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THE JENNER BICENTENARY
832 adult male and female worms which produce further broods of larvae in soil ; and this cycle may be repeated several times. Under the conditions in which prisoners lived and worked in Japanese internment camps, many became infected with S. stercoralis, particularly among the military prisoners working on the railway in Siam ; and on repatriation a high percentage of these were found still to harbour strongyloides. The symptoms of which these men complain are indefinite ; but both Napier and Caplan2 comment on curious cutaneous eruptions in association with the parasite. These eruptions have recurred periodically, and in some cases the recurrences have now continued for several years. The mechanism of their production is uncertain, but in view of the usual distribution of the lesions in the bathing-drawers region it is suggested that " exo-autoinfection affords the most satisfactory explanation, even though no larvae have been recovered from any of these skin lesions. Unhappily the methods of eradicating this parasite are unsatisfactory. "
ANÆMIA
IN
RHEUMATOID
ARTHRITIS
IN the study of rheumatoid arthritis attention has centred mainly on the articular and visceral lesions ; and little work has been done on the anaemia that commonly accompanies this condition. Nilsson,3 in a comprehensive study, suggests that this anaemia is akin to that of chronic sepsis. Formerly haemolysis was thought to play a large part in the production of anaemia in chronic sepsis, but quite recently the hypothesis of impaired haemoglobin synthesis has been put forward. Some of those who favour this hypothesis have demonstrated increased excretion of coproporphyrin i and III in the urine and faeces 4; while others have recorded an increased erythrocyte protoporphyrin, which, they suggest, reflects disordered haemoglobin synthesis. The haemolysis theory still has its exponents, however, the chief of whom is Heilmeyer. He attributes the anaemia to haemolysis largely- because of the increased urinary excretion of urobilin and urobilinogen and the erythroblastic bone-marrow and raised reticulocyte-count. Nilsson confirms these findings in respect of rheumatoid
arthritis, but he suggests other
causes.
Nilsson’s series of polyarthritics includes 27 cases of rheumatic fever, though he does not name the diagnostic criteria and there is no mention of an associated carditis. His differentiation between rheumatic fever and rheumatoid arthritis is not so precise as in this country ; and, like many other Continental workers, he finds His that the two conditions overlap considerably. studies of the bone-marrow show that with the disease at the peak of activity there is an increase of immature erythroblasts, while in the recovery phase mature These observations are erythroblasts predominate. confirmed by serial reticulocyte-counts ; at the peak of activity the reticulocytes remain low, but coincident with, or immediately before, a rise in haemoglobin there is slight reticulocytosis. The serum-iron, as with chronic sepsis,s is considerably reduced ; and in peroral iron-loading experiments with 0-5 g. of iron lactate, the level rises less than in normals. Intravenous iron-loading experiments with injection of 10 mg. of iron and ammonium citrate also show an abnormally rapid disappearance of serum-iron. These findings suggest that iron is stored more rapidly in rheumatoid arthritics than in normal subjects. The possibility that defective absorption from the gastro-intestinal tract causes the low serum-iron and the abnormal result of peroral 2. Caplan, J. P. Brit. Med. J. March 5, p. 396. Acta. med. scand. 1948, suppl. 210. 3. Nilsson, F. 4. Vaughan, J. M., Saifi, M. F. J. Path. Bact. 1939, 49, 69. 5. Cartwright, G. E., Lauritzen, M. A., Jones, P., Merril, L. M., Wintrobe, M. M. J. clin. Invest., 1946, 25, 81.
iron-loading experiments, is to some extent ruled out by the abnormal findings in intravenous iron-loading experiments. However, achylia has been described in rheumatoid arthritis, and impaired iron absorption has been demonstrated experimentally in dogs with turpentine abscesses by following radioactive iron after ingestion 6; moreover, in such animals the storage of iron in liver and spleen is increased.7 Nilsson has also found that in rheumatoid arthritis iron therapy has no effect on peroral iron-loading tests or on the haemoglobin, red blood-cell count, colour-index, mean cell diameter, It has been known for some or reticulocyte-count. time that iron is bound by proteins in the serum-an action for which the Bl globulin fraction is almost completely responsible. Cartwright and Wintrobe 8 have shown that in chronic infections the iron-binding capacity of serum is diminished. They have, however, also shown, by giving iron-binding protein intravenously, that this is not the cause of the low serum -iron. Moreover, they found no correlation between the lowered ironbinding capacity of serum and the level of the serumiron ; and thus they suggest that factors other than reduction of iron-binding globulin are responsible for the hypoferraemia of chronic sepsis. Nilsson concludes from his survey that anaemia in rheumatoid arthritis is probably due to impaired bonemarrow activity and defective hæmoglobin synthesis, but he does not discard the possibility that increased blood destruction may play a part. It should not be forgotten, however, that Mollison 9 found that in patients with anaemia from chronic sepsis the survival of transfused red cells was no shorter than normal. RADIOTHERAPY
AN Inquiry into the extent to which Cancer Patients in Great Britain receive Radiotherapy 10 has been made by Dr. Margaret Tod, who was acting secretary of the Radium Commission at its dissolution last year. She estimates that new cases of cancer in England, Scotland, and Wales in 1946 (population 46,560,500) numbered about 98,000, of which about 30,000 were treated in radiotherapy centres. These 30,000, she believes, were 77% of the cases needing radiotherapy : probably most cases of accessible cancer now receive treatment, but its quality requires improvement, and too few patients have palliation. She favours the commission’s policy of centralising radiotherapy in large centres. THE JENNER BICENTENARY
ON May 17 the Royal College of Physicians and the Royal College of Surgeons are commemorating the 200th anniversary of the birth of Edward Jenner. During the afternoon at the Royal College of Surgeons Sir Edward Mellanby, F.R.S., will deliver a commemorative lecture entitled Jenner and his Impact on Medical Science. In the evening there will be a reception at the Royal College of Physicians. Admission to both these functions is by invitation only. The MEDICAL REGISTER, which had become too cumberfor easy handling, now appears in two volumes :
some
1 containing surnames A-L ; and part 2 M-Z, Commonwealth list, and foreign list. The register as a whole contains 76,292 names of doctors. The number of newly registered names was 3968 in 1948, compared with 2787 in 1947 and 3556 (the highest previous number) in 1942. The Commonwealth list totals 6081, and the foreign list 1803. England and Wales account for almost half the names.
part
6. Whipple, G. H., Robscheit-Robbins, F. S. J. exp. Med., 1939, 69, 485. 7. Greenberg, G. R., Ashenbrucker, H., Lauritzen, M., Worth, W., Humphreys, S. R., Wintrobe, M. M. J. clin. Invest. 1947, 26, 121. 8. Cartwright, G. E., Wintrobe, M. M. Ibid, 1949, 28, 86. 9. Mollison, P. L. Clin. Sci. 1947, 6, 137. 10. Altrincham : John Sherratt & Son. Pp. 48. 3s. 6d.
ANÆMIA
IN
RHEUMATOID
ARTHRITIS
IN the study of rheumatoid arthritis attention has centred mainly on the articular and visceral lesions ; and little work has been done on the anaemia that commonly accompanies this condition. Nilsson,3 in a comprehensive study, suggests that this anaemia is akin to that of chronic sepsis. Formerly haemolysis was thought to play a large part in the production of anaemia in chronic sepsis, but quite recently the hypothesis of impaired haemoglobin synthesis has been put forward. Some of those who favour this hypothesis have demonstrated increased excretion of coproporphyrin i and III in the urine and faeces 4; while others have recorded an increased erythrocyte protoporphyrin, which, they suggest, reflects disordered haemoglobin synthesis. The haemolysis theory still has its exponents, however, the chief of whom is Heilmeyer. He attributes the anaemia to haemolysis largely- because of the increased urinary excretion of urobilin and urobilinogen and the erythroblastic bone-marrow and raised reticulocyte-count. Nilsson confirms these findings in respect of rheumatoid
arthritis, but he suggests other
causes.
Nilsson’s series of polyarthritics includes 27 cases of rheumatic fever, though he does not name the diagnostic criteria and there is no mention of an associated carditis. His differentiation between rheumatic fever and rheumatoid arthritis is not so precise as in this country ; and, like many other Continental workers, he finds His that the two conditions overlap considerably. studies of the bone-marrow show that with the disease at the peak of activity there is an increase of immature erythroblasts, while in the recovery phase mature These observations are erythroblasts predominate. confirmed by serial reticulocyte-counts ; at the peak of activity the reticulocytes remain low, but coincident with, or immediately before, a rise in haemoglobin there is slight reticulocytosis. The serum-iron, as with chronic sepsis,s is considerably reduced ; and in peroral iron-loading experiments with 0-5 g. of iron lactate, the level rises less than in normals. Intravenous iron-loading experiments with injection of 10 mg. of iron and ammonium citrate also show an abnormally rapid disappearance of serum-iron. These findings suggest that iron is stored more rapidly in rheumatoid arthritics than in normal subjects. The possibility that defective absorption from the gastro-intestinal tract causes the low serum-iron and the abnormal result of peroral 2. Caplan, J. P. Brit. Med. J. March 5, p. 396. Acta. med. scand. 1948, suppl. 210. 3. Nilsson, F. 4. Vaughan, J. M., Saifi, M. F. J. Path. Bact. 1939, 49, 69. 5. Cartwright, G. E., Lauritzen, M. A., Jones, P., Merril, L. M., Wintrobe, M. M. J. clin. Invest., 1946, 25, 81.
iron-loading experiments, is to some extent ruled out by the abnormal findings in intravenous iron-loading experiments. However, achylia has been described in rheumatoid arthritis, and impaired iron absorption has been demonstrated experimentally in dogs with turpentine abscesses by following radioactive iron after ingestion 6; moreover, in such animals the storage of iron in liver and spleen is increased.7 Nilsson has also found that in rheumatoid arthritis iron therapy has no effect on peroral iron-loading tests or on the haemoglobin, red blood-cell count, colour-index, mean cell diameter, It has been known for some or reticulocyte-count. time that iron is bound by proteins in the serum-an action for which the Bl globulin fraction is almost completely responsible. Cartwright and Wintrobe 8 have shown that in chronic infections the iron-binding capacity of serum is diminished. They have, however, also shown, by giving iron-binding protein intravenously, that this is not the cause of the low serum -iron. Moreover, they found no correlation between the lowered ironbinding capacity of serum and the level of the serumiron ; and thus they suggest that factors other than reduction of iron-binding globulin are responsible for the hypoferraemia of chronic sepsis. Nilsson concludes from his survey that anaemia in rheumatoid arthritis is probably due to impaired bonemarrow activity and defective hæmoglobin synthesis, but he does not discard the possibility that increased blood destruction may play a part. It should not be forgotten, however, that Mollison 9 found that in patients with anaemia from chronic sepsis the survival of transfused red cells was no shorter than normal. RADIOTHERAPY
AN Inquiry into the extent to which Cancer Patients in Great Britain receive Radiotherapy 10 has been made by Dr. Margaret Tod, who was acting secretary of the Radium Commission at its dissolution last year. She estimates that new cases of cancer in England, Scotland, and Wales in 1946 (population 46,560,500) numbered about 98,000, of which about 30,000 were treated in radiotherapy centres. These 30,000, she believes, were 77% of the cases needing radiotherapy : probably most cases of accessible cancer now receive treatment, but its quality requires improvement, and too few patients have palliation. She favours the commission’s policy of centralising radiotherapy in large centres. THE JENNER BICENTENARY
ON May 17 the Royal College of Physicians and the Royal College of Surgeons are commemorating the 200th anniversary of the birth of Edward Jenner. During the afternoon at the Royal College of Surgeons Sir Edward Mellanby, F.R.S., will deliver a commemorative lecture entitled Jenner and his Impact on Medical Science. In the evening there will be a reception at the Royal College of Physicians. Admission to both these functions is by invitation only. The MEDICAL REGISTER, which had become too cumberfor easy handling, now appears in two volumes :
some
1 containing surnames A-L ; and part 2 M-Z, Commonwealth list, and foreign list. The register as a whole contains 76,292 names of doctors. The number of newly registered names was 3968 in 1948, compared with 2787 in 1947 and 3556 (the highest previous number) in 1942. The Commonwealth list totals 6081, and the foreign list 1803. England and Wales account for almost half the names.
part
6. Whipple, G. H., Robscheit-Robbins, F. S. J. exp. Med., 1939, 69, 485. 7. Greenberg, G. R., Ashenbrucker, H., Lauritzen, M., Worth, W., Humphreys, S. R., Wintrobe, M. M. J. clin. Invest. 1947, 26, 121. 8. Cartwright, G. E., Wintrobe, M. M. Ibid, 1949, 28, 86. 9. Mollison, P. L. Clin. Sci. 1947, 6, 137. 10. Altrincham : John Sherratt & Son. Pp. 48. 3s. 6d.