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HEBERDEN SOCIETY AND NEDERLANDS VERENIGING VAN REUMATOLOGEN
1357
of pressure was maintained. The greatest mean rise achieved was 34 mm. Hg (figs. 1 and 2). The rabbits remained healthy and maintained their weight. No appreciable blood-pressure rise was found in three rabbits which were given angiotensin 0’05 to 0,06 g. per kg. per minute for periods varying from 1 to 3 months. Doses in excess of 0-25 jjLg. per kg. per minute had an immediate pressor effect; but the arterial pressure declined to basal levels within a few hours, and it then remained unchanged as the infusion continued (fig. 3). After each infusion transient hypotension occurred, and the blood-pressure then returned to the original basal level, even after the longest infusion. Six rabbits which had remained normotensive after unilateral nephrectomy and renal-artery clipping were
given angiotensin in the dose-range of 0-065 to 0-12 (g. per kg. per minute for up to a month. The results were essentially similar to those in the normal rabbits. Further experiments are in progress to study the effect of rabbit renin and smaller quantities of angiotensin given intravenously. We wish to thank Prof. W. S. Peart for his advice; Dr. C. D. Falconer and Mr. A. B. Tattersall, of Ciba Laboratories, Horsham, for supplies of angiotensin; Mr. W. G. Slater, of Sangamo Weston Ltd., for his help with the electric motors; and Mr. P. Harris, Mr. M. P. Jones, and Mr. A. R. Del Mar for technical assistance.
J. J. BROWN M.B.,
Lond., M.R.C.P. G. CHAPUIS
B.SC.
M.D.
Medical Unit,
J. I. S. ROBERTSON
St. Mary’s Hospital, London, W.2
M.B., B.SC.
Lond.,
M.R.C.P.
Medical Societies HEBERDEN SOCIETY AND NEDERLANDS VERENIGING VAN REUMATOLOGEN A JOINT meeting was held at Groningen, Netherlands, on May 17 and 18. Some of the papers are briefly summarised here. Dr.
J. J.
DE
Population Study a population study of a coastal that the half of the population who were
BLECOURT, in
island, had found
interrelated had no unusual incidence of rheumatoid disease of positive serological tests for rheumatoid factor.
or
Polyarthritis with Rubella Dr. JANE CHAMBERS (Taplow) discussed 5 cases of polyarthritis in patients with rubella. The synovial fluid from the effusions contained a high proportion of macrophages (up to 60%) with a conspicuous absence of polymorphs. The disorder pursued a benign course but might mimic rheumatic fever
or
rheumatoid arthritis.
Juvenile Dermatomyositis (Taplow) had found that, of 12 cases of juvenile dermatomyositis seen at Taplow between 1950 and 1963, severe generalised calcinosis developed in 3, 2 of whom died, and more localised calcinosis in a further 5. Corticosteroids, which had been given to 8 patients for periods ranging from six months to three years, were undoubtedly of value in Dr. E. HAMILTON
the
acute
phases but did
not
prevent calcinosis.
Chloroquine Dr. J. K. PAMEYER (Deventa) pointed out that retinal changes due to chloroquine may progress even after discontinuation of the drug. He suggested that every patient on chloroquine should have an ophthalmological examination every three months. He had noticed that paracentral scotoma was an early
sign of chloroquine retinopathy. Although one should always stop giving chloroquine as soon as deposits were found in the cornea, since further treatment could damage the retina, retinopathy could develop without chloroquine deposits in the cornea.
Amyloidosis Dr. J. H. SCHOLTEN (Groningen) described an investigation of 270 patients with rheumatoid arthritis or ankylosing spondylitis who were in hospital in 1960-61 and 1962 who were investigated for the presence of proteinuria and subsequently for amyloidosis. 30 cases of proteinuria were found, and amyloidosis was confirmed in 10. Rectal biopsy was a satisfactory diagnostic procedure, but the specimen must include the mucosa and the submucosa.
Reviews of Books Margin of Safety JOHN RowAN WILSON. London: Collins. 1963. Pp. 256. EVERYONE knew that
21s.
vaccine was few, outside
effective poliomyelitis great medical achievement; but comparatively the United States, were aware that there was anything particularly unusual in its history. Many doctors presumed that the project had followed the usual pattern of unhurried laboratory investigations, cautious clinical trials, and detached evaluation of data. But the story of the vaccine had several remarkable features, as Dr. Wilson now shows. It is a story that needed telling, and it is doubtful whether anyone could have told it more ably than Dr. Wilson. From some first-hand knowledge, obviously supplemented by much research, and with great literary skill, he has produced an exhaustive and fascinating book. There were several reasons why things turned out as they did. Perhaps the most important was that the main events took place in America and the principal figures were Americans. The history of the vaccines was therefore very strongly shaped by those attitudes and reactions which many outsiders regard as characteristically American, and which uncharitable observers call the least attractive of the attributes of that great nation and its way of life. Moreover, everywhere poliomyelitis has always aroused an intensity of feeling out of proportion to its true importance as a human disease-because it attacks the young and active, because its major complications are very unpleasant, and because it often leaves deformity and disability. And in the United States the disease had been more prevalent than elsewhere, and its notoriety was firmly established in the minds of the people by the illness of President Roosevelt. Finally the repetitive high-pressure fund-raising campaign of the National Foundation for Infantile Paralysis never let them forget it. Thus in America the promise of an effective vaccine aroused much excitement and a great sense of urgency; and those involved in vaccine research were subjected to emotional pressures rarely encountered in the medical research laboratory. As a result the production of poliomyelitis vaccine became a race run before a tense and impatient public audience. And, as Dr. Wilson points out, there are very good reasons why no scientific research should be pursued in this atmosphere, especially medical research. The race can be said to have started in 1934 when Brodie announced a killed vaccine and Kolmer an attenuated one. Next year both vaccines were discredited, but not before a pattern had been established: premature publicity, excitement and encouragement by supporters, assurances of safety, field trials, misgivings, disaster. Then the race was halted until the discovery, by Enders in 1949, that poliomyelitis virus could be made to grow in tissue-culture. Thereafter, first in the lead was Salk with his killed vaccine. The subsequent mass trial of this vaccine culminated in the publication of results, not through the pages of a medical journal but in "acircus atmosphere ", in the presence of the world’s Press, to a variety of medical scientists gathered in an auditorium and to those of a
an
of pressure was maintained. The greatest mean rise achieved was 34 mm. Hg (figs. 1 and 2). The rabbits remained healthy and maintained their weight. No appreciable blood-pressure rise was found in three rabbits which were given angiotensin 0’05 to 0,06 g. per kg. per minute for periods varying from 1 to 3 months. Doses in excess of 0-25 jjLg. per kg. per minute had an immediate pressor effect; but the arterial pressure declined to basal levels within a few hours, and it then remained unchanged as the infusion continued (fig. 3). After each infusion transient hypotension occurred, and the blood-pressure then returned to the original basal level, even after the longest infusion. Six rabbits which had remained normotensive after unilateral nephrectomy and renal-artery clipping were
given angiotensin in the dose-range of 0-065 to 0-12 (g. per kg. per minute for up to a month. The results were essentially similar to those in the normal rabbits. Further experiments are in progress to study the effect of rabbit renin and smaller quantities of angiotensin given intravenously. We wish to thank Prof. W. S. Peart for his advice; Dr. C. D. Falconer and Mr. A. B. Tattersall, of Ciba Laboratories, Horsham, for supplies of angiotensin; Mr. W. G. Slater, of Sangamo Weston Ltd., for his help with the electric motors; and Mr. P. Harris, Mr. M. P. Jones, and Mr. A. R. Del Mar for technical assistance.
J. J. BROWN M.B.,
Lond., M.R.C.P. G. CHAPUIS
B.SC.
M.D.
Medical Unit,
J. I. S. ROBERTSON
St. Mary’s Hospital, London, W.2
M.B., B.SC.
Lond.,
M.R.C.P.
Medical Societies HEBERDEN SOCIETY AND NEDERLANDS VERENIGING VAN REUMATOLOGEN A JOINT meeting was held at Groningen, Netherlands, on May 17 and 18. Some of the papers are briefly summarised here. Dr.
J. J.
DE
Population Study a population study of a coastal that the half of the population who were
BLECOURT, in
island, had found
interrelated had no unusual incidence of rheumatoid disease of positive serological tests for rheumatoid factor.
or
Polyarthritis with Rubella Dr. JANE CHAMBERS (Taplow) discussed 5 cases of polyarthritis in patients with rubella. The synovial fluid from the effusions contained a high proportion of macrophages (up to 60%) with a conspicuous absence of polymorphs. The disorder pursued a benign course but might mimic rheumatic fever
or
rheumatoid arthritis.
Juvenile Dermatomyositis (Taplow) had found that, of 12 cases of juvenile dermatomyositis seen at Taplow between 1950 and 1963, severe generalised calcinosis developed in 3, 2 of whom died, and more localised calcinosis in a further 5. Corticosteroids, which had been given to 8 patients for periods ranging from six months to three years, were undoubtedly of value in Dr. E. HAMILTON
the
acute
phases but did
not
prevent calcinosis.
Chloroquine Dr. J. K. PAMEYER (Deventa) pointed out that retinal changes due to chloroquine may progress even after discontinuation of the drug. He suggested that every patient on chloroquine should have an ophthalmological examination every three months. He had noticed that paracentral scotoma was an early
sign of chloroquine retinopathy. Although one should always stop giving chloroquine as soon as deposits were found in the cornea, since further treatment could damage the retina, retinopathy could develop without chloroquine deposits in the cornea.
Amyloidosis Dr. J. H. SCHOLTEN (Groningen) described an investigation of 270 patients with rheumatoid arthritis or ankylosing spondylitis who were in hospital in 1960-61 and 1962 who were investigated for the presence of proteinuria and subsequently for amyloidosis. 30 cases of proteinuria were found, and amyloidosis was confirmed in 10. Rectal biopsy was a satisfactory diagnostic procedure, but the specimen must include the mucosa and the submucosa.
Reviews of Books Margin of Safety JOHN RowAN WILSON. London: Collins. 1963. Pp. 256. EVERYONE knew that
21s.
vaccine was few, outside
effective poliomyelitis great medical achievement; but comparatively the United States, were aware that there was anything particularly unusual in its history. Many doctors presumed that the project had followed the usual pattern of unhurried laboratory investigations, cautious clinical trials, and detached evaluation of data. But the story of the vaccine had several remarkable features, as Dr. Wilson now shows. It is a story that needed telling, and it is doubtful whether anyone could have told it more ably than Dr. Wilson. From some first-hand knowledge, obviously supplemented by much research, and with great literary skill, he has produced an exhaustive and fascinating book. There were several reasons why things turned out as they did. Perhaps the most important was that the main events took place in America and the principal figures were Americans. The history of the vaccines was therefore very strongly shaped by those attitudes and reactions which many outsiders regard as characteristically American, and which uncharitable observers call the least attractive of the attributes of that great nation and its way of life. Moreover, everywhere poliomyelitis has always aroused an intensity of feeling out of proportion to its true importance as a human disease-because it attacks the young and active, because its major complications are very unpleasant, and because it often leaves deformity and disability. And in the United States the disease had been more prevalent than elsewhere, and its notoriety was firmly established in the minds of the people by the illness of President Roosevelt. Finally the repetitive high-pressure fund-raising campaign of the National Foundation for Infantile Paralysis never let them forget it. Thus in America the promise of an effective vaccine aroused much excitement and a great sense of urgency; and those involved in vaccine research were subjected to emotional pressures rarely encountered in the medical research laboratory. As a result the production of poliomyelitis vaccine became a race run before a tense and impatient public audience. And, as Dr. Wilson points out, there are very good reasons why no scientific research should be pursued in this atmosphere, especially medical research. The race can be said to have started in 1934 when Brodie announced a killed vaccine and Kolmer an attenuated one. Next year both vaccines were discredited, but not before a pattern had been established: premature publicity, excitement and encouragement by supporters, assurances of safety, field trials, misgivings, disaster. Then the race was halted until the discovery, by Enders in 1949, that poliomyelitis virus could be made to grow in tissue-culture. Thereafter, first in the lead was Salk with his killed vaccine. The subsequent mass trial of this vaccine culminated in the publication of results, not through the pages of a medical journal but in "acircus atmosphere ", in the presence of the world’s Press, to a variety of medical scientists gathered in an auditorium and to those of a
an