- Email: [email protected]
CLINICAL TESTS FOR KETONURIA
248 connection we can assume that failure of accommodation brings with it reduced activity and stimulation. Professor Sorsby has drawn attentionto the prevalence of cataract amongst the registered blind persons and suggests that in 34% of them it was remediable by operative treatment and that in another 29% operation might have been possible had it been attempted earlier or preliminary attention been paid to their general health. In this report stress is laid upon earlier operative treatment and the provision of more hospital beds, but nowhere do we find any suggestion that research should be undertaken for the prevention or postponement of the onset of cataract. Individual research has been made into the part radiation plays in the causation of cataract and the use of glandular extracts and vitamins in its treatment, but we never hear of any organised research into the aetiology of cataract, though it is one of the commonest causes of blindness and brings great distress to the elderly long In view of the before operation can be considered. in it has need to the employ elderly industry, greater become an even more urgent problem. 0. C. WEATHERSBEE. O. Slough. PROTEINURIA AND ŒDEMA
SiR,ńYour interesting leader of July 10 on the nephrotic syndrome suggests that a qualitative improvement in the
precede a quantitative change when remission occurs. - The clinical recovery sometimes observed in nephrotic patients after an acute infection could be explained on similar lines (the immunological process in the infective condition being perhaps involved in the blood-protein change). However, one could equally suggest that alterations in the permeability and re-absorptive capacity of the nephron might bring about the improvement. The following case illustrates these points. A boy, aged 8, was admitted to hospital with oadema and albuminuria on May 1, 1952. The condition had followed blood-proteins a spontaneous
may
tonsillitis two weeks previously. The oedema soon became generalised and massive, and he presented a typical nephrotic syndrome (gross proteinuria, blood-proteins as low as a total of 4-95 g. per 100 ml., with albumin 0-9 g. and globulin 4-05 g., cholesterol 1050 mg. per 100 ml.). The condition resisted highprotein diet, salt reduction, exchange resins, and mechanical removal of cedema. No mercurial diuretics were used, for I still believe there is no place for them when a renal lesion is
present. In August, 1952, he also developed considerable glycosuria with normal blood-sugar. At this stage, the blood findings were : albumin 1-2 g., globulin 4-4 g., total 5-6 g. ; cholesterol 1090 mg., blood-urea 44 mg. per 100 ml. Paper chromatography showed a striking decrease of albumin, decrease of gamma-globulin, and a gross increase of alpha2-globulin. Artificial fever therapy with T.A.B. was started in early September, but abandoned after the first injection on account of severe side-effects. A few days later the patient developed right lobar pneumonia and became very ill. He eventually responded to penicillin and on his recovery the oedema began to disappear rapidly, and three weeks later he had practically none. Gross muscular wasting was then
apparent. Blood examinations at this time showed : albumin 1-8 g., 3-1 g., total 4-9 g. ; blood-urea 59 mg., cholesterol 830 mg. per 100 ml. About six weeks later the examinations were repeated : albumin 4-8 g., globulin 1-2 g., total 6-0 g. ;; blood-urea 38 mg., cholesterol 240 mg. per 100 ml. Since then he has remained very well on a high-protein diet and his weight has increased steadily. He attends outpatients two months and on June 19, 1954, his blood showed : urea 36 mg. ; albumin 4-6 g., globulin 1-8 g., total 6-4 g. per 100 ml. The urine contained 15 mg. per 100 ml. of protein, and there was a deposit of a few red cells and a few hyaline casts. The condition has probably now settled as a slowly progressing chronic nephritis.
globulin
every
1. The Causes of Blindness in
Arnold Sorsby.
H.M.
England, 1948-50.
Stationery Office, 1953.
Report by Prof.
One can see how the blood-proteins were still very low when the improvement was well under way. On the other hand, the transient glycosuria would favour a disorganised renal function and it seems only logical to expect that changes in the kidney itself would bring about a remission in a syndrome in which renal lesions are the rule. ’
St. Alfege’s Hospital, London, S.E.10.
m
,j, i:..saA E. T. BASSADONE.
CLINICAL TESTS FOR KETONURIA to thank the various writers who have
SiR,-I wish
made interesting and helpful criticisms of our paper on this subject in your issue of April 17. The tablets which were used are marketed under the name ’Acetest.’ They are listed in the Drug Tang (p. 57) under the name " diagnostic nitroprusside tablets " and the exact composition is given. One of the difficulties we encountered in using tablets and powders of our own manufacture was in reproducing preparations of uniform sensitivity and in this respect the commercial product was superior. JOHN NASH. JOHN London, W.C.I. AN AMERICAN IN BRITAIN
SIR,—Dr. Dent (July 24) wants to collect figures for those doctors who are willing to express their support for Dr. Cort and for those who are too indifferent or timid to do so. He thinks they would have " statistical significance," presumably hoping that the latter would outnumber the former, who could no doubt then be ‘‘ represented as un-British’’ to your American readers. To be passively orthodox is easier than to make the effort required to form an independent conclusion, but I think that in this case Dr. Dent’s hopes would quite possibly be defeated, and I hope that he will make the attempt with the same care that he uses in framing his own researches. LEYS. DUNCAN LETS. Bickley, Kent. NAME THIS ORG.
SIR,—Your Widdicombe correspondent, "Harry Hawke," is to be congratulated on his sensible attitude to bacterial nomenclature, and pitied for his ignorance of the principles of bacterial taxonomy. It is right and proper that reports and papers intended for specialised workers-e.g., doctors-should be in language they will understand, but to be intelligible to all branches of science (and bacteriology is not a handmaiden of medicine but a branch of biology) a more The medical scientific nomenclature is necessary. bacteriologist has the easy task of sorting the wheat (pathogens) from the chaff (non-pathogens) but the chaff does contain bacteria of economic importance, organisms which have been known to influence a country’s ability to survive (e.g., Clostridium acetonigenum), and others, the nitrifiers, which enable the world to remain habitable. When bacteriologists founded their nomenclature on the Botanical Code, they did not (and could not) bind themselves to the botanist’s conception of taxonomy -something based essentially on structure. Taxonomy. which is the collection of similar biological entities into groups, should be completely divorced from nomenclature. the naming of the groups, but few bacteriologists are able to effect this separation. Harry Hawke cannot understand why habit (physiology) has a place in taxonomy : when we know more about our bacteria. then we shall be able to classify them better. In biological units as small as bacteria morphology fails to provide enough criteria to make more than a few major divisions, and bacterial taxonomists welcome all additional distinguishing characters. Neither the serologists nor the geneticists have, of late, done much to help taxonomy : the one makes multitudinous subdivision= which the other shows to be meaningless, and their work may well cancel out.
SiR,ńYour interesting leader of July 10 on the nephrotic syndrome suggests that a qualitative improvement in the
precede a quantitative change when remission occurs. - The clinical recovery sometimes observed in nephrotic patients after an acute infection could be explained on similar lines (the immunological process in the infective condition being perhaps involved in the blood-protein change). However, one could equally suggest that alterations in the permeability and re-absorptive capacity of the nephron might bring about the improvement. The following case illustrates these points. A boy, aged 8, was admitted to hospital with oadema and albuminuria on May 1, 1952. The condition had followed blood-proteins a spontaneous
may
tonsillitis two weeks previously. The oedema soon became generalised and massive, and he presented a typical nephrotic syndrome (gross proteinuria, blood-proteins as low as a total of 4-95 g. per 100 ml., with albumin 0-9 g. and globulin 4-05 g., cholesterol 1050 mg. per 100 ml.). The condition resisted highprotein diet, salt reduction, exchange resins, and mechanical removal of cedema. No mercurial diuretics were used, for I still believe there is no place for them when a renal lesion is
present. In August, 1952, he also developed considerable glycosuria with normal blood-sugar. At this stage, the blood findings were : albumin 1-2 g., globulin 4-4 g., total 5-6 g. ; cholesterol 1090 mg., blood-urea 44 mg. per 100 ml. Paper chromatography showed a striking decrease of albumin, decrease of gamma-globulin, and a gross increase of alpha2-globulin. Artificial fever therapy with T.A.B. was started in early September, but abandoned after the first injection on account of severe side-effects. A few days later the patient developed right lobar pneumonia and became very ill. He eventually responded to penicillin and on his recovery the oedema began to disappear rapidly, and three weeks later he had practically none. Gross muscular wasting was then
apparent. Blood examinations at this time showed : albumin 1-8 g., 3-1 g., total 4-9 g. ; blood-urea 59 mg., cholesterol 830 mg. per 100 ml. About six weeks later the examinations were repeated : albumin 4-8 g., globulin 1-2 g., total 6-0 g. ;; blood-urea 38 mg., cholesterol 240 mg. per 100 ml. Since then he has remained very well on a high-protein diet and his weight has increased steadily. He attends outpatients two months and on June 19, 1954, his blood showed : urea 36 mg. ; albumin 4-6 g., globulin 1-8 g., total 6-4 g. per 100 ml. The urine contained 15 mg. per 100 ml. of protein, and there was a deposit of a few red cells and a few hyaline casts. The condition has probably now settled as a slowly progressing chronic nephritis.
globulin
every
1. The Causes of Blindness in
Arnold Sorsby.
H.M.
England, 1948-50.
Stationery Office, 1953.
Report by Prof.
One can see how the blood-proteins were still very low when the improvement was well under way. On the other hand, the transient glycosuria would favour a disorganised renal function and it seems only logical to expect that changes in the kidney itself would bring about a remission in a syndrome in which renal lesions are the rule. ’
St. Alfege’s Hospital, London, S.E.10.
m
,j, i:..saA E. T. BASSADONE.
CLINICAL TESTS FOR KETONURIA to thank the various writers who have
SiR,-I wish
made interesting and helpful criticisms of our paper on this subject in your issue of April 17. The tablets which were used are marketed under the name ’Acetest.’ They are listed in the Drug Tang (p. 57) under the name " diagnostic nitroprusside tablets " and the exact composition is given. One of the difficulties we encountered in using tablets and powders of our own manufacture was in reproducing preparations of uniform sensitivity and in this respect the commercial product was superior. JOHN NASH. JOHN London, W.C.I. AN AMERICAN IN BRITAIN
SIR,—Dr. Dent (July 24) wants to collect figures for those doctors who are willing to express their support for Dr. Cort and for those who are too indifferent or timid to do so. He thinks they would have " statistical significance," presumably hoping that the latter would outnumber the former, who could no doubt then be ‘‘ represented as un-British’’ to your American readers. To be passively orthodox is easier than to make the effort required to form an independent conclusion, but I think that in this case Dr. Dent’s hopes would quite possibly be defeated, and I hope that he will make the attempt with the same care that he uses in framing his own researches. LEYS. DUNCAN LETS. Bickley, Kent. NAME THIS ORG.
SIR,—Your Widdicombe correspondent, "Harry Hawke," is to be congratulated on his sensible attitude to bacterial nomenclature, and pitied for his ignorance of the principles of bacterial taxonomy. It is right and proper that reports and papers intended for specialised workers-e.g., doctors-should be in language they will understand, but to be intelligible to all branches of science (and bacteriology is not a handmaiden of medicine but a branch of biology) a more The medical scientific nomenclature is necessary. bacteriologist has the easy task of sorting the wheat (pathogens) from the chaff (non-pathogens) but the chaff does contain bacteria of economic importance, organisms which have been known to influence a country’s ability to survive (e.g., Clostridium acetonigenum), and others, the nitrifiers, which enable the world to remain habitable. When bacteriologists founded their nomenclature on the Botanical Code, they did not (and could not) bind themselves to the botanist’s conception of taxonomy -something based essentially on structure. Taxonomy. which is the collection of similar biological entities into groups, should be completely divorced from nomenclature. the naming of the groups, but few bacteriologists are able to effect this separation. Harry Hawke cannot understand why habit (physiology) has a place in taxonomy : when we know more about our bacteria. then we shall be able to classify them better. In biological units as small as bacteria morphology fails to provide enough criteria to make more than a few major divisions, and bacterial taxonomists welcome all additional distinguishing characters. Neither the serologists nor the geneticists have, of late, done much to help taxonomy : the one makes multitudinous subdivision= which the other shows to be meaningless, and their work may well cancel out.