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VITAMIN E
715 work for the Health Service faithfully, and indeed many do far more than they are, or can be, paid for. The doctor’s position in the Health Service creates difficulties only when there is confusion between his two obligations. The doctor’s obligation to the patient, however, is in its own sphere absolute, and entirely beyond the scope of the employing authority, which, therefore, has no right to dictate to the individual doctor on any matter of professional practice or ethics. The most it can do, if it feels concerned in such matters, is to refer them to its appropriate medical advisory committee. Now, if I am right, doctors occupy, and will continue to occupy, a unique position in the Health Service. Others who work in the service also have their own professional obligations, but the doctor alone has the added responsibility of caring for the patient as a whole, and directing the work of others, who render the patient service. His professional independence within the Health Service is not merely an exaggerated form of sectionalism : it is essential to the welfare of the Health Service, and indirectly to the welfare of society. I do not believe that anyone would wish to be treated in hospital by a doctor who had some other professional allegiance than one solely directed to his patient’s welfare. Those of us
International
Congresses
VITAMIN E THE 3rd International Congress on vitamin E, which followed those of 1939 in London and of 1949 in New York, was held in Venice on Sept. 5-8, under the presidency of Prof. Carlo Foa. About 160 members from 16 nations attended. The communications included both reviews by invited lecturers on reports in specified fields of research, and reports of original work in these fields. The proceedings were greatly helped by the simultaneous translation of the communications, through headphones, into three other languages. The heavy accumulation of papers on vitamin E, assessed by P. L. Harris at about 1600, justified the calling of the conference but made heavy work for the lecturers. In experimental studies on the effect of the vitamin on metabolism much interest has centred on the effect of unsaturated fats in aggravating the symptoms of deficiency, on the breakdown products of the vitamin in the body, and on the extent to which the vitamin " can be replaced in its functions by certain " redox substances, including methylene-blue. H. Dam’s description of vitamin E as an " in-vivo antioxidant " continues in favour. Opinions are divided, however, as to whether this action is exerted evenly throughout the body, or is concentrated on special sites, such as the pituitary, adrenals, and thyroid. The discovery by J. Green, and other British workers, that cereal products contain two new forms of tocopherol (named s and ) has raised interest as to their biological activity and practical importance in our diet. With the previously known modifications (a, p, y, and 8) the total number of tocopherols is now six. In contrast to our detailed knowledge of the importance of vitamin E for laboratory animals, great uncertainty remains as to its value in the treatment of disease in man. At the 2nd congress sanguine hopes were raised by Dr. Evan Shute that vitamin E might revolutionise the treatment of diseases of the heart and peripheral vascular system. At the present congress he displayed further impressive photographic records showing the favourable progress of various peripheral vascular injuries, caused by accident, burns, or infection, after treatment with tocopherol. As on previous occasions sceptics might ascribe most of the cures to spontaneous recovery under the influence of adequate hospital treatment. In Shute’s opinion, however, the effect of toco-
spend much time considering and discussing general principles, admittedly of great importance, have to be careful to preserve our sense of proportion, and not to regard isolated cases as representative of what is going on generally. That is why I find it so refreshing and stimulating to meet, as I have the opportunity of doing today, the laymen and doctors who are getting on with the job. I believe that in general the doctor’s professional responsibility is recognised and respected. It gives rise to no difficulties, and hospital authorities and doctors are working harmoniously together. * * * who have to
We are fond of boasting that we are not a logical nation. Though we are often somewhat vague about theoretical principles, we have a habit of doing the right thing intuitively in practice, and then discovering afterwards that we have done it on principle. So far we have done it successfully in launching the Health Service ; and I have every hope, and see every prospect, that, if laymen and doctors go forward together in the same spirit of goodwill and mutual understanding, we shall succeed in creating a service which will be a model for the whole world. is so striking’ that demands for comparisons with controls untreated with vitamin E seem inhuman. V. R. O’Connor would presumably support this view in regard to cardiac and renal patients ; and in the veterinary field N. H. Lambert is enthusiastic on the effect of tocopherol in warding off the effects of old Convincing statistical evidence seems age in dogs. essential before tocopherol therapy can be accepted as more than an expensive placebo. An investigation by Maurice Lee on the progress of leg ulcers, with or without tocopherol, is therefore welcome. The vitamin appeared to accelerate healing slightly ; the difference was statistically significant in patients with a history of deep venous thrombosis. A point on which all other workers agree is that the doses given by Shute and his followers are greatly in excess of the normal requirements of the body. The alleged action of the vitamin cannot therefore be due to the correction of dietary deficiency. The prominence of muscular dystrophy as an effect of experimental avitaminosis E suggested the use of tocopherol in the treatment of muscular dystrophy in man. The results so far obtained have been very disappointing. Even in instances where tocopherol has influenced the muscle biochemically, as evidenced by decreased creatine excretion, the progress of the disease has been unaffected. An ingenious " split-frame " film by K. E. Mason, showing side by side motion pictures of dystrophic children photographed after various periods of treatment, reinforced this sad conIn contrast K. L. Blaxter and others have clusion. that many forms of muscular dystrophy in farm reported animals respond readily to treatment with tocopherol. Several workers mentioned the novel finding that tocopherol can influence the clotting-time of blood. In-vitro clotting appears to be slightly accelerated, which is perhaps difficult to reconcile with the supposed favourable effect of the vitamin in the treatment of thrombosis. E. Raverdino considers that tocopherol may be helpful, in combination with anticoagulants, in treating certain vascular abnormalities of the retina. P. Prosperi and A. Lottini observed beneficial effects in the treatment of a case of haemophilia. A pleasing feature of the congress was the evidence of intensive and fertile research on vitamin E in Italy. As the fruit of both clear scientific insight and high technical skill a communication by Prof. M. Aloisi, dealing with the microscopic changes in muscle made dystrophic by vitamin-E deficiency, earned the admiration of all present.
pherol
International
Congresses
VITAMIN E THE 3rd International Congress on vitamin E, which followed those of 1939 in London and of 1949 in New York, was held in Venice on Sept. 5-8, under the presidency of Prof. Carlo Foa. About 160 members from 16 nations attended. The communications included both reviews by invited lecturers on reports in specified fields of research, and reports of original work in these fields. The proceedings were greatly helped by the simultaneous translation of the communications, through headphones, into three other languages. The heavy accumulation of papers on vitamin E, assessed by P. L. Harris at about 1600, justified the calling of the conference but made heavy work for the lecturers. In experimental studies on the effect of the vitamin on metabolism much interest has centred on the effect of unsaturated fats in aggravating the symptoms of deficiency, on the breakdown products of the vitamin in the body, and on the extent to which the vitamin " can be replaced in its functions by certain " redox substances, including methylene-blue. H. Dam’s description of vitamin E as an " in-vivo antioxidant " continues in favour. Opinions are divided, however, as to whether this action is exerted evenly throughout the body, or is concentrated on special sites, such as the pituitary, adrenals, and thyroid. The discovery by J. Green, and other British workers, that cereal products contain two new forms of tocopherol (named s and ) has raised interest as to their biological activity and practical importance in our diet. With the previously known modifications (a, p, y, and 8) the total number of tocopherols is now six. In contrast to our detailed knowledge of the importance of vitamin E for laboratory animals, great uncertainty remains as to its value in the treatment of disease in man. At the 2nd congress sanguine hopes were raised by Dr. Evan Shute that vitamin E might revolutionise the treatment of diseases of the heart and peripheral vascular system. At the present congress he displayed further impressive photographic records showing the favourable progress of various peripheral vascular injuries, caused by accident, burns, or infection, after treatment with tocopherol. As on previous occasions sceptics might ascribe most of the cures to spontaneous recovery under the influence of adequate hospital treatment. In Shute’s opinion, however, the effect of toco-
spend much time considering and discussing general principles, admittedly of great importance, have to be careful to preserve our sense of proportion, and not to regard isolated cases as representative of what is going on generally. That is why I find it so refreshing and stimulating to meet, as I have the opportunity of doing today, the laymen and doctors who are getting on with the job. I believe that in general the doctor’s professional responsibility is recognised and respected. It gives rise to no difficulties, and hospital authorities and doctors are working harmoniously together. * * * who have to
We are fond of boasting that we are not a logical nation. Though we are often somewhat vague about theoretical principles, we have a habit of doing the right thing intuitively in practice, and then discovering afterwards that we have done it on principle. So far we have done it successfully in launching the Health Service ; and I have every hope, and see every prospect, that, if laymen and doctors go forward together in the same spirit of goodwill and mutual understanding, we shall succeed in creating a service which will be a model for the whole world. is so striking’ that demands for comparisons with controls untreated with vitamin E seem inhuman. V. R. O’Connor would presumably support this view in regard to cardiac and renal patients ; and in the veterinary field N. H. Lambert is enthusiastic on the effect of tocopherol in warding off the effects of old Convincing statistical evidence seems age in dogs. essential before tocopherol therapy can be accepted as more than an expensive placebo. An investigation by Maurice Lee on the progress of leg ulcers, with or without tocopherol, is therefore welcome. The vitamin appeared to accelerate healing slightly ; the difference was statistically significant in patients with a history of deep venous thrombosis. A point on which all other workers agree is that the doses given by Shute and his followers are greatly in excess of the normal requirements of the body. The alleged action of the vitamin cannot therefore be due to the correction of dietary deficiency. The prominence of muscular dystrophy as an effect of experimental avitaminosis E suggested the use of tocopherol in the treatment of muscular dystrophy in man. The results so far obtained have been very disappointing. Even in instances where tocopherol has influenced the muscle biochemically, as evidenced by decreased creatine excretion, the progress of the disease has been unaffected. An ingenious " split-frame " film by K. E. Mason, showing side by side motion pictures of dystrophic children photographed after various periods of treatment, reinforced this sad conIn contrast K. L. Blaxter and others have clusion. that many forms of muscular dystrophy in farm reported animals respond readily to treatment with tocopherol. Several workers mentioned the novel finding that tocopherol can influence the clotting-time of blood. In-vitro clotting appears to be slightly accelerated, which is perhaps difficult to reconcile with the supposed favourable effect of the vitamin in the treatment of thrombosis. E. Raverdino considers that tocopherol may be helpful, in combination with anticoagulants, in treating certain vascular abnormalities of the retina. P. Prosperi and A. Lottini observed beneficial effects in the treatment of a case of haemophilia. A pleasing feature of the congress was the evidence of intensive and fertile research on vitamin E in Italy. As the fruit of both clear scientific insight and high technical skill a communication by Prof. M. Aloisi, dealing with the microscopic changes in muscle made dystrophic by vitamin-E deficiency, earned the admiration of all present.
pherol