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COLLOIDS AND CALCULI
1198
but BROWN et al., consider that radiography is less valuable in diagnosis than the examination of the stools, the blood-diastase, and the secretin test. INNERFIELD and ANGRIST 18 found that, in, pancreatic carcinoma with jaundice, estimation of the antithrombin titre may help in early diagnosis. In 11 patients who had beenjaundiced for less than a month, the antithrombin titre was raised, and at laparotomy all the growths were found to be operable. In more advanced cases the antithrombin level fell to normal or below ; a low figure was especially associated with Normal antithrombin involvement of the liver. levels were obtained in 109 out of 113 patients with obstructive jaundice due to acute biliary-tract disease. Early diagnosis of pancreatic carcinoma must depend ultimately on early laparotomy. But if some of these tests for pancreatic insufficiency, particularly the examination of the stools, were regularly performed when a patient in the cancer age-group develops abdominal pain and begins to lose weight, with or withoutjaundice and with no clear evidence of gastro-intestinal disease, then laparotomy might be undertaken in more cases before the growth becomes
inoperable. Annotations
injection of hyaluronidase the tiny crystals dispersed in a mass of gel, which is what
but after
an
were seen
to be
happened when urine of normal colloid content was evaporated. Twenty patients in whom stones had been common were treated in this way, and eighteen have been free from trouble for from 11 to 15 months. Clearly this is not enough to justify definite claims of success, nor do the authors make such claims, but their ingenious method promises well, and we hope that a larger series of cases is in preparation. PROVISION FOR THE MENTALLY DEFECTIVE
SOME
mentally
defective
people,
like
some
of the
rest of us, are pleasant to live with ; others are not. But all mental defectives above the grade of idiot, however they may turn out later, need special training in childhood to help them to fit into a world which is always going to be beyond them ; and some, of course, will need to live in institutions, apart from the general community, for life. In the Times of April 7, Lady Norman and Prof. D. R. MacCalman said that of the 100,000 mentally defective people in the country, only 57,000 have found places in institutions ; and of those who have not, 12,000 are children who need education in special schools. Much hardship lies behind this bald statement, as a recent study1 by the Socialist Medical Association in Sheffield The committee which made the study illustrates. mentions the case of a family where a man earning a good wage applied to a charitable society for financial help because one of his four children was a mental defective so destructive of bedding, crockery, clothing, and furniture that the father could not provide adequately for the rest of the family. Another mentally defective boy of eighteen, who lived with his mother, was not only destructive but dangerously violent ; he was finally admitted to an infirmary intended for the elderly and chronic sick. At the other end of the scale are to be found charming and amenable mentally defective children who could profit greatly by special education and never get it. In Sheffield (which no doubt reflects the state of things elsewhere) there are some 4000 defectives of all ages. In the day special schools there are 360 places instead of the 720 estimated to be needed. These schools not only give the children the chance to develop their limited powers to the full but also greatly diminish the risk of the high-grade defective falling into delinquency.
CALCULI COLLOIDS AND WHY are Negroes less prone to urinary calculi than white people ? The difference may be explained, in part at least, by the fact that Negroes have more colloids in their urine. These protective colloids enable both electrolytes and non-electrolytes to remain in solution in the urine in much higher concentrations than their solubilities in pure water would allow. Attracted by the possibility that stones may form when this protection fails, Butt and Hauser 19 have measured-by surfacetension experiments, by counting the particles visible microscopically, and by other means-the hydrophilic colloids in the urine of several hundred people of various races, including a number living in West Florida, where urinary calculi are common. They found that those with the least concentration of colloids in their urine were the ones who developed stones most readily. Women generally had more colloids than men, and the difference Stasis and infection was increased duringa pregnancy. are often said to be predominant causes of stone ; but, quite apart from pregnancy, urinary infection is commoner in women, suggesting that they should have a greater tendency to stone formation than men. That the reverse is so supports Butt and Hauser’s conclusion that colloid depletion is the main factor in the disease. For a long time an imbalance between crystalloids and colloids has been thought to be a contributory cause, but no precise details of the mechanism are known, and certainly the idea has found little application in the prevention or treatment of calculi. Indeed attempts to stop stones forming have not on the whole been very successful. Butt and Hauser thought that hyaluronidase, the " spreading factor," might increase the protection given by urinary colloids in people who develop stones quickly. This enzyme encourages the natural colloids to form a gel which entangles the crystal nuclei as they appear and stops them from agglomerating and growing. They found, for example; that the low-colloid urine of a man who had been troubled by recurrent stones normally produced several large crystals and many smaller ones when allowed to evaporate on a microscope slide ;;
or unmanageable mentally defective children often do best in a residential school, and training in such a school may keep them from- qualifying for borstal or, eventually, for a term of imprisonment. Psychiatrists often report to a juvenile court that in order to prevent further delinquency a child or young person should be sent to a residential special school; but there are no such schools in Sheffield, or in many other places. The committee found that 9 Sheffield children
18. Innerfield, I., Angrist, A. Amer. J. med. Sci. 1952, 223, 422. 19. Butt, A. J., Hauser, E. A. Science, 1952, 115, 308 ; New Engl. J. Med. 1952, 246, 604.
1. The Mentally Defective. Prepared by the Sheffield branch of the Socialist Medical Association and obtainable from Dr. C. H. Foggitt, 754, Attercliffe Road, Sheffield, 9. Pp. 10. 1s.
In Sheffield, besides special schools, there are three special classes in ordinary schools, receiving about 60 dull and backward children who are not sufficiently retarded to need educating in special schools. Occupation centres have proved successful for imbecile children found to be ineducable; here the emphasis is on character and habit training, simple handicrafts, coordination, and simple domestic tasks ; and senior occupation centres run on the lines of sheltered workshops take boys over sixteen and endeavour to train them for employment in industry-sometimes very successfully. There is only one occupation centre for Sheffield ; Leeds, with a smaller population, has four centres. In scattered areas the local authorities have power to arrange for simple instruction of the child in his own home ; but the amount of training given is limited by the amount of staff available. In Sheffield 6 mentally defective children were taught at home in 1950.
Difficult, delinquent,
but BROWN et al., consider that radiography is less valuable in diagnosis than the examination of the stools, the blood-diastase, and the secretin test. INNERFIELD and ANGRIST 18 found that, in, pancreatic carcinoma with jaundice, estimation of the antithrombin titre may help in early diagnosis. In 11 patients who had beenjaundiced for less than a month, the antithrombin titre was raised, and at laparotomy all the growths were found to be operable. In more advanced cases the antithrombin level fell to normal or below ; a low figure was especially associated with Normal antithrombin involvement of the liver. levels were obtained in 109 out of 113 patients with obstructive jaundice due to acute biliary-tract disease. Early diagnosis of pancreatic carcinoma must depend ultimately on early laparotomy. But if some of these tests for pancreatic insufficiency, particularly the examination of the stools, were regularly performed when a patient in the cancer age-group develops abdominal pain and begins to lose weight, with or withoutjaundice and with no clear evidence of gastro-intestinal disease, then laparotomy might be undertaken in more cases before the growth becomes
inoperable. Annotations
injection of hyaluronidase the tiny crystals dispersed in a mass of gel, which is what
but after
an
were seen
to be
happened when urine of normal colloid content was evaporated. Twenty patients in whom stones had been common were treated in this way, and eighteen have been free from trouble for from 11 to 15 months. Clearly this is not enough to justify definite claims of success, nor do the authors make such claims, but their ingenious method promises well, and we hope that a larger series of cases is in preparation. PROVISION FOR THE MENTALLY DEFECTIVE
SOME
mentally
defective
people,
like
some
of the
rest of us, are pleasant to live with ; others are not. But all mental defectives above the grade of idiot, however they may turn out later, need special training in childhood to help them to fit into a world which is always going to be beyond them ; and some, of course, will need to live in institutions, apart from the general community, for life. In the Times of April 7, Lady Norman and Prof. D. R. MacCalman said that of the 100,000 mentally defective people in the country, only 57,000 have found places in institutions ; and of those who have not, 12,000 are children who need education in special schools. Much hardship lies behind this bald statement, as a recent study1 by the Socialist Medical Association in Sheffield The committee which made the study illustrates. mentions the case of a family where a man earning a good wage applied to a charitable society for financial help because one of his four children was a mental defective so destructive of bedding, crockery, clothing, and furniture that the father could not provide adequately for the rest of the family. Another mentally defective boy of eighteen, who lived with his mother, was not only destructive but dangerously violent ; he was finally admitted to an infirmary intended for the elderly and chronic sick. At the other end of the scale are to be found charming and amenable mentally defective children who could profit greatly by special education and never get it. In Sheffield (which no doubt reflects the state of things elsewhere) there are some 4000 defectives of all ages. In the day special schools there are 360 places instead of the 720 estimated to be needed. These schools not only give the children the chance to develop their limited powers to the full but also greatly diminish the risk of the high-grade defective falling into delinquency.
CALCULI COLLOIDS AND WHY are Negroes less prone to urinary calculi than white people ? The difference may be explained, in part at least, by the fact that Negroes have more colloids in their urine. These protective colloids enable both electrolytes and non-electrolytes to remain in solution in the urine in much higher concentrations than their solubilities in pure water would allow. Attracted by the possibility that stones may form when this protection fails, Butt and Hauser 19 have measured-by surfacetension experiments, by counting the particles visible microscopically, and by other means-the hydrophilic colloids in the urine of several hundred people of various races, including a number living in West Florida, where urinary calculi are common. They found that those with the least concentration of colloids in their urine were the ones who developed stones most readily. Women generally had more colloids than men, and the difference Stasis and infection was increased duringa pregnancy. are often said to be predominant causes of stone ; but, quite apart from pregnancy, urinary infection is commoner in women, suggesting that they should have a greater tendency to stone formation than men. That the reverse is so supports Butt and Hauser’s conclusion that colloid depletion is the main factor in the disease. For a long time an imbalance between crystalloids and colloids has been thought to be a contributory cause, but no precise details of the mechanism are known, and certainly the idea has found little application in the prevention or treatment of calculi. Indeed attempts to stop stones forming have not on the whole been very successful. Butt and Hauser thought that hyaluronidase, the " spreading factor," might increase the protection given by urinary colloids in people who develop stones quickly. This enzyme encourages the natural colloids to form a gel which entangles the crystal nuclei as they appear and stops them from agglomerating and growing. They found, for example; that the low-colloid urine of a man who had been troubled by recurrent stones normally produced several large crystals and many smaller ones when allowed to evaporate on a microscope slide ;;
or unmanageable mentally defective children often do best in a residential school, and training in such a school may keep them from- qualifying for borstal or, eventually, for a term of imprisonment. Psychiatrists often report to a juvenile court that in order to prevent further delinquency a child or young person should be sent to a residential special school; but there are no such schools in Sheffield, or in many other places. The committee found that 9 Sheffield children
18. Innerfield, I., Angrist, A. Amer. J. med. Sci. 1952, 223, 422. 19. Butt, A. J., Hauser, E. A. Science, 1952, 115, 308 ; New Engl. J. Med. 1952, 246, 604.
1. The Mentally Defective. Prepared by the Sheffield branch of the Socialist Medical Association and obtainable from Dr. C. H. Foggitt, 754, Attercliffe Road, Sheffield, 9. Pp. 10. 1s.
In Sheffield, besides special schools, there are three special classes in ordinary schools, receiving about 60 dull and backward children who are not sufficiently retarded to need educating in special schools. Occupation centres have proved successful for imbecile children found to be ineducable; here the emphasis is on character and habit training, simple handicrafts, coordination, and simple domestic tasks ; and senior occupation centres run on the lines of sheltered workshops take boys over sixteen and endeavour to train them for employment in industry-sometimes very successfully. There is only one occupation centre for Sheffield ; Leeds, with a smaller population, has four centres. In scattered areas the local authorities have power to arrange for simple instruction of the child in his own home ; but the amount of training given is limited by the amount of staff available. In Sheffield 6 mentally defective children were taught at home in 1950.
Difficult, delinquent,