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LIVER EXTRACTS IN DIABETES.
31
require, of course, to be coordinated with fluctuations in the population. The effect of the Criminal Justice Act of 1925, which enabled many offences to be disposed of summarily instead of being tried by indictment, is not easy to estimate. The official introduction furnishes useful material for attempting to understand the effect of education, the effect of the war, and the effect of shorter sentences ; there is also some examination of drunkenness in relation to crime. The conclusions may not be universally accepted, but the figures cannot be ignored by the student of social conditions.
EFFECT OF IRRADIATION ON RESISTANCE
TO INFECTION.
of mortality were considered, than that of the irradiated mice. When mortality from all causes save the specific infection was ignored the Jtwo It is clear expectations of life were identical. that in this experiment, which involved the use of more than 1000 mice, irradiation conferred no advantage upon the treated animals in respect of the hazards to which they were exposed. To the possible criticism that the mice were not shaved the authors have a cogent answer : exposure of the naked parts of the head and feet to irradiation suffices to protect young rats fed on a rickets-producing diet against rickets, and it would therefore seem probable that the mice used in this experiment received an effective exposure, so far as the antirachitic effect can be accepted as a causes
criterion of adequate dosage. These negative results of irradiation with mice correspond with those of guinea-pigs recorded in the annual report for 1929 of the Lister Institute of Preventive Medicine. A pneumococcal infection among the breeding stock of this Institute, to which reference was made in the report for 1928, still persists, though not to any serious degree. A statistical analysis of the results of irradiating one-half of the breeding stock by means of a mercury-vapour lamp during a period of 12 months has been completed with the cooperation of Dr. P. L. McKinlay. No evidence was obtained that irradiation reduced the incidence of the infection or had any beneficial influence upon the general health and fertility of the animals. The question whether exposure to ultra-violet light has any general beneficial action on the animal or the human body, apart from its specific effect on rickets, is still hotly debated, and more controlled investigations of this kind are needed. That benefit is felt by individual patients is undoubted. But, as with Hamlet’s ghost, the problem whether the phenomenon is objective or subjective remains unsolved.
IN the June issue of the British Journal of Experimental Pathology Sir Leonard Hill, Prof. M. Greenwood, and Prof. W. W. C. Topley describe an experiment designed to test upon a numerically adequate sample of animals exposed to infection whether irradiation confers any immunity from fatal infection. Starting on April 24th, 1929, an infected herd was formed by inoculating 25 mice with pasteurella and adding them to 100 normal mice, housed in the type of cage employed in the study of experimental epidemics. Thereafter, three normal mice were added to the cage each day. By May 5th all the inoculated mice were dead, and no effective spread to the contact mice had yet occurred. On that day a second batch of 25 inoculated mice were added to the cage. Within the next few days some of the contacts died of typical pasteurellosis, and on May 15th the experiment began by the daily addition of three irradiated mice at the same time as the three controls. The treatment of the irradiated mice was as follows. The lamp employed consisted of a frosted vitrosil tubular mercury-vapour lamp, screened by a sheet of glass permeable to ultra-violet rays. up to 2850 A.U., but not to shorter rays, along which on either side was LIVER EXTRACTS IN DIABETES. placed a row of incandescent lamps sufficient in THE surprising success of oral administration of number to balance the blue light coming from the in liver pernicious anaemia has naturally fostered mercury-vapour lamp and produce colours-e.g., of the hope that other diseases might respond to this flowers, equivalent to those produced by sunlight. The animals were placed in cages four feet below the treatment. Some 12 months ago H. Blotner and spite of its lamp and exposed to the light for 48 hours. A fan W. P. Murphy observed that liver, in and protein, The cages relatively high content of carbohydrate was kept running to keep the cages cool. is capable of lowering the blood-sugar when adminiswere at first covered with gauze which allowed about half the light to penetrate ; later this was done away tered by the mouth, and they now recordfurther with, and on July 17th the screen of glass was experiments bearing on the nature and action of In a series of diabetic removed from the lamp to allow shorter ultra-violet this hypoglycaemic principle. have the studied blood-sugar curve rays to pass. The change did not alter the negative patients they the circumstances : under (1) after adminisfollowing On August 22nd six normal character of the results. in various ways ; extracts of liver treated of tration controls and no irradiated mice were added but, with this exception, there was no departure from the rule (2) after hypodermic injection of insulin; and (3) of adding daily three of each class. On Oct. 30th without insulin or liver extract. The curves were blood-sugar readings taken the last batch of immigrants was added, and on constructed from and before at intervals during eight Dec. 31st the surviving members of the colony were immediately killed. The tables supplied of the general vital statistics hours after a fixed meal consisting of 20 g. carboof the community show that the course of events hydrate, 40 g. protein, and 35 g. fat. They find that differed in no significant way from that usuallyI, an aqueous extract, prepared by soaking pulped liver observed in such colonies. The planning of the in water at pH 4.6 to 5,2, and at a temperature of which lowers of a direct experiment admitted comparison of the fates 35-40° C., contains the active principle of normal and irradiated mice. Evaporation of this extract to a Thus of the entrants the blood-sugar. to the community down to July 16th there were 189 paste or a powder at 80° C. does not destroy the irradiated and 189 normal mice admitted on the active principle, but exposure to heat above 80° C. same days, and all of these died before the experiment causes it to deteriorate rapidly. They also observe was brought to an end. The mortality of the that a precipitate forms after heating an aqueous irradiated mice from the specific infection was extract at 80° C. for a few minutes, and that this insignificantly less and from other causes insignificantly precipitate contains almost the whole of the active greater than that of the control mice. The average principle. Incidentally, since the precipitate contains 1 lifetime of the controls was rather greater, when all Jour. Amer. Med. Assoc., June 7th, p. 1811.
regular
32 no
sugar, while the
supernatant fluid contains
an
appreciable quantity, this furnishes a simple method of getting rid of the undesirable carbohydrate. The effect of liver extracts on the blood-sugar is by no means startling. The equivalent of 500 g. of liver has roughly the same effect as 10 units of insulin, and the symptoms of hypoglycaemia have not, so far, been observed. Moreover, a lowered blood-sugar does not of necessity imply that the patient is receiving benefit. Nevertheless, it seems likely that In liver extract will prove to be of practical value. the severe grades of diabetes it may never be more than an adjunct, but perhaps the concentration can be further increased. The necessity of giving insulin by injection is a disadvantage which everyone is
works
on his premises for the preliminary treatment of his effluent, in order to comply with the local
authority’s regulations, he ought not to find that his costs of production are thereupon increased by the increased assessment of his premises for rating purposes. The exact
purport of the Committee’s present
recommendations
can
be
seen
from
a
set of draft
not framed draft Bill and they are not to be taken as the last word in verbal form, but they are a useful summary. The report recommends fresh legislation of a universal and not of an adoptive nature. Local authorities may find it desirable to combine for these purposes and this they will be encouraged to do. It seems .anxious to avoid. reasonable to hope that the new plan will have a better aggregate effect on the river. Efficiency ought to be greater if treatment is concentrated THE TRADER’S ACCESS TO THE TOWN in a single centre under the control of the local DRAIN. sanitary authority. The present scattered system a number of manufacturers to purify their APPOINTED in November, 1927, the Joint Advisory expects effluents separately ; but their interest is in manufacCommittee on River Pollution published in the followture not in sewage disposal, and a small factory with ing July its first report1 dealing with the question a moderate daily volume of effluent often cannot of machinery and of the units best adapted to enforce afford a whole-time qualified staff for purification. the prevention of pollution. Its second report2 the treatment and disposal of trade effluents Plainly deals with the problem of trade effluents in local should be the normal function of the local sanitary sanitary authorities’ sewers. The recommendations authority which already must receive and dispose of .are based on existing provisions in local Acts ; as domestic sewage. Moreover, in a few cases the is well known, experiments in public health and other chemical or bacteriological nature of the trade matters are often given a local trial and found worthy effluent causes treatment to be cheaper and more of more extended application. The Joint Advisory efficient if there is dilution with ordinary domestic Committee comes out frankly in favour of giving the z, The crux of the new plan is to get rid of trader a definite right to discharge his effluent into sewage. 7 of the River Pollution Prevention Act of 1876 Section the sewers and of requiring the local authority to and to clear away legal entanglements by giving the receive and dispose of it. This is the principle trader the right to discharge his effluent while obliging introduced in the Halifax Corporation Act of 1905 the local authority to receive and dispose of it. and various other local statutes since then. Certain The idea is worth trying. It will give anglers new .substances are still to be excluded from the sewers ; hope, while the general public may expect some petroleum-spirit and liquids of abnormally high restoration of ancient amenities even if their rates temperature cannot be received without risk of danger will cost them more, and the cause of public health .and nuisance. This exclusion, it is proposed, should be served. should be strictly maintained as contemplated by the existing general law. The local authority by a system of agreed local regulations is to secure that the PROGNOSIS IN MENTAL HOSPITALS. ,effluent received shall be tractable and that the THE ability to forecast the fate of a person entering necessary sedimentation or other preliminaries shall a mental hospital is important not only for the occur before discharge ; it is to have power to regulate the rate and volume of discharge, to impose reasonable patient and his friends, but also for the administrators, .charges and to provide for measuring quantities, who have to study their future accommodation. inspecting effluents and taking samples. The local The State Charities Aid Association in Xew York has authority is also to have power to remove sludge or investigated the expectation of hospital life on first other deposited matter from the trader’s premises ; admission, and Dr. R. G. Fuller reportson the fate such matter will be produced in complying with of six groups, each of 600 male and 600 female the regulations and the removal of it is a service for patients, representing consecutive first admissions which the trader is expected to be willing to pay. over a varying period beginning on Oct. 1st, 1909. Among consequential recommendations is one to The six groups chosen were manic-depressive, dementia permit the local authority to enter into special praecox, senile, arterio-sclerotic, alcoholic and general ,agreements with individual traders. Existing written paralytic, as the most important numerical groups agreements for disposal of effiuents for valuable in the State hospitals. All the cases have been consideration are to be safeguarded, and, where any observed over at least 15 years, and the results are trade effluent is already discharged into the sewers, set out in six statistical tables showing the number the trader is to be deemed to have required the local still in hospital, the number discharged, the number authority to receive and dispose of it under the new dead, and the relative proportions. It appears that principle. If capital works are necessary on more than half the general run of mental patients are the trader’s premises to enable him to carry out out of hospital within a year of their admission, preliminary treatment, the report suggests that local and that nearly three-quarters leave within five ,authorities be allowed to undertake such works on years. The manic-depressives seem either to be request and at his cost, and to advance him the discharged within three years or to remain the whole More than half the manicamount of the expenditure on terms to be agreed. period of 15 years. An excellent point here is that, if the trader provides depressive, senile. arterjo-sclerotic, and alcoholic patients are out of hospital, either dead or discharged 1 See THE LANCET, 1928 ii., 562. 2 H.M. Stationery Office. 6d.
clauses appended to the report.
They
are
as a
1
Psychiatric Quarterly, April, 1930.
require, of course, to be coordinated with fluctuations in the population. The effect of the Criminal Justice Act of 1925, which enabled many offences to be disposed of summarily instead of being tried by indictment, is not easy to estimate. The official introduction furnishes useful material for attempting to understand the effect of education, the effect of the war, and the effect of shorter sentences ; there is also some examination of drunkenness in relation to crime. The conclusions may not be universally accepted, but the figures cannot be ignored by the student of social conditions.
EFFECT OF IRRADIATION ON RESISTANCE
TO INFECTION.
of mortality were considered, than that of the irradiated mice. When mortality from all causes save the specific infection was ignored the Jtwo It is clear expectations of life were identical. that in this experiment, which involved the use of more than 1000 mice, irradiation conferred no advantage upon the treated animals in respect of the hazards to which they were exposed. To the possible criticism that the mice were not shaved the authors have a cogent answer : exposure of the naked parts of the head and feet to irradiation suffices to protect young rats fed on a rickets-producing diet against rickets, and it would therefore seem probable that the mice used in this experiment received an effective exposure, so far as the antirachitic effect can be accepted as a causes
criterion of adequate dosage. These negative results of irradiation with mice correspond with those of guinea-pigs recorded in the annual report for 1929 of the Lister Institute of Preventive Medicine. A pneumococcal infection among the breeding stock of this Institute, to which reference was made in the report for 1928, still persists, though not to any serious degree. A statistical analysis of the results of irradiating one-half of the breeding stock by means of a mercury-vapour lamp during a period of 12 months has been completed with the cooperation of Dr. P. L. McKinlay. No evidence was obtained that irradiation reduced the incidence of the infection or had any beneficial influence upon the general health and fertility of the animals. The question whether exposure to ultra-violet light has any general beneficial action on the animal or the human body, apart from its specific effect on rickets, is still hotly debated, and more controlled investigations of this kind are needed. That benefit is felt by individual patients is undoubted. But, as with Hamlet’s ghost, the problem whether the phenomenon is objective or subjective remains unsolved.
IN the June issue of the British Journal of Experimental Pathology Sir Leonard Hill, Prof. M. Greenwood, and Prof. W. W. C. Topley describe an experiment designed to test upon a numerically adequate sample of animals exposed to infection whether irradiation confers any immunity from fatal infection. Starting on April 24th, 1929, an infected herd was formed by inoculating 25 mice with pasteurella and adding them to 100 normal mice, housed in the type of cage employed in the study of experimental epidemics. Thereafter, three normal mice were added to the cage each day. By May 5th all the inoculated mice were dead, and no effective spread to the contact mice had yet occurred. On that day a second batch of 25 inoculated mice were added to the cage. Within the next few days some of the contacts died of typical pasteurellosis, and on May 15th the experiment began by the daily addition of three irradiated mice at the same time as the three controls. The treatment of the irradiated mice was as follows. The lamp employed consisted of a frosted vitrosil tubular mercury-vapour lamp, screened by a sheet of glass permeable to ultra-violet rays. up to 2850 A.U., but not to shorter rays, along which on either side was LIVER EXTRACTS IN DIABETES. placed a row of incandescent lamps sufficient in THE surprising success of oral administration of number to balance the blue light coming from the in liver pernicious anaemia has naturally fostered mercury-vapour lamp and produce colours-e.g., of the hope that other diseases might respond to this flowers, equivalent to those produced by sunlight. The animals were placed in cages four feet below the treatment. Some 12 months ago H. Blotner and spite of its lamp and exposed to the light for 48 hours. A fan W. P. Murphy observed that liver, in and protein, The cages relatively high content of carbohydrate was kept running to keep the cages cool. is capable of lowering the blood-sugar when adminiswere at first covered with gauze which allowed about half the light to penetrate ; later this was done away tered by the mouth, and they now recordfurther with, and on July 17th the screen of glass was experiments bearing on the nature and action of In a series of diabetic removed from the lamp to allow shorter ultra-violet this hypoglycaemic principle. have the studied blood-sugar curve rays to pass. The change did not alter the negative patients they the circumstances : under (1) after adminisfollowing On August 22nd six normal character of the results. in various ways ; extracts of liver treated of tration controls and no irradiated mice were added but, with this exception, there was no departure from the rule (2) after hypodermic injection of insulin; and (3) of adding daily three of each class. On Oct. 30th without insulin or liver extract. The curves were blood-sugar readings taken the last batch of immigrants was added, and on constructed from and before at intervals during eight Dec. 31st the surviving members of the colony were immediately killed. The tables supplied of the general vital statistics hours after a fixed meal consisting of 20 g. carboof the community show that the course of events hydrate, 40 g. protein, and 35 g. fat. They find that differed in no significant way from that usuallyI, an aqueous extract, prepared by soaking pulped liver observed in such colonies. The planning of the in water at pH 4.6 to 5,2, and at a temperature of which lowers of a direct experiment admitted comparison of the fates 35-40° C., contains the active principle of normal and irradiated mice. Evaporation of this extract to a Thus of the entrants the blood-sugar. to the community down to July 16th there were 189 paste or a powder at 80° C. does not destroy the irradiated and 189 normal mice admitted on the active principle, but exposure to heat above 80° C. same days, and all of these died before the experiment causes it to deteriorate rapidly. They also observe was brought to an end. The mortality of the that a precipitate forms after heating an aqueous irradiated mice from the specific infection was extract at 80° C. for a few minutes, and that this insignificantly less and from other causes insignificantly precipitate contains almost the whole of the active greater than that of the control mice. The average principle. Incidentally, since the precipitate contains 1 lifetime of the controls was rather greater, when all Jour. Amer. Med. Assoc., June 7th, p. 1811.
regular
32 no
sugar, while the
supernatant fluid contains
an
appreciable quantity, this furnishes a simple method of getting rid of the undesirable carbohydrate. The effect of liver extracts on the blood-sugar is by no means startling. The equivalent of 500 g. of liver has roughly the same effect as 10 units of insulin, and the symptoms of hypoglycaemia have not, so far, been observed. Moreover, a lowered blood-sugar does not of necessity imply that the patient is receiving benefit. Nevertheless, it seems likely that In liver extract will prove to be of practical value. the severe grades of diabetes it may never be more than an adjunct, but perhaps the concentration can be further increased. The necessity of giving insulin by injection is a disadvantage which everyone is
works
on his premises for the preliminary treatment of his effluent, in order to comply with the local
authority’s regulations, he ought not to find that his costs of production are thereupon increased by the increased assessment of his premises for rating purposes. The exact
purport of the Committee’s present
recommendations
can
be
seen
from
a
set of draft
not framed draft Bill and they are not to be taken as the last word in verbal form, but they are a useful summary. The report recommends fresh legislation of a universal and not of an adoptive nature. Local authorities may find it desirable to combine for these purposes and this they will be encouraged to do. It seems .anxious to avoid. reasonable to hope that the new plan will have a better aggregate effect on the river. Efficiency ought to be greater if treatment is concentrated THE TRADER’S ACCESS TO THE TOWN in a single centre under the control of the local DRAIN. sanitary authority. The present scattered system a number of manufacturers to purify their APPOINTED in November, 1927, the Joint Advisory expects effluents separately ; but their interest is in manufacCommittee on River Pollution published in the followture not in sewage disposal, and a small factory with ing July its first report1 dealing with the question a moderate daily volume of effluent often cannot of machinery and of the units best adapted to enforce afford a whole-time qualified staff for purification. the prevention of pollution. Its second report2 the treatment and disposal of trade effluents Plainly deals with the problem of trade effluents in local should be the normal function of the local sanitary sanitary authorities’ sewers. The recommendations authority which already must receive and dispose of .are based on existing provisions in local Acts ; as domestic sewage. Moreover, in a few cases the is well known, experiments in public health and other chemical or bacteriological nature of the trade matters are often given a local trial and found worthy effluent causes treatment to be cheaper and more of more extended application. The Joint Advisory efficient if there is dilution with ordinary domestic Committee comes out frankly in favour of giving the z, The crux of the new plan is to get rid of trader a definite right to discharge his effluent into sewage. 7 of the River Pollution Prevention Act of 1876 Section the sewers and of requiring the local authority to and to clear away legal entanglements by giving the receive and dispose of it. This is the principle trader the right to discharge his effluent while obliging introduced in the Halifax Corporation Act of 1905 the local authority to receive and dispose of it. and various other local statutes since then. Certain The idea is worth trying. It will give anglers new .substances are still to be excluded from the sewers ; hope, while the general public may expect some petroleum-spirit and liquids of abnormally high restoration of ancient amenities even if their rates temperature cannot be received without risk of danger will cost them more, and the cause of public health .and nuisance. This exclusion, it is proposed, should be served. should be strictly maintained as contemplated by the existing general law. The local authority by a system of agreed local regulations is to secure that the PROGNOSIS IN MENTAL HOSPITALS. ,effluent received shall be tractable and that the THE ability to forecast the fate of a person entering necessary sedimentation or other preliminaries shall a mental hospital is important not only for the occur before discharge ; it is to have power to regulate the rate and volume of discharge, to impose reasonable patient and his friends, but also for the administrators, .charges and to provide for measuring quantities, who have to study their future accommodation. inspecting effluents and taking samples. The local The State Charities Aid Association in Xew York has authority is also to have power to remove sludge or investigated the expectation of hospital life on first other deposited matter from the trader’s premises ; admission, and Dr. R. G. Fuller reportson the fate such matter will be produced in complying with of six groups, each of 600 male and 600 female the regulations and the removal of it is a service for patients, representing consecutive first admissions which the trader is expected to be willing to pay. over a varying period beginning on Oct. 1st, 1909. Among consequential recommendations is one to The six groups chosen were manic-depressive, dementia permit the local authority to enter into special praecox, senile, arterio-sclerotic, alcoholic and general ,agreements with individual traders. Existing written paralytic, as the most important numerical groups agreements for disposal of effiuents for valuable in the State hospitals. All the cases have been consideration are to be safeguarded, and, where any observed over at least 15 years, and the results are trade effluent is already discharged into the sewers, set out in six statistical tables showing the number the trader is to be deemed to have required the local still in hospital, the number discharged, the number authority to receive and dispose of it under the new dead, and the relative proportions. It appears that principle. If capital works are necessary on more than half the general run of mental patients are the trader’s premises to enable him to carry out out of hospital within a year of their admission, preliminary treatment, the report suggests that local and that nearly three-quarters leave within five ,authorities be allowed to undertake such works on years. The manic-depressives seem either to be request and at his cost, and to advance him the discharged within three years or to remain the whole More than half the manicamount of the expenditure on terms to be agreed. period of 15 years. An excellent point here is that, if the trader provides depressive, senile. arterjo-sclerotic, and alcoholic patients are out of hospital, either dead or discharged 1 See THE LANCET, 1928 ii., 562. 2 H.M. Stationery Office. 6d.
clauses appended to the report.
They
are
as a
1
Psychiatric Quarterly, April, 1930.