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UNITED SCIENTISTS
132
mounting, in spite of the quantity that must be taken ; between 1936 and 1938 it accounted for 101 of 271 deaths from narcotic poisoning. Nicotine, used for fumigation by gardeners, is becoming popular with suicides ; the lethal dose is minute and the action rapid. Strychnine is being given up though a few die-hards still The ban on its sale for destroying vermin swear by it. has been suspended during the war at the request of the farmers ; less cruel methods are available, and Dr. Roche Lynch hopes its use will be restricted again as soon as possible. Statistics of homicidal poisoning-for reasons beyond the control of the Registrar-General-are inaccurate. Probably only a -proportion of murders by poison come to light. Dr. Roche Lynch recalled that out of a series of 24 murders by poison, 8 were only discovered by exhumation ; and that many poisoners have killed more than one person. The more cautious ones probably escape detection, but those who are apprehended show a strongly conservative spirit in their choice of drug. Arsenic has always been a favourite because of its small bulk, but large doses are sometimes vomited too soon to cause death, and several doses are often necessary. Opium can still be obtained in spite of legal safeguards, and Nurse Waddingham saved up a quantity which had been prescribed for dying patients under her care. Dr.. Roche Lynch holds that it -is the duty of the doctor in charge of the case to take back any potent drugs from the nurse or family if the patient dies. Weed killer and industrial poisons like cyanide can be acquired fairly easily but attempts by a layman to buy an unusual poison are readily traced, and this limits the murderer’s choice. A diagnosis of poisoning is seldom easy ; sudden acute illness, he said, in a person in good health or stationary bad health is suspicious, and sudden atypical change of symptoms. It is so is a always worth noting if the patient complains of a change in the taste of food, drink or medicine. Bacterial or accidental food-poisoning usually affects all or nearly all who share in the food, whereas the murderer chooses his occasion to poison one victim. Recovery from poisoning is surprisingly rapid compared with that from most natural illnesses. If the doctor suspects poisoning while the patient is alive he is-in a difficult position; but he can approach the Home Office with a request for analysis of a specimen. If he cannot get the patient into hospital he should employ a trustworthy nurse and confide in her so that she can be on her guard, and prepare all food and drink for the patient herself. MEASURING
IMMUNITY TO
SMALLPOX
THE smallpox outbreak in Glasgow has brought home to us how little is known about the degree and duration of resistance which vaccinia produces to this dread disIn face of an outbreak of diphtheria, the Schick ease. test can be used to separate the susceptibles who need protection from the immunes who can be left alone. But when smallpox appears all likely and many unlikely contacts are vaccinated, and those who do not " take are left with the uncomfortable feeling that they may or may not be immune. A method that would measure resistance to smallpox would therefore be a great boon. When Hirstpublished his discovery of the agglutination of chick red blood corpuscles by the influenza virus, it was natural to inquire whether other viruses had a similar property. In the course of such an inquiry, Nagler2 found that vaccinia virus also had an agglutinating action on fowl red cells, and that, as was the case with influenza virus, the agglutination could be specifically inhibited by anti-vaccinia serum. For the test he used vaccinia virus grown on chick chorioallantoic membrane, which agglutinated a 2% suspension of fowl red cells to a dilution of 1/256 ; virus grown in the yolk-sac was ineffective, and the cells of certain birds, particularly 1. Hirst, G. K. Science, 1941, 94, 22. 2. Nagler, F. P. O. Med. J. Aust. 1942, 1, 281.
older birds, reacted poorly. Using the serum of an immunised rabbit as standard, Nagler showed that vaccination with egg-virus raised the titre of a patient’s serum from 0-025 unit before vaccination to 0-05 unit
days and 0-4 unit at 21 days and 28 days after vaccination. A test like this which can measure the degree of resistance obviously has a variety of uses. It can assess the relative antigenic value of egg, calf or otherwise produced virus, discover whether two or more insertions are more effective than one, and perhaps determine the potency of different virus preparations. But its primary use will be to decide whether or not to vaccinate when smallpox is about. at 12
SWAPPING
PATIENTS
DOCTORS are scarce and so is petrol, and it is no longer proper for practitioners to travel far afield to see patients who could well be visited by a doctor who lives nearer to them. Accordingly insurance patients are being reallocated, with the consent of the doctors concerned, for the duration of the war " so as to secure economy in the use of civilian medical man-power." But there is some doubt whether under the protection of practices scheme a doctor has the right to transfer to another practitioner patients assigned to him by a colleague absent on war-service, without written consent-which in these days of disturbed communications may be impossible to obtain. To meet this difficulty the Ministry of Health has issued an enabling regulation investing the deputy with the rights of a principal over these temporary patients and no longer requiring him to insert the name of the absent practitioner on any certificate or document issued in respect of his patients. Presumably the absent practitioner will no longer be responsible for the acts or omissions of his deputy. The BMA have made similar proposals-popularly known as the five-mile limit plan-for the temporary reallocation of private patients, but the experienced family doctor is not finding it easy to break the ties of a lifetime at the call of a ’
measuring tape.
SCIENTISTS the Royal Society of Medicine and the British Council for medical and scientific representatives of the united nations, Dr. A. M. H. Gray made his large and cosmopolitan body of guests feel the warmth of their welcome. Sir Henry Dale, with his wide contacts in science at home and abroad, was able to give perspective to the hopes and aims of, all those present, and Lord Snell spoke of the better uses to which we may hope to put science when it takes off the harness of war. Till then, as the professorial staff of the Gorky All-Union Institute of Experimental Medicine declared in a telegram of greetings received the same day by the Physiological Society: " We must pool our creative desires to form a fund of scientific achievements " which will help us all to speedy victory. In his reply Prof. A. V. Hill looked forward to a lasting brotherhood in scientific service. UNITED
AT
a
reception
on
July 23, given by
____
A MmwoRnEn ADVERTISEMENT.—Several correspondents have expressed surprise at an advertisement for a locum tenens in our issue of July 18 containing the proviso " Aliens and Jews need not apply." The intention of the advertiser was to signify that owing to the nature of the practice a doctor of British nationality was essential. We deeply regret that through an oversight the advertisement was allowed to appear in such form. "... A mass X-ray examination of 98’4% of the people in resulted in 7500 being suspected of tuberculous infection. A further examination of these confirmed the diagnosis in 3444 cases (i.e., 0-76% of the population) ; 737 had a progressive tuberculosis requiring treatment, of which they were ignorant, and of these 182 cases were open."From Boden8ee for April 6, 1942.
Stuttgart
-
mounting, in spite of the quantity that must be taken ; between 1936 and 1938 it accounted for 101 of 271 deaths from narcotic poisoning. Nicotine, used for fumigation by gardeners, is becoming popular with suicides ; the lethal dose is minute and the action rapid. Strychnine is being given up though a few die-hards still The ban on its sale for destroying vermin swear by it. has been suspended during the war at the request of the farmers ; less cruel methods are available, and Dr. Roche Lynch hopes its use will be restricted again as soon as possible. Statistics of homicidal poisoning-for reasons beyond the control of the Registrar-General-are inaccurate. Probably only a -proportion of murders by poison come to light. Dr. Roche Lynch recalled that out of a series of 24 murders by poison, 8 were only discovered by exhumation ; and that many poisoners have killed more than one person. The more cautious ones probably escape detection, but those who are apprehended show a strongly conservative spirit in their choice of drug. Arsenic has always been a favourite because of its small bulk, but large doses are sometimes vomited too soon to cause death, and several doses are often necessary. Opium can still be obtained in spite of legal safeguards, and Nurse Waddingham saved up a quantity which had been prescribed for dying patients under her care. Dr.. Roche Lynch holds that it -is the duty of the doctor in charge of the case to take back any potent drugs from the nurse or family if the patient dies. Weed killer and industrial poisons like cyanide can be acquired fairly easily but attempts by a layman to buy an unusual poison are readily traced, and this limits the murderer’s choice. A diagnosis of poisoning is seldom easy ; sudden acute illness, he said, in a person in good health or stationary bad health is suspicious, and sudden atypical change of symptoms. It is so is a always worth noting if the patient complains of a change in the taste of food, drink or medicine. Bacterial or accidental food-poisoning usually affects all or nearly all who share in the food, whereas the murderer chooses his occasion to poison one victim. Recovery from poisoning is surprisingly rapid compared with that from most natural illnesses. If the doctor suspects poisoning while the patient is alive he is-in a difficult position; but he can approach the Home Office with a request for analysis of a specimen. If he cannot get the patient into hospital he should employ a trustworthy nurse and confide in her so that she can be on her guard, and prepare all food and drink for the patient herself. MEASURING
IMMUNITY TO
SMALLPOX
THE smallpox outbreak in Glasgow has brought home to us how little is known about the degree and duration of resistance which vaccinia produces to this dread disIn face of an outbreak of diphtheria, the Schick ease. test can be used to separate the susceptibles who need protection from the immunes who can be left alone. But when smallpox appears all likely and many unlikely contacts are vaccinated, and those who do not " take are left with the uncomfortable feeling that they may or may not be immune. A method that would measure resistance to smallpox would therefore be a great boon. When Hirstpublished his discovery of the agglutination of chick red blood corpuscles by the influenza virus, it was natural to inquire whether other viruses had a similar property. In the course of such an inquiry, Nagler2 found that vaccinia virus also had an agglutinating action on fowl red cells, and that, as was the case with influenza virus, the agglutination could be specifically inhibited by anti-vaccinia serum. For the test he used vaccinia virus grown on chick chorioallantoic membrane, which agglutinated a 2% suspension of fowl red cells to a dilution of 1/256 ; virus grown in the yolk-sac was ineffective, and the cells of certain birds, particularly 1. Hirst, G. K. Science, 1941, 94, 22. 2. Nagler, F. P. O. Med. J. Aust. 1942, 1, 281.
older birds, reacted poorly. Using the serum of an immunised rabbit as standard, Nagler showed that vaccination with egg-virus raised the titre of a patient’s serum from 0-025 unit before vaccination to 0-05 unit
days and 0-4 unit at 21 days and 28 days after vaccination. A test like this which can measure the degree of resistance obviously has a variety of uses. It can assess the relative antigenic value of egg, calf or otherwise produced virus, discover whether two or more insertions are more effective than one, and perhaps determine the potency of different virus preparations. But its primary use will be to decide whether or not to vaccinate when smallpox is about. at 12
SWAPPING
PATIENTS
DOCTORS are scarce and so is petrol, and it is no longer proper for practitioners to travel far afield to see patients who could well be visited by a doctor who lives nearer to them. Accordingly insurance patients are being reallocated, with the consent of the doctors concerned, for the duration of the war " so as to secure economy in the use of civilian medical man-power." But there is some doubt whether under the protection of practices scheme a doctor has the right to transfer to another practitioner patients assigned to him by a colleague absent on war-service, without written consent-which in these days of disturbed communications may be impossible to obtain. To meet this difficulty the Ministry of Health has issued an enabling regulation investing the deputy with the rights of a principal over these temporary patients and no longer requiring him to insert the name of the absent practitioner on any certificate or document issued in respect of his patients. Presumably the absent practitioner will no longer be responsible for the acts or omissions of his deputy. The BMA have made similar proposals-popularly known as the five-mile limit plan-for the temporary reallocation of private patients, but the experienced family doctor is not finding it easy to break the ties of a lifetime at the call of a ’
measuring tape.
SCIENTISTS the Royal Society of Medicine and the British Council for medical and scientific representatives of the united nations, Dr. A. M. H. Gray made his large and cosmopolitan body of guests feel the warmth of their welcome. Sir Henry Dale, with his wide contacts in science at home and abroad, was able to give perspective to the hopes and aims of, all those present, and Lord Snell spoke of the better uses to which we may hope to put science when it takes off the harness of war. Till then, as the professorial staff of the Gorky All-Union Institute of Experimental Medicine declared in a telegram of greetings received the same day by the Physiological Society: " We must pool our creative desires to form a fund of scientific achievements " which will help us all to speedy victory. In his reply Prof. A. V. Hill looked forward to a lasting brotherhood in scientific service. UNITED
AT
a
reception
on
July 23, given by
____
A MmwoRnEn ADVERTISEMENT.—Several correspondents have expressed surprise at an advertisement for a locum tenens in our issue of July 18 containing the proviso " Aliens and Jews need not apply." The intention of the advertiser was to signify that owing to the nature of the practice a doctor of British nationality was essential. We deeply regret that through an oversight the advertisement was allowed to appear in such form. "... A mass X-ray examination of 98’4% of the people in resulted in 7500 being suspected of tuberculous infection. A further examination of these confirmed the diagnosis in 3444 cases (i.e., 0-76% of the population) ; 737 had a progressive tuberculosis requiring treatment, of which they were ignorant, and of these 182 cases were open."From Boden8ee for April 6, 1942.
Stuttgart
-