1371PROSTATIC TECHNIQUE.—SANATORIUMS OR " TUBERCULOSIS HOMES " ?

provided by the voluntary hospitals are carefullytaken into account. Even where local authoritieshave powers of reorganisation and expansion underold statutes which absolve them from the requirementof formal consultations with the voluntary institutions,they are nevertheless being advised to observe theletter of Section 27 of the 1929 Act. The report, whichincludes an account of the progress already madetowards getting the new system to work, insists

strongly upon the necessity for cooperation with thevoluntary hospitals for many purposes, " includingmedical teaching and research." No harm wouldhave been done by an even more pronounced insistenceupon this point, in view of the rapidly growingimportance of that preventive and curative work whichis based upon research in the hospital laboratory.

PROSTATIC TECHNIQUEUROLOGISTS are making every effort to remove

prostatectomy from the category of septic operations,and a paper by Mr. H. P. Devine 1 contains manyvaluable suggestions about how this may be done.He points out that the dangers of sepsis and haemor-rhage are partly due to the fact that the prostateis shelled out blindly rather than dissected awayfrom its bed. If, however, a satisfactory approachis obtained, there is no reason why the prostateshould not be dissected away, with vessels tied as

they are divided, torn mucous membrane removed,and the cuff of divided mucous membrane suturedto the prostatic bed. In order that this operationmay be carried out, he uses the well-known retractorbearing his name, which has been modified especiallyto fit the needs of prostatic and bladder surgery.Two of the blades which hold the bladder wall apartare fitted with small lamps placed in the middle ofspoons ; these spoons serve both as reflectors andretractors. During the operation the blood is drawnaway through a suction tube fixed to the frame andterminating in the lowest spoon. By this means andwith the patient in the exaggerated Trendelenburgposition, the removal of a prostate can be easilycarried out under full visual control. In order thatsepsis may be avoided, changes must be effected notonly in operative but in post-operative technique.The latter usually suffers from the disadvantagethat continuous contact of the wound with urineinterferes with the process of healing. Therefore inthe post-operative treatment of prostatectomy everyeffort should be made to have as little urine as

possible in contact with the prostatic cavity. Toachieve this, a rubber tube with many perforationsin its lower end is inserted as far as the cavity. Intothis is fitted a smaller metal tube, whose end is lowereduntil it is just touching the mucosa. This aspiratingtube is kept in position by means of an adjustablescrew on a circular metal plate lying over the abdomen.Suction is provided by a water pump attached to asurface tube. After seven or eight days, when thespace of Retzius is sealed off, the end of the aspiratingtube is raised so as to lie just within the bladder.By these means Devine claims that it is possible tokeep the bladder free from urine till granulation tissuehas formed to provide a protection for the prostaticwound. The great quantity of air which is aspiratedover the wounds assists in keeping them dry, clean,and healthy. He states that this method has beenin routine use for over 15 years, and that practicallyit has been found to be a great advance in prostatictechnique. The only criticism that can be made

1 Australian and New Zealand Jour. of Surg., March, 1932.

of it is that aspiration methods require a great dealof attention, and that what is undoubtedly excellentin theory sometimes breaks down in a busy hospitalpractice. ____

SANATORIUMS OR "TUBERCULOSIS HOMES"?

THE comparative merits of the different forms oftuberculosis institution are being keenly debated atthe present time in Norway, where two main typesalready exist. The one is represented by the largesanatoriums staffed by specialists, the other by thenumerous small "tuberculosis homes" which are

dotted all over the country. The latter are usuallyin the charge of a non-resident doctor, the localmedical officer of health, or some equivalent. Theseunpretentious homes cost comparatively little perbed, and they are an invaluable refuge to patients whoare in an advanced and incurable stage of the disease,and who wish to spend their latter days near home,without being a burden or danger to friends andrelations. The homes have, in fact, become such avaluable and integral part of the administrativetuberculosis machinery in Norway that some of theirover-zealous friends have been tempted to set them upas competitors of, instead of as auxiliaries to, the largesanatorium, the building and running of which isundoubtedly costly. A corrective to this movementis to be found in a singularly convincing and logicalexpose by Dr. Cathrine Hambro.l As she points out,treatment of the tuberculous has the double aim ofrendering them fit for work and non-infectious ;it is by these two standards that the efficacy of anytherapeutic system must be judged. To form anestimate of the value of treatment by specialistsin a sanatorium, she has studied the records of 205patients given sanatorium treatment between 1925and 1928 and kept under observation, with onlyabout five exceptions, till January, 1932. All, withthree exceptions, were sputum-positive, and allwere selected for pneumothorax treatment. It couldnot be carried out in 45 cases, and not more than oneof these 45 patients achieved both fitness for workand non-infectiousness-this only after prolongedconservative treatment. Among the 160 patients inwhom a pneumothorax could be induced, there wereas many as 63 who ceased to be infectious and achievedcomplete fitness for work. Another 20 also ceased tobe infectious and achieved a certain degree of fitnessfor work. Three other patients ceased to be infectious,,but could not work. It will thus be seen that morethan 50 per cent. of these pneumothorax-treatedpatients were restored to complete or partial fitnessfor work, and had ceased to be dangerous to theirsurroundings. Tuberculosis homes do not and,according to Dr. Hambro, should not attempt suchtherapeutic results. They should rather be clearingstations from which suitable potential pneumo-thorax cases should be sent to the large sanatoriums.It has, however, been suggested that the visitingphysicians attached to tuberculosis homes should

qualify themselves in artificial pneumothorax tech-nique by a residence of six months at a sanatorium.Dr. Hambro is very doubtful as to the standard of

efficiency likely to be reached by such a six months’stay; and (what is even more important) the medicalofficer of health who would like to convert his 40-bedtuberculosis home into a pneumothorax-inducingsanatorium would find an average of three hourswork a day not too much for the needs of his institu-tion. Few medical officers of health could possiblyspare so much time in view of the many other claims

1 Tidsskrift f. d. Norske Laegeforening, May 1st, 1932.

1372 DANGEROUS DRUG TRAFFIC IN EGYPT

upon them. Dr. Hambro concludes that Norway is Iprobably sufficiently well provided with children’s.homes, and more or less adequately with tuberculosishomes, whereas the shortage of public sanatoriumbeds entails a delay of three or four months on thewaiting lists. There is not, in fact, half a sanatoriumbed for every yearly death from pulmonary tuber-culosis. The solutions which Norway will ultimatelyfind to these administrative problems will assuredlybe of interest to the world at large, for most..countries are at present facing the same or similarproblems.

DANGEROUS DRUG TRAFFIC IN EGYPT

WITHIN the last three years, under T. W. RussellPasha’s direction, the Central Narcotics IntelligenceBureau of the Egyptian Government has shown howmuch can be accomplished, both nationally and inter-nationally, with zeal and determination in exposing.and restricting illicit trade in drugs of addiction.It was reported to the last meeting of the AdvisoryCommittee on Opium at Geneva that while in 1928-.29 there were some 500,000 addicts among a popula-tion of 14,000,000 there are now fewer than 150,000 ;while convictions for offences under the NarcoticsAct have fallen from 10,294 in 1930 to 5571 in 1931.Heroin is no longer imported in bulk into Egypt,though a large number of small consignments are

still introduced. Hashish, which has only recentlybeen added to the list of dangerous drugs, neverthelessclaims many victims, and it is estimated that thereare in Egypt no fewer than 282,000 hashish addicts !Russell Pasha has repeatedly called attention to thefact that under Egyptian legislation traffickersof foreign nationality cannot be proceeded against,otherwise the illicit traffic in that country would, heholds, by now have been very largely reduced. One,of his most striking coups has been the conviction on.June 15th of Mohamed Mustapha Nafei, the head ofthe greatest and most unscrupulous of the smugglingorganisations in the Levant. His agents were

widespread, ships and motor-cars conveyed the.contraband goods to hiding places for storage, a

,chemical laboratory was maintained at Cairo,respectable capitalists were inveigled into thebusiness, and police and soldiers had been bribedand corrupted. Caught at last, Mohamed MustaphaNafei was sentenced to five years’ imprisonment andfined ;EE.I000, while four of his confederates at thesame time received similar exemplary sentences.Russell Pasha has set an example to some of the morelethargic signatories of the opium conventions,in combating what he has termed " the ghastlyside of narcotic addiction."

HERTZIAN-WAVE THERAPY

A METHOD of procuring thermotherapy which has’been little tried in this country is the use of shortelectro-magnetic (Hertzian) waves. Their action onthe body and indications for their application are setout in a monograph by Drs. J. Saidman and R. Cahen,.in which the physical and electro-technical principlesunderlying the production of currents of extremely highfrequency through the agency of the triode valve are.enunciated. The authors regard most of the biological,effects that follow exposure of the body to shortHertzian waves as due to the heat produced in thetissues, but they discuss the possibility of some otheraction of the waves and speak of their

"

quasi-specific "

1 Les Ondes Hertziennes Courtes en Thérapeutique. By JeanSaidman, Director-fondateur de l’Institut d’Actinologie, andRoger Cahen, Chef de Laboratoire de l’Institut d’Actinologie.With preface by Prof. d’Arsonval. Paris: G. Doin et Cie.Pp. 135. Fr.35.

action in the treatment of the pain accompanyingneuritis and neuralgia. The use of these waves in theproduction of the so-called therapeutic fever andthe treatment of general paralysis is described. The

technique does not seem to be elaborate.When the current from the ordinary diathermy

machine is employed for heating the tissues theelectrodes are placed in contact with the body. If,however, the machine is constructed to producecurrent of much higher frequency the electrodes can becovered with insulating material and placed at a littledistance from the body ; the region of the bodybetween the electrodes will be heated. The rise of

temperature is attributed to the action of the shortelectro-magnetic waves to which the tissues are

subjected. Those who are interested in the progressof diathermy and diathermotherapy will want toknow what may be gained by the use of electro-

magnetic waves for the purpose of heating the bodyand treating disease. The authors maintain that thedeep regions can be heated to a higher degree thanthat which can be obtained with the diathermycurrent, and suggest that the biological effects broughtabout by the waves are not wholly due to the produc-

tion of heat. The fact that the deep-lying organs ofthe abdomen can be heated only very slightly by thediathermy current is recognised, but absolute proofthat they are heated by these waves has not yet beenobtained and it would be even more difficult to provethe thesis that the biological effects of exposure toelectro-magnetic waves are due, in part, to somephysical change other than the elevation of the

temperature of the tissues. One advantage of theemployment of the waves in place of the diathermycurrent is however evident. The electrodes can be

applied over the clothes. This not only saves the timespent in arranging electrodes in perfect appositionwith the uncovered skin, but avoids much of the riskthat some movement on the part of the patient undertreatment may cause accidental burns.

FULTON’S BIBLIOGRAPHY OF ROBERT BOYLE

As R. T. Gunther pointed out in "Early Scienceon Oxford," medicine owes more than can be readilydefined to Robert Boyle for his influence in establish-ing a proper physical and chemical basis for the

study of the human body in health and disease.

Though much in Oxford from 1654 to 1668 and a

leading spirit in its Philosophical Society, he was nevera

"

gown-man " there. But in 1665 he was created a

Doctor of Physic, he endowed an annual lecture indefence of natural and revealed religion, and his nameis further kept green by the Robert Boyle lecture,founded in 1892 by the Oxford University JuniorScientific Club. It is therefore fitting that at Oxfordthe University Press, under the guidance of her

Biographical Society, should bring out the scholarlyand fascinating " Bibliography of the HonourableRobert Boyle " which, after collecting for eight yearsthe early editions of these works, Dr. J. F. Fulton,sometime Fellow of Magdalen College, Oxford,and now Professor of Physiology at Yale, has compiled.It contains 250 items of Boyle’s works, a section onworks dedicated to him, including Joseph Needham’s" The Sceptical Biologist " (1930), his funeral sermonand elegies, his biographies and the criticisms andcommentaries made about him. The formal listof Boyle’s publications and their various editions is

generously illustrated by photographic facsimiles

1 Reprinted from the Oxford Bibliographical Society’s Pro-ceedings and Papers, vol. iii., part 1, pp. 1-172. OxfordUniversity Press. 1932.