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POSTURE AND TEMPERATURE REGULATION
720 not being directly related to occupation or social status). The controls are outpatients; it is not stated how coronaryartery disease was excluded, and they are a fortunate 24 if none is present. The patients have had a myocardial infarction (the criteria for the diagnosis are not given), yet the conclusions of the article refer to coronary-artery disease and the article is headed " occlusive coronary-artery disease ".
(these
Radcliffe Infirmary, Oxford.
VITAMIN-B12
C. F. ALLENBY.
think that the effective factors must belong to the Myco. tuberculosis. Nevertheless, it is possible that the B. leprr should contain them too, but bacteriological manipulations with this organism present a lot of difficulties. In previous work, Levendel and Kokasshowed that the Thorn test with tuberculotic patients is very often negative, and the pulse-rate and blood-pressure run parallel with the eosinophil reaction. Some endocrine factor might be we
implicated.
DEFICIENCY IN INDIAN INFANTS
SiR,-With reference to our article,’ we wish to report that we have lately been able to study two further cases of this syndrome, and to measure serum-folate activity using a microbiological assay 23 with Lactobacillus casei as the test organism. The results were as follows:
But in any case, the first step is the identification of the or factors, responsible for prevention, and the second is to investigate the effect on patients. The speculation step
factor,
can come
later.
I. SOMOGYI Metropolitan Hospital, Visegrád, and Physiopathological Institute, University of Budapest.
J. RIGÓ J. Sós.
POSTURE AND TEMPERATURE REGULATION SiR,-Over the years I have been forced by a num-
In other
words, the serum-folate levels in both children, and in their mothers, were normal while the serum-B12 levels were low. These findings confirm our previous impression that a pure vitamin-B12 deficiency is responsible for this syndrome. Department of Pædiatrics, M. JADHAV and Wellcome Research Unit, J. K. G. WEBB Christian Medical College Hospital, S. J. BAKER. South India. Vellore, AIR EMBOLISM
SIR,-Dr. Fine (March 16) recommended pure oxygen breathing to accelerate shrinkage of air-bubbles in the blood-stream. The rate of diffusion of nitrogen from a bubble into the blood is directly proportional to the difference between the partial nitrogen pressures in the bubble and in the blood. As a result of oxygen breathing, denitrogenation of the body indeed occurs and, if continued for hours, the difference between the nitrogen tensions in blood and bubble may even approach one atmosphere. This may be accomplished within a few minutes, however, by increasing the ambient pressure by one atmosphere, which has the additional important advantage that the volume of the bubble is already halved merely as a result of compression. It would seem better to treat patients with air embolism as if they were divers suffering from decompression sickness-i.e., in a compression chamber rather than with oxygen only. Applied Physiology Division, Department of Physiology, University of Leiden, The Netherlands.
J. A. KYLSTRA.
IMMUNISATION FOR THROMBOSIS AND ARTERIOSCLEROSIS
SIR,-We were very interested in the letter by Dr. Rogers (Jan. 19) and we thank him for his appreciation. In our preliminary communication4 we did not take into consideration the mechanism of the antihypertensive and antisclerotic effects of any constituents of the Mycobacterium tuberculosis. We only observed and described the results. In
a second publication 5 we investigated the possibility of immunological (allergic or anaphylactic) reaction to a fraction of Myco. tuberculosis. In later experiments we tried another mycobacterium, a saprophyte, the Bacillus phlei, but we did not succeed; hence an
1. Lancet, 1962, ii, 903. 2. Baker, H., Herbert, V., Frank, O., Parker, I., Wasserman, L. Sabotha, H. Clin. Chem. 1959, 5, 275. 3. Waters, A. H., Mollin, D. L. J. clin. Path. 1961, 14, 335. 4. Somogyi, I., Rigó, J., Sós, J. Lancet, 1962, ii, 280. 5. Somogyi, I., Rigó, J., Sós, J. Acta med. Hung. 1962, 4, 423.
R.,
ber of nocturnal fresh-air fiends to investigate their peculiarity, and to correct it if I could. In some the findings were as uniform as they were unhelpful. In the
could men;
waking hours their reaction to varying temperatures be distinguished from that of their healthy fellowyet, come the night, they would pour with sweat, tear not
the windows open, and throw off their blankets in winter and summer alike. Having eliminated, one by one, thyrotoxicosis, consuming fevers, and the menopause, I could do nothing beyond reassuring the patients-to whom it had never occurred -that this peculiarity had no sinister cause, and that it had something to do with the night. All these patients felt too hot, at night. After a motor accident a man of 52, who previously was well adapted to changes of temperature, had two compound fractures and concussion without evidence of cranial injury, and developed a tendency to rigors or attacks of shivering in the early part of the night. During convalescence, it became evident and easily verifiable that the factor provoking these fits was not the hour of the day but the assumption of the recumbent position. It was noted, during the early part of convalescence, that physical effort caused profuse sweating when the patient remained upright, but that he had rigors when he lay down afterwards. This suggests the existence of an abnormal, or normally latent, link between posture and gravity and the setting of the thermoregulatory thermostat.
TIBOR CSATO. " FREE ACID " AND " TOTAL ACID "
SIR,-Ihave read with interest Dr. Bock’s article7 criticising Michaelis’ earlier work.8 On consulting Michaelis’ original paper several interesting facts came to light. Contrary to Bock’s statement, Michaelis was fully aware of the differences in buffering capacity between the Ewald and bouillon test-meals. He found that the pH and the free-acid were the same, the difference being the increased combined acid from the sample obtained by the Ewald meal. Since these titration curves departed from the titration curve of HCl at the same point (about pH 2-8) and thereafter differed only in the slope, Michaelis drew the correct conclusions: there is an inconsequential amount of buffering agents in gastric juice which is effective at a pH below 2-8-3-5. Added buffer, therefore, affects the titration curve only above pH 35. Since the gastric juice with greater buffering capacity had the same pH as the bouillon-stimulated sample, he inferred that "... under normal conditions the gastric secretion aims at reaching a definite pH and the amount of secreted HC! necessary for this purpose differs according to the acidcombining capacity of the food ". In answer to the implications of fig. 4 in Bock’s article
readings
6. Levendel, L., Kokas, E. Tuberkulózis, 1957, 10, 66. 7. Lancet, 1962, ii, 1101. 8. Michaelis, L. Harvey Lect. 1926, 22, 59.
(these
Radcliffe Infirmary, Oxford.
VITAMIN-B12
C. F. ALLENBY.
think that the effective factors must belong to the Myco. tuberculosis. Nevertheless, it is possible that the B. leprr should contain them too, but bacteriological manipulations with this organism present a lot of difficulties. In previous work, Levendel and Kokasshowed that the Thorn test with tuberculotic patients is very often negative, and the pulse-rate and blood-pressure run parallel with the eosinophil reaction. Some endocrine factor might be we
implicated.
DEFICIENCY IN INDIAN INFANTS
SiR,-With reference to our article,’ we wish to report that we have lately been able to study two further cases of this syndrome, and to measure serum-folate activity using a microbiological assay 23 with Lactobacillus casei as the test organism. The results were as follows:
But in any case, the first step is the identification of the or factors, responsible for prevention, and the second is to investigate the effect on patients. The speculation step
factor,
can come
later.
I. SOMOGYI Metropolitan Hospital, Visegrád, and Physiopathological Institute, University of Budapest.
J. RIGÓ J. Sós.
POSTURE AND TEMPERATURE REGULATION SiR,-Over the years I have been forced by a num-
In other
words, the serum-folate levels in both children, and in their mothers, were normal while the serum-B12 levels were low. These findings confirm our previous impression that a pure vitamin-B12 deficiency is responsible for this syndrome. Department of Pædiatrics, M. JADHAV and Wellcome Research Unit, J. K. G. WEBB Christian Medical College Hospital, S. J. BAKER. South India. Vellore, AIR EMBOLISM
SIR,-Dr. Fine (March 16) recommended pure oxygen breathing to accelerate shrinkage of air-bubbles in the blood-stream. The rate of diffusion of nitrogen from a bubble into the blood is directly proportional to the difference between the partial nitrogen pressures in the bubble and in the blood. As a result of oxygen breathing, denitrogenation of the body indeed occurs and, if continued for hours, the difference between the nitrogen tensions in blood and bubble may even approach one atmosphere. This may be accomplished within a few minutes, however, by increasing the ambient pressure by one atmosphere, which has the additional important advantage that the volume of the bubble is already halved merely as a result of compression. It would seem better to treat patients with air embolism as if they were divers suffering from decompression sickness-i.e., in a compression chamber rather than with oxygen only. Applied Physiology Division, Department of Physiology, University of Leiden, The Netherlands.
J. A. KYLSTRA.
IMMUNISATION FOR THROMBOSIS AND ARTERIOSCLEROSIS
SIR,-We were very interested in the letter by Dr. Rogers (Jan. 19) and we thank him for his appreciation. In our preliminary communication4 we did not take into consideration the mechanism of the antihypertensive and antisclerotic effects of any constituents of the Mycobacterium tuberculosis. We only observed and described the results. In
a second publication 5 we investigated the possibility of immunological (allergic or anaphylactic) reaction to a fraction of Myco. tuberculosis. In later experiments we tried another mycobacterium, a saprophyte, the Bacillus phlei, but we did not succeed; hence an
1. Lancet, 1962, ii, 903. 2. Baker, H., Herbert, V., Frank, O., Parker, I., Wasserman, L. Sabotha, H. Clin. Chem. 1959, 5, 275. 3. Waters, A. H., Mollin, D. L. J. clin. Path. 1961, 14, 335. 4. Somogyi, I., Rigó, J., Sós, J. Lancet, 1962, ii, 280. 5. Somogyi, I., Rigó, J., Sós, J. Acta med. Hung. 1962, 4, 423.
R.,
ber of nocturnal fresh-air fiends to investigate their peculiarity, and to correct it if I could. In some the findings were as uniform as they were unhelpful. In the
could men;
waking hours their reaction to varying temperatures be distinguished from that of their healthy fellowyet, come the night, they would pour with sweat, tear not
the windows open, and throw off their blankets in winter and summer alike. Having eliminated, one by one, thyrotoxicosis, consuming fevers, and the menopause, I could do nothing beyond reassuring the patients-to whom it had never occurred -that this peculiarity had no sinister cause, and that it had something to do with the night. All these patients felt too hot, at night. After a motor accident a man of 52, who previously was well adapted to changes of temperature, had two compound fractures and concussion without evidence of cranial injury, and developed a tendency to rigors or attacks of shivering in the early part of the night. During convalescence, it became evident and easily verifiable that the factor provoking these fits was not the hour of the day but the assumption of the recumbent position. It was noted, during the early part of convalescence, that physical effort caused profuse sweating when the patient remained upright, but that he had rigors when he lay down afterwards. This suggests the existence of an abnormal, or normally latent, link between posture and gravity and the setting of the thermoregulatory thermostat.
TIBOR CSATO. " FREE ACID " AND " TOTAL ACID "
SIR,-Ihave read with interest Dr. Bock’s article7 criticising Michaelis’ earlier work.8 On consulting Michaelis’ original paper several interesting facts came to light. Contrary to Bock’s statement, Michaelis was fully aware of the differences in buffering capacity between the Ewald and bouillon test-meals. He found that the pH and the free-acid were the same, the difference being the increased combined acid from the sample obtained by the Ewald meal. Since these titration curves departed from the titration curve of HCl at the same point (about pH 2-8) and thereafter differed only in the slope, Michaelis drew the correct conclusions: there is an inconsequential amount of buffering agents in gastric juice which is effective at a pH below 2-8-3-5. Added buffer, therefore, affects the titration curve only above pH 35. Since the gastric juice with greater buffering capacity had the same pH as the bouillon-stimulated sample, he inferred that "... under normal conditions the gastric secretion aims at reaching a definite pH and the amount of secreted HC! necessary for this purpose differs according to the acidcombining capacity of the food ". In answer to the implications of fig. 4 in Bock’s article
readings
6. Levendel, L., Kokas, E. Tuberkulózis, 1957, 10, 66. 7. Lancet, 1962, ii, 1101. 8. Michaelis, L. Harvey Lect. 1926, 22, 59.