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THE CUP THAT CHEERS
29 of the isotope depends mainly on the changing pressures inside the peritoneal cavity. In forecasting the most fruitful line of inquiry into the cause of cancer, one man’s guess is as good as another’s. It seems not unlikely that it is to the intensive study of cell behaviour under widely varying conditions that we But it is can most hopefully look for further progress. heartening to find that the B.E.C.C. is encouraging work in almost every branch of medicine and biology. Judging from the projects recorded in the pages of this report, the contributions of the radiophysicist and biophysicist will feature increasingly in this widening field of inquiry. THE CUP THAT CHEERS
THE popularity of caffeine-containing beverages in many different civilisations is testimony to the solace and stimulus which mankind derives from this delectable alkaloid. But caffeine has always had its opponents, one of whom, Professor Steyn, of the University of Pretoria, has lately marshalled the case against it.1 Much of the evidence that Steyn cites is based on the results of experiments in which large doses of caffeine and the clinical were given to laboratory animals ; of must such always be somewhat application findings
conjectural.
Thus, when dogs
given caffeine by per kg. body-weight
are
mouth in doses of 50-400 mg. the plasma-prothrombin time falls.2 Steyn remarks that this " appears to have brought conclusive proof that the ingestion of caffeine most probably aggravates the already serious state of thrombosis in man." But this conclusion is not justified on the evidence presented. Steyn is on firmer ground when he discusses the relation between caffeine and peptic ulcer. Roth et aL3 gave 250 mg. of caffeine dissolved in 200 ml. of water to normal persons and to ulcer patients after an overnight fast, and demonstrated a copious flow of acid gastric juice. In most of the normal people this was shortlived, whereas in most of the patients with ulcer it continued longer. Similar results were obtained with caffeine-containing beverages as ordinarily served, but the addition of sugar and cream to coffee almost halved the secretory response. Merendino et awl. obtained similar results after giving two cups of strong black coffee to people who had fasted overnight. The experimental production of gastric ulcers in cats and guineapigs 4-6 by the repeated daily injection of large amounts of caffeine can be dismissed by the clinician as irrelevant. children drinking large quantities Steyn of soft drinks in warm weather ; and he would like it to be better known that many of these beverages contain appreciable quantities of caffeine. The caffeine content of one of the best known of these cola drinks is stated to be 33 mg. per bottle, and a similar well-known drink contains twice this amount.3 (This compares with .an estimate of 100-120 mg. of caffeine per cup of coffee, though-Steyn thinks that in South Africa the true figure for coffee is probably below 30 mg. per cup.) The young man admitted to hospital with a perforated peptic ulcer after drinking 150 bottles of an iced cola drink during five warm August days4 is an extreme example, and the danger from cola drinks in this country is probably slight. Professor Steyn, however, is right in saying that in certain soft drinks larger quantities of caffeine are consumed, especially by children, than in coffee, tea, or cocoa, and that those parents who do not wish their children to take caffeine should be informed of its presence in such drinks.
frequently sees
1.
2. 3. 4. 5. 6.
Steyn, D. G. Caffeine-containing Beverages and Human Health. Pretoria, 1954. Field, J. B., Lassen, E. G., Spero, L., Link, K. P. J. biol. Chem. 1944, 156, 725. Roth, J. A., Ivy, A. C., Atkinson, A. J. J. Amer. med. Ass. 1944, 126, 814. Merendino, K. A., Judd, E. S., Baronofsky, I., Litow, S. S., Lannin, B. G., Wangensteen, O. H. Surgery, 1945, 17, 650. Judd, E. S. Bull. Amer. Coll. Surg. 1943, 28, 46. Roth, J. A., Ivy, A. C. Gastroenterology, 1944, 2, 274 ; Surgery, 1945, 17, 644.
All this does not amount to a very damaging brief against caffeine-containing drinks. The only way of proving that excessive drinking of tea and coffee is harmful is to compare the prevalence of the various morbid conditions to which they are alleged to give rise, in large groups of people comparable in all respects other than consumption of caffeine. This is the method by which the relation between cigarette-smoking and lung
established.
But immense labour would be case against caffeine does not seem strong enough to justify this. Meanwhile the addicts among us will continue to rely on the reassurance of personal experience, as did Samuel Johnson. When attacked by a certain Mr. Jonas Hanway for his habit of tea-drinking, Johnson, than whom " no person ever enjoyed with more relish the infusion of that fragrant leaf," declared that Mr. Hanway had " considered the effects of Tea upon the health of the drinker, which, I think, he has aggravated in the vehemence of his zeal, and which, after soliciting them by this watery luxury, year after year, I have not felt."
cancer was
involved, and the prima-facie
BED REST AFTER MYOCARDIAL INFARCTION
MOST clinicians agree on the importance of bed rest after myocardial infarction, though they are mindful that in old persons complete immobilisation has its own hazards from venous stasis. Lary and de Takats1 have drawn attention to arterial embolism in patients who were on their feet shortly after a cardiac infarction. Of eight such patients, in whom embolism to the lower limb occurred 5-30 days after the infarct, five had not been kept in bed at all: and in two of these the embolus occurred within 6 days of the infarct. In four patients the infarction was not diagnosed until after the embolus had occurred ; but all except two had a clinical episode consistent with infarction-either chest or sudden dyspnoea. One had complained only of pain " " " while another dizziness," apparently had a silent infarct following cholecystectomy. There was electrocardiographic evidence of infarction in all but two cases. In one of these necropsy revealed multiple old infarcts. The other patient had auricular fibrillation, with no clear-cut history suggestive of infarction ; this case did not come to necropsy, so that embolism could not definitely be attributed to myocardial infarction. Failure to enforce bed rest seems to have been due as much to non-recognition of the myocardial infarction as to deliberate early ambulation after it. There can be little doubt that after a major infarction bed rest for at least 6 weeks is advisable, although variations, such as Levine’s2 "chair treatment," may sometimes be of value. The report by Lary and de Takats re-emphasises that myocardial infarction may show itself in several different ways, particularly in the elderly, and that sudden dyspnœa, syncope, and dizziness may be presenting symptoms without much pain.3 Landman et al.4 found that 11% of 255 myocardial infarcts were " silent." It is probably rare for infarction to be unaccompanied by any symptom whatever, although old people may give a vague history because their memory for the event is clouded. Infarction may present as angina of effort, and the sudden onset of this symptom is an indication for rest in bed. Lary and de Takats are not convinced of the value of anticoagulants in the prevention of arterial embolism following myocardial infarction. (There is a growing weight of opinion against administering anticoagulants to patients with a clinically small infarction, shortlived pain, and no hypotension or congestive heart1. Lary, B. G., de Takats, G. J. Amer. med. Ass. 1954, 155, 10. 2. Levine, S. A., Lown, B. Trans. Ass. Amer. Phycns. 1951, 64, 316. 3. See also Papp, C. Brit. Heart J. 1952, 14, 250. 4. Landman, M. E., Anholt, H. S., Angrist, A. Arch. intern. Med. 1949, 83, 665. 5. Wade, E. G., Morgan Jones. Brit. Heart J. 1951, 13, 319.
THE popularity of caffeine-containing beverages in many different civilisations is testimony to the solace and stimulus which mankind derives from this delectable alkaloid. But caffeine has always had its opponents, one of whom, Professor Steyn, of the University of Pretoria, has lately marshalled the case against it.1 Much of the evidence that Steyn cites is based on the results of experiments in which large doses of caffeine and the clinical were given to laboratory animals ; of must such always be somewhat application findings
conjectural.
Thus, when dogs
given caffeine by per kg. body-weight
are
mouth in doses of 50-400 mg. the plasma-prothrombin time falls.2 Steyn remarks that this " appears to have brought conclusive proof that the ingestion of caffeine most probably aggravates the already serious state of thrombosis in man." But this conclusion is not justified on the evidence presented. Steyn is on firmer ground when he discusses the relation between caffeine and peptic ulcer. Roth et aL3 gave 250 mg. of caffeine dissolved in 200 ml. of water to normal persons and to ulcer patients after an overnight fast, and demonstrated a copious flow of acid gastric juice. In most of the normal people this was shortlived, whereas in most of the patients with ulcer it continued longer. Similar results were obtained with caffeine-containing beverages as ordinarily served, but the addition of sugar and cream to coffee almost halved the secretory response. Merendino et awl. obtained similar results after giving two cups of strong black coffee to people who had fasted overnight. The experimental production of gastric ulcers in cats and guineapigs 4-6 by the repeated daily injection of large amounts of caffeine can be dismissed by the clinician as irrelevant. children drinking large quantities Steyn of soft drinks in warm weather ; and he would like it to be better known that many of these beverages contain appreciable quantities of caffeine. The caffeine content of one of the best known of these cola drinks is stated to be 33 mg. per bottle, and a similar well-known drink contains twice this amount.3 (This compares with .an estimate of 100-120 mg. of caffeine per cup of coffee, though-Steyn thinks that in South Africa the true figure for coffee is probably below 30 mg. per cup.) The young man admitted to hospital with a perforated peptic ulcer after drinking 150 bottles of an iced cola drink during five warm August days4 is an extreme example, and the danger from cola drinks in this country is probably slight. Professor Steyn, however, is right in saying that in certain soft drinks larger quantities of caffeine are consumed, especially by children, than in coffee, tea, or cocoa, and that those parents who do not wish their children to take caffeine should be informed of its presence in such drinks.
frequently sees
1.
2. 3. 4. 5. 6.
Steyn, D. G. Caffeine-containing Beverages and Human Health. Pretoria, 1954. Field, J. B., Lassen, E. G., Spero, L., Link, K. P. J. biol. Chem. 1944, 156, 725. Roth, J. A., Ivy, A. C., Atkinson, A. J. J. Amer. med. Ass. 1944, 126, 814. Merendino, K. A., Judd, E. S., Baronofsky, I., Litow, S. S., Lannin, B. G., Wangensteen, O. H. Surgery, 1945, 17, 650. Judd, E. S. Bull. Amer. Coll. Surg. 1943, 28, 46. Roth, J. A., Ivy, A. C. Gastroenterology, 1944, 2, 274 ; Surgery, 1945, 17, 644.
All this does not amount to a very damaging brief against caffeine-containing drinks. The only way of proving that excessive drinking of tea and coffee is harmful is to compare the prevalence of the various morbid conditions to which they are alleged to give rise, in large groups of people comparable in all respects other than consumption of caffeine. This is the method by which the relation between cigarette-smoking and lung
established.
But immense labour would be case against caffeine does not seem strong enough to justify this. Meanwhile the addicts among us will continue to rely on the reassurance of personal experience, as did Samuel Johnson. When attacked by a certain Mr. Jonas Hanway for his habit of tea-drinking, Johnson, than whom " no person ever enjoyed with more relish the infusion of that fragrant leaf," declared that Mr. Hanway had " considered the effects of Tea upon the health of the drinker, which, I think, he has aggravated in the vehemence of his zeal, and which, after soliciting them by this watery luxury, year after year, I have not felt."
cancer was
involved, and the prima-facie
BED REST AFTER MYOCARDIAL INFARCTION
MOST clinicians agree on the importance of bed rest after myocardial infarction, though they are mindful that in old persons complete immobilisation has its own hazards from venous stasis. Lary and de Takats1 have drawn attention to arterial embolism in patients who were on their feet shortly after a cardiac infarction. Of eight such patients, in whom embolism to the lower limb occurred 5-30 days after the infarct, five had not been kept in bed at all: and in two of these the embolus occurred within 6 days of the infarct. In four patients the infarction was not diagnosed until after the embolus had occurred ; but all except two had a clinical episode consistent with infarction-either chest or sudden dyspnoea. One had complained only of pain " " " while another dizziness," apparently had a silent infarct following cholecystectomy. There was electrocardiographic evidence of infarction in all but two cases. In one of these necropsy revealed multiple old infarcts. The other patient had auricular fibrillation, with no clear-cut history suggestive of infarction ; this case did not come to necropsy, so that embolism could not definitely be attributed to myocardial infarction. Failure to enforce bed rest seems to have been due as much to non-recognition of the myocardial infarction as to deliberate early ambulation after it. There can be little doubt that after a major infarction bed rest for at least 6 weeks is advisable, although variations, such as Levine’s2 "chair treatment," may sometimes be of value. The report by Lary and de Takats re-emphasises that myocardial infarction may show itself in several different ways, particularly in the elderly, and that sudden dyspnœa, syncope, and dizziness may be presenting symptoms without much pain.3 Landman et al.4 found that 11% of 255 myocardial infarcts were " silent." It is probably rare for infarction to be unaccompanied by any symptom whatever, although old people may give a vague history because their memory for the event is clouded. Infarction may present as angina of effort, and the sudden onset of this symptom is an indication for rest in bed. Lary and de Takats are not convinced of the value of anticoagulants in the prevention of arterial embolism following myocardial infarction. (There is a growing weight of opinion against administering anticoagulants to patients with a clinically small infarction, shortlived pain, and no hypotension or congestive heart1. Lary, B. G., de Takats, G. J. Amer. med. Ass. 1954, 155, 10. 2. Levine, S. A., Lown, B. Trans. Ass. Amer. Phycns. 1951, 64, 316. 3. See also Papp, C. Brit. Heart J. 1952, 14, 250. 4. Landman, M. E., Anholt, H. S., Angrist, A. Arch. intern. Med. 1949, 83, 665. 5. Wade, E. G., Morgan Jones. Brit. Heart J. 1951, 13, 319.