THE NEW R.A.F. HOSPITAL
1
982 follows the operation undoes its good effect. Results, indeed, have been so disappointing that most English surgeons have abandoned the attempt to treat sterility by operative means. In place of operation the surgeon has tried to meet the difficulty by the withdrawal of spermatozoa from the testis and the use of artificial insemination, but this merely substi- tutes one hopeless method for another. It is strange that artificial insemination, which gives good results in the stockyard, should be useless in the human being ; even when a good supply of semen is available insemination gives no result. There is excellent material here for research. Apparently all the ingredients are present and yet fertilisation is of the very rarest occurrence ; one is almost forced to the conclusion that the absence of the psychic element must be called in to explain its negative results. It is, therefore, incumbent upon surgeons to persevere in the improvement of the technique of anastomotic operations in the hope that some day the almost inevitable occlusion of the duct by cicatrisation may be avoided. The operation for sterility, described by Dr. H. C. Rolnick, of Chicago, in the October number of Surgery, Gynecology and Obstetrics, has been planned with this idea in view. Instead of carrying out anastomosis between the vas and the epididymal canal, a junction is effected between the vas and the rete testis ; the fact that in the latter structure there exist several tubules instead of one increases the chance of success. In order to diminish the risk of sealing up the end of the divided vas a catgut suture is passed through the last inch of the vas, the rete testis, and the testis itself ; this is brought out through the skin of the scrotum and tied on its external surface. The suture also acts as an anchor, preventing movements of the testis by the cremasteric muscle and improves the chance of primary union. It is left in seven to ten days and then removed. The whole object of the operation is to reduce to a minimum the amount of scarring round the site of the junction between the vas and the rete testis, and to ensure that during the process of healing the divided portion of the vas shall remain pervious. The operation is too recent to allow of the author publishing results ; it seems to have been satisfactory when carried out on dogs. THE DUST-CELLS OF THE LUNG. ANYONE who lives in London and looks with the microscope at a bit of the greyish or brownish mucoid sputum which he coughs up in the morning will see a most exquisite example of phagocytosis of dust par- ticles by large clear cells. It is the normal mechanism which does its best to keep our lungs as clear of extraneous matter as may be. Histological sections of the lung of anyone who breathes dirty air show the same picture which is developed to an extreme degree in mitral stenosis, when the remnants of red blood corpuscles which have oozed through the distended capillaries are taken up in great quantities by the similar " heart failure " cells. It used to be thought that these phagocytic cells came from the epithelium lining the alveoli, irritation leading to their prolifera- tion and detachment. But in recent years this origin has been much disputed, and it has been supposed that they were endothelial cells from the lung capillaries or histiocytes from the alveolar walls. A. Policard I (Lyons) has combined two views in his hypothesis, I that they come from the lining of the alveoli, and that I this is mesodermal rather than epithelial. Dr. H. M. Carleton, of Oxford, has recently 1 re-examined the I question in a variety of ways-histology, vital staining, tissue culture-and comes to the conclusion that dust cells are indeed derived from the cells lining the alveoli, and that these are epithelial in nature ; in other words, he reaffirms the original interpretation. Phagocytosis by epithelial cells is not really so very uncommon, even in mammals ; many cancers show an exaggerated degree of it. These epithelial dust cells are, perhaps, chiefly peculiar in their capacity for 1 Quart. Jour. Micros. Sci., 1927, lxxi 223. amoeboid movement, for after picking up particles in the alveoli they will penetrate the lymphatics of the lung, and travel long distances in these vessels and to the bronchial glands. - THE NEW R.A.F. HOSPITAL. I THE building opened at Halton, near Wendover, on Monday last will be the principal hospital for the Royal Air Force and already has accommodation for more than 200 patients. At the opening ceremony Sir Samuel Hoare, the Secretary of State for Air, pointed out that there is no intention of duplicating hospital accommodation where military, naval, and civil institutions are available for the needs of the Force. Last year more than 1200 R.A.F. cases were admitted to naval and military hospitals, which proves, he said, a sincere wish to avoid the extravagant policy of insisting upon special arrangements being made for every man in this branch of the Service. At Halton, however, there is no alternative accommodation, and although the Air Force station there is the largest in the world the hospital has hitherto been housed in huts that were erected early in the war and were converted to medical use later. The new building, which we describe on page 995, will not only serve the local camps, but will also be a centre for all R.A.F. cases for which convenient provision cannot otherwise be made, including those from overseas. The Force, said Sir Samuel Hoare, is rightly proud of its medical and nursing service, and the standard of health which it maintains is very high. The most efficient medical and surgical assistance is required to meet the inevitable strains and risks of life in the air, and at the present time, he might have added, there is a real need that candidates of the right type should join the service. Its attractions from various points of view deserve the close attention of men who are not committed to any other form of practice. CHOLECYSTOGRAPHY AND THE LYON TEST. CLAIMS for the serviceableness of the duodenal tube have been put before London medical societies recently 1 by Dr. B. B. Vincent Lyon, of Philadelphia. These claims lend interest to articles appearing in the American medical press concerning the relative value of the two main means at our disposal for investigating the pathology of the gall-bladder and biliary passages. Lyon’s test, which consists of the examination of the main fractions of bile recovered by duodenal tubage, after the injection of a solution of magnesium sulphate, is readily available to every practitioner who cares to devote the time and care necessary for its performance. Cholecystography, by which the filling and emptying of the gall-bladder are observed radiographically after the oral or intravenous administration of the heavier halogenated phenolphthaleins, can never be performed without expert radiological assistance. It seems, however, probable that when this latter assistance is available the method possesses a higher degree of accuracy than the Lyon test. Such, at any rate, is the opinion expressed 2 by W. W. Boardman, who has made a comparative study of the two methods in a series of more than 60 cases at the Stanford Medical School, San Francisco. Comparing, first, the oral with the intravenous method of dye administration for the X ray test, he finds a very high margin of error when the oral method is employed, more than 50 per cent. of his cases having appeared to be patho- logical by this method, whereas the intravenous procedure showed that only 12 per cent. were actually incapable of receiving the dye into the gall-bladder. These figures are far from agreeing with those of most observers in this country, and suggest that the technique used for oral administration has left some- thing to be desired. It, however, teaches a lesson that has been learnt here as elsewhere-namely, that failure to visualise the gall-bladder must be accepted with some reserve when the oral method only,has been employed. In 11 cases in which both tests were 1 See THE LANCET, Oct. 29th, p. 918. 2 Amer. Jour. Med. Sci., 1927, clxxiv., 536.
Transcript of THE NEW R.A.F. HOSPITAL
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follows the operation undoes its good effect. Results,indeed, have been so disappointing that most Englishsurgeons have abandoned the attempt to treatsterility by operative means. In place of operationthe surgeon has tried to meet the difficulty by thewithdrawal of spermatozoa from the testis and theuse of artificial insemination, but this merely substi-tutes one hopeless method for another. It is strangethat artificial insemination, which gives good resultsin the stockyard, should be useless in the humanbeing ; even when a good supply of semen is availableinsemination gives no result. There is excellentmaterial here for research. Apparently all theingredients are present and yet fertilisation is of thevery rarest occurrence ; one is almost forced to theconclusion that the absence of the psychic elementmust be called in to explain its negative results.It is, therefore, incumbent upon surgeons to perseverein the improvement of the technique of anastomoticoperations in the hope that some day the almostinevitable occlusion of the duct by cicatrisation maybe avoided. The operation for sterility, described byDr. H. C. Rolnick, of Chicago, in the October numberof Surgery, Gynecology and Obstetrics, has beenplanned with this idea in view. Instead of carryingout anastomosis between the vas and the epididymalcanal, a junction is effected between the vas and therete testis ; the fact that in the latter structure thereexist several tubules instead of one increases thechance of success. In order to diminish the risk of
sealing up the end of the divided vas a catgut sutureis passed through the last inch of the vas, the retetestis, and the testis itself ; this is brought out throughthe skin of the scrotum and tied on its externalsurface. The suture also acts as an anchor, preventingmovements of the testis by the cremasteric muscleand improves the chance of primary union. It isleft in seven to ten days and then removed. Thewhole object of the operation is to reduce to aminimum the amount of scarring round the site ofthe junction between the vas and the rete testis,and to ensure that during the process of healing thedivided portion of the vas shall remain pervious.The operation is too recent to allow of the authorpublishing results ; it seems to have been satisfactorywhen carried out on dogs.
THE DUST-CELLS OF THE LUNG.
ANYONE who lives in London and looks with themicroscope at a bit of the greyish or brownish mucoidsputum which he coughs up in the morning will seea most exquisite example of phagocytosis of dust par-ticles by large clear cells. It is the normal mechanismwhich does its best to keep our lungs as clear ofextraneous matter as may be. Histological sectionsof the lung of anyone who breathes dirty air show thesame picture which is developed to an extreme degreein mitral stenosis, when the remnants of red bloodcorpuscles which have oozed through the distendedcapillaries are taken up in great quantities by thesimilar " heart failure " cells. It used to be thoughtthat these phagocytic cells came from the epitheliumlining the alveoli, irritation leading to their prolifera-tion and detachment. But in recent years this originhas been much disputed, and it has been supposed thatthey were endothelial cells from the lung capillariesor histiocytes from the alveolar walls. A. Policard
I(Lyons) has combined two views in his hypothesis, Ithat they come from the lining of the alveoli, and that Ithis is mesodermal rather than epithelial. Dr. H. M.Carleton, of Oxford, has recently 1 re-examined the Iquestion in a variety of ways-histology, vital staining,tissue culture-and comes to the conclusion that dustcells are indeed derived from the cells lining the alveoli,and that these are epithelial in nature ; in otherwords, he reaffirms the original interpretation.Phagocytosis by epithelial cells is not really so veryuncommon, even in mammals ; many cancers showan exaggerated degree of it. These epithelial dustcells are, perhaps, chiefly peculiar in their capacity for
1 Quart. Jour. Micros. Sci., 1927, lxxi 223.
amoeboid movement, for after picking up particlesin the alveoli they will penetrate the lymphatics of thelung, and travel long distances in these vessels and tothe bronchial glands. -
THE NEW R.A.F. HOSPITAL.
I THE building opened at Halton, near Wendover,on Monday last will be the principal hospital for theRoyal Air Force and already has accommodation formore than 200 patients. At the opening ceremony SirSamuel Hoare, the Secretary of State for Air, pointedout that there is no intention of duplicating hospitalaccommodation where military, naval, and civilinstitutions are available for the needs of the Force.Last year more than 1200 R.A.F. cases were admittedto naval and military hospitals, which proves, hesaid, a sincere wish to avoid the extravagant policyof insisting upon special arrangements being made forevery man in this branch of the Service. At Halton,however, there is no alternative accommodation, andalthough the Air Force station there is the largest inthe world the hospital has hitherto been housed inhuts that were erected early in the war and wereconverted to medical use later. The new building,which we describe on page 995, will not only serve thelocal camps, but will also be a centre for all R.A.F.cases for which convenient provision cannot otherwisebe made, including those from overseas. The Force,said Sir Samuel Hoare, is rightly proud of its medicaland nursing service, and the standard of health whichit maintains is very high. The most efficient medicaland surgical assistance is required to meet theinevitable strains and risks of life in the air, and atthe present time, he might have added, there is a realneed that candidates of the right type should jointhe service. Its attractions from various points ofview deserve the close attention of men who are notcommitted to any other form of practice.
CHOLECYSTOGRAPHY AND THE LYON TEST.CLAIMS for the serviceableness of the duodenal
tube have been put before London medical societiesrecently 1 by Dr. B. B. Vincent Lyon, of Philadelphia.These claims lend interest to articles appearing in theAmerican medical press concerning the relative valueof the two main means at our disposal for investigatingthe pathology of the gall-bladder and biliary passages.Lyon’s test, which consists of the examination of themain fractions of bile recovered by duodenal tubage,after the injection of a solution of magnesium sulphate,is readily available to every practitioner who cares todevote the time and care necessary for its performance.Cholecystography, by which the filling and emptyingof the gall-bladder are observed radiographically afterthe oral or intravenous administration of the heavierhalogenated phenolphthaleins, can never be performedwithout expert radiological assistance. It seems,however, probable that when this latter assistance isavailable the method possesses a higher degree ofaccuracy than the Lyon test. Such, at any rate,is the opinion expressed 2 by W. W. Boardman, whohas made a comparative study of the two methods ina series of more than 60 cases at the Stanford MedicalSchool, San Francisco. Comparing, first, the oralwith the intravenous method of dye administrationfor the X ray test, he finds a very high margin oferror when the oral method is employed, more than50 per cent. of his cases having appeared to be patho-logical by this method, whereas the intravenousprocedure showed that only 12 per cent. were actuallyincapable of receiving the dye into the gall-bladder.These figures are far from agreeing with those ofmost observers in this country, and suggest that thetechnique used for oral administration has left some-thing to be desired. It, however, teaches a lessonthat has been learnt here as elsewhere-namely, thatfailure to visualise the gall-bladder must be acceptedwith some reserve when the oral method only,hasbeen employed. In 11 cases in which both tests were
1 See THE LANCET, Oct. 29th, p. 918.2 Amer. Jour. Med. Sci., 1927, clxxiv., 536.
