- Email: [email protected]
WAR SURGERY IN SPAIN
223
production (as in Hungary and France), sympathetic tariff or transport policy, and better
cultural
distribution. The Esthonian government have reduced
the duties on fresh fruit, and the government of India the duty on dried skim-milk. The Latvian ministry of agriculture has organised the state transport of fish to inland settlers, and the Queensland government charge no freight on fruit or vegetables going to outlying districts more than 200 miles away. In this country the Food Council has suggested The measures for rationalising the retailing of milk. Scandinavian countries and America have considered the merits of " internal dumping," or distributing milk and other foods at reduced prices in their own territory, as against spending large sums to enable foreign buyers to obtain cheap supplies of foodstuffs which their own populations badly need. Education and publicity have been found to accomplish much, and some countries, particularly Belgium, have made good progress in this direction. The Yugoslav government have opened numerous schools to teach peasants how to manage their households and their farms, take care of children, cook and prepare provisions for the winter. Hygiene talks are broadcast every week from Baghdad, but the difficulties of propaganda in an illiterate country are very great. The whole report brings home to the reader the great value of an energetic international body of this kind. HYPERTONIC INTRAVENOUS SALINE THAT the injection of strong salt solutions into a vein is not without danger is shown by Robertson and Barrett.’ Although an injection of 30 per cent. sodium chloride may raise the blood-volume of cats to double what it was before, this effect is only transient and the original level is regained in halff an hour. A less desirable result is haemolysis of red cells, which the investigators found sufficient to interfere with the vital-red method of blood-volume estimation, a similar effect being obtained in man. Other sequels to the infusion include crenation of the red cells with consequent reduction of the red-cell volume, and later an increase in the red-cell volume through mobilisation of the cells from the depots. This increase could be prevented by previous evisceration of the cats and exclusion of the liver from the circulation. Robertson and Barrett’s experiments provide a further demonstration of the great care necessary in reading the results of blood-volume estimations after intravenous infusions. SOCIAL FACTORS IN DISEASE
No general practitioner needs to be told that a large proportion of organic diseases have their origin in the patient’s environment, or that the degree of disability and suffering produced by an organic disease varies largely with the patient’s social conditions. In hospital patients, however, these facts are liable to be lost sight of and Dr. G. Canby Robinson2 of Johns Hopkins Hospital is doing a valuable service in setting them on a firmer basis. He has made an intimate personal study of the relation between clinical findings and social conditions in 145 patients of mixed nationality and sex, chosen more or less at random from the wards and outpatient departments. After complete physical investigation each patient was interviewed by Dr. Robinson himself and an 1 Robertson, J. D., and Barrett, J. F., Quart. J. exp. Physiol. December, 1938, p. 405. 2 Robinson, G. C., Trans. Ass. Amer. Phys. 1938, 53, 102.
attempt
was
made to divide the
symptoms
into those
by organic disease and those of emotional Either Dr. Robinson or the or psychogenic origin. social worker who collaborated with him subsequently visited 111 of the 145 patients in their homes. In caused
two-thirds of the total adverse social conditions were found to be directly related to the patient’s illness, and in more than a third they were considered its main precipitating cause. It should perhaps be added that 45 patients were found to be suffering from psychoneuroses or symptoms that could not be explained on the basis of demonstrable disease. Dr. Robinson’s study however is evidence that many of the symptoms even of organic disease can be traced back to emotional disturbances associated with home or other environmental difficulties, and he pleads for systematic study of this relation. WAR SURGERY IN SPAIN
THE possibility of being called upon to treat airraid casualties is compelling civilian doctors to pay increasing attention to military surgery, and this gives an added interest to the lessons of the Spanish civil war. At one time some 200 international doctors, and 500 nurses, &c., were attached to the government forces and on Jan. 17 four of the British contingent recounted their experiences at B.M.A. House. The first speaker, Dr. R. S. Saxton, dealt with bloodtransfusion under field conditions. He strongly advocated the " ampoule under pressure " method, using stored citrated blood, as being the simplest and most rapid and the only one practicable where doctors are scarce. Dr. A. E. Tudor Hart discussed gunshot fractures. He stressed the highly infected nature of the wounds met with and urged the importance of early excision rather than reliance on antiseptics. In his experience the necessity for primary amputation was rare in the case of the upper limb but much commoner in the lower, where gas-gangrene was more likely to arise. Amputation was not required where there was damage to the bones alone, but where the femoral or popliteal vessels were also involved. Organisation was essential in the treatment of gunshot fractures, and since something like three-quarters of field casualties had injuries to the limbs there was considerable scope for " traumatological teams " with special training in fracture work. Dr. C. C. Bradsworth had been medical officer of the British battalion of the international brigade. He gave a vivid account of the hardships endured by the troops and a modest but none the less definite impression of what a regimental doctor can do to lessen suffering and preserve morale. Finally, Dr. D. Jolly spoke of the organisation of field hospitals. Successful results, he said, depend largely on efficient classification of the wounded. Field hospitals should be placed so that they were reasonably safe from shell fire and air bombing and so that evacuation from the front line was easy and rapid and there was the least possible delay between the wounding and the surgical intervention-time and not distance being the main consideration. If operations were done in tents great care was required in obscuring all lights. Buildings in villages, convents, churches, and large houses were liable to air attack and were not suitable for operating centres ; recently the surgeons in Spain had placed their theatres in underground shelters, natural caves, and railway tunnels. Hospital trains could also be run into tunnels and used as both theatres and hospitals. Although mobile surgical teams were invaluable, mobile operating theatres apart from those in trains were fantastic. As regards equipment
224 all time-saving devices were to be encouraged and for that reason multiple sets of instruments and two or three tables should be available for each surgeon. The problems that these surgeons have been facing with the Spanish army are no doubt only a part of those which would arise among civilians. Air-raid wounds are more severe and more likely to be multiple than those due to shell, rifle, or machine-gun fire, and the difficulties of collection and evacuation that loom large in all schemes for dealing with civilian casualties are comparatively negligible in purely military surgery.
offspring had reduced prostates, vasa deferentia, seminal vesicles and epididymes, and also vaginse similar to those of newborn females. One possible interpretation of these experiments is that cestrogenic hormone has a morphogenetic effect comparable with that of androgenic hormone.
INTERSEXUALITY
The Minister of Health has given notice of regula. tions under the Census Act to come into operation forthwith. This will enable the compilers of the National Register to use the ordinary machinery of the census.
INTERSEXUAL individuals are found in almost every group of mammals. The earliest detailed investigations of mammalian intersexuality were made on freemartins, the externally female twins of male calves. Freemartins have female external genitalia, but as a rule their gonads are of the male type,
though they do not produce spermatozoa. In 1916 was suggested in America by Lillie, and in Germany by Keller and Tandler, that freemartins are zygotic females which have been modified by hormone passing from their male twins through the united embryonic membranes. This suggestion has now been experimentally investigated and partially confirmed by Dantchakoff,l who showed that female guineapig embryos are transformed in a male direction if they are injected with testosterone propionate in utero. The modifications affect the external genitalia, as well as the development of the wolffian ducts, seminal vesicles, and prostates. The ovaries remain unchanged. it
Similar observations have been made on rats and mice. Thus Greene, Burrill, and Ivy,23 succeeded in masculinising female rat embryos by injecting male hormone into the mother during gestation. The external genitalia changed to the male type and wolffian organs appeared, while the uterus, oviducts, and the upper part of the vagina persisted. The fact that only the upper vagina persisted suggested to these investigators that the lower part is derived from the urogenital sinus, which developed in a male direction under the influence of male hormone. Raynaud,4whose experiments were similar to those of Greene and his associates, found that when male hormone is injected into mice eight days before parturition the female offspring have accessory reproductive organs of both the male and the female type, together with ovaries and male external organs. Both the mullerian and wolffian organs continue to develop after birth, whether or not more male hormone is injected. If such intersexual mice (but born of mothers injected three or four days before parturition) are allowed to grow up, their sexual behaviour is found to be normal, though they are necessarily infertile since they have no vaginal openings. On the other hand, if these modified females are injected with testosterone propionate, their behaviour becomes typically masculine, which suggests that sexual behaviour in mice may be largely under hormonic control. The reverse change-that is the experimental feminisation of male fcetuses-has been reported recently by Greene, Burrill, and Ivy,S who injected cestradiol dipropionate into pregnant rats on the 13th, 14th, or 15th day of pregnancy. The male 1 Dantchakoff, V., Bull. biol. 1937, 71, 269. Greene, R. R., and Ivy, A. C., Science, 1937, 86, 200. Greene, Burrill, M. W., and Ivy, Amer. J. Obstet. Gynec. 1938, 36, 1038. 4 Raynaud, A., Bull. biol. 1938, 72, 297. 5 Greene, Burrill, and Ivy, Science, 1938, 88, 130. 2
3
conference summoned at B.M.A. House on Feb. 15, will be addressed by the Minister of Health who will outline his plans for utilising medical personnel in case of emergency. A
Wednesday,
The Minister of Labour has appointed an advisory council to advise him on the utilisation in war-time of persons with scientific technical, professional, and higher administrative qualifications. Sir Walter Moberly is chairman of this committee and among its members are Dr. E. J. Butler, F.R.S., Mr. H. L. Eason, F.R.C.S., and Sir Edward Mellanby, F.R.C.P., F.R.S. The secretary of the council is Miss B. M. Power, who may be addressed at the national service department of the Ministry, Montagu House, S.W.l.
The Duke of Gloucester will be the principal at a dinner next Monday to be given by the Lord Mayor at the Mansion House in support of an appeal on behalf of St. Bartholomew’s Hospital.
guest It is
to raise
to provide a paying home, and adequate buildings for the X-ray department and for inpatients of the special departments. On Tuesday, Feb. 7, the Society for the Protection of Science and Learning will inaugurate a national appeal at a conversazione which the Royal Society is holding at Burlington House, Piccadilly, London, W.1, at 8.30 P.M. The president of the Royal Society and the president of the British Academy will receive the guests. Croydon corporation has decided to take no disciplinary action against any officer or servant in connexion with the recent outbreak of typhoid. The corporation is also seeking power to pay compensation even in cases of hardship in which actions have not been brought, provided the issues are the The corporation has same as in the test case. reached an agreement with the Metropolitan Water Board to take over the whole of the supply of water
proposed
patients’ block,
to the
a new
65,000 nurses’
borough.
"... We have make it hard for
our us
personal likes and dislikes that assess impartially the scientific
to
contributions of our fellow workers. Often these emotional aberrations take the still more irrational form of liking or disliking large groups of people whom we don’t know but about whom we imagine things. Who among us maintains a strictly scientific attitude towards what is called the race issue, either in the form that is acute in Germany or in the form that is acute in the United States ? To be more offensively personal, is there any one so free from vanity that he can be strictly scientific about critical appraisals of his own work ? And on a higher level, are not most of us conscious of an unreasoned predilection for certain types of scientific inquiry balanced by an equally unreasoned tendency to depreciate the value of other types ? "-WESLEY C. MITCHELL, Science, Jan. 6, 1939, p. 4.
production (as in Hungary and France), sympathetic tariff or transport policy, and better
cultural
distribution. The Esthonian government have reduced
the duties on fresh fruit, and the government of India the duty on dried skim-milk. The Latvian ministry of agriculture has organised the state transport of fish to inland settlers, and the Queensland government charge no freight on fruit or vegetables going to outlying districts more than 200 miles away. In this country the Food Council has suggested The measures for rationalising the retailing of milk. Scandinavian countries and America have considered the merits of " internal dumping," or distributing milk and other foods at reduced prices in their own territory, as against spending large sums to enable foreign buyers to obtain cheap supplies of foodstuffs which their own populations badly need. Education and publicity have been found to accomplish much, and some countries, particularly Belgium, have made good progress in this direction. The Yugoslav government have opened numerous schools to teach peasants how to manage their households and their farms, take care of children, cook and prepare provisions for the winter. Hygiene talks are broadcast every week from Baghdad, but the difficulties of propaganda in an illiterate country are very great. The whole report brings home to the reader the great value of an energetic international body of this kind. HYPERTONIC INTRAVENOUS SALINE THAT the injection of strong salt solutions into a vein is not without danger is shown by Robertson and Barrett.’ Although an injection of 30 per cent. sodium chloride may raise the blood-volume of cats to double what it was before, this effect is only transient and the original level is regained in halff an hour. A less desirable result is haemolysis of red cells, which the investigators found sufficient to interfere with the vital-red method of blood-volume estimation, a similar effect being obtained in man. Other sequels to the infusion include crenation of the red cells with consequent reduction of the red-cell volume, and later an increase in the red-cell volume through mobilisation of the cells from the depots. This increase could be prevented by previous evisceration of the cats and exclusion of the liver from the circulation. Robertson and Barrett’s experiments provide a further demonstration of the great care necessary in reading the results of blood-volume estimations after intravenous infusions. SOCIAL FACTORS IN DISEASE
No general practitioner needs to be told that a large proportion of organic diseases have their origin in the patient’s environment, or that the degree of disability and suffering produced by an organic disease varies largely with the patient’s social conditions. In hospital patients, however, these facts are liable to be lost sight of and Dr. G. Canby Robinson2 of Johns Hopkins Hospital is doing a valuable service in setting them on a firmer basis. He has made an intimate personal study of the relation between clinical findings and social conditions in 145 patients of mixed nationality and sex, chosen more or less at random from the wards and outpatient departments. After complete physical investigation each patient was interviewed by Dr. Robinson himself and an 1 Robertson, J. D., and Barrett, J. F., Quart. J. exp. Physiol. December, 1938, p. 405. 2 Robinson, G. C., Trans. Ass. Amer. Phys. 1938, 53, 102.
attempt
was
made to divide the
symptoms
into those
by organic disease and those of emotional Either Dr. Robinson or the or psychogenic origin. social worker who collaborated with him subsequently visited 111 of the 145 patients in their homes. In caused
two-thirds of the total adverse social conditions were found to be directly related to the patient’s illness, and in more than a third they were considered its main precipitating cause. It should perhaps be added that 45 patients were found to be suffering from psychoneuroses or symptoms that could not be explained on the basis of demonstrable disease. Dr. Robinson’s study however is evidence that many of the symptoms even of organic disease can be traced back to emotional disturbances associated with home or other environmental difficulties, and he pleads for systematic study of this relation. WAR SURGERY IN SPAIN
THE possibility of being called upon to treat airraid casualties is compelling civilian doctors to pay increasing attention to military surgery, and this gives an added interest to the lessons of the Spanish civil war. At one time some 200 international doctors, and 500 nurses, &c., were attached to the government forces and on Jan. 17 four of the British contingent recounted their experiences at B.M.A. House. The first speaker, Dr. R. S. Saxton, dealt with bloodtransfusion under field conditions. He strongly advocated the " ampoule under pressure " method, using stored citrated blood, as being the simplest and most rapid and the only one practicable where doctors are scarce. Dr. A. E. Tudor Hart discussed gunshot fractures. He stressed the highly infected nature of the wounds met with and urged the importance of early excision rather than reliance on antiseptics. In his experience the necessity for primary amputation was rare in the case of the upper limb but much commoner in the lower, where gas-gangrene was more likely to arise. Amputation was not required where there was damage to the bones alone, but where the femoral or popliteal vessels were also involved. Organisation was essential in the treatment of gunshot fractures, and since something like three-quarters of field casualties had injuries to the limbs there was considerable scope for " traumatological teams " with special training in fracture work. Dr. C. C. Bradsworth had been medical officer of the British battalion of the international brigade. He gave a vivid account of the hardships endured by the troops and a modest but none the less definite impression of what a regimental doctor can do to lessen suffering and preserve morale. Finally, Dr. D. Jolly spoke of the organisation of field hospitals. Successful results, he said, depend largely on efficient classification of the wounded. Field hospitals should be placed so that they were reasonably safe from shell fire and air bombing and so that evacuation from the front line was easy and rapid and there was the least possible delay between the wounding and the surgical intervention-time and not distance being the main consideration. If operations were done in tents great care was required in obscuring all lights. Buildings in villages, convents, churches, and large houses were liable to air attack and were not suitable for operating centres ; recently the surgeons in Spain had placed their theatres in underground shelters, natural caves, and railway tunnels. Hospital trains could also be run into tunnels and used as both theatres and hospitals. Although mobile surgical teams were invaluable, mobile operating theatres apart from those in trains were fantastic. As regards equipment
224 all time-saving devices were to be encouraged and for that reason multiple sets of instruments and two or three tables should be available for each surgeon. The problems that these surgeons have been facing with the Spanish army are no doubt only a part of those which would arise among civilians. Air-raid wounds are more severe and more likely to be multiple than those due to shell, rifle, or machine-gun fire, and the difficulties of collection and evacuation that loom large in all schemes for dealing with civilian casualties are comparatively negligible in purely military surgery.
offspring had reduced prostates, vasa deferentia, seminal vesicles and epididymes, and also vaginse similar to those of newborn females. One possible interpretation of these experiments is that cestrogenic hormone has a morphogenetic effect comparable with that of androgenic hormone.
INTERSEXUALITY
The Minister of Health has given notice of regula. tions under the Census Act to come into operation forthwith. This will enable the compilers of the National Register to use the ordinary machinery of the census.
INTERSEXUAL individuals are found in almost every group of mammals. The earliest detailed investigations of mammalian intersexuality were made on freemartins, the externally female twins of male calves. Freemartins have female external genitalia, but as a rule their gonads are of the male type,
though they do not produce spermatozoa. In 1916 was suggested in America by Lillie, and in Germany by Keller and Tandler, that freemartins are zygotic females which have been modified by hormone passing from their male twins through the united embryonic membranes. This suggestion has now been experimentally investigated and partially confirmed by Dantchakoff,l who showed that female guineapig embryos are transformed in a male direction if they are injected with testosterone propionate in utero. The modifications affect the external genitalia, as well as the development of the wolffian ducts, seminal vesicles, and prostates. The ovaries remain unchanged. it
Similar observations have been made on rats and mice. Thus Greene, Burrill, and Ivy,23 succeeded in masculinising female rat embryos by injecting male hormone into the mother during gestation. The external genitalia changed to the male type and wolffian organs appeared, while the uterus, oviducts, and the upper part of the vagina persisted. The fact that only the upper vagina persisted suggested to these investigators that the lower part is derived from the urogenital sinus, which developed in a male direction under the influence of male hormone. Raynaud,4whose experiments were similar to those of Greene and his associates, found that when male hormone is injected into mice eight days before parturition the female offspring have accessory reproductive organs of both the male and the female type, together with ovaries and male external organs. Both the mullerian and wolffian organs continue to develop after birth, whether or not more male hormone is injected. If such intersexual mice (but born of mothers injected three or four days before parturition) are allowed to grow up, their sexual behaviour is found to be normal, though they are necessarily infertile since they have no vaginal openings. On the other hand, if these modified females are injected with testosterone propionate, their behaviour becomes typically masculine, which suggests that sexual behaviour in mice may be largely under hormonic control. The reverse change-that is the experimental feminisation of male fcetuses-has been reported recently by Greene, Burrill, and Ivy,S who injected cestradiol dipropionate into pregnant rats on the 13th, 14th, or 15th day of pregnancy. The male 1 Dantchakoff, V., Bull. biol. 1937, 71, 269. Greene, R. R., and Ivy, A. C., Science, 1937, 86, 200. Greene, Burrill, M. W., and Ivy, Amer. J. Obstet. Gynec. 1938, 36, 1038. 4 Raynaud, A., Bull. biol. 1938, 72, 297. 5 Greene, Burrill, and Ivy, Science, 1938, 88, 130. 2
3
conference summoned at B.M.A. House on Feb. 15, will be addressed by the Minister of Health who will outline his plans for utilising medical personnel in case of emergency. A
Wednesday,
The Minister of Labour has appointed an advisory council to advise him on the utilisation in war-time of persons with scientific technical, professional, and higher administrative qualifications. Sir Walter Moberly is chairman of this committee and among its members are Dr. E. J. Butler, F.R.S., Mr. H. L. Eason, F.R.C.S., and Sir Edward Mellanby, F.R.C.P., F.R.S. The secretary of the council is Miss B. M. Power, who may be addressed at the national service department of the Ministry, Montagu House, S.W.l.
The Duke of Gloucester will be the principal at a dinner next Monday to be given by the Lord Mayor at the Mansion House in support of an appeal on behalf of St. Bartholomew’s Hospital.
guest It is
to raise
to provide a paying home, and adequate buildings for the X-ray department and for inpatients of the special departments. On Tuesday, Feb. 7, the Society for the Protection of Science and Learning will inaugurate a national appeal at a conversazione which the Royal Society is holding at Burlington House, Piccadilly, London, W.1, at 8.30 P.M. The president of the Royal Society and the president of the British Academy will receive the guests. Croydon corporation has decided to take no disciplinary action against any officer or servant in connexion with the recent outbreak of typhoid. The corporation is also seeking power to pay compensation even in cases of hardship in which actions have not been brought, provided the issues are the The corporation has same as in the test case. reached an agreement with the Metropolitan Water Board to take over the whole of the supply of water
proposed
patients’ block,
to the
a new
65,000 nurses’
borough.
"... We have make it hard for
our us
personal likes and dislikes that assess impartially the scientific
to
contributions of our fellow workers. Often these emotional aberrations take the still more irrational form of liking or disliking large groups of people whom we don’t know but about whom we imagine things. Who among us maintains a strictly scientific attitude towards what is called the race issue, either in the form that is acute in Germany or in the form that is acute in the United States ? To be more offensively personal, is there any one so free from vanity that he can be strictly scientific about critical appraisals of his own work ? And on a higher level, are not most of us conscious of an unreasoned predilection for certain types of scientific inquiry balanced by an equally unreasoned tendency to depreciate the value of other types ? "-WESLEY C. MITCHELL, Science, Jan. 6, 1939, p. 4.