FAMILY PREDISPOSITION TO URINARY CALCULI

750 Dr. will release sufficient funds to enable the Medical causo of death was diabetic coma. Sowden regarded that statement as indicating in the Research Council to make provision for further posts mind of the practitioner that tuberculosis had little the same nature, and so to give younger workers if anything to do with the death and was only ascer- the possible prospect of a life devoted to the scientific clinical problems unhindered by the distractained incidentally; it certainly was not the morbid study condition which gave rise to the diabetic coma, tions of consulting practice or by the distance from and yet, he complains, tuberculosis is the cause human patients which posts in physiology or pathology selected by the rules of the General Register Office. enforce. The establishment of posts for clinical To put it another way, if the post-mortem examina- research should help to resolve the divergence of outtion had not been made, the practitioner would look between laboratory and clinical workers which is probably have certified " Diabetic coma-Diabetes," clearly demonstrated in the discussion reported on and the cause would have been accurately recorded. p. 740, and bring about the closer alliance between We gladly publish Dr. Sowden’s letter because it medicine and other branches of science which Dr. reveals a difficulty, which seems to be widely felt, Hutchison noted as one of the great needs of the day. of interpreting the present form of the death certificate The Rockefeller gift is entirely educational in scope and and the annotations accompanying it. If attention will in no way relieve any hospital thus endowed of is paid to the form of this certificate it must however the burden of raising funds for charitable purposes. be clear that, if the practitioner assigns diabetic coma as the immediate cause of death, the death would not be tabulated to diabetic coma, because FAMILY PREDISPOSITION TO URINARY CALCULI VERY little has been recorded about the heredity " immediate is specifically stated to be immediate in point of time. The Registrar-General might say factor in the formation of calculi. The French, it is have created the term " diathese oxalurique," very justly : "If you look at the official form you true, but the appearance of oxalic acid crystals in the urine will see that the practitioner certified that the immediate cause of death was diabetic coma due to does not necessarily imply, although, it may favour, formation of calculi. Dr. H. C. Gram belongs to pulmonary tuberculosis. In other words, he certified the a family in which a predisposition to calculus formathat the real cause of death was the tuberculosis, seems to exist, and has recently published the tion although it reached its fatal termination by the results of a study on oxalic urinary calculi from the of his the diabetic condition. instrumentality By In members of five certificate he made it clear that the immediate cause point of view of heredity. in his opinion was not the causa causans but merely generations observed there occurred with great an intermediate link in the chain between the real frequency stones which were found on analysis to antecedent cause of tuberculosis and the death consist of oxalate of calcium. The trouble was noted itself." The General Register Office has put up only in males ; this is in harmony with R. McCarrison’s a hard fight to keep out of certificates "causes" report on 34,325 Indian cases of calculus, in which the which are merely terminal modes of exit ; it does not ratio of male cases to female was as 13-2 to 1. It is not want to classify by subordinate links in the chain easy to find an explanation for this high relative of causation from the real cause to its fatal outcome. incidence of calculi amongst males. The long urethra In cases where a long chain of antecedent causation and the common occurrence of prostatic obstruction is certified, some question might arise as to where the amongst the elderly may suffice to explain the greater chain is to be cut for the purposes of classification ; frequency of vesical calculi in men, but can have no but no such question arises here. Had the prac- bearing on the higher proportion of renal calculus As regards the heredity titioner intended to signify that the two causes amongst younger men. Dr. Gram admits that his investigation were of independent origin and that the tuberculosis factor, had merely a contributory and collateral bearing upon concerns only one family, and does not prove that stone formation always shows a hereditary disposition ; a death ensuing from the diabetic condition or its direct consequences, he would (or should) have but it confirms the general impression that a tendency to calculi, as to gout, may be a familial characteristic. used paragraph II. on the form.

immediate

of

of

"

THE

conjunction

who would devote their whole time to the

of special clinical problems. Since 1916 the Medical Research Council has financed such a body of workers under the guidance of Sir Thomas Lewis at University College Hospital, and in 1930 the hospital formally recognised this group as a definite Department of Clinical Research. It is thus fitting that the post endowed should be the one at present held by Sir Thomas Lewis as physicianin-charge of this department. This magnificent gift

investigation

of

Physicians of London will on Tuesday, Oct. 18th,

when the Harveian Oration on the Debt of Preventive Medicine to Harvey and to the College will be delivered by Sir George Newman at 4 P.M. The commemoration dinner will be held in the College on the same evening, and the annual sermon, re-established under the scheme of the Charity Commissioners for the administration of the Sadleir Trust, will be preached at the Mercers’ Chapel, Ironmonger.lane, Cheapside, at Medical noon on Oct. 18th, being St. Luke’s Day.

with University College Hospital School since 1916. The idea underlying the scheme is that there should be brought into existence a body of workers, free from ordinary hospital routine and

teaching,

Royal College

commemorate its benefactors

AN ENDOWMENT OF CLINICAL RESEARCH THE Rockefeller Foundation has handed over to University College Hospital, London, the sum of JE48,800 "to constitute a fund for the permanent endowment of a post, the holder of which will devote his whole energies to the advancement of clinical research." The gift is made with a view to encouraging the progress of clinical research on lines which the Medical Research Council has been developing in

,

ON Thursday next, Oct. 6th, at 3.30 P.M., a memorial to the late Sir Andrew Balfour will be unveiled at the London School of Hygiene and Tropical Medicine by the Earl of Athlone, Chancellor of the University

of London.

__

-_

-

Summer Time, which commenced in Great Britain, Ireland, the Channel Islands, and the Isle of Man on Sunday, April 17th, will cease on Sunday next, Oct. 2nd, at 3 A.M., when the clock will be put back to 2 A.M. The hour 2-3 A.M. Summer Time will thus be followed by the hour 2-3 A.M. Greenwich time. 1 Acta Med. Scandinavica, 1932, lxxviii., 268.

’