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MUSCLE EXTRACTS IN CIRCULATORY DISORDERS.
533 this kind. G. ZtJELZERhas prepared an extract from the liver, named eutonon, which has claims to be regarded as a cardiac "tonic,"and there are numerous other tissue extracts in use, such as angioxyl (from the pancreas), myoston (from muscle), kallikrein (from urine),3 and lately lacarnol (from striped muscle). Similar claims are made for these preparations as for the original heart preparation (hormocardiol) of HABERLANDT ; in general they are held to increase the rate and strength of the pulse, to dilate vessels, especially the coronary arteries, and to restore a regular rhythm in experimental auricular fibrillation. Needless to say, such properties would be very valuable in clinical practice, and it is now possible to review the results obtained in a fairly large series of cases, mostly in continental clinics. The extracts have been employed mainly for angina pectoris, endarteritis obliterans, cardiac failure, and high blood pressure. Some preparations at least seem to be inactive therapeutically and such action as others department of the hospital. How far arrangements of this kind have already possess is apparently not limited to one muscle or been made locally and informally it would not be even one tissue alone. In angina pectoris numerous easy to determine. Some time ago the Paddington favourable reports have been published, and a Medical Society, following a lead given by the direct antispasmodic action is claimed by some London Public Medical Service, designed a leaflet workers. E. K. FREY4 in 1929 reported good for the use of panel practitioners when referring effects in cases of coronary sclerosis and also in patients to hospitals. It was thought that the high blood pressure from a circulation " hormone introduction of such a leaflet would tend to present in urine, blood, pancreatic tissue, and the encourage practitioners who had not been in the spleen. B. BUCHHOLZ,5 using lacarnol, treated 11 habit of sending a note or letter to the hospital patients with angina pectoris, of whom seven were with their patients to do so in future ; that it entirely relieved of their attacks, two were improved, would save the time of the consultant in replying, and two were unchanged. In two an alteration and particularly that it might result in patients in the electrocardiogram was noted pointing to being referred back at once to their insurance improved conduction from auricle to ventricle. practitioners when the need for hospital treatment R. SINGER6 treated 171 patients suffering from no longer existed, and in this way lessen the angina pectoris, hypertension, intermittent claudicongestion of the out-patient department. The cation, and vascular spasm with different circulaPaddington form resembles a sheet of note-paper tion hormone preparations, and found that and is far less forbidding than the Scottish form, lacarnol, hormocardiol, and eutonon seemed to be which is formidable in size and appearance. the most active. The results were especially good in angina pectoris. J. S. SCHWARZMANN7 and others also report marked improvement in angina IN CIRCULATORY MUSCLE EXTRACTS pectoris after the use of muscle extract. The preparations appear to be most efficacious DISORDERS. B when given subcutaneously, but they can also MUCH has been written on muscle extracts be given by mouth ; they are for the most part since L. HABERLANDT in 1929 ascribed remarkable no shock reaction should properties to one obtained from the heart. protein-free so R.that SCHMIDT 8 states that most of HABERLANDT, it may be recalled, isolated the result-though the due a benefit is to non-specific protein therapy sinus of the frog’s heart, macerated it in Ringer’s and not to hormonic action. Probably some any then showed and that the solution found solution, the power to augment the contractions of the chemical substance is present in the extracts which capable of dilating arterioles and increasing the frog’s ventricle. From this he concluded that isheart’s action, possibly by improving the blood flow there was in the sinus node a chemical hormone Definite improvespecific for1 the heart, which he called a " heart through the coronary arteries. in ment has thus been cases of endarteritis recorded hormone." His experiments were soon confirmed, and five cases and of thrombobut it was noted that a similar action could be recently gangrene, were shown M. SCHWARTZMAN obliterans obtained by using the muscle of the ventricle angiitis by the Royal Society itself, and later it was found that the same was true of other tissues of different origin. It has 2 See THE LANCET, 1930, ii., 1203. now been shown, indeed, that extracts from almost 3 Ibid., p. 601. 4 Münch. Med. Woch., 1929, lxxvi., 1951. all body tissues will stimulate the frog’s heart ; Deut. Med. Woch, 1931, lvii., 188. and that even the urine in cases of heart disease Wien. Klin. Woch., 1931, xliv., 39.
be made a definite condition on a hospital which does not accept any governmental grant. So long as this is the case the panel service must depend on the courtesy and enthusiasm of certain members of hospital staffs, than which nothing could be more exemplary ; but some general understanding would be a distinct step forward in linking up the hospitals with the national insurance system. Even in Scotland the arrangement has come with a certain shock of novelty and has evoked some resentment on the part of hospital staffs and managements. The latter no doubt fear the expense and trouble of the additional clerical work involved, although the mere cost may well be onset by a saving of unnecessary references to hospital and of unnecessary treatment in hospital. It is in fact the feeling of the Scottish department that when the procedure is well established it may result in the more frequent treatment of the insured person by the practitioner instead of at the out-patient
can
has
some
activity of
"
at
Clinical Section of the 5
6
1 Das Herzhormon, Jena, 1930.
7 Münch. Med. Woch., 1930, lxxvii., 439 and 2224 8 Ibid., p. 440.
534
of
Medicine, all of which
had
under chemical substances, present in - many animal tissues and possibly containing adenosin, is capableacting beneficially upon the heart and bloodvessels and may be of real value in cases of vascular spasm, coronary disease, angina pectoris, and possibly some other cardiovascular disorders. Further reports upon the therapeutic uses of the non-specific extracts will be awaited with interest.
improved
treatment with muscle extract. This substance has not been certainly identified, but it is clearly not histamine : adenosin has a dilator action upon the coronary arteries and may well be one of the substances concerned. Its use in treatment is still under trial. The bulk of the evidence at
present available suggests that
some
of
ANNOTATIONS science student who has not learned at school to, write clear and forceful English is at a disadvantage IN 1927 the British Science Guild appointed a in communicating his results to the unscientific. It committee to inquire into the functions of the does not follow that the more colloquial turn given scientific and professional staffs in the public services to his report by the works manager will convey its. and industry from the point of view of efficient meaning better. One of the advantages of the funcThis tional type of organisation (mentioned in an appendix) administration and national development. committee, of which Sir Richard Redmayne acted as is "that specialised work is more economical than chairman and on which medical science was repre- unspecialised work when the volume of work is sufficient sented by Sir Arthur Newshoime, has now issued its to keep officials and workmen continuously engaged report.! The position of the scientific expert is rela- for the entire period of their employment on specific tively new and has arisen from necessity, owing to specialised work." This is, no doubt, true in the the complex nature of problems now present in both limited sense; it is clearly advantageous for a. business and administration, and it is reasonable to physicist to be occupied all his working time at suppose that it has not yet been stabilised. The physics, or even among physicists that an expert on committee point out that : calorimetry should do this if there is enough to fill his receive It is essential that all proposals and schemes shall time, rather than also dabbling in work on high adequate consideration from every point of view. This can vacua. But the inevitable tendency, even for workers. only be obtained if suitable provision is made for the proper in different branches of the same science, to get out. presentation of the various technical, financial, and other of touch is not likely to help in the coordination of considerations involved in every problem in such a manner that those ultimately responsible for making decisions may the sciences or to relate them more closely to thebe put in a position to weigh the several considerations in everyday work of the nation. Closer cooperation their bearing upon questions of general policy between the various branches of services is necessary This is the position of a judge who is hearing a eom- if all are to pull their weight, and this can only come plicated case, and it can only be secured if the various about if each is able by status and attainments to experts are able to give their views, and so much of command a proper hearing of his contribution to the their reasons for holding such views as they can solution of the common problems. That this is far make intelligible to the final arbiters. It is evident to from an accomplished fact is clear not only from thethe committee that this desirable state of affairs is matter of the report, but from the fact that it has far from being realised in either State or industrial been deemed necessary to write it. services. They refer to the stupid and groundless views which prevail that work of a scientific and DIAGNOSIS OF TUBERCLE IN CHILDREN. technical kind is inferior to that of an administrative kind. That such views do prevail will be generally THE early diagnosis of pulmonary tuberculosis in admitted. They rest in the main on the dislike of children is often made more difficult by an absence of the average Briton for precise knowledge of any kind sputum. Since this is usually swallowed it may be as a guide to action and on the belief that what is worth while to examine the faeces, but of late years true in the laboratory is not necessarily true outside it. gastric has been increasingly employed tolavage Hence the scientific expert is often kept in his place, bring the bacilli to light. V. Poulsen, of Copenhagen,L which is often to furnish results of routine testing, recommends that the child’s stomach be washed out. to explain and excuse the delicts of branches not with a small amount of weak alkaline solution ; the under his control, and to draft reports which will be material obtained is examined directly, a portion i edited by his administrative superiors before they cultured on Petroff’s medium and a portion is. reach the directorate. The committee’s remark that inoculated into a guinea-pig. Altogether he ha " an officer should supervise only work which he is examined 110 children in this way and has found competent to judge and concerning which he can tubercle bacilli in 53. In 38 of the positive cases a. make helpful constructive suggestions to his sub- successful result was obtained on the first examination, ordinates " implies that the head of a staff, including in 12 a second attempt was necessary, while the scientific members, should have at least a sound remaining three cases were positive at the third knowledge of the meaning of their work if he is to or fourth examination. For the most part the present it to the heads of the organisation. One children excreting tubercle bacilli were under 3 yearsdifficulty which is not always fully appreciated by of age (41 positive in 62 cases), but Poulsen explainsscientific people is the ignorance of scientific termino- this by pointing out that older children suspected of logy and manner of thinking prevalent even among tuberculosis are not often seen by him but go straight educated people. To write in language and cona special tuberculosis department. struction which most people can understand the ’ An example of the help given by this method is the caseexpert must continually keep in mind the need for of a 2-year-old child who was admitted with an unexplained simplicity and the avoidance of mere erudition. The i pyrexia in August, 192U. Clinical examination was negative SCIENTIFIC STAFFS.
°
ito
I
1 Price 1s. from the Guild, 6, John-street,
Adelphi, W.C.2.
1
Jahrb. f. Kinderh., 1931
cxxx., 127.
’
be made a definite condition on a hospital which does not accept any governmental grant. So long as this is the case the panel service must depend on the courtesy and enthusiasm of certain members of hospital staffs, than which nothing could be more exemplary ; but some general understanding would be a distinct step forward in linking up the hospitals with the national insurance system. Even in Scotland the arrangement has come with a certain shock of novelty and has evoked some resentment on the part of hospital staffs and managements. The latter no doubt fear the expense and trouble of the additional clerical work involved, although the mere cost may well be onset by a saving of unnecessary references to hospital and of unnecessary treatment in hospital. It is in fact the feeling of the Scottish department that when the procedure is well established it may result in the more frequent treatment of the insured person by the practitioner instead of at the out-patient
can
has
some
activity of
"
at
Clinical Section of the 5
6
1 Das Herzhormon, Jena, 1930.
7 Münch. Med. Woch., 1930, lxxvii., 439 and 2224 8 Ibid., p. 440.
534
of
Medicine, all of which
had
under chemical substances, present in - many animal tissues and possibly containing adenosin, is capableacting beneficially upon the heart and bloodvessels and may be of real value in cases of vascular spasm, coronary disease, angina pectoris, and possibly some other cardiovascular disorders. Further reports upon the therapeutic uses of the non-specific extracts will be awaited with interest.
improved
treatment with muscle extract. This substance has not been certainly identified, but it is clearly not histamine : adenosin has a dilator action upon the coronary arteries and may well be one of the substances concerned. Its use in treatment is still under trial. The bulk of the evidence at
present available suggests that
some
of
ANNOTATIONS science student who has not learned at school to, write clear and forceful English is at a disadvantage IN 1927 the British Science Guild appointed a in communicating his results to the unscientific. It committee to inquire into the functions of the does not follow that the more colloquial turn given scientific and professional staffs in the public services to his report by the works manager will convey its. and industry from the point of view of efficient meaning better. One of the advantages of the funcThis tional type of organisation (mentioned in an appendix) administration and national development. committee, of which Sir Richard Redmayne acted as is "that specialised work is more economical than chairman and on which medical science was repre- unspecialised work when the volume of work is sufficient sented by Sir Arthur Newshoime, has now issued its to keep officials and workmen continuously engaged report.! The position of the scientific expert is rela- for the entire period of their employment on specific tively new and has arisen from necessity, owing to specialised work." This is, no doubt, true in the the complex nature of problems now present in both limited sense; it is clearly advantageous for a. business and administration, and it is reasonable to physicist to be occupied all his working time at suppose that it has not yet been stabilised. The physics, or even among physicists that an expert on committee point out that : calorimetry should do this if there is enough to fill his receive It is essential that all proposals and schemes shall time, rather than also dabbling in work on high adequate consideration from every point of view. This can vacua. But the inevitable tendency, even for workers. only be obtained if suitable provision is made for the proper in different branches of the same science, to get out. presentation of the various technical, financial, and other of touch is not likely to help in the coordination of considerations involved in every problem in such a manner that those ultimately responsible for making decisions may the sciences or to relate them more closely to thebe put in a position to weigh the several considerations in everyday work of the nation. Closer cooperation their bearing upon questions of general policy between the various branches of services is necessary This is the position of a judge who is hearing a eom- if all are to pull their weight, and this can only come plicated case, and it can only be secured if the various about if each is able by status and attainments to experts are able to give their views, and so much of command a proper hearing of his contribution to the their reasons for holding such views as they can solution of the common problems. That this is far make intelligible to the final arbiters. It is evident to from an accomplished fact is clear not only from thethe committee that this desirable state of affairs is matter of the report, but from the fact that it has far from being realised in either State or industrial been deemed necessary to write it. services. They refer to the stupid and groundless views which prevail that work of a scientific and DIAGNOSIS OF TUBERCLE IN CHILDREN. technical kind is inferior to that of an administrative kind. That such views do prevail will be generally THE early diagnosis of pulmonary tuberculosis in admitted. They rest in the main on the dislike of children is often made more difficult by an absence of the average Briton for precise knowledge of any kind sputum. Since this is usually swallowed it may be as a guide to action and on the belief that what is worth while to examine the faeces, but of late years true in the laboratory is not necessarily true outside it. gastric has been increasingly employed tolavage Hence the scientific expert is often kept in his place, bring the bacilli to light. V. Poulsen, of Copenhagen,L which is often to furnish results of routine testing, recommends that the child’s stomach be washed out. to explain and excuse the delicts of branches not with a small amount of weak alkaline solution ; the under his control, and to draft reports which will be material obtained is examined directly, a portion i edited by his administrative superiors before they cultured on Petroff’s medium and a portion is. reach the directorate. The committee’s remark that inoculated into a guinea-pig. Altogether he ha " an officer should supervise only work which he is examined 110 children in this way and has found competent to judge and concerning which he can tubercle bacilli in 53. In 38 of the positive cases a. make helpful constructive suggestions to his sub- successful result was obtained on the first examination, ordinates " implies that the head of a staff, including in 12 a second attempt was necessary, while the scientific members, should have at least a sound remaining three cases were positive at the third knowledge of the meaning of their work if he is to or fourth examination. For the most part the present it to the heads of the organisation. One children excreting tubercle bacilli were under 3 yearsdifficulty which is not always fully appreciated by of age (41 positive in 62 cases), but Poulsen explainsscientific people is the ignorance of scientific termino- this by pointing out that older children suspected of logy and manner of thinking prevalent even among tuberculosis are not often seen by him but go straight educated people. To write in language and cona special tuberculosis department. struction which most people can understand the ’ An example of the help given by this method is the caseexpert must continually keep in mind the need for of a 2-year-old child who was admitted with an unexplained simplicity and the avoidance of mere erudition. The i pyrexia in August, 192U. Clinical examination was negative SCIENTIFIC STAFFS.
°
ito
I
1 Price 1s. from the Guild, 6, John-street,
Adelphi, W.C.2.
1
Jahrb. f. Kinderh., 1931
cxxx., 127.
’