440

may have gained, since male hormone is also indicatedin the management of benign enlargement of theprostate on the view that the condition results fromthe prolonged activity of oestrogens. It is idle,however, to speculate, in the present state ofknowledge, on these various issues. One thingonly is plain. Several hypotheses regarding the

2etiology of enlarged prostate have implied that malehormone would be of use in the treatment of thecondition. Information about the chemistry and

biology of male hormone compounds has also

multiplied rapidly in the past year. It is time, there-fore, that male hormone was given a fair and adequateclinical trial im those conditions which experimentalwork suggests may benefit from its use.

WHOOPING-COUGH AND THE PUBLIC

IN spite of unanimous medical opinion and theevidence of statistics to the contrary, the publicof most countries continues to regard whooping-cough as a disease of little account. Dr. F. Barbary,of Nice, in a communication 1 to the Paris Academyof Medicine, deplores the indifference shown in therural districts of France. Evidently an optimistthen, he is disappointed now, seeing that since he drewattention to the matter ten years ago nothing hasbeen done. Dr. Barbary alludes to the well-knownfact that the actual numbers of cases and deathsfrom whooping-cough far exceed those known tothe sanitary authorities. From personal inquiryhe found that, although very few cases had beennotified voluntarily, several hundreds of childrenhad been attacked by the disease in the districthe surveyed and of these many had died from

pneumonia or broncho-pneumonia, the true cause

of which, namely whooping-cough, had not beenrevealed on the certificate. Dr. Barbary advocatesthe education of the public by means of addresses andhandbills. In his view, it is essential to explodethe legend of the efficacity " du fameux changementd’air," since removal of the child results not in theamelioration of the attack but in the spread ofinfection to a fresh locality. He deprecates, too,the practice of permitting children suffering from thedisease to play with others in the street. At intervals,games are interrupted while the sufferer, during aparoxysm, sprays his playmates with infection.It should be impressed upon the public that a fewminutes’ contact with an infective child are sufficientfor the transmission of a disease which, far from beingtrivial, may result in fatal complications. Dr. Barbarydeclares for compulsory notification in order thatspecific measures may be taken for the detection ofsuspects and the protection of contacts. Earlydiagnosis is facilitated by the cough-plate methodand should be followed by isolation. For the contactsDr. Barbary advocates either passive immunisationby means of convalescent serum or active immunisa-tion by means of vaccines.The problem of the control of whooping-cough

in rural France presents the same features in urbanEngland. It is true that in the large cities a com-mencement towards its solution has been made byhospitalisation upon a fairly large scale ; at the

present time, for example, not far short of 700children suffering from whooping-cough are in thewards of the infectious diseases hospitals of theLondon County Council. Since, however, as is thecase in measles, patients are removed to hospitalonly when the phase of maximum infectivity haspassed, hospitalisation is mainly a curative measure.

1 Bull. Acad. de Méd. de Paris, 1936, cxv., 192.

Vaccine prophylaxis, when adequately attested, mayprovide the real solution of the problem if the public,as the result of education, agrees to the necessity.

A PIONEER OF ACTINOTHERAPY

A MEMORIAL to Albert Jesionek in the Niinchenermedizinische Wochenschrift of Jan. 31st is a worthytribute to the work and personality of an outstandingdermatologist of modern times. In this country hewill be remembered chiefly for the remarkable results.he obtained in all forms of cutaneous tuberculosis

by purely " natural " means-viz., diet and sunlight-at- his Lupusheilstatte at Giessen. In this achieve-ment his clinic was probably unique, for his energieswere concentrated on the dermatoses; neither-

pulmonary nor articular cases, as in many other"

biological" institutes, shared the available spaceand facilities. Jesionek was a long way ahead of his.time in formulating his problems and visualising thembroadly as biological. He was no slave to this orthat type of diet, lamp, or local application, and hewas rarely seen at medical congresses with some newgospel of cure or prevention. He preferred the quietatmosphere of his now famous institute at Giessen,and consistently refused the offer of larger and moreimportant spheres of scientific activity. He will beremembered with Finsen, Rollier, and the other

pioneers for his services to actinotherapy and themanagement of cutaneous tuberculosis.

ASPIRATION FOR MAMMARY ABSCESS

DISSATISFIED with the results of incision and

drainage in a carefully controlled series of 42 cases-of abscess of the breast, Mr. R. J. V. Battle andMr. G. N. Bailey resorted to aspiration and lavageof the abscess cavity.l As irrigating fluid they usedat first " bouillons vaccins," and later Dakin’s.solution, and they report results from aspirationwhich compare favourably with those of incision.To their recommendation of aspiration as a routinetreatment there are exceptions-notably the verylarge abscess that results from neglect of a small,localised one, and the diffuse cellulitic type of infectionwhich shows poor localisation and severe constitu-tional reaction from the start. The combinationof a virulent infection with a poor physical conditionprobably accounts for the incidence of this type ofbreast infection. In general, Battle and Baileybelieve that the cause of breast abscess is engorge-ment followed by infection of the stagnant secretionby organisms present in the ducts or gaining accessto them by way of the nipple. Cracks of the nippleincrease the liability to infection in so far as painleads to curtailment of suckling and hence to engorge--ment. Aspiration is most successful when infectionremains localised, but watch must always be kept formultiple infection. Where the suppurative processis of the cellulitic type it is better to incise and explorewith the finger until all pockets have been opened intoone main cavity. Before starting aspiration, the

baby is taken off the affected breast, which is emptiedby a pump. Battle and Bailey use a 25 c.cm. syringeand a needle of 2-5 mm., and they have two or threeof such needles in readiness. They prefer a syringewith a Luer fitting instead of the Record, which is.too narrow in calibre. The breast surface is cleansedwith ether, and a point with definite fluctuation,or, in patients seen before this is present, a point ofmaximum tenderness, is selected. Novocain (2 percent.) is injected through the tissues down to theabscess cavity. The wide-bore needle is inserted,the pus aspirated, and an equal quantity injected

1 Brit. Jour. Surg., January, 1936, p. 640.