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NOTES, COMMENTS, AND ABSTRACTS

ADVERTISING VITAMINS

IN June, 1931, a conference of experts, sitting inLondon under the chairmanship of Prof. E. Mellanby,made some recommendations for standardising thevitamins which the state of knowledge then justified.It was agreed for instance at this conference toaccept carotene as a provisional international standardof reference for vitamin A, and to hold a selectedsample of cod-liver oil as a possible secondary stan-dard ; to adopt a solution of irradiated ergosterolas the standard for vitamin D ; for vitamin B touse the adsorption product of the medical laboratoryat Batavia (Java ) ; for vitamin C the fresh juice ofthe lemon.

Since that time the United States Pharmacopoeiahas adopted these units for A and D, and althoughthe standards are provisional they do form, as Prof.J. C. Drummond pointed out in our correspondencecolumns a fortnight ago, some sort of base line uponwhich to correlate the results of assays made indifferent laboratories. In his letter Prof. Drummondasked that statements regarding the vitamin potencyof preparations should be expressed in terms of theseprovisional international units, and he deprecatedspecially such vague claims as that a product is richin vitamins. The correspondence which Prof. Drum-mond’s letter has provoked shows how timely washis intervention.

It will interest readers to learn that the Swissauthorities have taken action in this direction, asmay be read in detail in Chemistry and Industry forJan. 19th (page 53). Switzerland, it is there remarked,has always had somewhat stringent food regulationsand, perhaps we may add, with some reason, forSwitzerland has always been the happy huntingground of cranks and quacks of all kinds. Threeyears ago the Federal Service of Public Hygiene madeit illegal to issue statements about the vitamincontent of foods without a certificate from a recog-nised authority that the vitamin content had beennotably increased by additions or by special treat-ment. The restrictions were good as far as theywent, but did not give sufficient guidance to theCantonal inspecting authorities, and these have nowbeen armed with detailed instructions drawn up bythe Federal Service with the assistance of universityphysiological institutes at Basle and Lausanne.When permission has been given for a product to

indicate a particularly high content of some vitaminit would be permissible to indicate generally in theadvertising matter that vitamins are essential for arational diet, especially for infants, and that amongthe substances known as vitamins the following havebeen recognised as indispensable for man-viz., theanti-xerophthalmic vitamin A, the anti-beriberivitamin B1, the anti-pellagra vitamin B2, the anti-scorbutic vitamin C, and the anti-rachitic vitamin D.But the text of the advertisement must not give theimpression that the product contains other vitaminsthan those mentioned in the authorisation, and inregard to each several vitamin the limit of what itis permissible to state is expressly set out. Forinstance, if a particularly high content of vitamin Ahas been certificated it may be mentioned that thisvitamin is necessary for normal growth of the body,and that its absence lessens the resistance of theorganism to infections. Packings and literature mustalways give accurate statements of the vitamincontent in the foodstuffs, and the figures must bethose of the official analysis ; but it is forbidden toreproduce or mention recommendations or certifi-cates, even if they have been provided by experts.

In cases of a rational combination of differentvitamins it is permissible to mention each of themas well as their action even if their presence has

only been confirmed in moderate quantity but ifin a food product the simultaneous presence of twovitamins has been stated, one in considerable andthe other in unimportant quantity, the second may

not be mentioned without expressly specifying theinsufficiency of its quantity.

Although these instructions are approved they donot come into force until July 1st, giving thoseconcerned time to dispose of advertising materialwhich no longer conforms to them.

CHOLECYSTO-TYPHOIDTHE occurrence of acute cholecystitis at the height

of an attack of typhoid fever-especially in the thirdor fourth week-and also in convalescence is wellknown, but it is very unusual to encounter thiscomplication at the onset. P. H. Hillemand, J. Mezard,and G. Valensi (Paris Med., Jan. 13th, p. 47) recordexamples of this rare event in a woman aged 42 anda boy aged 14. In both cases the first symptoms toattract attention were pain and tenderness over thegall-bladder, resistance of the abdominal wall onpalpation of the area, and the presence of a tenderpyriform swelling below the margin of the loin, whilethe characteristic symptoms of typhoid fever did not

appear until later. Both patients developedmyocarditis but otherwise made an uncomplicatedrecovery. Similar cases of pretyphoid cholecystitiswere recorded by Worms and Hamant in 1912, Rogerand Collard in 1915, and Fournier, Bertolini, Alvarez,and Gath in 1928. These five cases justify theisolation of an atypical form of onset of typhoid feverwhich may be called cholecysto-typhoid on theanalogy of pneumo-typhoid, meningo -typhoid, orartbro-typhoid. Clinically there is nothing to suggest thetrue nature of pretyphoid cholecystitis. In four ofthe recorded cases, including those of Hillemand andhis colleagues, the diagnosis was not established untilafter the appearance of rose spots as the result ofblood culture. Fournier and his collaborators howeveremphasise the diagnostic importance of early epistaxisand the value of leucopenia occurring in acutecholecystitis.

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INFECTIOUS DISEASEIN ENGLAND AND WALES DURING THE WEEK ENDED

JAN. 13TH, 1934

Notifications.—The following cases of infectiousdisease were notified during the week : Small-pox, 13(last week 3) ; scarlet fever, 3290 ; diphtheria, 1256enteric fever, 15 ; acute pneumonia (primary or

influenzal), 1867 ; puerperal fever, 61 ; puerperalpyrexia, 135 ; cerebro-spinal fever, 34 ; acutepoliomyelitis, 8 ; acute polio-encephalitis, 1 ; encepha-litis lethargica, 8 ; dysentery, 23 ; ophthalmianeonatorum, 96. No case of cholera, plague, ortyphus fever was notified during the week.The number of cases in the Infectious Hospitals of the

London County Council on Jan. 16th-17th was as follows:Small-pox, 20 under treatment ; 2 under observation (lastweek 14 and 0 respectively) ; scarlet fever, 2569 ; diphtheria,2071 ; enteric fever, 7 ; measles, 997 ; whooping-cough, 239 ;puerperal fever, 19 mothers (plus 11 babies) ; encephalitislethargica, 260 ; poliomyelitis, 5 " other diseases," 242. AtSt. Margaret’s Hospital there were 20 babies (plus 10 mothers)with ophthalmia neonatorum.

Deaths.-In 118 great towns, including London,there was no death from small-pox, 1 (0) from entericfever, 49 (14) from measles, 18 (4) from scarlet fever,15 (3) from whooping-cough, 37 (2) from diphtheria,34 (16) from diarrhoea and enteritis under two years,and 100 (19) from influenza. The figures in paren-theses are those for London itself.The deaths from influenza during the’past few weeks (working

backwards) have been as follows : 100, 109, 83, 97, 95, 70, 59.The 209 deaths during the first two weeks of the year comparewith 1715 deaths for the corresponding weeks of 1933. Ninedeaths were this week attributed to influenza at Birmingham,3 each at Southend-on-Sea, Leicester, and Plymouth ; no morethan 2 in any other great town. Bradford reported the onlydeath from enteric fever outside London. Eleven fatal casesof measles occurred at Manchester, 4 each at Leeds and LiverpoolOf the fatal cases of diphtheria, 6 were reported from Leeds,3 each from Liverpool and Salford.

The number of stillbirths notified during the weekwas 244 (corresponding to a rate of 37 per 1000total births), including 27 in London.