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A BOOK REVIEW
701 and fungal and bacterial activity is known to be increased during its preparation. Rowlands and Wilkinson3 reported rat-feeding experiments with grass and clover seeds grown in soils treated by the artificial and organic manurial methods, which would appear to suggest that vitamin-B factors may well be absorbed directly or indirectly from the soil solution by plants grown under organic conditions; and in this connexion Rayner’s work on the mycorrhizal association of plants should not be forgotten.4 It is known that natural organic manures contain
plant tissues,
vitamin-B factors, amino-acids, auxins, and intestinal bacteria capable of synthesising vitamin-B and other factors. It is believed by many that these manures produce healthier plants of greater nutritional value for animals and man. Is it not time that we of the medical profession paid a little more attention to the work of the Soil Association and to their clamouring for more research on this matter, which may well be of vital importance to the survival of our civilisation ? ROBERT WIGGLESWORTH. STREPTOMYCIN IN INFLUENZAL MENINGITIS SIR,-In your issue of Oct. 25 Dr. Gottlieb writes:
Influenzal meningitis responds to penicillin in adequate doses, as we have recently shown (Lancet, Aug. 2, p. 164)." The article to which he refers contains reports of 4 cases of influenzal meningitis treated with penicillin-surely an inadequate number on which to base his conclusion. While there are a number of reports of successful treatment of this condition by varying doses of penicillin we do not seem to be justified yet in expecting success in every case, even with large doses. It may be argued that streptomycin should not be exhibited until massive penicillin therapy has failed to arrest the infection, thus freeing more streptomycin for hsematogenous forms of tuberculosis. Even then, however, the condition of the patient might have deteriorated to such an extent that streptomycin might fail. I therefore do not agree with Dr. Gottlieb that meningitis due to H: influenzae should not for the present be treated by streptomycin. Those suffering from this disease should havethe benefit of a drug which has undoubtedly proved highly successful in the United States, while at the same time the Medical Research Council can have the opportunity of comparing results in this country with those reported in America. C. DOVE CORMAC.
ESTIMATION OF PREGNANEDIOL IN URINE SiB,—The methods hitherto described for the estimation of pregnanediol in human urine are, because of their lack of sensitivity or specificity, not entirely satisfactory for the determination of small amounts excreted during the menstrual cycle or the early stages of pregnancy. We have recently developed a procedure based on the methods of Astwood and Jones5 and of Talbot, Berman, MacLachlan, and Wolfe 6 ; this seems to have certain advantages over previously described methods. Using one-fifth of a 24-hour sample of urine it is possible to determine pregnanediol with fair accuracy when this is present in amounts greater than about 2 mg. per 24 hours. Four to six estimations can be completed in two 8-hour working days, and the procedure is one that can be carried out by a competent laboratory technician under supervision. In the procedure devised by Astwood and Jones and
developed by Talbot and his associates free pregnanediol is by toluene from the urine after boiling with acid ; purified by treatment of the extract with sodium hydroxide to remove acidic substances, and by subsequent precipitation from hot ethanolic solution with four volumes of N/10 sodium hydroxide and/or water. This procedure has been modified by us in order to achieve the rigid stan-
extracted and it is
dardisation of technique which is essential if small
amounts
of pregnanediol in the urine are to be estimated with reasonable accuracy. The most important of these modifications is concerned with cooling after the hot-precipitation purifica-
3. 4. 5. 6.
Biochem. J. 1930, 24, 199. 1927. Astwood, E. B., Jones, G. E. S. J. biol. Chem. 1941, 137, 397. N. Talbot, B., Berman, R. A., MacLachlan, E. A., Wolfe, J. K. J. clin. Endocrin. 1941, 1, 668.
Mycorrhiza, London,
tion procedure ; it has been shown that rapid cooling of the precipitation mixtures results in low and irregular recoveries of pregnanediol, while slow controlled cooling regularly gives more exact quantitative recoveries. The accuracy of the method has been tested out by recovery experiments in which pure sodium pregnanediol glucuronidate7 was added in varying amounts to 24-hour samples of human male urine. Recoveries of about 70-80% and of 90-100% were obtained when 2 mg. and more than 5 mg. of pregnanediol (as the glucuronidate) respectively were added to 24-hour samples of urine. With less than 2 mg. per 24 hours the recoveries were poor.
This method is likely to be of value in quantitative investigations of pregnanediol excretion during the menstrual cycle and in pregnancy. It may also be of some value for the diagnosis of pregnancy, and there is reason to hope that for this purpose it may be less subject to both positive and negative errors than the more rapid procedure of Guterman.88 Full experimental details of this work will be published elsewhere. Since, owing to present conditions, publication is likely to be greatly delayed, the authors will be pleased to supply privately full details of the procedure to any workers who may be interested. They regret, however, that they will be unable to supply samples of pregnane-3(a),20a-diol and of sodium pregnanediol glucuronidate for use as standards. Department of Biochemistry, University of Edinburgh.
I. F. SOMERVILLE NANCY GOUGH G. F. MARRIAN.
A BOOK REVIEW
SiB,—With reference to the review of my Diseases of Children’s Eyes in your.issue of Sept. 27, I shall not try to deal with the matters in which that writer’s opinion on
clinical work differs from mine.
When the reviewer
states, however, that " the influence of maternal rubella in the aaiology of congenital cataract is not mentioned," he is saying what is untrue. The subject is mentioned on p. 54 of the book in question. I submit, Sir, that a reviewer’s duty to his professional public should prevent him from making such a statement iinless he has read the whole of the book which he purports to discuss.
Otherwise the obvious retort must be : " What you mean is that the subject was not mentioned in those pages of the book at which you happened to glance." J. H. DOGGART.
**Mr. Doggart is right in saying that this subject is in fact mentioned on p. 54 of his book, where it receives the following sentence : " It has also been proved that infantile cataract is in many cases due to German measles affecting the mother during pregnancy." This important contemporary discovery is not, however, accorded a place in the sections on Cataract, Diseases of the Lens, or the Development of the Eye ; nor do Rubella, Measles, or German Measles figure in the index. Readers turning to the book for information on the association of cataract with rubella might well share our disappointment.-ED. L. STUDENT HEALTH aware that the British Medical Students’ Association has been discussing the problem of student health for the past two years. At the last annual general meeting in London the following resolutions were made : " That the B.M.S.A., taking into account the hazards to which clinical students are exposed and bearing in mind the facilities which already exist in all teaching hospitals, views with concern the absence of any compulsory medical examination for clinical students on admission to hospitals. The B.M.S.A., therefore, recommends very strongly that all schools which have not already done so should with the least possible delay arrange for regular compulsory medical examinations for all their clinical students." " That the B.M.S.A. recommends that every university should appoint a full-time medical officer who, together with such assistance as may be necessary, should be responsible for the routine compulsory medical examination of all 7. Sutherland, E., Marrian, G. F. Biochem. J. 1947, 41, 193. 8. Guterman, H. S. J. clin. Endocrin. 1944, 4, 262; Ibid, 1945, 5, 407.
SzR, Your readers may be
plant tissues,
vitamin-B factors, amino-acids, auxins, and intestinal bacteria capable of synthesising vitamin-B and other factors. It is believed by many that these manures produce healthier plants of greater nutritional value for animals and man. Is it not time that we of the medical profession paid a little more attention to the work of the Soil Association and to their clamouring for more research on this matter, which may well be of vital importance to the survival of our civilisation ? ROBERT WIGGLESWORTH. STREPTOMYCIN IN INFLUENZAL MENINGITIS SIR,-In your issue of Oct. 25 Dr. Gottlieb writes:
Influenzal meningitis responds to penicillin in adequate doses, as we have recently shown (Lancet, Aug. 2, p. 164)." The article to which he refers contains reports of 4 cases of influenzal meningitis treated with penicillin-surely an inadequate number on which to base his conclusion. While there are a number of reports of successful treatment of this condition by varying doses of penicillin we do not seem to be justified yet in expecting success in every case, even with large doses. It may be argued that streptomycin should not be exhibited until massive penicillin therapy has failed to arrest the infection, thus freeing more streptomycin for hsematogenous forms of tuberculosis. Even then, however, the condition of the patient might have deteriorated to such an extent that streptomycin might fail. I therefore do not agree with Dr. Gottlieb that meningitis due to H: influenzae should not for the present be treated by streptomycin. Those suffering from this disease should havethe benefit of a drug which has undoubtedly proved highly successful in the United States, while at the same time the Medical Research Council can have the opportunity of comparing results in this country with those reported in America. C. DOVE CORMAC.
ESTIMATION OF PREGNANEDIOL IN URINE SiB,—The methods hitherto described for the estimation of pregnanediol in human urine are, because of their lack of sensitivity or specificity, not entirely satisfactory for the determination of small amounts excreted during the menstrual cycle or the early stages of pregnancy. We have recently developed a procedure based on the methods of Astwood and Jones5 and of Talbot, Berman, MacLachlan, and Wolfe 6 ; this seems to have certain advantages over previously described methods. Using one-fifth of a 24-hour sample of urine it is possible to determine pregnanediol with fair accuracy when this is present in amounts greater than about 2 mg. per 24 hours. Four to six estimations can be completed in two 8-hour working days, and the procedure is one that can be carried out by a competent laboratory technician under supervision. In the procedure devised by Astwood and Jones and
developed by Talbot and his associates free pregnanediol is by toluene from the urine after boiling with acid ; purified by treatment of the extract with sodium hydroxide to remove acidic substances, and by subsequent precipitation from hot ethanolic solution with four volumes of N/10 sodium hydroxide and/or water. This procedure has been modified by us in order to achieve the rigid stan-
extracted and it is
dardisation of technique which is essential if small
amounts
of pregnanediol in the urine are to be estimated with reasonable accuracy. The most important of these modifications is concerned with cooling after the hot-precipitation purifica-
3. 4. 5. 6.
Biochem. J. 1930, 24, 199. 1927. Astwood, E. B., Jones, G. E. S. J. biol. Chem. 1941, 137, 397. N. Talbot, B., Berman, R. A., MacLachlan, E. A., Wolfe, J. K. J. clin. Endocrin. 1941, 1, 668.
Mycorrhiza, London,
tion procedure ; it has been shown that rapid cooling of the precipitation mixtures results in low and irregular recoveries of pregnanediol, while slow controlled cooling regularly gives more exact quantitative recoveries. The accuracy of the method has been tested out by recovery experiments in which pure sodium pregnanediol glucuronidate7 was added in varying amounts to 24-hour samples of human male urine. Recoveries of about 70-80% and of 90-100% were obtained when 2 mg. and more than 5 mg. of pregnanediol (as the glucuronidate) respectively were added to 24-hour samples of urine. With less than 2 mg. per 24 hours the recoveries were poor.
This method is likely to be of value in quantitative investigations of pregnanediol excretion during the menstrual cycle and in pregnancy. It may also be of some value for the diagnosis of pregnancy, and there is reason to hope that for this purpose it may be less subject to both positive and negative errors than the more rapid procedure of Guterman.88 Full experimental details of this work will be published elsewhere. Since, owing to present conditions, publication is likely to be greatly delayed, the authors will be pleased to supply privately full details of the procedure to any workers who may be interested. They regret, however, that they will be unable to supply samples of pregnane-3(a),20a-diol and of sodium pregnanediol glucuronidate for use as standards. Department of Biochemistry, University of Edinburgh.
I. F. SOMERVILLE NANCY GOUGH G. F. MARRIAN.
A BOOK REVIEW
SiB,—With reference to the review of my Diseases of Children’s Eyes in your.issue of Sept. 27, I shall not try to deal with the matters in which that writer’s opinion on
clinical work differs from mine.
When the reviewer
states, however, that " the influence of maternal rubella in the aaiology of congenital cataract is not mentioned," he is saying what is untrue. The subject is mentioned on p. 54 of the book in question. I submit, Sir, that a reviewer’s duty to his professional public should prevent him from making such a statement iinless he has read the whole of the book which he purports to discuss.
Otherwise the obvious retort must be : " What you mean is that the subject was not mentioned in those pages of the book at which you happened to glance." J. H. DOGGART.
**Mr. Doggart is right in saying that this subject is in fact mentioned on p. 54 of his book, where it receives the following sentence : " It has also been proved that infantile cataract is in many cases due to German measles affecting the mother during pregnancy." This important contemporary discovery is not, however, accorded a place in the sections on Cataract, Diseases of the Lens, or the Development of the Eye ; nor do Rubella, Measles, or German Measles figure in the index. Readers turning to the book for information on the association of cataract with rubella might well share our disappointment.-ED. L. STUDENT HEALTH aware that the British Medical Students’ Association has been discussing the problem of student health for the past two years. At the last annual general meeting in London the following resolutions were made : " That the B.M.S.A., taking into account the hazards to which clinical students are exposed and bearing in mind the facilities which already exist in all teaching hospitals, views with concern the absence of any compulsory medical examination for clinical students on admission to hospitals. The B.M.S.A., therefore, recommends very strongly that all schools which have not already done so should with the least possible delay arrange for regular compulsory medical examinations for all their clinical students." " That the B.M.S.A. recommends that every university should appoint a full-time medical officer who, together with such assistance as may be necessary, should be responsible for the routine compulsory medical examination of all 7. Sutherland, E., Marrian, G. F. Biochem. J. 1947, 41, 193. 8. Guterman, H. S. J. clin. Endocrin. 1944, 4, 262; Ibid, 1945, 5, 407.
SzR, Your readers may be