathogen to be

Staph. aureus.BX’e thank Miss E. Taylor for expert technical assistance in the isola-

tion and identification of anaerobes, and the clinicians for permissionto study their patients.

Requests for reprints should be addressed to I.P., Department ofMicrobiology, St. Thomas’ Hospital, London SE1 7EH.

REFERENCES

1. Carlsson, J J appl. Microbiol. 1973, 25, 287.2. Beigelman, P M., Rantz, L. A. Archs. intern. Med. 1949, 84, 605.3. Pearson, H E Surgery Gynec. Obstet. 1967, 125, 800.4. Hale. J. E.. Pennpanayagam, R M., Smith, G. Lancet, 1976, ii, 70.5. Casvwell, H. T., Burnett, W. E. Surgery Gynec. Obstet. 1956, 102, 439.6 Habif, D V., Perzin, K. H., Lipton, R., Lattes, R. Am. J. Surg. 1970, 119,

523

7. Hughes, L. E. Lancet, 1976, ii, 198.

Round the World

From our CorrespondentsItaly

INFORMATION ABOUT DRUGS

THE most widely circulated Italian monthly publication forthe medical profession is the Bollettino dinformazione suiFarmaci (Information Bulletin on Drugs), an eight-pagepocketsize production devoted primarily to undesirable effectsof drugs. With 200 000 copies of each issue distributed free, itexceeds by far any other Italian medical periodical. It sur-

passes even Federazione Medica, the official organ of theItalian Medical Association, which each of Italy’s 140 000 doc-tors is entitled to receive, the subscription being included in theannual Association fee. The Bollettino started its third year of

publication this month, and its circulation has jumped from182 000 to about 200 000, because the Ministry of Health,which publishes it, decided to include 15 000 drug-houserepresentatives in the mailing list, which also includes the140 000 doctors, 40 000 pharmacists, and some 2000 leadinghealth experts and other moulders of public opinion. The Bol-lettino includes warnings about side-effects of drugs, thera-peutic notes, and news of the Ministry of Health’s activities.It is Italy’s biggest educational effort promoted by a Govern-ment agency and directed to health workers. Prof. Duilio Pog-giolini, general director of the pharmaceutical division at theMinistry, is both the promoter and the editor of the Bollettino.A strong supporter of rigid regulations on approval of drugsand on distribution and prescription, Professor Poggiolini isopenly against the consumer approach in pharmaceuticaladvertising. He insists that the medical profession is entitled tobe better informed. The 1979 series of his Bollettino will in-clude lists of drugs with their chemical names and the corres-ponding trade names. He thereby hopes to achieve at least onegoal: to help doctors to avoid listing in the same prescriptionidentical substances disguised under different trade names.United States and Canada

TELEVISION

THE three large U.S. television networks put forth a flow ofsoap operas, cops and robbers, ancient motion pictures, andmaudlin sentiment, punctuated by disheartening commercials.It is left to the Public Broadcasting System (P.B.S.) to restorefaith in humanity. Unfortunately, P.B.S. is available only toa minority, and many large U.S. cities soldier on in philistineisolation. Although P.B.S. is partly supported by Federalgrants, and by contributions from various philanthropic trustsand other organisations, most P.B.S. stations have to rely oncontributions from the viewing public to remain in business,and for the most part they lead a precarious hand-to-mouthfinancial existence. But P.B.S. has done a marvellous job andan increasing number of North Americans have been intro-duced to, and have greatly enjoyed, many B.B.C. productions,including The Forsyte Saga, The Pallisers, and Jude the Ob-scure. The situation in Canada is appreciably better, and asidefrom the usual large U.S. networks, and in some areas P.B.S.(which is usually pirated), the Canadian Broadcasting Com-pany (C.B.C.) has its own television programmes. Both P.B.S.and C.B.C. also maintain excellent radio programmes.Although Canadians seem to be perpetually criticising C.B.C.,and, at recent public hearings, C.B.C. was repeatedly hauledover the coals, Canadians would do well to count their bless-ings. While C.B.C. may not quite achieve the standard of theB.B.C., it is streets ahead of all its American rivals. Many ofits programmes, and in particular its documentaries, comparevery favourably with those of the B.B.C. Like P.B.S., C.B.C.exists on a shoestring budget, and, moreover, the recent aus-terity programme introduced by the Government sliced largesums from C.B.C.’s appropriations. It is hoped that the Cana-dian Government, in its zeal for balancing the budget,remembers that C.B.C. does much to balance the mind

throughout the long Canadian winter.