UNIVERSITY DEPARTMENTS OF INDUSTRIAL HEALTH

665 Recent susceptibility of the pancreatic- islets of the monkey to the action of alloxan may well encourage those who hope to find in this drug a means of destroying malignant although- as many as 12,564 egg-whites were given to islet-cell tumours. Two main hypotheses have been advanced to explain one patient in 315 days. Very likely had any result the transitory hvpoglycaemia seen in alloxan-treated been evident host and tumour would have shown equal animals before they develop hyperglycaemia due to islet effects of deprivation-just as in crymotherapy both necrosis. The first, propounded by Shaw Dunn et al., suffer from lack of fluid. This lavish but ineffectual use of egg-white demonstrates again that the human suggested that alloxan stimulates the islet cells to oversubject is unsuitable for first tests. Of the three test work, and that in pouring out the insulin that lowers the methods, the effect on standard tumours in inbred blood-sugar the cells are exhausted and die. According to the second hypothesis, advanced by Hughes, Ware animals is for the present far the most reliable. and Young,6 the primary effect of alloxan on the islet UNIVERSITY DEPARTMENTS OF INDUSTRIAL cells is toxic, and the hypoglycsemia results from the HEALTH washing out of pre-formed stores of insulin from dead or GREAT BRITAIN has at present no university departdying islet cells. In support of this idea Hughes et al. ment devoted to educational work in industrialhealth, showed that the amount of extractable insulin known to and scarcely any facilities for postgraduate training in be present in the pancreas of the rabbit was sufficient, industrial medicine. In January, 1943, a select comwhen administered to normal rabbits in the form of mitteeof the House of Commons, reporting on the health protamine-zinc-insulin, to bring about a phase of and welfare of women workers, rightly remarked that hypoglycaemia similar to that seen after a necrosis" doctors who are new to industrial work have to learn inducing dose of alloxan. Evidence further suppqrting slowly and painfully by experience many lessons that this hypothesis has lately come from the laboratory of should and could be taught in courses of preliminary Prof. C. H. Best in Toronto, where it has been shown7 training if such were available." It is good news, that though, in both rats and dogs, injection of alloxan therefore, that the Nuffield Foundation has offered the reduces the insulin content of the pancreas, the pancreatic universities of Durham, Glasgow and Manchester grants insulin does not diminish until some time after most of totalling :E 150,000 to assist them to carry out schemes the islet cells have died. Evidence that the hypothey have submitted for the development, as soon as glycaemic action of alloxan is the result of its action on suitable staffs can be appointed, of teaching and research the pancreas rather than on the liver or other tissues was in industrial health. These grants will be spread over obtained by giving alloxan to dogs previously rendered ten years. Manchester, where it is proposed to create a diabetic by pancreatectomy or by administration of chair of industrial health, will receive 70,000. Durham alloxan, the diabetes being controlled by administration has been offered 40,000 for the establishment of a of PZI. In diabetic dogs alloxan did not exert a department under a university reader, and a similar transitory hypoglycsemic action, though this was amount is being allocated to Glasgow for a subdepartpronounced in normal dogs receiving alloxan. The ment of industrial health within the existing department investigators conclude that the cause of the hypoof social medicine. glycaemia is that alloxan kills islet cells and thus allows their contained insulin to be leached into the blood-stream. ALLOXAN AND THE PANCREATIC ISLETS It now remains to be determined why alloxan acts RESEARCH on the action of alloxan, stimulated by the particularly on islet cells, and how it causes their rapid late Professor Shaw Dunn and his colleagues,4continues necrosis. to give interesting and important results. His original HINTS AND TIPS FOR THE TUBERCULOUS observation that intravenous injection of alloxan can cause rapid necrosis of the’ pancreatic islets has been THE school of wishful thinking which maintained amply confirmed, and is known to be true for rats and that tuberculous patients fared best when in ignorance dogs as well as for rabbits. Brunschwig et al.,5 who about their disease is dying fast. A patient when first injected alloxan intravenously into four human patients diagnosed as suffering from tuberculosis usually suffers with carcinomatosis, report transitory benefit in one of more intensely still from tuberculophobia and feels them who was suffering from hyperinsulinism resulting impelled to ask questions and to seek reassurance. To from islet-cell carcinoma ; after the administration some 0:Þ his questions his family doctor may not be any of alloxan, hypoglycsemic symptoms were abolished for too sure of the answers. The chest specialist to whom 10-20 days, whereas before treatment there had been he may next be referred very likely has a way of putting 2-5 attacks each day. The other three patients received things different from the GP’s. On arrival at the doses larger (per kg. body-weight) than are required to sanatorium the patient finds that the physicians there produce islet necrosis in dogs and rabbits, but the too seem to speak a different language, and moreover blood-sugar level was affected in only one case, and then to exhibit a different approach to the whole subject. but slightly. From this it was concluded that man is On the other hand there are patients who display no more resistant to the action of alloxan than is the dog or lively curiosity about their complaint and who submit the rabbit, and the more interest therefore attaches to with unquestioning docility to whatever is prescribed Banerjee’s description, elsewhere in this issue, of hyper- for them. Some of these are doubtless too engrossed glycsemia and islet changes in monkeys treated with a in other problems. A few may be too dumb ; but v single moderate dose of alloxan (300 mg. per kg.) by many of them are deterredfrom "asking too many " intravenous injection. Banerjee suggests that Brunquestions " lest they be labelled as." introspective or schwig’s observation that alloxan did not affect the islet " neurotic." And yet, to quote Dr. G. S. Erwin’s tissue in his case of islet-cell carcinoma may be ascribed preface to his Guide for the Tuberculous Patient (Heineto the use of too small a dose. A demonstration of the mann, pp. 112, 3s. 6
foodstuff, both tumour and host usually suffer.

tests on human tumours with avidin (egg-white)3 have failed to starve either the tumour or the host of biotin,

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i, 484 ; Dunn, S., Kirkpatrick, J., McLetchie, Telfer, S. V. J. Path. Bact. 1943, 55, 245 ; Dunn, J. S., and McLetchie, N. G. B. Lancet, 1943, ii, 384 ; Dunn, J. S., Duffy, E., Gilmour, M. K.; Kirkpatrick, J. and McLetchie, N. G. B. J. Physiol. 1944, 103, 233. 5. Brunschwig, A., Allen, J. G., Goldner, M. G. and Gomori, G. J. Amer, med. Ass. 1943, 122, 966 ; Brunschwig, A., Alien, J. G., Owens, F. M. and Thornton, T. F. Ibid. 1944, 124, 212 ;

Brunschwig, A. and Allen, J. G. Cancer Research, 1944, 4, 45.

treatment can be influenced evil, by the patient himself."

for the outcome of the

materially, for good

or

Dr. Erwin’s little volume is accurate and well balanced : it cannot fail to dispel the terrors of the unknown, and 6. Hughes, H., Ware, L. L. and Young, F. G. Lancet, 1944, i, 148. 7. Ridout, J. H., Ham, A. W., Wrenshall, G. A. Science, 1944, 100, 57.

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