2
18 present in the vaginal epithelium of healthy adult women, and according to Listontis an important factor in favouring the growth of the trichomonas, either by supplying food (glycogen can be demonstrated inside the protozoa) or by presenting a suitably acij environment for growth. The optimum pH for proliferation of T. vaginalis seems to be between 5 and 6, although the acidity in the healthy vagina is considerably higher (pH 3.8-4-2) and this latter reaction is usually reached when the trichomonas infection is eliminated by proper treatment. Infection probably develops when local or general ill-health upsets the normally high acidity in the vagina-for example, trichomonas vaginitis is a not uncommon sequel to a gonorrhoeal infection, while it often recurs after a menstrual period when vaginal epithelium is shed and the reaction of the secretion is more alkaline. The infection must in most instances be endogenous in origin for it occurs in virgins 2 and is a much more common affliction of the female than of the male in whom it rarely causes urethritis (cf. Liston and Lees 3). For clinical and laboratory diagnosis the patient must he in the lithotomy position, so that the genital tract can be examined in a good light with a bivalve speculum. It is desirable that some of the discharge be collected in a con- tainer rather than on a swab for microscopic examination. Cruickshank and Sharman used a long-handled shallow spoon ; Liston recommends a special vaginal pipette which mixes some of the discharge with saline and aspir- ates it into a glass bulb. The frothy non-mucoid grey- ish-yellow nature of the discharge is often characteristic while the pH, tested with the B.D.H. capillator, is usually between 5 and 6. The discharge may now be examined microscopically with a high-power dry lens, and pre- ferably warmed up if there has been a delay of more than .an hour since the specimen was taken. The jerky counter-clockwise movement of the trichomonads and the active lashing of their flagella-often noted when other movements have ceased-are diagnostic. If a drop of Lugol’s iodine is added it will be seen that there is a deficiency of glycogen in the epithelial cells, another feature of trichomonas infection. Films of the discharge should be stained by Gram’s method for gonococci and the thrush fungus, and also with Leishman’s stain, which Liston claims is a useful method for demonstrating the trichomonads, although most workers find them difficult to stain in fixed preparations. PRISONERS OF WAR As soon as a war breaks out the International Red Cross Committee at Geneva sends delegates to report on conditions, to inspect prisoners of war and interned civilians in camps, and_to act as liaison officers between the warring country and Geneva. The international ,delegate to Great Britain at present is Monsieur R. A. Haccius, to Canada Monsieur Maag, to Egypt Monsieur Vaucher, to Greece Monsieur R. Brunel, to Italy Monsieur de Pourtales, to unoccupied France Dr. Cramer, and to Germany and occupied territories Dr. Marcel Junod, Dr. R. Marti, Dr. P. Desmudres and Dr. Exchaquet. A delegate. is to be sent to Kenya, and Colonel Iselin has gone to Lisbon to supervise the sending of food and parcels to prisoners of war. All the delegates are Swiss. The first news they send of British prisoners in occupied France is reassuring. Dr. Junod and Dr. Marti have seen prisoners at Brussels, Malines, Ghent, Enghien, Paris and St. Denis. They are well treated, fed as well as the wounded Germans, who in some cases share the same hospitals, and chiefly lack news, soap and socks. The telegrams sent by the delegates, via Geneva, to the British Red Cross tell much the same stories of life at the various prison camps. At Brussels there are 17 wounded privates receiving excellent treatment by 2. Cruickshank, R. and Sharman, A. J. Obstet. Gynœc. 1934, 41, 369. 3. Liston and Lees, R. Brit. J. vener. Dis. 1940, 16, 34. German specialists. At Malines 70 slightly wounded N.C.O.s are treated by English Army doctors, the food is good and the men are satisfied. In a military hospital at Ghent over 200 men are under the care of their own doctors ; recovered men sent to German camps each receive a double set of underclothing from the Belgian Red Cross. At Enghien, where there are over 450 wounded, there are 24 British Army doctors and 4 chaplains ; care is said to be good and each man receives daily a ration of vegetables and potatoes, bread 200 g., meat 50 g., fats 50 g. They are described, like those in many other prisons, as " suffering for want of news." Most of the men have been allowed to write home. At a big camp for civil interned at St. Denis, food is adequate and the prisoners receive visits from relatives twice a month. There is good sanitation, hot showers are available and the hospital has 7 British doctors and dentists on its staff. Dr. Junod obtained for these prisoners authority to correspond with England through the postal scheme of the International Red Cross, via the German Red Cross. Dr. Marti has visited various camps for the R.A.F. At one of these 231 N.C.O.s and 57 privates are housed comfortably in wooden barracks with a heating plant. The food is good and the prisoners are satisfied but need mittens and socks. The canteen sells fresh vegetables, beer and cigarettes. The men work in labour detachments and are paid 20.8 marks a month. Their correspondence arrives, though irregularly, and they would like to be allowed personal parcels. At a camp for 126 officers, the prisoners need underclothing and books but are otherwise comfortable, and at another there are easy chairs and whisky every evening ; in this last one, Dr. Marti records, there are no complaints. The whole report is encouraging and should help to allay the anxietv of relatives at home. SMOKING AND CORONARY DISEASE WE are all prepared to lay down the law as to the ill effects of the addictions of other civilisations-hashish, opium or whatever it may be-but when it comes to our own addictions-tobacco and alcohol-there’is not the same unanimity. of opinion. Dilling 1 in his textbook says that " excessive use of tobacco may lead to weakness and irregularity of the heart and pulse," but where does excess begin ? Willius and his colleagues,2 who have access to the unrivalled records of the Mayo Clinic, have tried to clarify the position by investigating the role of tobacco in the aetiology of coronary disease. Selecting at random the records of 1000 males aged 40 and upwards with coronary disease as shown by a diagnosis of recurrent angina pectoris, healed, recent or acute cardiac infarc- tion, they noted whether the patient was a smoker or not, and if so to what extent, though they do not explain the basis of their four groups. The vast majority of those who smoked were apparently cigarette smokers. Their controls consisted of 1000 men of the same age-group with no evidence of coronary disease. Of the patients with coronary disease 69-8% were smokers, compared with 66-3% in the controls-not a statistically signifi- cant difference. In men between 40 and 49, however, 79-7% of those with coronary disease were smokers compared with 61-9% of the controls-a significant but hardly striking difference. As a further check they noted the incidence of coronary disease in 1000 male smokers and 1000 male non-smokers aged 40 and over. Again there was no significant difference between the two groups considered as a whole, the incidence being 5.4% in smokers and 3-8% in non-smokers ; but in the 40-49 age-group the smokers’ incidence was 4-8% com- pared with only 1 % in the controls, and the incidence went up to 5-9% in heavy smokers. It was concluded 1. Dilling, W. J. The Pharmacology and Therapeutics of the Materia Medica, London, 1939. 2. English, J. P., Willius, F. A. and Berkson, J. J. Amer. med. Ass. Oct. 19, 1940, p. 1327.
