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CAUSATION AND TREATMENT OF MORPHINE ADDICTION
624
VITAMN C AND ASCORBIC ACID
different ; the risk is insidious, as the fumes can be breathed without much immediate inconvenience ; but a few hours later pulmonary oedema supervenes and not infrequently ends fatally. Such was the fate of animals exposed sufficiently to the fumes from electro-welding. A fatality is reported from America of a man employed in the basement of an apartment house at electro-welding the two halves In this country of a galvanised hot-water tank. no less than 17 other cases, one being fatal, are reported2 following the use of large oxy-acetylene burners for the purpose of heating a heavy steel crosshead in order to remove it from the rudder post in a confined space on board a large liner. Here then is a hazard which, when once its existence and nature are recognised, may easily be avoided. Either the workplace may be well ventilated, or the fumes may be removed by local exhaust, or suitable respirators or air masks may be worn. CAUSATION AND TREATMENT OF MORPHINE ADDICTION A NOVEL theory of morphine addiction and of the symptoms which may attend the withdrawal of the drug has been advanced by Dr. Iwan I. Ostromislensky, of New York, formerly professor of organic chemistry in the University of NijniNovgorod. His theory of addiction propounded is based on analogy with anaphylaxis. Morphine, it is suggested, generates an antigen and the antigen produces an antibody which appears on about the
twentieth day after daily administration. The withdrawal of morphine from an addict, on this assumption, will leave the antigen to react on its antibody and occasion symptoms of anaphylactic shock, accom" panied by a craving for the drug, which if unrelieved may result in collapse and death. This has Dr. of addiction led theory Ostromislensky to advocate the employment of a new synthetic preparation (diphenylmethylpyrazolonyl) as a " valuable therapeutic for the unfortunate morphine addicts." It is claimed that the new remedy, which has been named " rossium," relieves the craving, checks the withdrawal symptoms, and overcomes addiction to the drug. In a communication to the Russian Medical Society in New York3 it is stated that the remedy is being tested in hospitals and sanatoria in the United States and in Canada. "
MARRIAGE OF SYPHILITICS UNDER TREATMENT
ONE of the urgent questions put to their doctors by adult male patients suffering from syphilis is
when intercourse is to be allowed. The conservative practitioner usually allows marriage without restrictions after a period-of three to five years of treatment and observation. When the biological urge is very great intercourse is usually permitted after a shorter period to men with negative Wassermann reactions provided that they are actually receiving arsenical injections at the time and that they wear a condom as a protection against seminal infection. That this latter may occur has been shown not only experimentally in monkeys but also by demonstrating spirocheetes in human semen by the dark-ground method. In a recent investigation4 the infectivity was tested of the semen of 25 syphilitic patients, 5 acute and 20 chronic, all under treatment with 2 Annual Report of the Chief Inspector of Factories for 1934. London : H.M. Stationery Office. 1935. Pp. 68-69. 3 Medical Record, 1935, cxli., 556. 4 Greenbaum, S., Katz, S., and Rule, A. : Amer. Jour. of Syph. and Neur., 1935, xix., 210.
arsenic
bismuth or both. The semen was collected and was injected into the testicles of two rabbits within half an hour of ejaculation. After three months of negative observation by dark-ground illumination of puncture fluid taken from the testicles of the rabbits, their inguinal glands were ground up and passaged into two fresh animals, who were similarly observed. In no case was there any demonstrable lesion or spirochaetes. The authors draw the conclusion that the syphilitic is not infectious for so long a period as is generally thought, and that marriage might safely be allowed at an earlier period. This conclusion seems to us unwarrantable, being based on 25 cases in which only one examination was made, and that presumably whilst the case was under treatment. Once intercourse is allowed it is unlikely that the average patient will confine himself to specified periods-i.e., during courses of injectionand there is nothing in the experiment to show how long the semen remains safe. D. Nabarro in this country has shown cases where the birth of normal children, conceived after the parents have had some treatment, was followed by the birth of a syphilitic child as the result of a relapse of the disease, or the awakening of a latent syphilis. It would therefore seem wiser to continue to insist on fully three years of treatment and observation before allowing marriage. Greenbaum and his collaborators suggest that their method of examining semen might be of value as a method of testing syphilitic men who insist on marriage before they have had adequate therapy. The test would certainly be a useful adjunct to venereal practice if it proved to be reliable after the first animal inoculation, and the passage into the second animal, which adds another three months to its duration, could be dispensed with ; further trial would be essential before this could be assumed, and even then the cautious physician would insist on at least two negative results. or
aseptically
VITAMIN C AND ASCORBIC ACID
article of August 24th touched only of vitamin C with ascorbic the identification briefly acid, and the account given by Mr. S. S. Zilva, D.Sc., in the August Archives for Disecase in Childhood deserves a further note. The discovery is one which illustrates the intimate relations of chemistry and medicine. Briefly it arose out of two apparently unconnected observations ; one the isolation from the adrenal cortex (in 1928, by Szent-Gyorgyi working OUR
leading
on
in Gowland
Hopkins’s laboratory) of a stronglyreduchexose derivative, called by him hexuronic acid ; the other the elaboration of a test by the late J. Tillmans of Strasbourg to discriminate between lemon juice made from fresh lemons and spurious imitations thereof. Tillmans’s test consisted in using 2:6 dichloroindophenol as an indicator, this being decolorised by the real, but unaffected by the artificial, lemon juice ; and he came to the conclusion that the substance which reduced the indicator was vitamin C. Hexuronic acid was also found to decolorise 2:6 dichloroindophenol; Tillmans suggested that it was probably identical with vitamin C ; and in 1932 Szent-Gyorgyi actually proved that it had antiscorbutic powers. Then came a series of investigations in the chemistry department of the University of Birmingham by W. N. Haworth, E. L. Hirst, and others, with the following results : (1) the hexose derivative obtained by Szent-Gyorgyi was found by Haworth and Szent-Gyorgyi to contain a molecule of water less than is required for a hexuronic acid, and the name ascorbic acid was suggested in its stead ; (2) the structural formula of ascorbic acid
ing
VITAMN C AND ASCORBIC ACID
different ; the risk is insidious, as the fumes can be breathed without much immediate inconvenience ; but a few hours later pulmonary oedema supervenes and not infrequently ends fatally. Such was the fate of animals exposed sufficiently to the fumes from electro-welding. A fatality is reported from America of a man employed in the basement of an apartment house at electro-welding the two halves In this country of a galvanised hot-water tank. no less than 17 other cases, one being fatal, are reported2 following the use of large oxy-acetylene burners for the purpose of heating a heavy steel crosshead in order to remove it from the rudder post in a confined space on board a large liner. Here then is a hazard which, when once its existence and nature are recognised, may easily be avoided. Either the workplace may be well ventilated, or the fumes may be removed by local exhaust, or suitable respirators or air masks may be worn. CAUSATION AND TREATMENT OF MORPHINE ADDICTION A NOVEL theory of morphine addiction and of the symptoms which may attend the withdrawal of the drug has been advanced by Dr. Iwan I. Ostromislensky, of New York, formerly professor of organic chemistry in the University of NijniNovgorod. His theory of addiction propounded is based on analogy with anaphylaxis. Morphine, it is suggested, generates an antigen and the antigen produces an antibody which appears on about the
twentieth day after daily administration. The withdrawal of morphine from an addict, on this assumption, will leave the antigen to react on its antibody and occasion symptoms of anaphylactic shock, accom" panied by a craving for the drug, which if unrelieved may result in collapse and death. This has Dr. of addiction led theory Ostromislensky to advocate the employment of a new synthetic preparation (diphenylmethylpyrazolonyl) as a " valuable therapeutic for the unfortunate morphine addicts." It is claimed that the new remedy, which has been named " rossium," relieves the craving, checks the withdrawal symptoms, and overcomes addiction to the drug. In a communication to the Russian Medical Society in New York3 it is stated that the remedy is being tested in hospitals and sanatoria in the United States and in Canada. "
MARRIAGE OF SYPHILITICS UNDER TREATMENT
ONE of the urgent questions put to their doctors by adult male patients suffering from syphilis is
when intercourse is to be allowed. The conservative practitioner usually allows marriage without restrictions after a period-of three to five years of treatment and observation. When the biological urge is very great intercourse is usually permitted after a shorter period to men with negative Wassermann reactions provided that they are actually receiving arsenical injections at the time and that they wear a condom as a protection against seminal infection. That this latter may occur has been shown not only experimentally in monkeys but also by demonstrating spirocheetes in human semen by the dark-ground method. In a recent investigation4 the infectivity was tested of the semen of 25 syphilitic patients, 5 acute and 20 chronic, all under treatment with 2 Annual Report of the Chief Inspector of Factories for 1934. London : H.M. Stationery Office. 1935. Pp. 68-69. 3 Medical Record, 1935, cxli., 556. 4 Greenbaum, S., Katz, S., and Rule, A. : Amer. Jour. of Syph. and Neur., 1935, xix., 210.
arsenic
bismuth or both. The semen was collected and was injected into the testicles of two rabbits within half an hour of ejaculation. After three months of negative observation by dark-ground illumination of puncture fluid taken from the testicles of the rabbits, their inguinal glands were ground up and passaged into two fresh animals, who were similarly observed. In no case was there any demonstrable lesion or spirochaetes. The authors draw the conclusion that the syphilitic is not infectious for so long a period as is generally thought, and that marriage might safely be allowed at an earlier period. This conclusion seems to us unwarrantable, being based on 25 cases in which only one examination was made, and that presumably whilst the case was under treatment. Once intercourse is allowed it is unlikely that the average patient will confine himself to specified periods-i.e., during courses of injectionand there is nothing in the experiment to show how long the semen remains safe. D. Nabarro in this country has shown cases where the birth of normal children, conceived after the parents have had some treatment, was followed by the birth of a syphilitic child as the result of a relapse of the disease, or the awakening of a latent syphilis. It would therefore seem wiser to continue to insist on fully three years of treatment and observation before allowing marriage. Greenbaum and his collaborators suggest that their method of examining semen might be of value as a method of testing syphilitic men who insist on marriage before they have had adequate therapy. The test would certainly be a useful adjunct to venereal practice if it proved to be reliable after the first animal inoculation, and the passage into the second animal, which adds another three months to its duration, could be dispensed with ; further trial would be essential before this could be assumed, and even then the cautious physician would insist on at least two negative results. or
aseptically
VITAMIN C AND ASCORBIC ACID
article of August 24th touched only of vitamin C with ascorbic the identification briefly acid, and the account given by Mr. S. S. Zilva, D.Sc., in the August Archives for Disecase in Childhood deserves a further note. The discovery is one which illustrates the intimate relations of chemistry and medicine. Briefly it arose out of two apparently unconnected observations ; one the isolation from the adrenal cortex (in 1928, by Szent-Gyorgyi working OUR
leading
on
in Gowland
Hopkins’s laboratory) of a stronglyreduchexose derivative, called by him hexuronic acid ; the other the elaboration of a test by the late J. Tillmans of Strasbourg to discriminate between lemon juice made from fresh lemons and spurious imitations thereof. Tillmans’s test consisted in using 2:6 dichloroindophenol as an indicator, this being decolorised by the real, but unaffected by the artificial, lemon juice ; and he came to the conclusion that the substance which reduced the indicator was vitamin C. Hexuronic acid was also found to decolorise 2:6 dichloroindophenol; Tillmans suggested that it was probably identical with vitamin C ; and in 1932 Szent-Gyorgyi actually proved that it had antiscorbutic powers. Then came a series of investigations in the chemistry department of the University of Birmingham by W. N. Haworth, E. L. Hirst, and others, with the following results : (1) the hexose derivative obtained by Szent-Gyorgyi was found by Haworth and Szent-Gyorgyi to contain a molecule of water less than is required for a hexuronic acid, and the name ascorbic acid was suggested in its stead ; (2) the structural formula of ascorbic acid
ing