410 tablet night and morning on each of two consecutive days. This produces either withdrawal bleeding (no pregnancy) or no bleeding (indicating pregnancy) within 3-6 days. In 23 cases during the past year this method has proved completely accurate, and the cost to the N.H.S. compares favourably with that of gonadotrophin tests. R. J. KENTON. Glasgow.
ACUTE PARENCHYMATOUS GLOSSITIS WITH GANGRENE OF THE TONGUE SiR,—The condition here described appears to be ! unique in the annals of surgery. The case has been : discussed with many eminent authorities on surgery and pathology, but no-one seems to have heard of anything similar. Isolated patches of gangrene of the tongue mayi appear in conditions of cancrum oris, but such an example VARICOSE VEINS of massive gangrene does not appear in the literature. i SiR,—Icannot let pass without comment Surgeon I of an edentulous female of a The 74, complained patient, Captain Cleave’s fascinating contribution of Aug. 22. which started above the angles of the jaws. The pain i pain His explanation in regard to the sluggish and overgradually moved up to the temporal areas on both sides, the I loaded colon resulting from low-residue civilised diet right being worse than the left. She noticed heavy sweating at I affecting the venous return from the lower parts of the night which continued for two to three weeks. The sweating body is fully satisfying and in line with the general was so severe that she had to change her nightwear two or three observation that, whilst faulty anatomy is a rare cause of times a night. Aspirin eased the pain but had no effect on the sweating. After three weeks her throat became swollen and disease, faulty use of the body is a common cause. and she had difficulty in swallowing. After a further Acceptance of his hypothesis brings this condition, congested two weeks the neck became swollen and her tongue began to I which is exceedingly common and is the cause of consider- swell until it filled the whole of the oral She was unable ’ cavity. able discomfort and disability, within the effective realm to protrude the tongue or to open her mouth more than a of preventive medicine. quarter of an inch. The condition gradually worsened until, on a night six weeks from the onset, she suffered intense pain the of the extractionaside controversial issue Leaving and felt she was choking. Her doctor had put her on oxytetrain of there now rate cereals, regard to nutritive value cycline but she was unable to swallow the tablets. At this stage seems to be firm ground for recommending cereals of one of us (S. H.) was called to see her. high extraction-rate not only in the prevention of sympThe patient was in great distress, her temperature was 103°, tomatic constipation but also in relation to the perhaps 120, and she was obviously suffering great apprehension pulse unsuspected overloaded colon. from the fact that she was finding it difficult to breathe and could For many of us Surgeon Captain Cleave’s paper will not even take liquids by this time. On attempting to open the represent an added and important reason to recommend jaws it was found that by straining with a spatula about oneas a matter of basic family nutritional health education third of an inch opening could be obtained, and this revealed good-quality whole-grain cereals and a minimum of a grossly enlarged tongue which completely filled the cavity of the mouth and which was compressing the fauces and refined starchy and sugary substances. soft palate. She complained of great pain in the course of Health and Welfare K. O. A. VICKERY examination. Services Department, Medical Officer of Health. Eastbourne. She was immediately removed to hospital and the aural surgeon (M. D. C.) was called as an urgent tracheotomy would ANTIMONY DIMERCAPTOSUCCINATE probably be needed. She was immediately given 1 g. of streptoIN URINARY BILHARZIASIS mycin parenterally. It was noticed that her breath had a SIR,-Friedheim and de Jongh1 found in Liberia that faintly sweetish odour, not in the least offensive. Further examination showed the surface of the tongue to be a single intramuscular injection of antimony dimercaptosuccinate (TWSb) stopped the elimination of living ova of covered with dry heaped-up epithelium which could easily be Schistosoma hcematobium for a period ranging from one to scraped off. Some of this was immediately sent for bacteriofive months. This led to the concept of a " one dose per logical examination. The patient was given an injection of and settled down for the night. month suppressive management of bilharziasis " in morphine Next day the condition seemed easier. Her temperature was endemic areas, where the significance of a parasitological cure is lessened by the heavy chances of reinfection. We have made a pilot trial of " suppressive management ". 50 persons who were excreting living and hatching ova of S. haematobium were selected at random in a village of the endemic area in the Nile delta, and given a single intramuscular
injection of TWSb, depending on body-weight: 11-20 kg., 0-3 g.; 21-30 kg., 0-4 g.; above 30 kg., 0-5 g. The 50 subjects were examined one month after the treatment. None were passing living hatching ova of S. haematobium ; 11 patients passed dead ova (i.e., motionless, granular, opaque, and deformed ova); 39 patients passed no ova at all. -
These findings in Egypt confirm the observations made in Liberia and support the view that a single dose of
TWSb, repeated at monthly (and possibly longer) intervals, may be expected to suppress the elimination of hatching ova, and thereby remove the patient as a hazard to the public health. ERNST A. H. FRIEDHEIM. New York. Department of Tropical Medicine, HASSAN H. SALEM. University of Alexandria. High Institute of Hygiene, ABDEL F. EL SHERIF. Alexandria, Egypt. 1. Friedheim, E. A. H., de Jongh, R. T. 1959 (in the press).
The condition of the tongue profuse salivation.
after the onset of gangrene. SoIt