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THE PROPHYLAXIS OF POLIOMYELITIS.
1190
days has passed, and, perhaps for an additional days because of the possibility that the incubation period would be lengthened by the hexamine as it is in monkeys. Although Flexner and Clark do not appear to have 14 14
THE DISSOLUTION OF INSULIN. To the Editor of THE LANCET.
SIR,-Prof. Funk’s letter in your last issue must be of great interest to all workers with insulin in this country, as it is the first account, apart from incomplete and therefore uninformed newspaper ones, of his recent new work. Unfortunately, however, his letter would appear to have suffered in the translation, because the third paragraph describing his substance is disappointingly obscure, to me at any rate. As far as I can make out, this substance A reduces the blood-sugar of normal rabbits if the fasting level is high, but has no effect or even raises the blood-sugar if the fasting level is low. Similar results have been obtained in rabbits by Dr. Buckley and myself, working with the ordinary whole insulin (A.B.) produced commercially by The British Drug Houses. These rabbits had been poisoned by diphtheria toxin and it was found that when the fasting blood-sugar was low, insulin failed to lower it, and sometimes even raised it, but when the fasting level was high, insulin always reduced the blood-sugar to a certain extent. On some occasions also normal rabbits with A.B. insulin, one unit, gave a rise of blood-sugar similar to that produced by a small dose of adrenalin. These results obtained with whole insulin (which will shortly be published in extenso) seem to have something common with those of Prof. Funk with his substances A and B. We are advancing as an explanation of these results an abnormal metabolic condition produced by the action of diphtheria toxin on the adrenal and thyroid. We have, however, no adequate explanation to offer for the occasional rise in blood-sugar observed after insulin in normal rabbits. I am, Sir, yours faithfully,
made any observations as to whether hexamine prevents the full development of the symptom in monkeys when the infection is once established, it has become usual to give the drug during the acute stage of the natural disease. I would suggest that at the first suspicion of the disease being present 100 gr. should be given three times a day instead of he usual 10 or 15 gr. A mixture containing 60 gr. each of sodium bicarbonate and potassium citrate in 1 oz. of water is given after breakfast, after tea, and after a glass of milk last thing at night. The hexamine is given at the same time, but in a different mixture so that the dose can, if necessary, be varied without altering the dose of alkali. It is, perhaps, safest to begin with 50 gr. inoz. of water and add a drachm of the solution to each dose every day till the full 100 gr. in 1 oz. of water are being given. In the unusual event of bladder irritation occurring the dose of hexamine should be reduced slightly and the dose of alkali further increased. T
>1.m-
Sir.
yours
faithfully.
ARTHUR
F. HURST.
RACIAL DEGENERATION.
Editor of THE LANCET SiR,,-I think none who have the interests of the country at heart can have read Dean Inge’s lecture on Racial Degeneration, which appeared in THE LANCET on Nov. 27th, without interest, and a R. D. LAWRENCE. sense of the importance and gravity of the indictBiochemical Department, King’s College Hospital, ment, suggested rather than urged, of recent social Nov. 26th, 1926. tendencies. On the question of general social degeneration medical men, as such, have no special claim to be THE PROPHYLAXIS OF POLIOMYELITIS. listened to, but it seems to me on the question of To the Editor of THE LANCET. physique the profession has a right, and, indeed, a to make its voice heard, if it has any reason to SiB,—In the interesting leading article on polio- duty, believe there is even the possibility of widespread of which in issue 27th Nov. myelitis appeared your deterioration. I believe that if there were a strong no reference is made to prophylaxis or treatment with hexamine (urotropine). As our investigations during and influential medical demand for some sort of the last four years on the antiseptic treatment of official commission of inquiry into the alleged existence of such deterioration and into its causes, biliary infections show that very large doses can be if present, we might ultimately get an investigation .administered with perfect safety, it seems advisable to draw attention to the important observations of and a report which would prove of value in checking Flexner and Clark, published in 1911, on the effects the mischief. Personally, I have little doubt, as a result of my of hexamine in preventing the disease in monkeys. during the war and since, that deterioration When a large dose is administered by mouth, its presence is going on to an alarming extent. can be demonstrated in the cerebro-spinal fluid soon afterL am. Sir, yours faithfully. wards. We have ascertained that when the virus of polioE. W. DEWEY. is in in which myelitis injected intracerebrally monkeys, the hexamine is already present in the fluid, and the drug is then administered by mouth daily afterwards, in a proporTo the Editor of THE LANCET. tion of animals so treated.... the incubation period of the disease is prolonged from 6 to 8 to 24 days, and the SIR,—No doubt every reader of THE LANCET will onset of paralysis is entirely prevented." have enjoyed Dean Inge’s eloquent address-the Lloyd Any attempts to prevent the disease in contacts Roberts lecture, published on Nov. 27th. No doubt, by similar means in the past have been unlikely to also, they will regard his pessimistic view of the meet with success owing to the relatively small dose situation with apprehension, provided they consider which has to be given on account of the irritation of that his deductions are based upon an accurate the bladder and haematuria which result from .the interpretation of existing conditions. That Dean setting free of formalin in acid urine. We have found, Inge would have spoken with equal pessimism at any the
experience
"
however, that
To
so
much
as
100 gr. of hexamine
can
be given three times a day so long as alkalis are administered at the same time in sufficient quantity to keep the urine alkaline, as formalin cannot then be set free and the bladder is not irritated. Dr. F. A. Knott has shown that the alkali does not prevent the urotropine acting on the alkaline bile, and in view of Flexner and Clark’s observations it seems unlikely that it would inhibit the action in the cerebro-spinal fluid,’ which is also always alkaline. I would, therefore, suggest giving these large doses to all people who have been in ..contact with the disease until the incubation period of
period of our history is ever my impression when reading his opinions. Unfortunately, like most other writers upon the welfare of our race, the Dean does not offer any remedies save those which have done duty since social problems first obtruded themselves. The only way out of the difficulty that I have met with is contained in the writings of Mr. Matthias whose " Man’s Supreme Inheritance" Alexander, " and Constructive Conscious Control " I would earnestly recommend to Dean Inge as an antidote. I a,m. Sir. vours ffJ.ithful1vMACLEOD YEARSLEY.
days has passed, and, perhaps for an additional days because of the possibility that the incubation period would be lengthened by the hexamine as it is in monkeys. Although Flexner and Clark do not appear to have 14 14
THE DISSOLUTION OF INSULIN. To the Editor of THE LANCET.
SIR,-Prof. Funk’s letter in your last issue must be of great interest to all workers with insulin in this country, as it is the first account, apart from incomplete and therefore uninformed newspaper ones, of his recent new work. Unfortunately, however, his letter would appear to have suffered in the translation, because the third paragraph describing his substance is disappointingly obscure, to me at any rate. As far as I can make out, this substance A reduces the blood-sugar of normal rabbits if the fasting level is high, but has no effect or even raises the blood-sugar if the fasting level is low. Similar results have been obtained in rabbits by Dr. Buckley and myself, working with the ordinary whole insulin (A.B.) produced commercially by The British Drug Houses. These rabbits had been poisoned by diphtheria toxin and it was found that when the fasting blood-sugar was low, insulin failed to lower it, and sometimes even raised it, but when the fasting level was high, insulin always reduced the blood-sugar to a certain extent. On some occasions also normal rabbits with A.B. insulin, one unit, gave a rise of blood-sugar similar to that produced by a small dose of adrenalin. These results obtained with whole insulin (which will shortly be published in extenso) seem to have something common with those of Prof. Funk with his substances A and B. We are advancing as an explanation of these results an abnormal metabolic condition produced by the action of diphtheria toxin on the adrenal and thyroid. We have, however, no adequate explanation to offer for the occasional rise in blood-sugar observed after insulin in normal rabbits. I am, Sir, yours faithfully,
made any observations as to whether hexamine prevents the full development of the symptom in monkeys when the infection is once established, it has become usual to give the drug during the acute stage of the natural disease. I would suggest that at the first suspicion of the disease being present 100 gr. should be given three times a day instead of he usual 10 or 15 gr. A mixture containing 60 gr. each of sodium bicarbonate and potassium citrate in 1 oz. of water is given after breakfast, after tea, and after a glass of milk last thing at night. The hexamine is given at the same time, but in a different mixture so that the dose can, if necessary, be varied without altering the dose of alkali. It is, perhaps, safest to begin with 50 gr. inoz. of water and add a drachm of the solution to each dose every day till the full 100 gr. in 1 oz. of water are being given. In the unusual event of bladder irritation occurring the dose of hexamine should be reduced slightly and the dose of alkali further increased. T
>1.m-
Sir.
yours
faithfully.
ARTHUR
F. HURST.
RACIAL DEGENERATION.
Editor of THE LANCET SiR,,-I think none who have the interests of the country at heart can have read Dean Inge’s lecture on Racial Degeneration, which appeared in THE LANCET on Nov. 27th, without interest, and a R. D. LAWRENCE. sense of the importance and gravity of the indictBiochemical Department, King’s College Hospital, ment, suggested rather than urged, of recent social Nov. 26th, 1926. tendencies. On the question of general social degeneration medical men, as such, have no special claim to be THE PROPHYLAXIS OF POLIOMYELITIS. listened to, but it seems to me on the question of To the Editor of THE LANCET. physique the profession has a right, and, indeed, a to make its voice heard, if it has any reason to SiB,—In the interesting leading article on polio- duty, believe there is even the possibility of widespread of which in issue 27th Nov. myelitis appeared your deterioration. I believe that if there were a strong no reference is made to prophylaxis or treatment with hexamine (urotropine). As our investigations during and influential medical demand for some sort of the last four years on the antiseptic treatment of official commission of inquiry into the alleged existence of such deterioration and into its causes, biliary infections show that very large doses can be if present, we might ultimately get an investigation .administered with perfect safety, it seems advisable to draw attention to the important observations of and a report which would prove of value in checking Flexner and Clark, published in 1911, on the effects the mischief. Personally, I have little doubt, as a result of my of hexamine in preventing the disease in monkeys. during the war and since, that deterioration When a large dose is administered by mouth, its presence is going on to an alarming extent. can be demonstrated in the cerebro-spinal fluid soon afterL am. Sir, yours faithfully. wards. We have ascertained that when the virus of polioE. W. DEWEY. is in in which myelitis injected intracerebrally monkeys, the hexamine is already present in the fluid, and the drug is then administered by mouth daily afterwards, in a proporTo the Editor of THE LANCET. tion of animals so treated.... the incubation period of the disease is prolonged from 6 to 8 to 24 days, and the SIR,—No doubt every reader of THE LANCET will onset of paralysis is entirely prevented." have enjoyed Dean Inge’s eloquent address-the Lloyd Any attempts to prevent the disease in contacts Roberts lecture, published on Nov. 27th. No doubt, by similar means in the past have been unlikely to also, they will regard his pessimistic view of the meet with success owing to the relatively small dose situation with apprehension, provided they consider which has to be given on account of the irritation of that his deductions are based upon an accurate the bladder and haematuria which result from .the interpretation of existing conditions. That Dean setting free of formalin in acid urine. We have found, Inge would have spoken with equal pessimism at any the
experience
"
however, that
To
so
much
as
100 gr. of hexamine
can
be given three times a day so long as alkalis are administered at the same time in sufficient quantity to keep the urine alkaline, as formalin cannot then be set free and the bladder is not irritated. Dr. F. A. Knott has shown that the alkali does not prevent the urotropine acting on the alkaline bile, and in view of Flexner and Clark’s observations it seems unlikely that it would inhibit the action in the cerebro-spinal fluid,’ which is also always alkaline. I would, therefore, suggest giving these large doses to all people who have been in ..contact with the disease until the incubation period of
period of our history is ever my impression when reading his opinions. Unfortunately, like most other writers upon the welfare of our race, the Dean does not offer any remedies save those which have done duty since social problems first obtruded themselves. The only way out of the difficulty that I have met with is contained in the writings of Mr. Matthias whose " Man’s Supreme Inheritance" Alexander, " and Constructive Conscious Control " I would earnestly recommend to Dean Inge as an antidote. I a,m. Sir. vours ffJ.ithful1vMACLEOD YEARSLEY.