674

Correspondence.

VENEREAL DISEASE IN THE MERCANTILEMARINE.

"Audi alteram partem."

To the Fditor of THE LANCET.

SIR.—Having spent over six years at sea, in morethan a dozen steamship companies, there has beenopportunity to note both the large number of casesseen of venereal disease among seamen and to cleplurethat something is not done to modify what is an ever-present evil.Examination of Crew.—Before signing on this is

supposed to be done by the ship surgeon. I havenever forgotten the words used by the Board ofTrade official on more than one occasion to me :

"You might ’look’ these men over, doctor." Ofcourse too often this " looking over" is a purelyperfunctory affair, with the result that men are signedon who, though not apparently unfit, soon make theirappearance at the dispensary.

Inspection in Foreign Ports.—This also is a for-mality. Men are drawn up in a line and ship surgeonand port doctor pass rapidly along, in haste to get itover and obtain pratique.The object of this letter is principally to suggest

an aid in the matter of dealing with venereal diseasewhile in foreign ports. Statistics are given sliowingthe benefit of early prophylactic treatment of casesin the United States Navy during the first 12hours after possible infection. Immediate treatmentcould hardly be carried out on board merchantvessels, where the surgeon is usually single-handed.but it should be obligatory on all men who haveexposed themselves to infection to present themselvesat the dispensary the following day for prophylactictreatment. In addition a notice should be placed inall fo’c’stles drawing attention tu the danger run bymen when in foreign ports : the danger of prumis-cuous use of towels, pipes, shaving gear, tobacco-pouches, and even teoth-brushes. The danger ofine’’ticiemt treatment should also be drawn attentionto, as I know from experience that men will oftenseek the aid of a chemist rather than report to thesurgeon. There are then too often disastrous cun-sequences from wrong treatment, or advice from aman who is simply out for profit. Capsules are

sold at extortionate prices, and injections are dis-pensed with no knowledge of the strength to be usedor suitability of the remedy. Again, there is theuntreated man, who becomes a source of gravedanger on his arrival home.

L. L. BURTON, M.D., F.R.C.S.Dargaville, New Zealand.

EXCISION OF THE METATARSAL HEAD.

l’o the Editor of THE LANCET.SIR,—Like Mr. Geurge Perkins, whose summary of

the results of excision of the metatarsal head, halluxligidus, &c., I have read with interest in your issueof March 12th, I have found that although thepatients have expressed satisfactiun with the resultof this operation, the condition as regards bothcomfort and function has not been quite satisfactoryto the surgeon. Ten years ago I removed the meta-tarsal heads for double painful bunion in a memberof my household, and seeing the result daily over aperiod of years has made it clear that removal of thehead of the bone has reduced the stabilitv of the feetto a not inconsiderable extent. The patient has to"

pick her way " on irregular ground, has to keep the

flexors of the four outer toes contracted, and so utilisethese toes in place of the absent metatarsal head (orelse be reduced to a plantigrade gait), and is no longerfit for long tramps as formerly.

For the past eight years I have treated all cases ofbunion and hallux flexus by excising at least in.of the proximal end of the proximal phalanx of thegreat toe, and removing exuberant bone from the

upper and outer aspects of the metatarsal head withbone forceps. The results of this operation have beendefinitely better than of the orthodox excision of the

metatarsal head, and I can, with confidence, recom-mend it for all conditions of arthritic deformity

of the great toe.I am. Sir, vours faithfully.Bradford, March 19th, 1927. JAMES PHILLIPS.

CAN TAR CAUSE PULMONARY CANCER ?

To the Editor of THE LANCET.SIR,—I have read with interest Dr. Robert

Hutchison’s tetter in your issue of March 19th un thelikelihood of tar being a cause uf pulmonary cancer,and from 40 years study of cancer I think it is a veryfeasible hypothesis. Two cases of pulmonary cancerthat I have lately encountered would tend to bearthis out-both in females, aged 76, both for years hadbeen emphatic in their enjuvment of the warmth cfananthracite, iron. enamelled stove in their bedroom,and both must, therefore, have inhaled for many hoursat a time the tarry vapours and dust incident to thismethod of bedroum heating. The effect of suchdeleterious inhalations is desiccation of the mucousmembranes, and then atrophy of the mucous glands,which are specially abundant on the posterior surfaceof the trachea and in the larger bronchi. Tins exposesthe denuded mucous membrane to irritation from thetarry and dusty fumes.

It is difficult to understand how the persistent localapplication of tar can bring about epithelioma in atissue, but my opinion is that it does so by dissolvingout the thin layer of mucin that encases every cell,separating one cell from another, no matter how

closely they are packed, even when so approximated asin the cutaneous tissues, thus allowing the individualcells to rub shoulders, so to speak, and thus an attritionof cells arises and cell division is set up with its direconsequences of infiltration, dissemination. andmetastasis.

WM. STUART-LOW, F.R.C.S.Wimpole-street, W., March 22nd, 1927.

THE PATENTING QUESTION.To the Editor of THE LANCET.

SIR,—We desire to make the strongest possibleprotest against the article on the Patenting Questionin your issue of March 12th, in regard to the sywcitirreference to the patent of Herrmann and Fränkel(E.P. 113,311). As proprietors of the patent inquestion we arc in a position to throw some light onthe matter, relying upon your courtesy to publishthese comments in your esteemed journal.

For ten years we have been manufacturing accevrd-ing to that patent an ovarian preparation. " Sisto-rnensin," and are selling it also in Great Britainthrough our concessionaires, the Olayton Aniline Co.,Ltd., London, in any required quantities ; the pricesfixed bv our concessionaires are considered by every-body to be fair and reasonable. The reproach thatthrough not granting a licf nce for this process weprevent the intruduction of potent preparations isunjustified, because of the very fact that Sistomensinitself is recognised to be a potent preparation, asirrefutably shown by a considerable number of spon-taneous scientific publications emanating from leadinghospitals as well as from private practitioners, with-out mentioning the innumerable unpublished reportsand communications from members of the medical

profession. We shall be glad at any time to submitthis documentary evidence to your perusal.We may add that our product is standardised

physiologically by the recognised and approved