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in warmed castor oil, supplemented by a smallamount of a solution of " dihydro-follicular-hormonebenzoate" in sesame oil (the Progynon B Oleosumforte prepared by Messrs. Schering). The injectionswere intramuscular and preceded by a control periodof at least 14 days, and the following calculationswere made for successive three-day periods: meandaily milk yield, mean daily production of milk fat,mean daily production of milk non-fatty solids,mean percentage of fat in milk, and mean percentageof non-fatty solids in milk. The results showedthat oestrogenic hormone injections were alwaysfollowed by a considerable diminution in milk yield.The inhibition was temporary and was obviouslycorrelated with a transient but considerable increasein the level of oestrogenic hormone in the blood.An attempt was made, by giving to one cow simul-taneous injections of the oestrogenic hormone andprolactin, to determine whether the inhibition isexerted primarily on the anterior pituitary or whetherit is a direct effect on the mammary gland ; unfor-

tunately the results were inconclusive. The effectsof the cestrogenic hormone on the composition of themilk were remarkable, suggesting that the treatmenthad conferred upon the mammary gland the powerto synthesise milk constituents at a higher rate thanbefore treatment. An increase in concentrationof solids in the milk secreted lasted for two or threemonths. These investigations have an obviousinterest for those concerned with promoting the

breast-feeding of infants, though the direct applica-tion of the results of such studies to the humansubject would not be easy especially in view of thesuperstitions which have accumulated round the

subject of breast-feeding. P. J. Greenway,3 who isthe systematic botanist at the East African Agri-cultural Research Station in Tanganyika Territory,has recently recorded some interesting observationson the artificial induction of lactation in women byadministration of various concoctions both by mouthand by local injection. He records over a dozen

plants which have a reputation in the territoryas galactagogues, and there seems little doubt thatsome activity in the breast even of women who wouldnot otherwise be lactating can be induced by theiruse. Greenway suggests that the plants he mentionsmay have some action on the hormones which controllactation.

THE EFFECT OF VENOUS STASIS ON BONE

REPAIR

THE acceleration of bone growth in conditions ofvenous stasis, clinical as well as experimental, isdiscussed by Herman E. Pearse and John J. Morton 4in the first issue of a new American journal whichwe have already had occasion to notice.5 5 The asso-ciation between chronic cardiac and pulmonarydisease and bone changes in the fingers-the well-known club-fingers-has long been recognised, andPearse and Morton mention various local circulatorychanges associated with hsemangiectasis, arterio-venous aneurysm, and meningioma which have beenheld responsible for overgrowth of bone. They haveconducted experiments on dogs by which they claimto have demonstrated a direct acceleration of bonerepair in artificially-produced defects in the fibulaby ligature of the popliteal vein. These experimentswere first described in 1930, but since they werechallenged by J. A. Key and P. Walton, further

3 E. Afr. med. J. February, 1937, p. 346.4 Surgery, 1937, 1, 106.

5 Lancet, March 13th, 1937, p. 640.

work has been undertaken. Pearse and Mortonhave now done 28 experiments on dogs’ fibule, andthese have shown an increase in the rate of healingin 25 on the side with venous congestion. The

progress of repair is controlled by X ray examination.Great care is necessary to maintain the continuity ofthe periosteum, as failures in bony union occur ifmuscle is allowed to interpose between the fragments.Bleeding is avoided by approaching the fibula throughthe plane of the intermuscular septa, and care isneeded to distinguish the popliteal vein, which it isintended to ligature, from the lesser saphenous vein.The requirements laid down by Pearse and Mortonfor these experiments are that post-operative splintingshall be avoided, that functional disability shall beminimised, and that damage to the circulation shallbe absent. Failure to reproduce their results are

attributable, in their opinion, to some imperfectionof technique. They have found, however, that repairof bone in young animals is so rapid that it isdifficult to accelerate it further, and this also mayaccount for certain anomalies. The object of thisstudy was to explain the clinical results reported byother observers, and to suggest that venous stasis hasa place in the treatment of fractures in the humansubject.

THE CHEMOTHERAPY OF STREPTOCOCCAL

INFECTIONS

A FLOW of literature dealing with the therapeuticuse of Prontosil and sulphonamide is now in fullcurrent. What is more particularly needed at thepresent stage is guidance on such matters as dosage,the type of preparation to be used, and the effect to beexpected in different types of infection by Strepto-coccus pyogenes. A solid contribution on these linesis made by Long and Bliss 1 of the Johns HopkinsHospital, Baltimore, who have treated 70 cases

of such infection involving various parts of the body.Among these there were 4 deaths, two being casesof Ludwig’s angina, one a septicaemia in extremis,and the fourth an infant with peritonitis. Therecoveries included 22 cases of erysipelas and cellu-litis, 27 of acute infections of the upper air-passages,including 8 of scarlet fever, 9 cases of otitis media,and smaller numbers of septicaemia, puerperal fever,and other miscellaneous conditions. Long and Blissare convinced of the efficacy of the treatment. Theyhave used both prontosil injections and oral sulphon-amide ; their dosage is heavy (up to 5 grammes of thelatter daily), and they report few signs of toxicaction, including only three examples of sulphaemo-globinaemia. That an adequate concentration ofthe drug can be maintained continuously in theblood and tissues by present methods of administra-tion is indicated by the useful work of Marshall,Emerson, and Cutting,2 who have studied the absorp-tion, in-vivo distribution, and excretion of sulphon-amide given either by injection or by the mouth.This is a straightforward pharmacological study of akind which is apt to find a too belated place whenenthusiasm for a new remedy outstrips the orderlyprogress of its study. The investigations, which werecarried out in dogs, show that whether the drug isgiven by the mouth, by subcutaneous injection, or

intravenously, a high concentration is maintained inthe blood for six hours and diminishes only slowly,owing to the very gradual onset of elimination in theurine. It was likewise shown that a concentration

1 Long, P. H., and Bliss, Eleanor A. (1937) Arch. Surg. 34, 351.2 Marshall, E. K., Emerson, K., and Cutting, W. C. (1937)

J. Amer. med. Ass. 108, 953.