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VITAMIN C IN BULK
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by an interdental splint as the method of choice. The metal generally used is an alloy of silver and copper in equal parts, known as cuprous-silver. It is fixed to the teeth by copper cement. When a single splint can be used, covering the lower teeth only, free movement of the jaw is allowed. In some cases, notably in fractures at the angle or ascending ramus of the mandible or of the condyle, it is necessary to fix splints to both upper and lower jaws and wire them together. Dunning1 recommends the cap splint for fractures in the median line, which do not tend to produce much displacement. In his experience fractures in the molar region, or behind the last molar, generally have to be treated by intermaxillary wiring. He advises the removal of the wiring in ten days and the substitution of a cap splint, being impressed with the difficulties of keeping the mouth clean and of avoiding respiratory complications when the jaws are wired together for Edentulous jaws present special problems. Samuels describes a method whereby wires are passed around the bone, close to its upper and lower borders, the ends of the wires being twisted, on the buccal surface, over a vulcanite splint fitted to the upper border of the jaw. A method of fixation quite different in principle to those just described is used by J. Vorschutz, of Hamburg.6s Under local anaesthesia he inserts two long " lever screws " into the mandible, on either side of the fracture, and 6 cm. distant from it. The fracture is reduced and, with the jaws in accurate occlusion, a catgut stitch is passed around the teeth on each side of the fracture. The jaw and screws are then enclosed in a plaster-of-Paris bandage passed around the neck and lower part of the head below the ears and over the chin. It is claimed that, wearing the splint, the patient can open and close the jaw without disturbing the fractured ends. The older methods of plating and wiring fractures of the jaw seem to have fallen into complete disfavour now that dental surgeons are called in to help in treatment.
long.
VITAMIN C IN BULK THE lemon has been dethroned : it is no longer the sovereign antiscorbutic material, and its place has been taken by certain peppers of the genus capsicum. Prof. Szent-Gyorgyi, the discoverer of ascorbic acid as vitamin C, tells how pure crystalline ascorbic acid may be prepared from the ripe fruits of either the " noble" pepper (used for the preparation of Hungarian paprika) or the fleshy pepper (used as a vegetable) by a complicated series of chemical manipulations. At the end of these he held in his hand not a scanty milligramme or two but 3 kg. of the material. Moreover, when recrystallised, the vitamin is found to be stable even at room temperature. It should not be long now surely before scurvy becomes unknown. That it has not been negligible hitherto is shown by the Times account (Dec. 28th) of the recent disastrous expedition against Nanga Parbat in the Himalayas, in which it is suggested that lack of vitamin C may have contributed to the failure. The protective daily dose of ascorbic acid for an infant is reckoned to be about 25 mg.,8and a man suffering from fully developed scurvy has been cured by daily intravenous injections of 40 mg.9 If the protective dose for a man is calculated on the liberal basis of 50 mg. a day, 1 g. would last him 20 days. Clearly the problem of 6 Med. Welt, Oct. 20th, 1934, p. 475. 7 Banga, I., and Szent-Gyorgyi, A. : Biochem. Jour., 1934, 1625. xxviii., 8 Szent-Györgyi, A. : Deut. med. Woch., 1934, lx., 556. 9 Schultzer, P. : THE LANCET, 1933, ii., 589.
transport and storage of vitamin C for Arctic sledgand remote climbing expeditions is solved. In considering further possibilities it should not be forgotten that Z-ascorbic acid, active vitamin C, has actually been synthesised, though not as yet on any considerable scale.10 Prof. Szent-Gyorgyi is an internationalist and a man of goodwill. His paper describing the process for preparing ascorbic acid on the large scale ends with this simple sentence : " No patents were taken out for the process." In our present issue appears a paper by Dr. L. J. Harris and Dr. S. N. Ray, which points to a further practical application for vitamin C in bulk. These workers have studied the urinary excretion of ascorbic acid on various diets and have confirmed the observation that the amount excreted differs according to saturation " of the the vitamin C reserves or that tested. this fact might be They suggest person used as the basis of a test for the prescorbutic condition-a suggestion also made this week in our correspondence columns. For instance, if an infant was suspected, from dietary history and failure to gain weight, of being in a state of latent scurvy, it could be given a known large dose of ascorbic acid, and the proportion excreted would, it is believed, give definite information as to its need of the vitamin. Since the estimation can be made by titration of the urine, the test presents no special difficulties. The only one of the kind hitherto used has been Gothlin’s capillary resistance test or modifications of it, but this is usually considered unreliable, since it may even give different results for the two arms of the same individual. In Scandinavia and other countries with a long Arctic winter an accurate test would be useful for adults as well as infants, and everywhere where babies are artificially fed there may be from time to time an application for it. There does not seem to be any published evidence of widespread latent deficiency of this type in the British Islespresumably, as Dr. Helen Mackay said in her recent review,l1 because fruit juice is so generally given to infants. But the advance of pasteurisation makes such a supplement more than ever necessary, and Dr. Harris’s comparison of bovine and human milk shows that even fresh untreated milk from the farm is not reliable as a constant source of vitamin C. The cult of the orange cannot yet be universal, and it may well prove that latent scurvy is not so rare here as has been assumed.
ing parties completely
"
TERATOMA OF THE BRAIN
TERATOMATA and dermoid cysts of the central nervous are so rare that they perhaps hold a greater fascination for the pathologist than for the clinician. They may, however, show some very interesting localising symptoms. Thus in a large proportion of the reported cases of teratoma of the brain the tumour occupied the pineal body, and .in some of them the patient (always a male) exhibited the syndrome known as macrogenitosomia praecox. Another relatively common site is the infundibular region ; an example of this is seen in the first of the two cases reported by Dr. H. E. Harding and Prof. A. E. Naish in our present issue. The patient, a girl of 9 years and 11 months, showed symptoms pointing to extensive hypothalamic disturbance. As an infant she slept for longer periods than was usual for her age, and later on this habit developed into pathological sleep. Although intelligent she was remarkably unemotional
system
10 Reichstein, T., Grüssner, A., and Oppenauer, R. : Helv. chim. Acta, 1933, xvi., 1019. 11 Mackay, H. M. M.: THE
LANCET, 1934, ii., 1462.
by an interdental splint as the method of choice. The metal generally used is an alloy of silver and copper in equal parts, known as cuprous-silver. It is fixed to the teeth by copper cement. When a single splint can be used, covering the lower teeth only, free movement of the jaw is allowed. In some cases, notably in fractures at the angle or ascending ramus of the mandible or of the condyle, it is necessary to fix splints to both upper and lower jaws and wire them together. Dunning1 recommends the cap splint for fractures in the median line, which do not tend to produce much displacement. In his experience fractures in the molar region, or behind the last molar, generally have to be treated by intermaxillary wiring. He advises the removal of the wiring in ten days and the substitution of a cap splint, being impressed with the difficulties of keeping the mouth clean and of avoiding respiratory complications when the jaws are wired together for Edentulous jaws present special problems. Samuels describes a method whereby wires are passed around the bone, close to its upper and lower borders, the ends of the wires being twisted, on the buccal surface, over a vulcanite splint fitted to the upper border of the jaw. A method of fixation quite different in principle to those just described is used by J. Vorschutz, of Hamburg.6s Under local anaesthesia he inserts two long " lever screws " into the mandible, on either side of the fracture, and 6 cm. distant from it. The fracture is reduced and, with the jaws in accurate occlusion, a catgut stitch is passed around the teeth on each side of the fracture. The jaw and screws are then enclosed in a plaster-of-Paris bandage passed around the neck and lower part of the head below the ears and over the chin. It is claimed that, wearing the splint, the patient can open and close the jaw without disturbing the fractured ends. The older methods of plating and wiring fractures of the jaw seem to have fallen into complete disfavour now that dental surgeons are called in to help in treatment.
long.
VITAMIN C IN BULK THE lemon has been dethroned : it is no longer the sovereign antiscorbutic material, and its place has been taken by certain peppers of the genus capsicum. Prof. Szent-Gyorgyi, the discoverer of ascorbic acid as vitamin C, tells how pure crystalline ascorbic acid may be prepared from the ripe fruits of either the " noble" pepper (used for the preparation of Hungarian paprika) or the fleshy pepper (used as a vegetable) by a complicated series of chemical manipulations. At the end of these he held in his hand not a scanty milligramme or two but 3 kg. of the material. Moreover, when recrystallised, the vitamin is found to be stable even at room temperature. It should not be long now surely before scurvy becomes unknown. That it has not been negligible hitherto is shown by the Times account (Dec. 28th) of the recent disastrous expedition against Nanga Parbat in the Himalayas, in which it is suggested that lack of vitamin C may have contributed to the failure. The protective daily dose of ascorbic acid for an infant is reckoned to be about 25 mg.,8and a man suffering from fully developed scurvy has been cured by daily intravenous injections of 40 mg.9 If the protective dose for a man is calculated on the liberal basis of 50 mg. a day, 1 g. would last him 20 days. Clearly the problem of 6 Med. Welt, Oct. 20th, 1934, p. 475. 7 Banga, I., and Szent-Gyorgyi, A. : Biochem. Jour., 1934, 1625. xxviii., 8 Szent-Györgyi, A. : Deut. med. Woch., 1934, lx., 556. 9 Schultzer, P. : THE LANCET, 1933, ii., 589.
transport and storage of vitamin C for Arctic sledgand remote climbing expeditions is solved. In considering further possibilities it should not be forgotten that Z-ascorbic acid, active vitamin C, has actually been synthesised, though not as yet on any considerable scale.10 Prof. Szent-Gyorgyi is an internationalist and a man of goodwill. His paper describing the process for preparing ascorbic acid on the large scale ends with this simple sentence : " No patents were taken out for the process." In our present issue appears a paper by Dr. L. J. Harris and Dr. S. N. Ray, which points to a further practical application for vitamin C in bulk. These workers have studied the urinary excretion of ascorbic acid on various diets and have confirmed the observation that the amount excreted differs according to saturation " of the the vitamin C reserves or that tested. this fact might be They suggest person used as the basis of a test for the prescorbutic condition-a suggestion also made this week in our correspondence columns. For instance, if an infant was suspected, from dietary history and failure to gain weight, of being in a state of latent scurvy, it could be given a known large dose of ascorbic acid, and the proportion excreted would, it is believed, give definite information as to its need of the vitamin. Since the estimation can be made by titration of the urine, the test presents no special difficulties. The only one of the kind hitherto used has been Gothlin’s capillary resistance test or modifications of it, but this is usually considered unreliable, since it may even give different results for the two arms of the same individual. In Scandinavia and other countries with a long Arctic winter an accurate test would be useful for adults as well as infants, and everywhere where babies are artificially fed there may be from time to time an application for it. There does not seem to be any published evidence of widespread latent deficiency of this type in the British Islespresumably, as Dr. Helen Mackay said in her recent review,l1 because fruit juice is so generally given to infants. But the advance of pasteurisation makes such a supplement more than ever necessary, and Dr. Harris’s comparison of bovine and human milk shows that even fresh untreated milk from the farm is not reliable as a constant source of vitamin C. The cult of the orange cannot yet be universal, and it may well prove that latent scurvy is not so rare here as has been assumed.
ing parties completely
"
TERATOMA OF THE BRAIN
TERATOMATA and dermoid cysts of the central nervous are so rare that they perhaps hold a greater fascination for the pathologist than for the clinician. They may, however, show some very interesting localising symptoms. Thus in a large proportion of the reported cases of teratoma of the brain the tumour occupied the pineal body, and .in some of them the patient (always a male) exhibited the syndrome known as macrogenitosomia praecox. Another relatively common site is the infundibular region ; an example of this is seen in the first of the two cases reported by Dr. H. E. Harding and Prof. A. E. Naish in our present issue. The patient, a girl of 9 years and 11 months, showed symptoms pointing to extensive hypothalamic disturbance. As an infant she slept for longer periods than was usual for her age, and later on this habit developed into pathological sleep. Although intelligent she was remarkably unemotional
system
10 Reichstein, T., Grüssner, A., and Oppenauer, R. : Helv. chim. Acta, 1933, xvi., 1019. 11 Mackay, H. M. M.: THE
LANCET, 1934, ii., 1462.