574

namely, that " where tuberculosis campaigns remainweak, it is in the field of prevention that the greatestresults are to be expected."The authors show that the fall in chijdhood

mortality from tuberculosis has been as great, or greater,in communities relying on prevention of infection withoutthe use of B.C.G. as in countries using B.C.G. to supplementother measures. They therefore doubt the wisdom ofusing B.c.G. alone as a control measure, without the aidof established methods of preventing infection. Manypeople in this country are just as doubtful, though fewof them would question the safety of B.c.G. inoculation,even under adverse environmental conditions.

1. Stevenson, H. J. R., Bolduan, O. E. A. Science, 1952, 116, 111.2. Darrow, P. C., Pratt, E. L. J. Amer. med. Ass. 1950, 143, 365,

432.3. Cooke, R. E., Crowley, L. G. N ew Engl. J. Med. 1952, 246, 637.

INFRA-RED SPECTROPHOTOMETRY OF BACTERIA

Stevenson and Bolduan 1 have lately described the useof infra-red spectrophotometry to identify bacteria. Themethod appears to be fairly simple. Dried films are

prepared from a few colonies of the test organism, whichare spread over the surface of a silver chloride plate.The spectra are then recorded on an infra-red spectro-photometer, differentiation depending on qualitativedifferences in the shapes of the absorption bands. Spectraof almost all organisms have the same major absorptionbands, but Stevenson and Bolduan claim that variationsin their relative intensity and the presence of minor

absorption bands are consistent enough for the organismsstudied to be identified. One disadvantage is the need forcareful control of conditions known to affect the chemicalcomposition of the organisms-culture-medium, age ofculture, and temperature of incubation. Another dis-

advantage is that very dissimilar organisms show onlyslender differences by this technique.

It is difficult to picture any practical application ofthis work, but Stevenson and Bolduan have at any rateadded another cell to the body of abstract knowledge.

ELECTROLYTE REPLACEMENT SOLUTIONS

REPLACEMENT of fluid losses from the gastro-intestinaltract has always been a difficulty in surgical wards ;" saline " or " glucose saline " used to be the standby,but results were not always satisfactory. Lately moreattention has been paid to potassium loss ; and manydifferent replacement solutions have been used. Givena medical staff familiar with the metabolic problem,and suitable laboratory facilities, the amount of variouselectrolytes can be worked out individually for each

patient.2 Something simpler than this, however, isneeded in the majority of hospitals, and Cooke and

Crowley 3 have attempted to give a practical answer.The basis of this is that with losses from above the

pylorus, by vomiting or gastric suction, an acid fluidwith chloride ions in excess of the bases is lost by thebody ; whereas with loss of biliary or pancreatic juiceor by intubation of the intestine an alkaline fluid, withbase in excess of chloride, is removed.They suggest two replacement solutions : (1) a

’ gastric " solution containing 17 ï m.eq. per litre of

potassium. 63 rm.eq. per litre of sodium, and 150 m.eq.per litre of chlorides (the excess 70 m.eq. of chlorides beingneutralised with ammonium) ; and (2) an " intestinal "one containing 12 m.eq. per litre of potassium, 138 m.eq.per litre of sodium, 100 m.eq. per litre of chlorides, andexcess 50 m.eq. of base neutralised with lactate. Thefixed ion content of these two solutions is very nearto that of the fluids they are to replace, and the.. allllllOlliulll" and" lactate" are, of course, rapidlymetabolised. Cooke and Crowley claim that up to

15 ml. per 1t1. body-weight per hour of the ’‘

gastric"fluid can be given without accumulation of ammoniumions. If the appropriate solution is given in volume

equivalent to the fluid lost, there should be no significantchange in electrolyte composition of the body, and thetables in the paper bear this out. The solutions areisotonic and can be given intravenously, or hypodermicallyif preferred. Although these are described only as replace-ment solutions, and do not allow for complete mainten-ance and electrolyte repair, they should make life easierfor the smaller hospital.

1. Freyberg, R. H., Patterson, M., Adams, C. H., Durivage, J.,Traeger, C. H. Ann. rheum. Dis. 1951, 10, 1.

2. Gordon, E. S., Kelsey, C., Meyer, E. S. Proceeding of thesecond Clinical A.C.T.H. Conference. Philadelphia, 1951:vol. II, p. 30.

3. Renold, A. E., Jenkins. D., Forsham, P. H., Thorn, G. W.J. clin. Endocrinol. 1952, 12, 763.

4. Dixon, A. S. Lancet, 1951, ii, 593.5. Wolfson, W. Q., Fajans, S. S. New Engl. J. Med. 1952, 246, 1000.

LONG-ACTING A.C.T.H.

MANY modern drugs share the disadvantage that, foroptimal effect, they must be given parenterally. This,with the increasing necessity for control of therapy byblood tests, means that more and more patients receiveneedle pricks. The judicious use of oral penicillin hasdone something to check this undesirable trend ; andwith cortisone the expectation that administration bymouth would be effective has been largely realised.Adrenocorticotropic hormone, however, with its proteinnature is unlikely to survive ingestion ; and con-

sequently efforts have been directed at prolonging theaction of each parenteral dose. Experience with A.c.T.H.by intravenous injection has shown that this method isnot only clinically effective 2 but strikingly economical;indeed, Renold et al.,3 using recognised criteria ofadrenal cortical activation, obtained evidence relatingthe significant effect of a small fixed dose of A.c.T.H. tothe period during which it was continuously infused.Among the disadvantages of the intravenous route

are long immobilisation of the patient, and the possibilityof anaphylactoid or hypersensitivity reactions-althoughthe risk of such reactions may have been overestimated"

Long-acting A.C.T.H., given subcutaneously, may wellovercome these disadvantages. At present the mosteffective preparation is aluminium-phosphate-absorbedA.C.T.H. suspended in polyvinyl pyrrolidone. Earlier

preparations of this sort caused considerable localirritation ; but it is now claimed that this is obviated bythe addition of 0-5% phenol. Wolfson and Fajans 5gave such a preparation in single subcutaneous doses(containing 100 mg. A.c.T.H. in 5 ml. of vehicle) to 68people, and found that 75% of them had a significantresidual eosinopenia after 24 hours ; A.c.T.H. in gelatinand A.c.T.H. in peanut-oil were less effective. The realvalue of long-acting A.c.T.H. must be judged by itsclinical effects ; and these have been promising, ifsomewhat variable. Economy is greatest if the long-acting preparation is given 6-hourly. Alternatively, theinjections may be reduced to one daily : but then thedose required is the sum of the four doses ordinafilvgiven in the 24 hours. Economy of both dosage andinjections does not seem possible at present.

Sir RICHARD GREGORY, F.R.S., who died on Sept. 15at the age of 88, was associated with Nature for almosthalf a century. His editorship, which lasted for twentyyears, was an effective contribution to science andeducation.

On Sept. 15, Mr. Iamr MACLEOD, the Minister ofHealth, attended the opening session of the secondInternational Congress of Internal Medicine, which hasbeen held in London this week.

THE INDEX and title-page to Vol. I, 1952, which wascompleted with THE LANCET of June 28, is publishedwith our present issue. A copy will be sent gratis tosubscribers on receipt of a postcard addressed to theManager of THE LAXCET, 7, Adam Street, Adelphi, W.C.2.Subsetibers who have not already indicated their desiret receive indexes regularly as published should do so now.