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exerts a contractile force in direct proportion to thepressure of fluid in the bladder, and an external sphincterunder voluntary control. By using radio-opaque sodiumiodide in the bladder and taking direct manometric

readings Barnes established that a given volume of fluidin the normal bladder results in a smaller intracysticpressure than exactly the same volume does in thebladder of a woman suffering from uterine prolapse.This simply means that the prolapsed bladder makes agreater demand on the internal sphincter than thenormal bladder so that a cough or sneeze may providethe threshold pressure for incontinence, the external

sphincter alone being unable to dam back the rising tide.By inserting a finger-shaped balloon into the urethraand filling it with sodium iodide Barnes demonstratedthat the normal urethra is able to tolerate pressures upto 35 c.cm. of water and remain closed throughout itswhole length, right up to the urethrovesical junction.Funneling of the upper end of the urethra indicatespartial weakness of the internal sphincter and is a

constant finding in many cases of stress incontinence. Ifthe patient is asked to strain while the balloon is in

position and the bladder partially filled intravesicalpressures up to 80 c.cm. of water may be obtained. Eventhis increased pressure is unable to cause funneling of theurethrovesical junction if the internal sphincter is intact.Thus it seems that the internal sphincter is by farthe more important of the two in preserving urinarycontinence.

SPLEEN EXTRACTS IN CANCER THERAPY

AN idea is widely held that certain tissues are anti-blastic-that they, or their extracts, specifically inhibitthe growth of tumour cells. The spleen especially enjoysa reputation as an antiblastic organ because macro-

scopic metastases of the spleen are rare. Microscopicdeposits are often found in it however, as Kettle andothers have shown.1 These deposits are probablypumped out of its relatively wide sinusoids into thesplenic vein before they are able to gain a hold byinfiltrating the spleen itself. In fact the comparativefreedom of this organ from secondary growths probablyhas a physiological and anatomical rather than a

humoral basis. Nevertheless the number of experi-ments in which spleen extract is used as a therapeuticantiblastic agent continually grow. Extract of spleen,if injected into an animal will act as an antigen provokingantibodies to foreign cells of any kind that may subse-quently be inoculated. Thus if the efficacy of extractis tested against the growth of transplanted tumours itbecomes impossible to assess any purely antiblasticcapacities which may have been conveyed by it to theinjected animal. The only test in which an assessmentof specific anti-tumour-growth properties can be mademust be planned on spontaneous primary tumours.This necessity has been seen by Lewisohn, Leuchten-berger and Laszlo who report some encouraging results.The spleens used by Lewisohn and his colleagues came

from mice which had received previous injections andtransplants. The injections were highly concentratedextracts of beef spleen ; the transplants were cells ofmouse sarcoma 180. As was to be expected, some ofthese transplants regressed when the extracts provokedsufficient foreign-cell antibody to deal with them. Themice in which these expected regressions occurred werethen made the source of the spleen extract used in thenext test. The test of specific antiblastic action wasmade on spontaneous mammary carcinomas in a strainof mice in which natural regressions have never beenobserved. Among the tumour-bearing mice treatedsome growths regressed and disappeared. The finalresults are recorded in a footnote made 7 months after

1. Kettle, E. H. J. Path. Bact. 1912, 17, 40.2. Lewisohn, R., Leuchtenberger, R. and Laszlo, D. Surg. Gynec.

Obstet. September, 1940, p. 274.

the first treated tumour disappeared and about 4 monthsafter the last. Of 83 mice, 17 were apparently cured;of these 17 only 4 had remained free of macroscopicsigns of a tumour for 7 months. Recurrences hadoccurred recently in 8 mice which were classed as curedat the time of presentation of the paper and before thefootnote was added. A longer period of observationand a larger number of animals successfully treated willbe required before any great hopes can be raised by amethod based on such a dubious theory.

FŒTAL HÆMORRHAGE

IT is generally believed that haemorrhagic disease ofthe newborn develops between the second and sixthdays after birth but Javert 1 has obtained evidence ofits onset during the first day in over a third of a seriesof cases. He calls attention to the higher incidence ofantepartum complications in the mothers of theseinfants and finds the condition to be associated eitherwith prolonged labour or with excessively violentuterine contractions. He reports 2 three cases of neo.natal haemorrhage which began in utero, in which themothers had a severe labour of short duration. In twothe amniotic fluid was blood-stained, and in the thirdthere were placental haematomas. While it may betrue, as Javert suggests, that uterine contractionsincrease the infant’s intracapillary pressure and so tendto produce haemorrhage, it is surely going too far toconclude that neonatal haemorrhages may be regardedas physiological, becoming pathological only when theclotting mechanism is disturbed. Javert draws atten-tion to his finding of a prothrombin level of 13% in oneinfant while that of the mother was normal, and this heregards as evidence in support of his idea. He alsosuggests that a low prothrombin level in the infantmay be a factor in producing premature separation ofthe placenta, and supports Shettles, Delfs and Hellman 3in advocating the administration of vitamin K tomothers during the last month of pregnancy to lowerthe incidence of neonatal haemorrhage. On the basisof a single case he maintains that there is a reductionin the infant’s prothrombin level when the mother hasreceived antisyphilitic therapy. In this connexion it

may be recalled that Home and Scarborough 4 found anincreased capillary fragility to be associated withintolerance to antisyphilitic treatment, and increasedcapillary fragility in an infant would presumably con-tribute to the production of haemorrhage.

MACULAR DYSTROPHY

CONDITIONS like Doyne’s choroiditis, Best’s disease,Stargardt’s disease, familial macular degeneration andvarious nondescript varieties of familial or hereditarymacular affections float like disembodied ghosts in theliterature on fundus lesions. That these affections areall different aspects of a distinct clinical entity is sug-gested by Arnold Sorsby 5 in an extensive survey of theliterature, supported by eight personally observed familialgroups. On the basis of his own cases he holds thatwhile the basic form of the affection consists of mottlingof the maculae many families show considerable depar-ture from the basic type, while all sorts of gradationsoccur between the two extremes. It is true that afamilial stamp characterises the affection, differentmembers of the same family often showing strong re-semblances in their lesions ; but well-marked variationsare also present within some families. The durationof the affection is probably largely responsible for thedifferences in aspect in different members of a family, sothat we should be careful to recognise intermediate

1. Javert, C. T. Amer. J. Obstet. Gynec. 1938, 35, 200.2. Javert, Ibid, September 1940, p. 453.3. Shettles, L., Delfs, E. and Hellman, L. M. Bull. Johns. Hopk.

Hosp. 1939, 65, 419.4. Horne, G. O. and Scarborough, H. Lancet, July 20, 1940, p. 66.5. Brit. J. Ophthal. 1940, 24, 469.