SWEDEN

1396 medical examiner. He put the letters M.D. to indicate his qualifications, adding what the prosecution described as " some peculiar hieroglyphic." There was no doubt that the defendant was not, and never had been, on the Medical Register. For the defence it was claimed that he had gone out of his way to indicate that he was not a registered medical practitioner by putting in brackets the letter " J " after the letters M.D. Mr. Day explained that " J " stood for Jefferson College, Chicago ; he had no intention to represent himself falsely ; he had thought that his examination of the applicant for the pilot’s The magistrate licence was merely preliminary. a of fine with :E10 10s. 20s. cost. imposed

SWEDEN

(FROM

AN OCCASIONAL

CORRESPONDENT)

THE TREATMENT OF PNEUMONIA

THOUGH recent advances in the treatment

of

pneumonia may greatly improve the prognosis, they have by no means simplified the task of the doctor called on to choose between serotherapy, chemotherapy, neither, or both. At a meeting of the Swedish Medical Society last September the complexity of the problem was emphasised, and various solutions were discussed. Now Prof. Hilding Berglund, of Stockholm, has issued a memorandum on the diagnosis and treatment of pneumonia as adopted at the St. Erik Hospital. This memorandum is not intended to stereotype treatment but to encourage uniformity of procedure, so that really comparable data may shortly be forthcoming from many different hospitals. The pneumonia patient admitted to Prof. Berglund’s hospital is promptly subjected to a variety of tests, which include sputum examinations, blood-cultures, type determinations, and radiography. The choice between horse or serum and M. & B. 693 is made as follows. In all early cases in which definite typing is possible by Neufeld’s method, serum, if it is available, is given ; if not, M. & B. 693 is given. When there is no available sputum, or the Neufeld method does not immediately assure a type diagnosis, and the patient’s condition is satisfactory, treatment is deferred twelve hours or more while the typing tests are continued. If, however, the general condition is unsatisfactory, or if the blood-pressure cannot be maintained above 110 mm. Hg with such remedies as ephedrine, M. & B. 693 is given. The nauseating effect of this drug can be counteracted by chloretone suppositories. In fulminating type III pneumonia very large doses of serum (up to 700,000 units) are to be preferred to M. & B. 693. In general, M. & B. 693 medication should never be started before a bacteriological examination of the sputum and a blood-culture have been made.

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THE NOTIFICATION OF TUBERCULOSIS

There is a proposal before the Swedish parliament for revision of the law of 1914 with regard to measures for the prevention of spread of tuberculosis. Hitherto the public-health authorities have had to dispense with legislative measures giving them a free hand in the matter of notification. This is incumbent on doctors only when they find that persons with pulmonary tuberculosis are living under conditions calculated to cause grave risks of infection for those who come in contact with them. The new proposals aim at making the notification of all cases of tuberculosis compulsory. It is also proposed that, when

patients with infectious tuberculosis are discharged hospital or sanatorium, notice of such discharge shall be sent to the tuberculosis dispensary in the area to whichthe patient returns. Dispensary doctors will have to keep a register of notifications, and patients known to be infectious will be forbidden to accept employment in dairies or as nursemaids. If these proposals become law, the public-health machinery in Sweden, so far as tuberculosis is concerned, will correspond more closely to that in Norway than hitherto. from

VACCINATION AGAINST SMALLPOX

It is proposed that the vaccination of children during the first two years of life shall be encouraged, and that, when children reach the school age without having been vaccinated, the school medical officer shall vaccinate them, unless their parents or guardians have formally protested. At least fourteen days

before the date of the intended vaccination notice thereof shall be read in church, published in the local press, and communicated in writing to the child’s

custodian. SICKNESS INSURANCE

With a population of only six million odd, Sweden had at the end of 1938 as many as 1,251,627 persons insured against sickness in approved societies. In 1938 alone 130,000 new members joined the societies.

SCOTLAND (FROM OUR OWN CORRESPONDENT) METABOLISM OF THE HEART

THE third Sharpey Schafer memorial lecture was given in Edinburgh last week by Prof. C. A. Lovatt Evans, F.R.S., of University College, London. He began by describing the enormous amount of work which the human heart performs during its life-i.e., sufficient to lift 10 kg. through ten miles-a feat of endurance which is almost unequalled, for the heart weighs only some 300 g. The heart, however, is outstripped by the muscle of the insect’s wing in quickShort ness of contraction and speed of recovery. films illustrated the operation of the heart-lung preparation and showed the increase in output which results from increasing the inflow, and the rise in work performed when the arterial resistance is raised. The lecturer described the external and the internal methods of measuring the heart’s consumption of. oxygen. By both methods it has been shown that the efficiency of the heart probably never exceeds 30 per cent. and under normal conditions is usually between 5 and 10 per cent. In the denervated preparation increase in the work done is accompanied by increase in consumption of oxygen and in efficiency, but the increased work induced by increasing the inflow is associated with a greater rise in efficiency than that following increase in arterial pressure. In this preparation these manipulations are not complicated by any change in heart-rate. In the heart-lung preparation, however, in which the nerve-supply is maintained, increase in arterial pressure lowers the heart-rate, whereas increase in output raises the rate. Gollwitzer-DTeier has shown that vagal slowing is followed by a greater degree of reduction in the consumption of oxygen than can be accounted for by the fall in heart-rate alone. Similarly adrenaline increases metabolism apart from the rise in rate which it may induce. In the innervated heart, indeed, increase in work done is often effected without