INTERNATIONAL STANDARDISATION OF DIGITALIS AND ERGOT.

27 nucleus of the new school the troubles that arose from Moynihan, who was in the chair, in a speech disthe proposal to employ private property for public tinguished alike by its brilliance and its affectionate purposes were inevitable. For one group of medical intimacy. As an indication of the feelings which men, out of a recognition, no doubt, of the Overends’ prompted the tribute, a few of Sir Berkeley’s actual pioneer labours, desired to maintain the Overend words may be quoted :Museum as a permanent centre of the new school, This volume, written by a band of brothers, is dedicated while another group, foreseeing the complications with greatest respect and with warmest affection to Sir that might ensue, wished to make a new start, taking Robert Jones on the occasion of the seventieth anniversary the form of a Medical Institution. The term " school " of his birth. The opportunity to pay tribute to our friend, in whom we recognise one of the masters of surgery, was was not employed in connexion with this later movemost eagerly welcomed. We felt that it gave us the chance directed to the of which was rather formation ment, to openly what has long been in our hearts, in regard what would now be considered a learned society, to say his work for our profession, and in acknowledgment and this perhaps accounts for the fact that in the first of the inspiration, encouragement, and example he has instance the Overends, father and son, appear to have given to all who have had the high privilege of association been quite friendly to the scheme. But the new with him. All those who contribute to this volume are Medical Institution soon became the centre of medical proud to think that the influence of Robert Jones, of his education in Sheffield, in accordance with the pre- methods, and of his teaching has inspired them, has found a place in their work to be transmitted by them in due time vailing views for the training of students, and thus to their successors. Spirit alone is immortal. In the for a short time Sheffield possessed two rival schools, of orthopaedic surgery the spirit of Robert Jones practice with the disagreeable division of opinion thus implied. will live for ever. To Robert Jones, great surgeon, inspiring But the dissension came to an end dramatically by teacher, loyal colleague, and good friend, we affectionately the disappearance of the Overend Museum. The inscribe this volume." Museum itself had been removed from the back of the In addition to Sir Robert’s daughter and son-in-law, Overends’ house, owing to the feeling that patho- Mr. and Mrs. Frederick Watson, and his son and logical specimens were inconvenient property to have daughter-in-law, Mr. and Mrs. Arthur Probyn Jones, on domestic premises at a time when the public the following were Sir Berkeley Moynihan, feeling against body-snatching was so high. And Sir Harold Stiles, present: Sir John Lynn-Thomas, Mr. E. the action was certainly prudent, for in 1835 the Muirhead Little, Prof. Murk Jansen, Mr. A. B. Museum was sacked and destroyed by a mob, inflamed Dr. Thurstan Holland. Sir William de Courcy Mitchell, accounts of the Burke and Hare atrocities. by the Mr. E. Laming Evans, Mr. H. A. T. Fairbank, But although the Sheffield School of Medicine did Wheeler, Prof. E. W. Hey Groves, Mr. R. C. Elmslie, Mr. A. S. not have its material start in the Overends’ Museum, Blundell Bankart, Mr. W. Rowley Bristow, Mr. Dr. Porter says, and all will agree with him, that Dunn, Mr. G. R. Girdlestone, Mr. Harry Hall Overend was the true founder of the Sheffield Naughton Mr. D. McCrae Aitken, Mr. W. H. Trethowan, Platt, medical school. The rise of an entirely independent and Mr. T. P. McMurray. institution was the only sound method to ensure permanency for the ideals of the Sheffield citizen, but the ideals themselves were implanted by Hall I INTERNATIONAL STANDARDISATION OF Overend. DIGITALIS AND ERGOT. While the beginnings of the Sheffield School of Medicine are quite clearly chronicled, the next stage THE first insight obtained by any student into the appears to have escaped public notice generally, for principle of international units of measurement dates even the Sheffield Local Registers are silent as regards from his school days. When he opened his first textthe school between the years 1835 and 1850. Evidently book on physics he learned with surprise that the the school showed no promise of great developments metre, which was the familiar basis of many of his before the year 1883. But in that year the associa- sums, could be defined with accuracy only as the tion with the Firth College wrought a magical difference distance, at the temperature of melting ic-e, between in outlook and performance, and four years later the two marks cut in a bar of durable metal preserved in foundation-stone of the new school in Leopold-street It would be absurd to pretend that such was laid, after which the record of success becomes precise standards will ever be available in the sphere progressive. Of the growth from a university college of pharmacology or therapeutics, but their developto a faculty of medicine in a university nothing need ment on scientific lines must depend largely on the be said, as such recent medical history must be familiar extent to which it is possible to set up units of measureto all our readers. We follow Dr. Porter in quoting ment common to all countries. The practitioner has the concluding words of the inaugural address at the hitherto not been very exacting in his demands for foundation of the Sheffield School of Medicine in 1828. standardised drugs, or, indeed, very receptive to " If it be competent," said Sir Arnold Knight, " to suggestions from pharmacologists that a popular supply that knowledge which the increasing wants of mixture is not necessarily a potent one. He has been an improving profession so urgently require-if it content to assume that the preparations of such drugs be calculated to advance the interests of the general as digitalis, squill, and ergot in common use are of practitioner-if by increasing the intelligence it add uniform strength without inquiring closely into the to the dignity of the profession and render its honours grounds for this assumption. Recent research has still more an object of ambition among the truly shown that his confidence is misplaced, and that the great-if by promoting professional skill it tend to great variations in clinical response which he has alleviate the sufferings of mankind ... then will the doubtless attributed to the idiosyncrasies of the Sheffield Medical Institution succeed: and it will patients are at least as likely to be due to the differences succeed-because it will deserve success." No doubt in the activity of the drug exhibited. The Health these words were greeted one hundred years ago with Organisation of the Leasue of Nations is thus doing an approval that their powers of prophecy deserved. most valuable work by collecting together experts from all countries with the idea of devising tests for the potency of those therapeutic substances which cannot be standardised by purely chemical means. A DINNER TO SIR ROBERT JONES. The permanent Commission appointed by the League ON Thursday, June 28th, a group of surgeons- to consider the standardisation of sera, serological friends, colleagues, and pupils-entertained Sir reactions, and biological products have already dealt Robert Jones to dinner at the Cafe Royal, London. with salvarsan, insulin, and pituitary extract on these A book, specially written for the occasion and entitled lines, and the report1 of their last session, held at The Robert Jones Birthday Volume, was presented Frankfort in April last, shows that they have made to him, comprising a collection of surgical essays considerable progress towards the establishment of written by experts in his own subject with full know- a uniform international unit for preparations of digitalis ledge of the position occupied by Robert Jones. This feeling was admirably set out by Sir Berkeley 1 Publications of the League of Nations: Health, 1928, iii., 6. "

’

Paris.

28 The late Prof. Rudolf Magnus of Utrecht was asked in 1925 to make a dried powdered preparation of the leaves of digitalis purpurea of a certain strength. He was instructed to use for this purpose a mixture of 10 different powders, made from leaves properly dried at 55-60° C., to adjust its activity by biological assay on cats, and to distribute the preparation for international use. The activity of the standard product was to be controlled by annual tests, and if it should deteriorate, or the supply become exhausted, a new preparation of equal activity was to be made. This work was duly carried out, and favourable reports on the standard product have been received from various countries. The Commission of the League of Nations have therefore decided definitely to adopt the preparation for international use. Arrangements for renewal of the standard have had to be reconsidered owing to the death of Prof. Magnus, and Dr. Bijlsma, of Utrecht, has been entrusted with the task. Only when the new standard has been proved by various biological tests-such as intravenous infusion in mammals or the lethal dose method in frogs-to be identical in activity with the existing one, will it be forwarded to the National Institute for Medical Research for distribution on behalf of the League of Nations. In future, when the dosage of digitalis or its preparations is expressed in units of activity, the unit employed will be the specific activity contained in 0-1g. of the international standard powder. As to ergot, in view of the results of recent clinical work,2 showing that the essential factor in the activity of ergot on the uterus is the action of the specific alkaloids, the Commission have decided to proceed with the standardisation of ergot and its preparations by a method measuring its content of the specific alkaloid (ergotoxine or ergotamine). For this purpose the method of Broom and Clark, using the isolated uterus of the rabbit, will be adopted. The possibilities of preparing a stable standard for squill are now being explored. When such popular drugs as digitalis, ergot and squill have been added to the list of standardised substances, some important obstacles to the correlation of clinical impressions with experimental observations will have been removed.

I

ModernTechnique in Treatment. A Series of Special Articles, contributed by invitation, on the Treatment of Medical and Surgical Conditions.

I

CCLXXXIII. THE SURGICAL TREATMENT OF CHRONIC INFECTIONS OF THE SEMINAL VESICLES. CHRONIC

infections

of

the

seminal

vesicles

are

responsible for a considerable amount of ill-health, causing as they do persistent urethritis with unfitness for marriage, sterility, crippling arthritis, myositis, relapsing cystitis with rigors, epididymitis, and many other complications of intersubinfection " or "

"

bacteriaemia." Local urethral treatment, diathermy, vesicular massage, intravenous injections of neosalvarsan, or protein shock therapy will often bring about a cure. But many cases remain where cure can be hastened or can only be attained by lavage of one or both seminal vesicles by way of the vas. The operation of vasostomy or vasotomy, devised by ]3elfield,l of Chicago, in 1905, since modified by him and others in many important particulars, and performed by him on more than 1100 patients, should be more widely known and practised in this country, since recent improvements in technique have done away with complications which at first proved troublesome and caused the operation to be viewed with disfavour. The operation has been criticised chiefly on the ground that if it is not properly carried out it may lead to a stricture of the vas with consequent sterility. Quite apart from the fact that most of the patients who need the operation are already sterile as the result of the disease of the vesicle, it is now known that stricture of the vas should not follow the operation when performed according to the latest technique ; and, indeed, it is likely to render fertile many perons who without it would be condemned to permanent sterility. It appears, from numerous observations and experiments, that colloid silver, or other chemical, when injected into the lumen of the seminal tract does not injure in any way the epithelial lining of that tract. On the other hand, if colloid silver or other chemical be permitted to leak into the interstitial tissues around the vas, funiculitis may be produced, and in some cases lead to a stricture of ROYAL NAVAL MEDICAL SERVICE. the vas at the site of the incision. Such a condition THE following appointment has been notified :—Surg. can be remedied by the perfected operation of Comdr. G. H. Hayes to Barham. vasectomy with end-to-end suture. But with the new technique of vasotomy this necessity is not likely to ROYAL ARMY MEDICAL CORPS. arise. For instance, Dr. Clinton Smith, of Kansas Col. F. J. Brakenridge, late R.A.M.C., retires on retd. City, reported 100 consecutive cases in which he was on reaching the age for retirement. able to test the sperm at long intervals after the Lt.-Col. T. E. Fielding, from R.A.M.C., to be Col., vice operation. In 98 of the cases living sperm was Col. F. J. Brakenridge. The chances, then, of sterility seem remote. found. Maj. J. P. Lynch to be Lt.-Col., vice Lt.-Col. T. E. Fielding. All who have had extensive experience of this Capt. T. S. Law to be Maj. operation are now pretty well agreed that attempts ARMY DENTAL CORPS. to leave a cannula in the vas for repeated washings The undermentioned Lts. (on prob.) to be confirmed in should be given up. It was these attempts that led their rank : R. G. J. Tovey, A. K. Inglis, W. McD. Birse, to reflux of the chemical injected and to subsequent W. P. Baxendine, and N. I. Macmillan. stricture formation. It was found that stricture TERRITORIAL ARMY. might result whatever chemical antiseptic was used for the injection. It was not the nature of the Capts. R. B. Lilly and I. J. Williams to be Majs. 2nd Lt. H. R. Vernon (late R.F.A.) to be Lt. antiseptic, but it was the reflux of the antiseptic H. A. Eccles, L. D. Williams, and J. Wright to be Lts. into the interstitial tissues that caused the stricture. General Hospitals: Maj. J. Wallace, from Gen. List, to be Since colloid silver is found in practice to be the most Lt.-Col. and to comd. the 13th (4th Lond.) Gen. Hosp., efficient antiseptic, it should be used in preference to vice Lt.-Col. (Bt. Col.) A. H. Gosse, vacated. any other so far suggested, such as acriflavine. The operation should not be carried out in the ROYAL AIR FORCE. out-patient department. Patients should be confined to bed for two or three days at least, preferably four Flying Officer J. Hill is promoted to the rank of Flight to five days. Lieutenant. mittent

The Services.

I

pay

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z

INDIAN MEDICAL SERVICE. The undermentioned officers retire : Lt.-Col. A. and Maj. A. Seddon (on account of ill-health). 2

See THE LANCET, 1927, ii., 560.

Technique of Vasotomy. operation can be carried out under local is Murphy or general anaesthesia. If a local anaesthetic preferred, it is administered as follows. Pick up The

1 Jour. Amer. Med. Assoc., 1905, xliv., 1277.