MEDICINE AND GEOGRAPHY

384 of

pharmaceutical

chemists

first

passed the

minor

examination ; but since the introduction of university

degrees in pharmacy, graduates have obtained this higher by way of a greatly modified examination. In practice, however, no-one outside the profession realised that any distinction or difference existed. Recently the Pharmaceutical Society ceased to examine at the " chemist and druggist " level ; so the holders of this title now form a dwindling group. The Pharmacy Bill, a private member’s Bill now before Parliament, seeks to place all pharmacists on the register of pharmaceutical title

If this becomes law, the present chemists and pharmaceutical druggists will receive the title of chemist " by way of bonus. Perhaps the existing holders of this qualification will feel they have suffered some loss of status and they may wish for a distinctive title as a sign of the standard they have attained. The century-old Act not only prohibited the Pharmaceutical Society from conducting examinations in medicine, surgery, and midwifery, but also debarred members of the medical profession from registering as pharmaceutical chemists ; the new Bill will repeal the latter and retain the former provision. Certain domestic matters of the society, including the abolition of the limit on the annual retention fee paid by members, are also covered by the Bill. The Bill is sponsored by memchemists.

"

bers on both sides of the House and seems to contain little that is controversial. Incidentally, there is talk at the moment of establishing an examination in practical pharmacy for unqualified assistants ; but it is to be hoped that this will not lead to a repetition of history and a demand for legislation to recognise a new class by ata/tte.

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MEDICINE AND GEOGRAPHY the ORGANISED scientific collaboration between different countries of the British Commonwealth is one happy result of the late world war. Representatives of the Medical Research Council, Department of Scientific and Industrial Research, Agricultural Research Council, and Commonwealth Agricultural Bureaux have met regularly in London since 1946 with scientific representatives of Canada, Australia, Southern Rhodesia, South Africa, India, New Zealand, the Colonies, and latterly also Pakistan and Ceylon, to see what can be done to improve the exchange of scientific information and of specialist scientists, and how national laboratories can work for the benefit of the whole Commonwealth or share in international research. The fruits of this combined approach include an index of English translations of foreign scientific papers, a book listing inter-Commonwealth postgraduate scholarships in science, maps of the prevalence of insect and fungus plant diseases, and the coördination of culture collections of micro-organisms : two reference laboratories of the Public Health Laboratory Service at Colindale (dysentery and food-poisoning) now work for the whole Commonwealth, with the exception of Canada. These and other achievements are recorded in the report, just published,! of a special Commonwealth conference held in Australia last vear. On the whole this scientific liaison work is for the benefit of official science, and relatively little is of medical import ; but geographical anthropometry-the study of the normal physical standards of inhabitants of different countries or of different tribes in a single country-is proposed as suitable for research by collaboration throughout the Commonwealth. This not only is essential for where disease begins, but may also prove a defining good test of the value of somatotyping and similar attempts to classify human physiques. It seems a pity that the conference turned down a proposal to study geographically the prevalence of dental caries-appar1. British Commonwealth Scientific Conference, Australia, 1952 : Report of Proceedings. H.M. Stationery Office. Pp. 74. 3s.

ently because this would be better investigated on a full international scale. The Commonwealth is large enough for useful studies on the geography of many diseases ; and to wait till, say, the World Health Organisation has money for international research of this sort and can persuade its member nations to collaborate may be to wait a very long time. The American Geographical Society has already begun to publish maps of the distribution of diseases2 and how this is changing with the years ; and Sigerist 3 has discussed the kind of useful work to be done. Research on this subject can only be by international collaboration ; and the British Commonwealth Scientific Conference ought to consider further how it might be promoted-for instance, by coordinating the work of national health departments on the notification of disease. RUPTURE OF THE BLADDER of intraperitoneal rupture of the bladder may be difficult. Moreover, Negley4 emphasised its importance by drawing attention to the danger of spread of infection ; he found that the operative mortality within the first twelve hours was 11%it rose to 22% after twelve hours, and. to 43% by the second day. Various tests for the earlier diagnosis of this condition have been suggested and tried. Recently, Cipolla and THE

early diagnosis

his colleagues5 reported that in dogs a 0.5% solution of fluorescein was not absorbed from an intact bladder, but was readily absorbed from the peritoneal cavity and could be detected later in the blaod-stream. Similar results were obtained in experiments on human beings. The authors suggest that in -every case of suspected rupture of the bladder a 10 ml. specimen of blood should be taken, and then 100 ml. of a 0-5% solution of fluorescein passed through a urethral catheter into the bladder. The control serum is compared with three specimens of at intervals of five minutes; the serum removed presence of fluorescein confirms the diagnosis. A tear in the bladder may be plugged by omentum and the perforation may not be detected by other tests. In dogs, Cipolla et al. found that less fluorescein was absorbed when the tear was plugged by omentum than when it was open to the peritoneal cavity ; and they suggest that this finding may be used to distinguish between a ruptured bladder which is sealed with omentum and one which is not. DIAGNOSIS OF MYASTHENIA GRAVIS BEFORE the introduction of neostigmine by Mary Walker in 1935 myasthenia gravis was usually diagnosed by observing the characteristic distribution of the muscles affected-the occular and bulbar muscles and proximal rather than distal limb muscles-and by the history of diurnal fluctuations as well as remissions and relapses The greatest difficulty arose in over months or years. patients with an unusual mode of onset, those with no tendency to remission, and those who in an early stage of the disease showed no physical signs and might be

diagnosed as hysterical. Neostigmine, with its rapid action, was widely welcomed as a diagnostic agent. The patient whose muscular power is not increased by a dose of 1-5 mg. intramuscularly or 0.5 mg. intravenously has not got myasthenia gravis-though the response varies widely from one patient to another. Neostigmine may, however, also cause some temporary improvement in thyrotoxic myopathy 6and in dysphagia due to early progressive bulbar palsy. ’Moreover, it has to be. used with some care, and always with atropine (0-6 mg.) because of its 2. Sci. Amer. February, 1953, p. 22. 3. Sigerist, H. E. A History of Medicine. 1951 ; vol. 1, p. 66. 4. Negley, J. C. J. Urol. 1927, 18, 207. 5.

Cipolla,

A.

New York and London,

F., Khedroo, L. G., Casella, P. A.

33, 102. 6. Laurent, L. P. E. Lancet, 1944, i, 87. 7. Sheldon, J. H., Walker, R. M. Ibid, 1946, i, 342.

Surgery, 1953,