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DICOUMAROL IN CORONARY THROMBOSIS
801 but it is probable that no-one who is not suffering from vitamin-D deficiency can take large amounts for several weeks without suffering some degree of temporary or permanent renal damage. Hence it is inadvisable to give a patient a prescription for calciferol and allow him to use it at his own discretion. If he gives himself several courses of treatment during a succession of winters he may require advice for symptoms far more serious than those of chilblains. A SOCIAL RESEARCH COUNCIL ?
met in London to consider a, memorandum on the furtherance of the social sciences. Just over a year ago the Clapham Committee, which had been asked " whether additional provision is necessary for research into social and economic questions," recommendedthe establishment of (1) a standing interdepartmental Economic and Social Research Committee, and (2) a subcommittee of the University Grants Committee to advise and foster, the social sciences within the universities. The association agrees with both suggestions, but also favours the proposal made two or three years ago for the formation of an official Social Research Council, comparable with the Medical Research Council and others concerned with the physical and biological sciences. The Clapham Committee turned this proposal down: (1) because the chief needs of the social sciences are the strengthening of staffs and provision for routine research ; (2) ’because at the present stage of the social sciences an official body might promote crystallisation of spurious orthodoxies ; and (3) because the best men must not be diverted from active research to the coordination of research. The association does not dispute that staffs are insufficient, but it holds that in the scramble for could adjudicate trained personnel no unofficial between the claims of Government and other research establishments. It rebuts the Clapham Committee’s contention that existing research councils have never assisted, and are not suited to assist, research carried out as a normal routine function. Many sciences, it says, have fallen into spurious orthodoxies, irrespective of control by omcial bodies, and the key to safety lies in untrammelled discussion among workers. The danger that the best men may be diverted to duties of coördination is overshadowed, in the association’s view, by the need to prevent overlap and to fill the most important gaps. The association thinks that the Clapham Committee greatly underestimated the importance of increasing social research ; and it wants to see teams formed to examine the factual background of social problems and to collaborate with the people who have to carry out social policies. ’
body
DICOUMAROL IN
CORONARY THROMBOSIS
INCREASING evidence of the value of anticoagulant in the treatment of coronary thrombosis is forthcoming from America. A recent report from the Mayo Clinic is based on a series of 50 cases of acute myocardial infarction admitted to hospital within a few days of onset.2 In 40 cases dicoumarol was used alone, while in the remainder heparin was also given. The plan of dosage was that recommended by Barker et al.,3 wherein the aim is to keep the prothrombin level between 10% and 30% of normal. This was achieved by giving 300 mg. of dicoumarol on the first day, and 200 mg. on the second. On each succeeding day that the prothrombin level was greater than 20% of normal
therapy
1.
Report of the Committee on the Provision for Social and Economic Research. (Chairman: the late Sir John Clapham.) Cmd. 6868. H.M. Stationery Office. 1946. 2. Parker, R. L., Barker, N. W. Proc. Mayo Clin. 1947. 22, 185. 3. Barker, N. W., Cromer. H. E., Hurn, M., Waugh, J. M. Surgery.
1945, 17. 207.
200 mg. was given in a single dose. If the prothrombin level was less than 20% of normal, no dicoumarol was given on that particular day. While an immediate anticoagulant effect is obtained with heparin, there is a lag of 36-48 hours with dicoumarol. The only complications encountered were 1 case of spontaneous hoemorrhage into the knee-joint, which cleared completely, and 1 mild epistaxis ; and microscopic haematuria was noted in 1 case. The importance of daily estimations of the prothrombin-time is indicated by the finding that in 12 cases the prothrombin level fell to less than 10%, and in 6 of these the intravenous administration of menadione bisulphite was necessary, while in 6 cases the level rose to above 30% for a few days and during this time a second myocardial infarct occurred in one of the patients. In assessing the results of treatment a series from the same clinic reported by Nay and Barnes 4 was used as a control : of 100 consecutive cases of acute myocardial infarction, in which anticoagulant therapy was not attempted, thrombo-embolic complications ensued in 37%. In contrast to this, in Parker and Barker’s 50 cases, treated with anticoagulants, there were only 2 instances of secondary thrombo-embolic complications. Even more interesting is the observation that in the 2 cases that came to necropsy neither pulmonary emboli nor mural cardiac thrombi were present, whereas pulmonary emboli were found in 5, and mural thrombi in 7, of the Ilcases which came to necropsy in the control series. The mortality-rate was not appreciably different in the two series : 10% in the patients receiving anticoagulant therapy and 13% in the control series. The Mayo Clinic report supports the impression from earlier accounts that dicoumarol is useful in the treatment of myocardial infarction. THE NATIONAL HEARING-AID
IN response to a request by the Ministry of Health, the Medical Research Council appointed, at the beginning of 1944, a committee on electro-acoustics5 to design a single type of electrically operated hearing-aid, and to determine specifications for pure-tone audiometers. The committee’s design for an aid has already been approved by the Ministry of Health ; and under the National Health Service this is to be issued free of charge to those found, after examination at special centres, to be in need of it. In a report published this week,the committee describe the investigations which preceded their choice of prototypes. Intelligibility for speech was regarded as the real measure of success ; and theoretical consideration indicated that maximum speech intelligibility need not necessarily result from matching the amplification provided by the aid to the hearing loss of the user. This view was confirmed by practical work at Manchester University and at the National Hospital, Queen Square, London ; and it was concluded that, while effective amplification must be provided for all sounds within the 31/2-octave range needed for good reproduction of speech, this amplification should increase smoothly with increasing pitch over the lower part of the range, and then either continue to increase at a slower rate or remain constant for the middle and higher-pitched sounds. Piezo-electric microphones were considered to.." be the 4. Nay, R. M., Barnes, A. R. Amer. Heart J. 1945, 30, 65. 5. The members are : W. G. RADLEY, C.B.E., B.SC., PH.D., M.I.E.E.. controller of research, Engineering Department, General Post Office (chairman) ; Sir LAWRENCE BRAGG, O.B.E.. M.C., M.A., D.SC., F.R.S., Cavendish professor of experimental physics, University of Cambridge ; R. S. DADSON, M.A., National Physical Laboratory ; C. S. HALLPIKE. M.B., F.R.C.P., F.R.C.S., Medical Colonel D. MCMILLAN, O.B.E., B.SC.. Research Council: A.M.I.E.E., Post Office Engineering Research Station; L. C. POCOCK, M.SC., A.M.I.E.E., Standard Telephones & Cables Ltd.: and T. S. LITTLER, M.SC., PH.D., University of Manchester
(secretary). 6. Hearing Aids and Audiometers. Spec. Rep. Ser. med. Res. Coun., Lond. no. 261. H.M. Stationery Office. 1947. Pp. 71. 1s. 3d.
met in London to consider a, memorandum on the furtherance of the social sciences. Just over a year ago the Clapham Committee, which had been asked " whether additional provision is necessary for research into social and economic questions," recommendedthe establishment of (1) a standing interdepartmental Economic and Social Research Committee, and (2) a subcommittee of the University Grants Committee to advise and foster, the social sciences within the universities. The association agrees with both suggestions, but also favours the proposal made two or three years ago for the formation of an official Social Research Council, comparable with the Medical Research Council and others concerned with the physical and biological sciences. The Clapham Committee turned this proposal down: (1) because the chief needs of the social sciences are the strengthening of staffs and provision for routine research ; (2) ’because at the present stage of the social sciences an official body might promote crystallisation of spurious orthodoxies ; and (3) because the best men must not be diverted from active research to the coordination of research. The association does not dispute that staffs are insufficient, but it holds that in the scramble for could adjudicate trained personnel no unofficial between the claims of Government and other research establishments. It rebuts the Clapham Committee’s contention that existing research councils have never assisted, and are not suited to assist, research carried out as a normal routine function. Many sciences, it says, have fallen into spurious orthodoxies, irrespective of control by omcial bodies, and the key to safety lies in untrammelled discussion among workers. The danger that the best men may be diverted to duties of coördination is overshadowed, in the association’s view, by the need to prevent overlap and to fill the most important gaps. The association thinks that the Clapham Committee greatly underestimated the importance of increasing social research ; and it wants to see teams formed to examine the factual background of social problems and to collaborate with the people who have to carry out social policies. ’
body
DICOUMAROL IN
CORONARY THROMBOSIS
INCREASING evidence of the value of anticoagulant in the treatment of coronary thrombosis is forthcoming from America. A recent report from the Mayo Clinic is based on a series of 50 cases of acute myocardial infarction admitted to hospital within a few days of onset.2 In 40 cases dicoumarol was used alone, while in the remainder heparin was also given. The plan of dosage was that recommended by Barker et al.,3 wherein the aim is to keep the prothrombin level between 10% and 30% of normal. This was achieved by giving 300 mg. of dicoumarol on the first day, and 200 mg. on the second. On each succeeding day that the prothrombin level was greater than 20% of normal
therapy
1.
Report of the Committee on the Provision for Social and Economic Research. (Chairman: the late Sir John Clapham.) Cmd. 6868. H.M. Stationery Office. 1946. 2. Parker, R. L., Barker, N. W. Proc. Mayo Clin. 1947. 22, 185. 3. Barker, N. W., Cromer. H. E., Hurn, M., Waugh, J. M. Surgery.
1945, 17. 207.
200 mg. was given in a single dose. If the prothrombin level was less than 20% of normal, no dicoumarol was given on that particular day. While an immediate anticoagulant effect is obtained with heparin, there is a lag of 36-48 hours with dicoumarol. The only complications encountered were 1 case of spontaneous hoemorrhage into the knee-joint, which cleared completely, and 1 mild epistaxis ; and microscopic haematuria was noted in 1 case. The importance of daily estimations of the prothrombin-time is indicated by the finding that in 12 cases the prothrombin level fell to less than 10%, and in 6 of these the intravenous administration of menadione bisulphite was necessary, while in 6 cases the level rose to above 30% for a few days and during this time a second myocardial infarct occurred in one of the patients. In assessing the results of treatment a series from the same clinic reported by Nay and Barnes 4 was used as a control : of 100 consecutive cases of acute myocardial infarction, in which anticoagulant therapy was not attempted, thrombo-embolic complications ensued in 37%. In contrast to this, in Parker and Barker’s 50 cases, treated with anticoagulants, there were only 2 instances of secondary thrombo-embolic complications. Even more interesting is the observation that in the 2 cases that came to necropsy neither pulmonary emboli nor mural cardiac thrombi were present, whereas pulmonary emboli were found in 5, and mural thrombi in 7, of the Ilcases which came to necropsy in the control series. The mortality-rate was not appreciably different in the two series : 10% in the patients receiving anticoagulant therapy and 13% in the control series. The Mayo Clinic report supports the impression from earlier accounts that dicoumarol is useful in the treatment of myocardial infarction. THE NATIONAL HEARING-AID
IN response to a request by the Ministry of Health, the Medical Research Council appointed, at the beginning of 1944, a committee on electro-acoustics5 to design a single type of electrically operated hearing-aid, and to determine specifications for pure-tone audiometers. The committee’s design for an aid has already been approved by the Ministry of Health ; and under the National Health Service this is to be issued free of charge to those found, after examination at special centres, to be in need of it. In a report published this week,the committee describe the investigations which preceded their choice of prototypes. Intelligibility for speech was regarded as the real measure of success ; and theoretical consideration indicated that maximum speech intelligibility need not necessarily result from matching the amplification provided by the aid to the hearing loss of the user. This view was confirmed by practical work at Manchester University and at the National Hospital, Queen Square, London ; and it was concluded that, while effective amplification must be provided for all sounds within the 31/2-octave range needed for good reproduction of speech, this amplification should increase smoothly with increasing pitch over the lower part of the range, and then either continue to increase at a slower rate or remain constant for the middle and higher-pitched sounds. Piezo-electric microphones were considered to.." be the 4. Nay, R. M., Barnes, A. R. Amer. Heart J. 1945, 30, 65. 5. The members are : W. G. RADLEY, C.B.E., B.SC., PH.D., M.I.E.E.. controller of research, Engineering Department, General Post Office (chairman) ; Sir LAWRENCE BRAGG, O.B.E.. M.C., M.A., D.SC., F.R.S., Cavendish professor of experimental physics, University of Cambridge ; R. S. DADSON, M.A., National Physical Laboratory ; C. S. HALLPIKE. M.B., F.R.C.P., F.R.C.S., Medical Colonel D. MCMILLAN, O.B.E., B.SC.. Research Council: A.M.I.E.E., Post Office Engineering Research Station; L. C. POCOCK, M.SC., A.M.I.E.E., Standard Telephones & Cables Ltd.: and T. S. LITTLER, M.SC., PH.D., University of Manchester
(secretary). 6. Hearing Aids and Audiometers. Spec. Rep. Ser. med. Res. Coun., Lond. no. 261. H.M. Stationery Office. 1947. Pp. 71. 1s. 3d.