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TUBERCULOSIS SURVEYS
565 and the growth and disease of bone on the other. The findings of King and Delory,3 however, throw doubt on one at least of them ; for careful experiment with several samples of ascorbic acid failed to substantiate the activating effect of vitamin C on serum phosphatase. If one of Thannhauser’s claims is ill founded, the other becomes less secure. TUBERCULOSIS SURVEYS
ELSEWHERE in this issue
(p. 568) will be found preliminary report of a tuberculosis carried out by Dr. Noel D. Bardswell in
summarised survey
a
Cyprus. The accumulation of such local tuberculosis surveys is by now bulky and covers a considerable period. Their administrative and human aspects have altered but little with the years ; the advances made in the technique of diagnosis are reflected in the changes made in the methods of routine examinations. In the earlier surveys more prominence was given to the stethoscope than to X rays, whereas of late there has been a pronounced tendency to relegate the stethoscope to a place of second importance, and to exalt the virtues of screening and radiography with the help of portable X ray outfits. Dr. Bardswell apparently decided, doubtless for good reasons, to do his work without this modern and perhaps, to Cypriots, alarming apparatus. In the matter of tuberculin testing also certain swings of the pendulum are to be noted. The Pirquet test is with difficulty holding its own in the face of the disparaging comparisons made between it and the Mantoux test by Prof. Th. Madsen and his school in Denmark where the latter test is gaining ground. Both these tests labour under the disability of causing pain, however slight, and Dr. Bardswell has found it expedient to use Moro’s quite painless test with the inunction of He admits, however, that a tuberculin ointment. the Mantoux test would have brought the Cyprus tuberculin observations more into line with similar surveys in other countries. It is impossible to read his report, full of shrewd observations on the foibles of his fellow-beings, without coming to the conclusion that, in such a delicate mission as his, tact and diplomacy are as essential to success as is a profound knowledge of the scientific aspects of the problem. His survey is, in fact, not only a study of the behaviour of tuberculosis in Cyprus, but also a determined attempt on the part of the West to understand the East. VITAMIN A AND PREGNANCY
IN rats deficiency of vitamin A is known to favour difficult labour. Dr. W. H. Newton,4who has been pursuing this observation, finds that the proportion of difficult labours is far exceeded by the proportion of uncompleted pregnancies. His method was to put batches of rats on a diet deficient in vitamin A at different ages varying from 3 weeks (the time of weaning) to 65 days. One control group of rats was given a supplement of carotene daily ; another group received a supplement of vitamin E, deficiency of which might otherwise have been held responsible for the incomplete pregnancies, but this addition made no appreciable difference. As a rule the rats became pregnant when about three months old. Among the 75 deficient animals, 12 showed no sign of pregnancy; in 8 the pregnancy was not completed, apparently because of reabsorption or abortion; and in 8 others pregnancy was incomplete for reasons undetermined. On the other hand there were no 3
King,
E.
J.,
and 4
Delory, G. E., Chem. & Ind. 1938, 57, J. Physiol. 1938, 92, 32.
incomplete pregnancies or failures to conceive among the 21 animals receiving the carotene supplement. Judging by vaginal smears, which contained large numbers of cornified cells but no spermatozoa, Newton thinks that the failure to conceive was due to failure in copulation. The pregnant rats deficient in vitamin A had a higher proportion of dead foetuses in their litters and the average weight of the foetuses at birth was smaller. Twelve cases of difficult labour were observed ; 3 of these rats were allowed to recover, 4 showed no apparent sepsis apart from possible secondary infection of the necrotic foetal material in the uterus, but 5 exhibited definite infection of the uterus or the surrounding tissues. The degree of vitamin-A deficiency produced in the rats made respiratory infection hard to control among them but no xerophthalmia was seen. How far comparable deficiency prevails amongst women and how far these effects in animals have any human counterpart is not known, but with so many obstetric disasters attributable to lack of vitamin A it seems reasonable-until the contrary is proved-to ensure that pregnant women receive a sufficiency of that vitamin. STANDARDS OF COMMERCIAL ADVERTISEMENT
Proprietary Association of Great Britain is honourably striving to abolish by voluntary effort the unscrupulous advertisement of medical remedies and surgical appliances. Two years ago the House of Commons neglected the opportunity to set up uniform standards in these matters when it failed to give a second reading to Mr. Duckworth’s Medicines and Surgical Appliances (Advertisement) Bill.’- The rules now made by the Proprietary Association oblige its members to give an undertaking which in effect incorporates the standards of the Duckworth Bill. They undertake not to advertise or offer for sale to the public any medicine or treatment which is held out as being effective in regard to diseases like Bright’s disease, cancer, tuberculosis, diabetes, epilepsy, lupus, or paralysis, or in regard to blindness, deafness, or sexual ailments, or any medicine for procuring the miscarriage of women. The Association’s standard, indeed, is even higher than that of THE
the Duckworth Bill; for, in certain cases where the Bill forbade the advertisement of remedies promising a cure, the Association’s undertaking forbids advertisements which even commend a particular treatment. This attempt to control by private enterprise the deplorable abuses of advertisement, the exploitation of fear, and the dangerous and fraudulent preying upon gullible men and women is one which deserves recognition and support. Old-fashioned theory deprecated the policy of trying to make people good by Act of Parliament. Moral suasion and ethical education were to be relied upon to reform abuses and improve standards. This kind of reform, however, is a plant of slow growth ; meanwhile in the commercial world the pioneers who set the higher standard are out-distanced by less scrupulous competitors. The enforcement of a decent uniformity is difficult without statutory backing. When the Duckworth Bill failed in 1936, the accustomed arts of obstruction were employed. Opponents welcomed the principle while rejecting the opportunity. Reform ? Yes, of course, but never this particular reform. One of the severest tests of Parliament as a legislative body is its treatment of non-party measures on their own merits. The conflict of interests has strange results upon a private member’s
85.
1 See Lancet, 1936, 1, 787.
ELSEWHERE in this issue
(p. 568) will be found preliminary report of a tuberculosis carried out by Dr. Noel D. Bardswell in
summarised survey
a
Cyprus. The accumulation of such local tuberculosis surveys is by now bulky and covers a considerable period. Their administrative and human aspects have altered but little with the years ; the advances made in the technique of diagnosis are reflected in the changes made in the methods of routine examinations. In the earlier surveys more prominence was given to the stethoscope than to X rays, whereas of late there has been a pronounced tendency to relegate the stethoscope to a place of second importance, and to exalt the virtues of screening and radiography with the help of portable X ray outfits. Dr. Bardswell apparently decided, doubtless for good reasons, to do his work without this modern and perhaps, to Cypriots, alarming apparatus. In the matter of tuberculin testing also certain swings of the pendulum are to be noted. The Pirquet test is with difficulty holding its own in the face of the disparaging comparisons made between it and the Mantoux test by Prof. Th. Madsen and his school in Denmark where the latter test is gaining ground. Both these tests labour under the disability of causing pain, however slight, and Dr. Bardswell has found it expedient to use Moro’s quite painless test with the inunction of He admits, however, that a tuberculin ointment. the Mantoux test would have brought the Cyprus tuberculin observations more into line with similar surveys in other countries. It is impossible to read his report, full of shrewd observations on the foibles of his fellow-beings, without coming to the conclusion that, in such a delicate mission as his, tact and diplomacy are as essential to success as is a profound knowledge of the scientific aspects of the problem. His survey is, in fact, not only a study of the behaviour of tuberculosis in Cyprus, but also a determined attempt on the part of the West to understand the East. VITAMIN A AND PREGNANCY
IN rats deficiency of vitamin A is known to favour difficult labour. Dr. W. H. Newton,4who has been pursuing this observation, finds that the proportion of difficult labours is far exceeded by the proportion of uncompleted pregnancies. His method was to put batches of rats on a diet deficient in vitamin A at different ages varying from 3 weeks (the time of weaning) to 65 days. One control group of rats was given a supplement of carotene daily ; another group received a supplement of vitamin E, deficiency of which might otherwise have been held responsible for the incomplete pregnancies, but this addition made no appreciable difference. As a rule the rats became pregnant when about three months old. Among the 75 deficient animals, 12 showed no sign of pregnancy; in 8 the pregnancy was not completed, apparently because of reabsorption or abortion; and in 8 others pregnancy was incomplete for reasons undetermined. On the other hand there were no 3
King,
E.
J.,
and 4
Delory, G. E., Chem. & Ind. 1938, 57, J. Physiol. 1938, 92, 32.
incomplete pregnancies or failures to conceive among the 21 animals receiving the carotene supplement. Judging by vaginal smears, which contained large numbers of cornified cells but no spermatozoa, Newton thinks that the failure to conceive was due to failure in copulation. The pregnant rats deficient in vitamin A had a higher proportion of dead foetuses in their litters and the average weight of the foetuses at birth was smaller. Twelve cases of difficult labour were observed ; 3 of these rats were allowed to recover, 4 showed no apparent sepsis apart from possible secondary infection of the necrotic foetal material in the uterus, but 5 exhibited definite infection of the uterus or the surrounding tissues. The degree of vitamin-A deficiency produced in the rats made respiratory infection hard to control among them but no xerophthalmia was seen. How far comparable deficiency prevails amongst women and how far these effects in animals have any human counterpart is not known, but with so many obstetric disasters attributable to lack of vitamin A it seems reasonable-until the contrary is proved-to ensure that pregnant women receive a sufficiency of that vitamin. STANDARDS OF COMMERCIAL ADVERTISEMENT
Proprietary Association of Great Britain is honourably striving to abolish by voluntary effort the unscrupulous advertisement of medical remedies and surgical appliances. Two years ago the House of Commons neglected the opportunity to set up uniform standards in these matters when it failed to give a second reading to Mr. Duckworth’s Medicines and Surgical Appliances (Advertisement) Bill.’- The rules now made by the Proprietary Association oblige its members to give an undertaking which in effect incorporates the standards of the Duckworth Bill. They undertake not to advertise or offer for sale to the public any medicine or treatment which is held out as being effective in regard to diseases like Bright’s disease, cancer, tuberculosis, diabetes, epilepsy, lupus, or paralysis, or in regard to blindness, deafness, or sexual ailments, or any medicine for procuring the miscarriage of women. The Association’s standard, indeed, is even higher than that of THE
the Duckworth Bill; for, in certain cases where the Bill forbade the advertisement of remedies promising a cure, the Association’s undertaking forbids advertisements which even commend a particular treatment. This attempt to control by private enterprise the deplorable abuses of advertisement, the exploitation of fear, and the dangerous and fraudulent preying upon gullible men and women is one which deserves recognition and support. Old-fashioned theory deprecated the policy of trying to make people good by Act of Parliament. Moral suasion and ethical education were to be relied upon to reform abuses and improve standards. This kind of reform, however, is a plant of slow growth ; meanwhile in the commercial world the pioneers who set the higher standard are out-distanced by less scrupulous competitors. The enforcement of a decent uniformity is difficult without statutory backing. When the Duckworth Bill failed in 1936, the accustomed arts of obstruction were employed. Opponents welcomed the principle while rejecting the opportunity. Reform ? Yes, of course, but never this particular reform. One of the severest tests of Parliament as a legislative body is its treatment of non-party measures on their own merits. The conflict of interests has strange results upon a private member’s
85.
1 See Lancet, 1936, 1, 787.