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HEPATIC DYSFUNCTION IN PEPTIC ULCER
449
Letters
to
in the last 23 consecutive unselected patients, of whom had strains of bacteria requiring up to 6 units of penicillin per ml. for in-yitro inhibition, there has not been a single failure. Of this last group of patients approximately one-half received from 1 to 2 million units per day either- at the outset or later in their treatment, and approximately one-half had pre viously failed to recover on daily dosages of less than 500,000 units. WALTER S. PRIEST. Chicago. 83
the Editor
% ; and
some
THE NEED FOR TEXTBOOKS SIR,-Your admirable educational number reminds It is me that the academic year is about to commence. the duty of teachers to recommend textbooks and other reading matter to their students. To make my advice practical, I called in at a leading medical library to find out what books were available in my subject. A few copies of one English standard textbook might be seen in solitary state, and odd copies of some American textbooks could, I was told, be obtained from ’time to time. It seems that not only in morals but also in culture we are revertine- to the Dark A2’es. SAMSON WRIGHT. Middlesex Hospital, W.1.
PROVIDENT SCHEMES
SIR,-In the article entitled Treatment in Private Wards under the National Health Service, in your issue of Sept. 6, a correspondent outlines the growth of schemes. May I bring to notice the latest in this field ? Earlier this year a new association, entitled the British United Provident Association, was incorporated. Its primary aim is to amalgamate, as far as possible, the numerous existing local associations to which your correspondent refers, and to establish in their place a uniform service on a nation-wide basis. Past experience has shown the old haphazard development to be unsatis. factory in many respects, and in any case it is unlikely that many of the existing bodies would be able to carry on alone under the National Health Service. In addition, it is the intention to place the business on a sound actuarial basis, such as has not been possible in the past owing to lack of uniform statistical information. This should raise the status of the business, and enable it to obtain a more effective voice in medical health
provident
development
HEPATIC DYSFUNCTION IN PEPTIC ULCER
SIR,—Iread with interest Dr. Pollak’s results (July 26) and interpretation of the hippuric-acid test in patients with peptic ulcer. Reports of hepatic dysfunction in this condition are still scanty, but personal observations on the hippuric-acid synthesis test, which are entirely
in agreement with Dr. Pollak’s findings, show that in most patients with active peptic ulceration the synthesis of hippuric acid is impaired. To establish the value of the cephalin-cholesterol flocculation reaction as a test of hepatic function,1 I employed a group of patients with diseases not primarily hepatic. Among 29 patients with various alimentary disorders 22 had peptic ulceration and were admitted to hospital because of activity ; all were proved radio_
politics. Four of the largest existing provident associations have agreed to amalgamate to form the association. They are the Birmingham Extended Benefits Scheme, the British Provident Association, the Central Provident Association (with its branch, the Scottish Nuffield Provident Society), and the Oxford and District Provident Association. Others have joined since. The membership of these four bodies exceeds 30,000, and they have all substantial financial reserves to place in the common pool. In addition, the association enjoys a guarantee of z50,000 administered through the Nuffield Provident Guarantee Fund. The intention is to establish, as soon as possible, a network of branches throughout the country, based on the hospital regions, and to give them the widest degree of autonomy consistent with their experience and the control of policy from the centre. Thus it is hoped to combine local goodwill, initiative, and energy with uniformity of policy and of practice. The founders of the association believe that, as far ahead as can be foreseen, there will be a widespread demand for private specialist and hospital treatment, for which many people will want to make advance provision by joining a provident association ; and that, by keeping in step with developments in the National Health Service, the British United Provident Association will be able to provide a valuable service supplementary to the State insurance. Fuller information will gladly be sent on request. E. F. WEBB British United Provident Association, Ltd., General Manager. 92, Queen Street, London, E.C.4. PENICILLIN FOR INFECTIVE ENDOCARDITIS SIR,-In your leading article of June 28 reference was made to work by my colleagues and rayself.1 Your article does not, I think, bring out what we regard as our most significant finding-namely, that the recoveryrate in endocarditis is apparently related to the daily dose of penicillin. In our earliest cases, when 200,000400,000 units per day was considered an heroic dose, the recovery-rate was 50 %. When 500,000 units was adopted as the minimal dailv dose our rfftoverv-rate increased to 1. Priest, W. S., Smith, J. M., McGee, C. J. Arch. intern. Med. 79, 333.
1947,
.
SODIUM BENZOATE
Results of intravenous
hippuric-acid
test
(9.)
in 22
patients with peptic
ulcer and in 15 normal persons.
The ulcer was located in the duodenum in 18 cases, stomach in 3 cases, and oesophagus in 1. The cephalin-cholesterol reaction was negative in all cases, suggesting absence of hepatic dysfunction. The intravenous hippuric-acid testwas also used in the 22 patients. The intravenous technique is considered by some to be more sensitive than the oral test, and vomiting and malabsorption are eliminated. The results I obtained (see figure) show that the recovery of hippuric acid expressed as sodium benzoate ranged from ,1’34 to 0-14 g. with a mean of 0-674 g., whereas in 15 healthy medical students the results ranged from 1.25 to 0’74 g. with a mean of 0-945 g. The standard deviation of this difference (0-271) is 0-072, and the difference is 3-77 times the standard deviation of the difference ; this is significant. The volume of urine during the test period was adequate in all my cases, and in some in whom renal function was fully investigated no impairment was found. Hippuric-acid synthesis is therefore likely to be impaired in the active stage of peptic ulceration; but in view of the findings of Dr. Sheila Sherlock3 is appears that the results of hippuric-acid synthesis alone cannot be interpreted as indicating hepatic dysfunction. Further investigation of hepatic function by all tests of established value seems to be necessary in patients with peptic ulceration. DICK. ARCHIBALD DICK. Shefraeld.
logically.
’
1. Dick, A. Brit. med. J. 1945, i, 182. 2. Weichselbaum, T. E., Probstein, J. 1939, 24, 636. 3. Sherlock, S. Lancet, 1946, i, 159.
G.
J. Lab. clin. Med.
Letters
to
in the last 23 consecutive unselected patients, of whom had strains of bacteria requiring up to 6 units of penicillin per ml. for in-yitro inhibition, there has not been a single failure. Of this last group of patients approximately one-half received from 1 to 2 million units per day either- at the outset or later in their treatment, and approximately one-half had pre viously failed to recover on daily dosages of less than 500,000 units. WALTER S. PRIEST. Chicago. 83
the Editor
% ; and
some
THE NEED FOR TEXTBOOKS SIR,-Your admirable educational number reminds It is me that the academic year is about to commence. the duty of teachers to recommend textbooks and other reading matter to their students. To make my advice practical, I called in at a leading medical library to find out what books were available in my subject. A few copies of one English standard textbook might be seen in solitary state, and odd copies of some American textbooks could, I was told, be obtained from ’time to time. It seems that not only in morals but also in culture we are revertine- to the Dark A2’es. SAMSON WRIGHT. Middlesex Hospital, W.1.
PROVIDENT SCHEMES
SIR,-In the article entitled Treatment in Private Wards under the National Health Service, in your issue of Sept. 6, a correspondent outlines the growth of schemes. May I bring to notice the latest in this field ? Earlier this year a new association, entitled the British United Provident Association, was incorporated. Its primary aim is to amalgamate, as far as possible, the numerous existing local associations to which your correspondent refers, and to establish in their place a uniform service on a nation-wide basis. Past experience has shown the old haphazard development to be unsatis. factory in many respects, and in any case it is unlikely that many of the existing bodies would be able to carry on alone under the National Health Service. In addition, it is the intention to place the business on a sound actuarial basis, such as has not been possible in the past owing to lack of uniform statistical information. This should raise the status of the business, and enable it to obtain a more effective voice in medical health
provident
development
HEPATIC DYSFUNCTION IN PEPTIC ULCER
SIR,—Iread with interest Dr. Pollak’s results (July 26) and interpretation of the hippuric-acid test in patients with peptic ulcer. Reports of hepatic dysfunction in this condition are still scanty, but personal observations on the hippuric-acid synthesis test, which are entirely
in agreement with Dr. Pollak’s findings, show that in most patients with active peptic ulceration the synthesis of hippuric acid is impaired. To establish the value of the cephalin-cholesterol flocculation reaction as a test of hepatic function,1 I employed a group of patients with diseases not primarily hepatic. Among 29 patients with various alimentary disorders 22 had peptic ulceration and were admitted to hospital because of activity ; all were proved radio_
politics. Four of the largest existing provident associations have agreed to amalgamate to form the association. They are the Birmingham Extended Benefits Scheme, the British Provident Association, the Central Provident Association (with its branch, the Scottish Nuffield Provident Society), and the Oxford and District Provident Association. Others have joined since. The membership of these four bodies exceeds 30,000, and they have all substantial financial reserves to place in the common pool. In addition, the association enjoys a guarantee of z50,000 administered through the Nuffield Provident Guarantee Fund. The intention is to establish, as soon as possible, a network of branches throughout the country, based on the hospital regions, and to give them the widest degree of autonomy consistent with their experience and the control of policy from the centre. Thus it is hoped to combine local goodwill, initiative, and energy with uniformity of policy and of practice. The founders of the association believe that, as far ahead as can be foreseen, there will be a widespread demand for private specialist and hospital treatment, for which many people will want to make advance provision by joining a provident association ; and that, by keeping in step with developments in the National Health Service, the British United Provident Association will be able to provide a valuable service supplementary to the State insurance. Fuller information will gladly be sent on request. E. F. WEBB British United Provident Association, Ltd., General Manager. 92, Queen Street, London, E.C.4. PENICILLIN FOR INFECTIVE ENDOCARDITIS SIR,-In your leading article of June 28 reference was made to work by my colleagues and rayself.1 Your article does not, I think, bring out what we regard as our most significant finding-namely, that the recoveryrate in endocarditis is apparently related to the daily dose of penicillin. In our earliest cases, when 200,000400,000 units per day was considered an heroic dose, the recovery-rate was 50 %. When 500,000 units was adopted as the minimal dailv dose our rfftoverv-rate increased to 1. Priest, W. S., Smith, J. M., McGee, C. J. Arch. intern. Med. 79, 333.
1947,
.
SODIUM BENZOATE
Results of intravenous
hippuric-acid
test
(9.)
in 22
patients with peptic
ulcer and in 15 normal persons.
The ulcer was located in the duodenum in 18 cases, stomach in 3 cases, and oesophagus in 1. The cephalin-cholesterol reaction was negative in all cases, suggesting absence of hepatic dysfunction. The intravenous hippuric-acid testwas also used in the 22 patients. The intravenous technique is considered by some to be more sensitive than the oral test, and vomiting and malabsorption are eliminated. The results I obtained (see figure) show that the recovery of hippuric acid expressed as sodium benzoate ranged from ,1’34 to 0-14 g. with a mean of 0-674 g., whereas in 15 healthy medical students the results ranged from 1.25 to 0’74 g. with a mean of 0-945 g. The standard deviation of this difference (0-271) is 0-072, and the difference is 3-77 times the standard deviation of the difference ; this is significant. The volume of urine during the test period was adequate in all my cases, and in some in whom renal function was fully investigated no impairment was found. Hippuric-acid synthesis is therefore likely to be impaired in the active stage of peptic ulceration; but in view of the findings of Dr. Sheila Sherlock3 is appears that the results of hippuric-acid synthesis alone cannot be interpreted as indicating hepatic dysfunction. Further investigation of hepatic function by all tests of established value seems to be necessary in patients with peptic ulceration. DICK. ARCHIBALD DICK. Shefraeld.
logically.
’
1. Dick, A. Brit. med. J. 1945, i, 182. 2. Weichselbaum, T. E., Probstein, J. 1939, 24, 636. 3. Sherlock, S. Lancet, 1946, i, 159.
G.
J. Lab. clin. Med.