519

REPAIR OF HERNIÆ WITH NYLON MESH

SIR,—Since 1951 there has been a close postoperativesurvey of all inguinal herniae in men treated in the

Liverpool United Hospitals. For several years now,Mr. S. V. Unsworth and his registrars have been carryingout a repair using’ Nylon ’ tricot in a manner very similarto that described by Professor Stock in your issue ofFeb. 20. 47 cases have been so repaired since the surveybegan on July 1, 1951, but only 23 have at present hadrheir routine examination one year after operation. AllM-ere sound, except a man of 59 years who had (unknownto himself) a direct recurrent sac at the pubic end of thee,,tiial: this was excised and the defect repaired, and theoperation notes record " surprisingly little fibrosis,layers defined easily, but little evidence of presence ofnylon tricot."There is one other important feature : 4 cases of the

3 became infected, and although 2 of them were healedwithin five weeks, 1 discharged for four months, andanother for nine months. As with surgical modifications,judgment must await the test of time, but these findingssuggest that infection after this type of repair can beparticalarly unfortunate.

AUSTIN MARSDEN.

SiR,—I was interested in Professor Stock’s report ofthe 12 hernise he ha,; treated successfully by the insertionof pieces of nylon mesh, or net.For the last three years it has been my practice to

treat all inguinal hernite in patients over fifty and allthose over twenty with recurrent hernia, with a nylon-net1llljllant. I have treated 72 patients, the oldest beinga man of eighty seven with a large irreducible scrotalhernia. In 2 cases the liernia has recurred.

Although it is true, as Professor Stock asserts, thatnylon is inert in the tissues, I think he may find that asmall proportion of persons are sensitive to it. I have had

excise one net because of a persistent sinus, and the1(1(ltioii,s showed a severe foreign-body reaction aroundthe nylon Prof. D. !I. Douglas, who is also testing thismethod, tells me that lie has had a similar experience.

F. S. A. DORAN.All Saints’ Hospital,

Bromsgrove.

1. Logan, W. P. D. Lancet, 1953, ii, 1199.

RELATION OF CANCER TO MARRIAGE ANDCHILDBEARING

SIR,—In a recent article in your columns,l I mentionedthat death-rates from breast cancer were in generalhigher amongst single than married women, but thatan exception apparently occurred at ages under 35. Itbeen noted by a number of observers that the rates,ere higher amongst married than single women atThese younger ages. In England and Wales in 1948-49the figures I gave (death-rates per million) were :

Age Single l11arried15-24 .. 1’ .. 1- 2.)-34 .. 21 .. 3335-44 .. 236 .. 20045-54 .. 663.. 469

ages over 55 the excess mortality of single women-

fn his letter of Jan. 9, Dr. Kuhne sagaciously pointed"It that the pecifflarity at ages 25-34 might be explain-’’!’’ hy the increasing proportions of married comparedati single women at increasing years of age within theage-group, and suggested that a way to test this possi-bility would be to standardise the rates- for married and

women within the ten-year age-group. This Inow done. To ensure reasonably accurate popula-estimates of single and of married women at eachyear of age, I used unpublished data from thecensus 1°Q Sample, and accordingly calculated

-of-breast death-rates for the years 1950-52.

The effect of standardisation has been, as Dr. Kühneforesaw, to reduce considerably the excess mortality ofthe married women under 35 ; but it has not eliminatedit, and still less has it’ been able to transfer the excessmortality over to single women, as at ages from 35

upwards.I therefore adhere to the view that I expressed

previously that, in contradistinction to older ages, therisk of dying from cancer of breast at ages under 35 isgreater amongst married than single women.

W. P. D. LOGAN.General Register Office, London, W.C.2.

WHAT IS ULCERATIVE COLITIS ?

SIR,—Mr. Brooke, in the role of the friendly sailor,welcomes me upon the deep waters in his letter ofFeb. 13, and almost immediately starts to fire torpedoesabout me. Most of these, however, are spent and havemissed the target. Many of his points I dealt with inmy letter of Jan. 16 ; but I shall reply briefly to the newissues raised.

I should like to remind your readers that, on Jan. 16 I pointed out that I was speaking on behalf of the X-raydepartment at St. Mark’s and not voicing the opinionsof all the staff.The term " regional colitis " does not suggest a lesion

similar to Crohn’s disease, occurring at different levels inthe .colon, as Mr. Brooke hints : regional colitis is simplya localised area of inflammation which may start in anypart of the bowel from the caecum to the rectum, andthere may be a number of such foci of inflammation. Ifterms such as " proctosigmoiditis " are preferred bysome, to draw special attention to this area, then nodoubt their use will continue. Further, make no mistake,proctosigmoiditis does not always proceed to ulcerativecolitis. It may remain stationary, but when it spreads itcommonly moves higher up the bowel, sometimes evenright round the colon to the caecum, still perhaps as asimple mucous or perhaps granular colitis. Only a fewcases go on to ulceration.

I am disappointed at Mr. Brooke’s remarks about"

thixotrophic gelocolloid suspension of barium," whichhe refers to as one of the " newer preparations of barium."While an assistant in the X-ray department at theLondon Hospital in 1928, with the then director, thelate Dr. Gilbert Scott, I was associated with the use of’ Raybar,’ a thixotrophic gelocolloid, for meal andenema work. In 1929 I introduced it to St. Mark’s

Hospital and later to various other hospitals in Londonand the provinces. The thixotrophic gelocolloids havenow been largely abandoned in favour of the dispersioncolloidal solution of barium, known as ’ Micropaque,’which has been on the market for some years and onwhich I carried out some of the original tests for themanufacturers. I believe that at Queen Elizabeth

Hospital, Birmingham, research on steatorrhcea has beenin progress for some time and perhaps the older prepara-tion of raybar may have had certain advantages and soits use was continued.

Mr. Brooke says that at Birmingham the lesions ofenterocolitis are revealed only sometimes and withdifficulty by thixotrophic gelocolloid barium. I suggest atrial of the more modern preparation and perhapsassessment of the radiological changes on the lines Ihave indicated. There is no question of arguing " thatsuch investigations are unnecessary in a hospital whichmostly receives patients destined for surgery and does notdeal with the gamut of intestinal disorder ..." because