GASTRIC UREASE AND PEPTIC ULCER

GASTRIC UREASE AND PEPTIC ULCER

1044 several hours. It was perhaps a pity that C10 was put on the market soon after its first clinical tests. The anaesthetics committee of the Medica...

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1044 several hours. It was perhaps a pity that C10 was put on the market soon after its first clinical tests. The anaesthetics committee of the Medical Research Council and Royal Society of Medicine had arranged for a large-scale clinical trial, but only an interim report 14 was published. Much more experience will be needed before its place in anaesthesia can be fully assessed.

Annotations UNIVERSITY STUDENTS IF the science of human ecology is to justify its name, may expect increasing attention to be paid to the relation between different groups within society, and in particular to the ways in which such groups become differentiated and maintain themselves. University students are a group of almost boundless interest to the sociologist, since they are highly diverse in both origin and destination, respecting neither social, economic, nor geographical boundaries ; and yet within this diversity they show clearly some of the main trends of social development at the present time. The Universities’ Group of P.E.P.15 have investigated the origins of students at six university institutions. The principal change in recent years has, of course, been in the direction of more equal representation at the university of students from different economic levels ; but the stage which this process has reached varies widely between different universities. Information on this point was collected from four universities. According . to the P.E.P. figures, the proportion of sons of manual workers rises from 7-7% at one of the two ancient universities (Camford) to 28.8% at a college of the University of Wales, with intermediate percentages at two modern English universities. For comparison, the proportion of manual workers in the employed population generally is given as z 1 % . Professional and administrative workers, who comprise 9.3% of the employed population, account for 66% of Camford students and 44-2%, 27-3%, and 25.8% of students at the other three institutions. Women students are found to come from slightly higher social and economic strata than the men. Educational statistics show a similar gradient, ranging from Camford, where of the students come from fee-paying schools, to a college of the University of Wales with 6%. During the last twenty years the number of overseas students has risen only slightly, and their proportion has actually fallen. The most notable change is in the institutions they attend ; the red-brick universities now attract their full share, and in consequence Oxford and Cambridge, London, and Edinburghtraditional goals of Commonwealth and foreign studentstake rather fewer than they did twenty years ago. United Kingdom students, it is found, have become more peripatetic ; about 40% of men come from homes more than thirty miles away from the university-though this radius obviously has a very different significance in London and in Oxford or Cambridge (where the proportion is over 90%). Most of the trends shown in this report conform with expectation. No more is claimed by the authors than that they are giving " some degree of statistical precision to what had been before only general impressions " ; and they have been careful not to confuse testimony as to fact with political advocacy. The importance of this type of social accountancy is that it enables discussion of future policy to start from a basis of agreed we

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knowledge. 14. Organe, G. Ibid, 1949, i, 773. 15. University Students: a Pilot Survey. Political and Economic Planning, 16, Queen Anne’s Gate, London, S.W.1.

CANCER OF THE UTERINE CERVIX CANCER of the uterine cervix comes second to cancer of the breast as a cause of death in women, yet it is probably the most curable of the major cancers. It is often said that the first step towards better results is more prompt diagnosis by the general practitioner; but Harnett,! describing a five-year follow-up of 955 cases, shows that the patient herself, and not the doctor, is responsible for most of the delay. Only 45-5% of patients consulted their doctors within three months of noticing the first symptom, which was usually vaginal haemorrhage ; but 79-1% of all patients were referred to hospital at the time of their first visit to the doctor. Among 55 cases in stages i and 11 treated by Wertheim’s hysterectomy the five-year survival-rate was 52,7%, while among 221 in stages i and 11 treated with radium alone the survival-rate was 40.7%. These samples, however, are not comparable. Of the cases treated surgically, 34 were in stage i and 21 in stage 11 (a ratio of roughly 3 to 2) ; while of those treated with radium alone 87 were in stage i and 134 in stage II-almost a reversal of the proportion. The survival-rate for all cases, treated by any method, was 27-7% at five years. This account, which refers to cases seen in London hospitals during 1938 and 1939, may be compared with a report from Stockholm,2 which shows that the crude survival-rate among 7675 cases of cancer of the cervix treated by radiotherapy in ten contributing hospitals between 1936 and 1941 was 37-8%. Clearly during the last twenty years radiotherapy has improved the prognosis of this form of cancer. The Cancer Act of 1939 included provision for complete registration of cancer, one of the objects being the statistical comparison of methods of treatment. This part of the Act still stands, and one or two regions have started complete registration. Is it too much to ask that registration should now be extended to the whole country ?‘ GASTRIC UREASE AND PEPTIC ULCER THE work of Fitzgerald and Murphy3 on the distribution and function of the enzyme urease may throw some light on the pathology of peptic ulceration. This enzyme, which splits urea into ammonia and carbon dioxide, has been found in the gastric mucosa of several species of animals, and its concentration in the mucosa can be increased by feeding with extra protein or with urea. Fitzgerald and Murphy suggest that the ammonia formed by the urease may have an intramucosal neutralising action, thus protecting the stomach from digestion by its own acid. This idea seems to be supported by their finding the urease particularly in association with the acidproducing parietal cells. It was also present in the floor of an ulcer. Fitzgerald and Murphy demonstrated in man that raising the blood-urea by giving urea by mouth reduced the amount of acid and increased the amount of ammonia in the gastric contents after the injection of histamine ; the amount of ammonium ion present did not completely cover the reduction in the amount of acid. Since the total chloride secreted did not fall, it is clear that they were dealing with neutralisation and not with suppression of secretion. The mechanism is a potentially powerful one, for the OH ions derived from 300 mg. of urea could neutralise 100 ml. of JV/10 acid. Consideration of gastric blood-flow suggests that an arteriovenous difference in the concentration of urea of only 2-3 mg. per 100 ml. would supply enough urea to neutralise 100 ml. of Njl0 acid per hour in man. The neutralisation of gastric acid by gastric urease suggested that the administration of urea might be useful 1. Harnett, W. L. Brit. J. Cancer, 1949, 3, 433. 2. Fifth Volume of Annual Reports on the Results of Radiotherapy in Cancer of the Uterine Cervix : Statement of Results Obtained in 1941 and Previous Years. Ed. by J. Heyman. Stockholm, 1949. 3. Fitzgerald, O., Murphy, P. Lancet, 1949, ii, 1108; Irish J. med. Sci. March, 1950, p. 97.

1045 in the treatment of peptic ulcer. So far Fitzgerald and Murphy have treated 62 cases with 15 g. of urea four to eight times daily, their object being to raise the bloodurea to 60-80 mg. per 100 ml. for periods up to six months. Bearing in mind that many of their cases had already proved refractory to other treatment, their results seem encouraging, particularly in patients with anastomotic ulcers. But they add that the urea is unpalatable, frequent doses have to be taken, and the blood-urea levels must be watched. MEDICINE IN 1850 Dr. Ashworth Underwood, curator of the Wellcome Historical Museum, has got more rare and curious things to show than he has space to show them. The museum is now housed at 28, Portman Square, London, in a .house of charm and character ; but the galleries are not big enough to allow of any large permanent display. He is therefore arranging a series of small exhibitions, of which that on the history of the microscope has now been open for some time. However annoying this system may be for foreign doctors (who often arrive anxious to see some special treasure of which they have heard, only to find it is not for the moment on view), it has the merit of bringing various aspects of medical history under detailed review, thus enabling the regular visitor to study them more precisely and even enjoy some agreeable trifles which might otherwise never have seen the light. On May 30 a pleasing exhibition on " Medicine in 1850 " was opened by Prof. Henry Sigerist, whose visit to this country is a momentous event for all his fellow medical historians. One of a curator’s excitements is that of making unexpected finds among his own material. Dr. Underwood has had the pleasure of discovering a hitherto undescribed portrait of Liebig-a fine and lively piece of worksigned and dated by Wilhelm Trautschold. This, of course, has a place of honour in the new exhibition ; and a drawing, by the same artist, of Liebig’s laboratory The exhibition is at Giesson, in 1842, is also on view. arranged under subjects, beginning with physics (one of the original electrical piles made by Volta is there) and ranging through chemistry, biology, anatomy, physiology, and pathology to medicine and surgery. One thing strikes home from many of the well-planned cases : how little importance we now attach to style and finish Here are early microscope slides in our equipment. beautifully mounted in scarlet and gilt paper; shells and insects, prepared for microscopy on little ivory discs, as attractive as the pieces of a mah-jongg set; Galvani’s insulator of twisted Venetian glass like a sugar-stick; rubber as it first reached us in the form of decorated bags or pouches to which wooden nozzles were fitted to make syringes ; the endless varieties of early stethoscope, in this wood or that wood, gracefully shaped, lovingly polished; the beautiful teaching model of the ear and all its parts carved in ivory; the elaborate papier-mache brain which shows relations as no diagram could ever do; and plate after lovely plate of coloured diagrams and drawings-the infusoria from Ehrenberg’s Atlas, the open pages of Cruveilhier’s Anatomic pathologique du Corps Humain and Carswell’s Pathological Anatomy, and the engravings printed in colour which Richard Say did from Bright’s own preparations. To see these things is to long for the return of leisured craftsmanship. But the exhibition shows too how far modern technique has been able to carry some early pieces of ingenuity. Here are the first photomicrographs - daguerreotypes taken in 1844 by Leon Foucauld, working with Alfred Donne. There was no known method of reproducing the daguerreotypes, so engravings were made from them, and published in 1845. Then there are the thermometers-shrinking from massive and bent forms to the first self-registering form, with an air-speck which could be lost for ever by too resolute a shaking-

down, and then to Clifford Allbutt’s short thermometer, kin to the modern type. The sphygmograph and laryngoscope, too, have had interesting stories. Blood-transfusion, first tried in the 17th century, and demonstrated to Pepys and others at the Royal Society, slept forgotten for over a hundred years, and was revivedin the early 19th century with a deal of apparatus ; its history is well told here. The development of the hypodermic needle has its place too-and a teasing problem it was for those who had to solve it. This exhibition will have as much charm for laymen as for doctors, and fortunately it has been thrown open to them as well as to the profession. Until further notice it will be on view on every weekday, Saturdays included, near

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DELAYED EFFECTS OF RADIATION IT is a disquieting fact for the radiologist, and particularly for the radiotherapist, that doses of the ionising radiations sometimes give rise to long-delayed reactions which are usually serious. One could find no better illustration of the essential difference between the reactions of ordinary chemical or physical mediaand those of -the living cell. Living structures do not react quantitatively to X rays and radium or neutrons, they react specifically ; when exposed to radiations they may seem completely unaffected, and yet in time, perhaps This is after several years, a reaction may appear. of human lens the late the reaction reported typified by in two different groups of ten people, the first being victims of the atom-bomb explosions in Japan,1 and the second scientists working on the cyclotron.2 Here the late reaction consisted in changes in the posterior cortex of the lens, tendirig in severe cases to produce complete opacity. In the first group the latent periods before visual symptoms appeared ranged from 6 months to 21/2 years. In the second group the severe effects (in 3 patients) did not develop fully until about 3 years after exposure to the radiation. These cyclotron’ workers had never been exposed to more than a " safe dose " of neutron and y radiation, but it was continued for some years ; the cumulative doses they received were estimated at about 50n. Perhaps the nervous strain that these people were subjected to was a contributory factor. Another kind of delayed effect may follow irradiation with radium or X rays for the control of uterine haemorrhage if pregnancy occurs after this treatment. Giles 3 reported two such cases in which radium had been used before conception. In both of these the pregnancy ended in abortion, but Giles referred to the low abortionrate claimedby D. P. Murphy in similar cases. Apparently no systematic study has yet been made of the children born of such parentage, but no-one would suppose that the considerable dose of radium commonly given for these uterine conditions could leave normal ovaries and uterus. Giles urged that if radium treatment is the method of choice the dose should be large enough to ensure an artificial menopause. Looking still further down the time-scale, H. J. Muller and Frank Ellis have both drawn attention to the danger that lies ahead for future generations if their forebears now living are unduly exposed to radiation ; for the gene mutations so caused may be passed down from generation to generation. This danger is limited by the fact that damaged genes are recessive, and a total dose of some 300r would be required to double the natural rate of Few radiation workers are spontaneous mutation. to receive more than 20r in ten years.4 But men likely and women doing work which exposes them to larger doses should perhaps find their life partners in other professions. Cogan, D. G., Martin, S. F., Kimura, S. J. 654. 2. Abelson, P. H., Kruger, P. G. Ibid, p. 655. 3. Giles, A. M. J. Obstet. Gynœc. 1949, 56, 1041. 4. Evans, R. D. Brit. J. Radiol. 1950, 23, 175. 1.

Science, 1949, 110,