good, men still die when excision of the affected muscles is limited, and this failure is attributed to toxic factors liberated from necrotic muscle. Work of less obvious immediate application concerns the nuclear structures of the actinomycetes, hyaluronidase production by various organisms, and trichomoniasis in cattle. The production of better vaccine lymph still stimulates the investigator, as does cardiac hypertrophy induced by arteriovenous anastomosis in rabbits. On the biochemical side attention centres on the specific blood-group substances, and experiments have been designed to suppress and control the natural anti-A
operation. Nearly fifty years ago, ovariectomy as a remedy in cancer of the breast was advocated with some enthusiasm, but the enthusiasm was of short duration, presumably because the benefits were not so great as had been hoped. Recently there has been a revival, and Adair with his colleagueshas recorded the results of spaying and of sterilisation of the ovaries by X rays in 335 premenopausal women who had mammary cancer. The outcome does not appear encouraging, and it will be noticed that the results of spaying and X-ray sterilisation, in spite of their different biological consequences, were about equal.
agglutinin by injecting rabbits with A-hapten. It is hoped to discover a non-antigenic hapten preparation which will reduce maternal iso-agglutinins below the pathological level. Analyst of antibiotic substances such as gramicidin, and the study of the interplay of antibacterial agents, are obvious but none the less important routes that are also being followed. The physicists have found new methods of producing fibrinogen and prothrombin, and materials such as fibrin foam elaborated by them are being issued for clinical use., Freezedrying of penicillin, human plasma, and human milk is another important practical advance. In nutrition the growth-promoting value of nitrogenous substances in potatoes and wheat, and the definite deterioration in nutritive value of clamped potatoes, have
In 4 men with cancer of the breast, aged 63-75 years, castration appeared to have distinctly curative effects, though the operation did not benefit a man of 39 with the same condition. The figures given by Adair suggest that gonadectomy does not help young patients of either sex who have cancer of the breast, though it may be worth a further trial in elderly men, and perhaps also in
It is a comfort to learn that the n,itrogenous materials contained in potato skin are no more valuable than those in the inner part of the tuber. Deprivation of vitamin A can apparently cause severe gastric ulceration in rats ; but they can survive with no (or very slight) skin lesions when potato is their only source of this substance. It is hoped to publish shortly the results of a study begun in 1942 on deprivation of vitamin A in the human subject. Work also continues on iodine deficiency and on the part played by the intestinal flora in nicotinamide production and its effect on the aetiology and cure of pellagra. More than thirty papers have been published during the year by members of the institute on these and related subjects, and they form a record of solid and painstaking work.
APPROACH TO BREAST
EXPERIMENTS in the laboratory have shown that the ovaries, largely because they secrete oestrogen, are intimately concerned in the aetiology of mammary cancer, and attempts to eliminate or counteract their carcinogenic influence are logical enough. Here- are some of the facts revealed by experiments on animals : (1) Removal of the ovaries early in life reduces the expectancy
But the influence of age on the progress of mammary cancer, whether treated or not, is well known. Thus at a discussion a year ago at the Royal Society of :Medicine2 various clinicians produced records of 121 cases of mammary cancer which had been treated with synthetic oestrogens, and in this series also the patient’s age seemed to have a considerable influence on the benefit attributed to the treatment, the patients showing spectacular improvement being all over 58 years. Judging by experimental results the dosage of cestrogens used would hardly have been expected to arrest the growth of the mammary ducts, and it is hard to be sure that the treatment was really responsible for the improvement. Speaking broadly, cancer of the breast progresses with less and less speed as the patient gets older, and may run a very protracted course in people of advanced years. For this reason it is essential, when assessing the results of any method of treatment, to pay special attention, as Adair and his fellow workers have done, to the age of the patients. Otherwise a natural phenomenon due to advanced years may be mistakenly attributed to treatment.
DEVELOPMENT OF PHARMACEUTICAL CHEMISTRY TucuCrH pharmaceutical chemistry has in recent (2) oestrogen to the male or decades been largely concerned with the purity, potency, expectancy of mammary and methods of manufacture of substances used in medicancer. cine, it is directly descended from the iatro-chemists (3) Unless given in very large doses, oestrogen causes growth whose interest in science was secondary to their desire to of the lactiferous ducts. The discover new chemical entities for use in medicine. in much excess of leads Given the normal (4) supply oestrogen to stunted growth of these ducts. present training of those who wish to specialise in this (5) The adrenals can produce oestrogen, and in the absence of subject, and its future development, were discussed by the ovaries this capacity may be increased. Mr. H. Brindle, of Manchester University, in his address (6) Sterilisation of the ovaries by X radiation does not prevent as chairman of the British Pharmaceutical Conference on them from secreting oestrogen, and is, therefore, not the July 18. The first-year course, following upon training equivalent of ovariectomy. to the intermediate standard in general chemistry, up In addition we have to bear in mind the pituitaryis chiefly spent in acquiring a knowledge of analytical ovarian interplay whereby in health the output of methods, and these are considered in greater detail in the cestrogen is adapted to biological needs. advanced course which completes the- training for the The most obvious way to reduce the supply of oestrogen qualification of the Pharmaceutical Society ; higher is ovariectomy, but in order to lessen the probability of concurrent theoretical studies include inorganic, phymammary cancer developing, or perhaps lessen the sical, and organic chemistry to the standard of a science speed of encroachment when cancer has developed, degree. Synthetic demand increasing attention spaying would have to be done early in life ; so as a year by year ; amongdrugs the tried and trusted drugs included preventive it is not practical. Against its use as an in the seven addenda to the British P/tecyMM[cop<6Mt ameliorative treatment when cancer has already appeared 1. Adair, F. E., Treves, N., Farrow, J. H., Scharnagel, I. M. J. Amer. no objection can be raised, provided the amelioration is med. Ass. 1945, 128, 161. of sufficient degree to outweigh the drawbacks of the 2. See Lancet, 1944, ii, 20. of mammary cancer. Persistent administration of spayed female increases the
86 since 1932, somel fifty synthetic medicaments included, and these represent only a small fraction of
the number introduced within the last 13 years. Pharmacists who wish to go further in this field may be handicapped by a lack of mathematical knowledge. An initial training which opens wider possibilities and opportunities consists in combining a degree course in pharmacy with a course in another subject such as chemistry
may enter and inspect agency premises, and the Minister suggests that such inspections should usually be made by State-registered nurses. Whenever a licensing authority finds it necessary to refuse or revoke a licence,
the Minister is to be informed of the refusal and of the grounds on which it was made,- and he considers that all other licensing authorities should be told about such Those carrying on agencies are safeguardecl cases. or physiology. by rights of appeal against unfair refusal of licences. There is ample scope for research in pharmaceutical The types of nurse whom an agency may employ are at followchemists are set out, and besides State-registered nurses, enrolled chemistry ; many " pure " present ing lines that are fundamentally pharmaceutical. Mr. assistant nurses, and certified midwives, include toberBrindle recommends that pharmaceutical research culosis, orthopaedic, and mental nurses, holding certificates should be begun on a national’scale, after the fashion set offered by voluntary bodies, Service-trained male nurses, I by the Medical Research Council. Few grants haveand others. The patient is to be informed of the hitherto been made either by the State or by independent qualifications of the nurse sent. firms to enable colleges to undertake such work, and the In the same circular the Minister mentions that the Pharmaceutical- Society itself confines its attention and Assistant Nurses Committee of the General Nursing its funds to research within its own college. The status Council for England and Wales has submitted to him of the pharmacist depends ultimately on the judgment rules for the trainingof such nurses, but that he has not passed on him by the public, and in Mr. Brindle’s view yet approved them. The committee was set up as long one of the factors which contributes to the formation of ago as May, 1943, and the Assistant Nurses Act was this opinion should be the fact that pharmacists carry rushed through as an urgent measure ; the delay in out research. putting it into force seems perhaps excessive. Possibly the moment at which the measure, in its present form, THE KING’S FUND could be of most use has already gone by, and the country THE voluntary hospitals of London have a great task is now ready for more fundamental changes in its nursing of reconstruction and development ahead of them. At service along the lines lately advocated in our columns.3 the annual meeting of King Edward’s Hospital Fund for If we are to have two grades of nurse we may as well call London on July 13, the Speaker of the House of Comthem by names which give a hint of their quality. A girl mons, who took the chair, noted how much the Fund who is actually nursing patients, as many existing has to offer the hospitals in the form of support and nurses " are doing, is not an assistant, she is guidance. Its representatives during the past year a nurse. That she resents the title of assistant is have consulted on future policy with the Minister of evident enough from the lack of enthusiasm with which Health and the British Hospitals Association, and the the name has been greeted. Few recruits are said to be Fund is now about to issue, jointly with the Voluntary coming forward to train for the grade ; many existing Hospitals Committee for London, a report on post-war assistant nurses have failed to fill in the form which hospital problems in London and the Home Counties. would put them on the roll; and the hospitals applying He mentioned two other-reports it has lately producedto train them are said to be under a score. Objections to that on standards of staffing,! and the second memorthe name may well be increased by the classification laid andum on hospital diet, which has only just appeared. down in the circular of persons entitled to call themselves " Dr. Morley Fletcher, in presenting the report oi the nurse." These include Christian Science nurses, which nursing recruitment committee, noted that the wastage makes nonsense of the whole attempt to safeguard the rate of nurses leaving hospital without completing title " nurse." It is as though the law were to say that training has risen steeply during the war years and is people allowed to use the title of doctor " must be now excessive. those who hold a medical degree-’and faith healers. The income from the Fund has been well maintained. The intention of medical registration was to enable the Legacies in 1944 amounted to over E50,000, and a public to distinguish between practitioners who had had grant of equal size from Lord Nuffield’s Trust for the a recognised medical education and those who had not; Special Areas made it possible for all but E1800 of the and the public is surely justified in expecting that the receipts from legacies to be transferred to the general word " nurse " would be defined according to similar funds. principles. Another new measure4 relates to the Civil Nursing SOME NEW NURSING MEASURES Reserve. Because of the shortage of staff this body is AGENCIES supplying nurses to patients vary greatly not to be disbanded at present, but will be used " to in their standards. Some are reputable cooperative supplement the permanent nursing staff of the health ventures dealing fairly with the patient and with- the services." This, though a useful temporary expedient, nurses who join them ; others have been used to exploit may prove harmful to recruitment in the long run. The both nurse and patient for private advantage. Some of CNR nurses are above those of student salaries unifying measure has long been needed, and will be and their conditions of life are more attractive. nurses, These applied by part II of the Nurses Act, 1943, which, the nurses may live out, and they have access to an authority Minister of Health announces,2 is now to take effect. other than the matron of their hospital-to a. regional County and district nursing associations, and other nursing officer attached to the Ministry of Health. The similar organisations which provide non-resident nurses reserve is thus more likely to attract recruits than the to visit patients in their homes, have been deliberately nursing service proper, and may possibly reduce the excluded from the regulations by the Nurses Act; but all numbers seeking to qualify. other agencies supplying nurses must now apply for licences from the appropriate local authority, usually 3. Lancet, 1945, i, 664. 4. Circular 102/45. the county council. The authority may lay down what conditions are thought fit to ensure the proper conduct of the agency, including the fees to be charged by the IN recognition of his work on thevarious types of Rh factors people running the agency, either to patients or to the and their genetic transmission, the College of Physicians of Officers authorised by the authority nurses suppfied. Philadelphia has awarded the Alvarenga prize for this year ’
1. See Lancet, June 30, p. 826. 2. Circular 97/45. HM Stationery
to Dr. Alexander S. Wiener. Office.
He will give the Alvarenga Rh blood factors in clinical medicine.