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THE CROYDON TYPHOID CLAIMS
998 could be duplicated. The diminution in the respiratory quotient was striking and the increase in respiratory quotient following ingestion of glucose could be much diminished by simultaneous injection of the 622. The possible uses of the new preparation in the treatment of obesity and other conditions in which
an
tageous
increased metabolic rate would be advan-
are
being investigated. Certainly a preparaphysiological action of this
tion with a quick and kind would be welcome.
THE CROYDON TYPHOID CLAIMS
IT was reported last week that 70 of the 230 claims against the Croydon corporation in respect of the typhoid epidemic at the end of 1937 have now been settled; 7 of these are said to be related to fatal cases. It appears that some 70 or 80 claims received by the corporation were sent in too late; for under the Public Authorities Protection Act claims against a public authority must be made within six months of the act, neglect or default complained of. The Croydon town council has already decided by an overwhelming majority to pay compensation in these cases which are out of time, and for this purpose a clause has been included in a bill now before Parliament. No payment can be made until the bill receives the Royal Assentprobably just before Parliament rises for the autumn vacation in August. VITAMIN E
FROM being the most dubious of the vitamins, vitamin E has emerged into being a well-defined substance. Its properties are becoming well known and it may soon achieve the distinction of an international standard and unit. On April 22 it was the sole subject of discussion at a whole-day conference held at the London School of Hygiene and Tropical Medicine, and organised by the nutrition panel of the food group of the Society of Chemistry and Industry. The morning session was devoted to the chemistry of the vitamin and provided probably the most interesting discussion and the most exact information. The chief topic of general interest was the correlation between chemical structure and specificity of biological action. It was made clear that biological action is not confined to one isomer or even to the one substance, but that the tocopherol molecule could be subjected to some degree of substitution without losing all biological activity, though with certain substituents in certain positions this activity is intensified. The outcome of studies on this subject, as summarised by the chairman, Prof. A. R. Todd, seems to be that as in some of the sex hormones there is a narrow specificity but a possibility of action by a wide group of unrelated substances. At the afternoon session most of the communications turned on whether or not vitamin E is related to the hormones. No overwhelmingly convincing evidence was adduced, for or against a relation, nor did the protagonists on either side succeed in convincing their opponents or the neutral observers. Interesting work from America by Dr. Karl Mason tended to show how small is the transfer of vitamin E from the mother rat to her young, either by way of the placenta or the milk, though some transfer was found to take place in the milk. An excellent film demonstrating the peculiar head and leg movement of young rats deprived of vitamin E was shown by Dr. H. M. Wuest of Basle. In the evening the clinical applications of vitamin E in human beings were under discussion. All the clinical work in which vitamin E has been used in treatment of habitual and threatened abortion
is based on belief in a close relation between vitamin E and the sex hormones. A number of clinicians have recorded successful results, usually in 70 or 80 per cent. of the women treated for one or other of these conditions, and encouraging reports were presented to the meeting from Dr. Vogt-M61ler of Copenhagen, Dr. E. V. Shute of Toronto, Mr. D. W. Currie of Leeds and Dr. C. R. Macdonald of Sheffield. It is recognised however that the assessment of such clinical results is full of pitfalls. It is difficult to obtain accurate and reliable case-histories of
habitual abortion, or to define threatened abortion. Moreover, to obtain reliable figures very large numbers of cases are needed for study, with an equal number of comparable untreated controls. In his summing-up, Prof. F. J. Browne, who presided at this third session, was at particular pains to emphasise these points. Those who remained at the conference throughout the day, as most did, must have left with the feeling that they had surveyed the field in excellent company, and carried away a well-balanced idea of the subject. TEMPERATURE MEASUREMENT IN ARTIFICIAL PYREXIA
ALTHOUGH it is generally taken for granted that the rectal temperature gives the most exact estimate of the temperature of the body, it is also recognised that in the ordinary course of practice a compromise with accuracy is permissible. Most doctors use either the mouth or the axillary temperature, which, provided the usual precautions have been observed, will differ from the rectal temperature by a constant amount. It is doubtful, however, if the practitioner ever performs this bit of mental arithmetic. He knows from experience what the thermometer reading " means when he "takes the patient’s temperature" by his own method, and it is of little interest to him or to the patient whether or not it has any precise scientific meaning. The position is different during treatment by artificial pyrexia, in which the patient’s temperature is forcibly raised against the resistance of all his compensatory mechanisms. Here a casual record of how the patient is getting on is insufficient, for his life has been taken entirely out of the control of nature and lies in the hands of his attendants. The temperature of the cells of his body must not exceed a certain limit, and it is important that such record as is kept should indicate his maximum temperature, or bear an infallible relation to it. It must be remembered that all the physiological mechanisms for reducing temperature are at the highest pitch of activity, and although the heating process overcomes them and prevents any general lowering of the body temperature, they may well set up a local lag peripherally in the heating process. Mouth temperature has very grave deficiencies as a criterion, and there is much to be said for some apparatus giving a continuous record. The patient’s temperature may rise for a time after withdrawal of the actual heat owing to the abnormal stimulus to cell metabolism, and in order to predict the course of his pyrexia after such withdrawal a continuous record of his temperature for comparison with standard curves would seem advisable. The use of a pyrometer in the rectum would fulfil the necessary conditions, and could be read at frequent regular intervals without disturbing the patient. Neymann and Osborne1 investigated the temperature of various parts of the body during treatment with several methods of artificial pyrexia, and their records are 1. Neymann, C. 18, 28.
A.,
and
Osborne, S. L., Amer. J. Syph. 1934,
an
tageous
increased metabolic rate would be advan-
are
being investigated. Certainly a preparaphysiological action of this
tion with a quick and kind would be welcome.
THE CROYDON TYPHOID CLAIMS
IT was reported last week that 70 of the 230 claims against the Croydon corporation in respect of the typhoid epidemic at the end of 1937 have now been settled; 7 of these are said to be related to fatal cases. It appears that some 70 or 80 claims received by the corporation were sent in too late; for under the Public Authorities Protection Act claims against a public authority must be made within six months of the act, neglect or default complained of. The Croydon town council has already decided by an overwhelming majority to pay compensation in these cases which are out of time, and for this purpose a clause has been included in a bill now before Parliament. No payment can be made until the bill receives the Royal Assentprobably just before Parliament rises for the autumn vacation in August. VITAMIN E
FROM being the most dubious of the vitamins, vitamin E has emerged into being a well-defined substance. Its properties are becoming well known and it may soon achieve the distinction of an international standard and unit. On April 22 it was the sole subject of discussion at a whole-day conference held at the London School of Hygiene and Tropical Medicine, and organised by the nutrition panel of the food group of the Society of Chemistry and Industry. The morning session was devoted to the chemistry of the vitamin and provided probably the most interesting discussion and the most exact information. The chief topic of general interest was the correlation between chemical structure and specificity of biological action. It was made clear that biological action is not confined to one isomer or even to the one substance, but that the tocopherol molecule could be subjected to some degree of substitution without losing all biological activity, though with certain substituents in certain positions this activity is intensified. The outcome of studies on this subject, as summarised by the chairman, Prof. A. R. Todd, seems to be that as in some of the sex hormones there is a narrow specificity but a possibility of action by a wide group of unrelated substances. At the afternoon session most of the communications turned on whether or not vitamin E is related to the hormones. No overwhelmingly convincing evidence was adduced, for or against a relation, nor did the protagonists on either side succeed in convincing their opponents or the neutral observers. Interesting work from America by Dr. Karl Mason tended to show how small is the transfer of vitamin E from the mother rat to her young, either by way of the placenta or the milk, though some transfer was found to take place in the milk. An excellent film demonstrating the peculiar head and leg movement of young rats deprived of vitamin E was shown by Dr. H. M. Wuest of Basle. In the evening the clinical applications of vitamin E in human beings were under discussion. All the clinical work in which vitamin E has been used in treatment of habitual and threatened abortion
is based on belief in a close relation between vitamin E and the sex hormones. A number of clinicians have recorded successful results, usually in 70 or 80 per cent. of the women treated for one or other of these conditions, and encouraging reports were presented to the meeting from Dr. Vogt-M61ler of Copenhagen, Dr. E. V. Shute of Toronto, Mr. D. W. Currie of Leeds and Dr. C. R. Macdonald of Sheffield. It is recognised however that the assessment of such clinical results is full of pitfalls. It is difficult to obtain accurate and reliable case-histories of
habitual abortion, or to define threatened abortion. Moreover, to obtain reliable figures very large numbers of cases are needed for study, with an equal number of comparable untreated controls. In his summing-up, Prof. F. J. Browne, who presided at this third session, was at particular pains to emphasise these points. Those who remained at the conference throughout the day, as most did, must have left with the feeling that they had surveyed the field in excellent company, and carried away a well-balanced idea of the subject. TEMPERATURE MEASUREMENT IN ARTIFICIAL PYREXIA
ALTHOUGH it is generally taken for granted that the rectal temperature gives the most exact estimate of the temperature of the body, it is also recognised that in the ordinary course of practice a compromise with accuracy is permissible. Most doctors use either the mouth or the axillary temperature, which, provided the usual precautions have been observed, will differ from the rectal temperature by a constant amount. It is doubtful, however, if the practitioner ever performs this bit of mental arithmetic. He knows from experience what the thermometer reading " means when he "takes the patient’s temperature" by his own method, and it is of little interest to him or to the patient whether or not it has any precise scientific meaning. The position is different during treatment by artificial pyrexia, in which the patient’s temperature is forcibly raised against the resistance of all his compensatory mechanisms. Here a casual record of how the patient is getting on is insufficient, for his life has been taken entirely out of the control of nature and lies in the hands of his attendants. The temperature of the cells of his body must not exceed a certain limit, and it is important that such record as is kept should indicate his maximum temperature, or bear an infallible relation to it. It must be remembered that all the physiological mechanisms for reducing temperature are at the highest pitch of activity, and although the heating process overcomes them and prevents any general lowering of the body temperature, they may well set up a local lag peripherally in the heating process. Mouth temperature has very grave deficiencies as a criterion, and there is much to be said for some apparatus giving a continuous record. The patient’s temperature may rise for a time after withdrawal of the actual heat owing to the abnormal stimulus to cell metabolism, and in order to predict the course of his pyrexia after such withdrawal a continuous record of his temperature for comparison with standard curves would seem advisable. The use of a pyrometer in the rectum would fulfil the necessary conditions, and could be read at frequent regular intervals without disturbing the patient. Neymann and Osborne1 investigated the temperature of various parts of the body during treatment with several methods of artificial pyrexia, and their records are 1. Neymann, C. 18, 28.
A.,
and
Osborne, S. L., Amer. J. Syph. 1934,