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enable the best possible medical service to be available to thepublic."

-

Several local medical committees had tabled motionsseeking to modify this recommendation, most of -themsetting out which changes in distribution would, or

would -not, be acceptable. None of these motions wasendorsed by the conference, the delegates taking theview that any working party set up to study redistribu-tion should approach its task without predeterminedcommitments of any kind, whether from the side of theGovernment or that of the profession.The decisions of the conference were conveyed that

same evening by hand to the Minister. The G.M.S.C.now has a mandate to arbitrate, if allowed, and aninstruction to take action to precipitate a dispute ifarbitration is refused. There is no reason to expect thatat this juncture the Minister will oppose arbitration.

A VISTA OF ANTIBIOTICSOuR outlook in medicine, like the view from a moving

train, seems to spin interminably round some ill-definedaxis in the middle distance, though in fact it continuouslydissolves and re-forms. An important discovery, however,jostles our whole prospect, and-as though the train hadsuddenly come out of a tunnel-presents us with the oldlandmarks in a new setting. Moulds and fungi have beenwith us since our earliest days on this planet, and fromtime to time man has used them medicinally in a hap-hazard and desultory fashion. But the discovery of thepowerful antibiotic properties of Penicillium notatum hasgiven us a new eye for these common weeds, and hasprofoundly changed our experience of infections. Ithas also, as the housewives say, made a lot of work.

In his Boyle lecture, delivered before the OxfordScientific Club on June 1 last year, and now published,lSir -Howard Florey, F.R.S., explained how far Fleming’sobservation has already led us in the search for somethingbetter still. The field is unimaginably wide : it has

already been found that some thousands of species ofmicro-organisms produce antibiotics. All the promisingones have to be assayed ; and the first step in each caseis to grow the organism in a liquid medium, so that theactive substance can be recovered from the liquid.Some-especially fungi-form a pellicle on- the surfaceof the liquid ; and this means that, if the antibiotic isto be obtained in quantity, a very large surface area isneeded. Thus it is necessary, in large-scale production,to get the organism to grow throughout the fluid. Thisis done by bubbling sterile air through the medium,which is also constantly stirred ; the organism is thus

kept oxygenated and dispersed. Illustrations to SirHoward’s lecture show a home-made-almost, it seems,an Emett-made-laboratory apparatus for this purpose ;a larger more solid pilot plant ; and a vast and stream-lined apparatus, engineer-built and capable of holding10.000 gallons, used to produce penicillin by the Dis-tillers Company at Liverpool. New antibiotics can bedetected readily enough in the laboratory ; and theireffects on animals----’---usually mice-can be assayed ; butif enough material is to be produced for trial in mana pilot plant, at least, is needed. The most active anti-biotic research is, therefore, now being conducted byAmerican pharmaceutical firms, who have great resourcesfor work of this kind.Even when ample supplies, of a new antibiotic are

available the evaluation of its use in man still presentsgreat practical difficulties. Effects on the body must bemeasured, toxic effects noted, dosage schemes drawn -dp,and the diseases susceptible to treatment defined. Andsince any given disease in man shows much greatervariety than the same disease in animals, every judgmentmust be backed by control experiments. With the fivemost active antibiotics now available-penicillin, ’strep-1. Antibiotics. Oxford : Blackwell Scientific Publications 1951.

Pp. 35. 6s.

tomycin, ’Aureomycin,’ chloramphenicol, and ’Terra-

mycin’-the great majority of bacterial infections, asSir Howard pointed out, can usually be successfullytreated. Penicillin counters the pus-forming organisms,streptomycin is effective in some cases of tuberculosis andin plague, and chloramphenicol and aureomycin deal

faithfully with the rickettsise. But the filtrable viruses-influenza, measles, encephalitis, infantile paralysis, andmany others-still disport themselves outside the rangeof any chemical treatment. Veterinarians find antibioticsas useful as do doctors ; and there may be great uses forthem in the treatment of plant diseases when the cost ofproduction comes down. So far chloramphenicol is theonly antibiotic of medical interest to be synthesisedso effectively that manufacture through fermentationprocesses is superseded.

Quite apart from their practical uses, antibiotics arethrowing light, by their mode of action, on the metabolicactivities of micro-organisms. The new study, in fact,claims people of widely different technical training andmental outlook as its servants ; and apparently therecan hardly be too many of them.

THE LIVELY SLIME

NEARLY all traditional accounts of the origin of lifedescribe it as being derived from mud, slime, or dust;and modern biophysics supports this ancient guess, addingsome reasonable speculations about method and time-table. In his Guthrie lecture, delivered to the PhysicalSociety in 1947, Prof. J. D. Bernal, F.R.s.; reviewed thegrowth in scope of these speculations since Prof. T. H.Huxley, in 1901, delivered his famous lecture of the samename-the Physical Basis of Life. Professor Bernal’slecture has now been published 1; and though it restson a technical plane quite outside the experience of theaverage doctor, it fascinates no less because it offers anexplanation (so essential if a mystery is to be fullysavoured) of how the thing was done, than because itsketches in the methods of a highly complex and exactdiscipline. Reduced to its simplest terms the theory isthat conditions on the surface of the primitive earthwere such as to favour chemical reactions now no longerpossible, partly because the atmosphere consisted of

hydrogen and hydrides, and partly because solar’radia-tion, " out to the far ultra-violet of 2000 A or less," wasat that time reaching the earth’s surface (it has sincebeen cut out by the ozone layer). In such circumstancesit is possible-and this, Professor Bernal suggested,could be settled by experiment-that introgenous organiccompounds, such as the amino-acids, would be formed;and large concentrations of such molecules, he thinks,might have been adsorbed on the surface of fine clay, of- which there was, and is, a good deal about. Moleculesattach themselves to clay not at random but " in definitepositions relative not only to the clay but to each other,and held in such positions they can interact and formmore complex compounds, especially if energy be suppliedin the form of light." The upshot, as he sees it, was theformation of macromolecules which " might be able topersist in colloidal form, even without clay, and becomecatalysts, or, as we should now call them, enzymes...."An enzyme without an organism seems, at first sight,and to the mind trained only in medicine, almost as

improbable as a grin without a cat ; but it is only amatter of getting used to the idea. Professor Bernalproceeds to develop this picture of protein moleculescarrying out the chemical reactions of- the cell beforethere were cells to profit by them. " So many of the chemi-cal reactions occurring in living systems have been shownto be catalytic processes - occurring isothermally on thesurface of specific proteins, referred to as enzymes, thatit seems fairly safe to assume that all are of this nature

1. The Physical Basis of Life. London : Routledge & Kegan Paul.1951. Pp. 80. 6s.

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and that the proteins are the necessary- basis for carryingout the processes that we call life."

AV, as this moment-" the first moment that steadyinteractions occurred - between complex molecules in ageneral medium "-the origin of life ? ‘ Or did life onlybegin " when a section of this medium was separated out,sufficiently large to contain a self-maintaining system ofreactions within the medium ’’ Professor Bernal equatesthe first with the origin of life, the second with the originof living things-a new and nice distinction for many ofus. The steps in the theory could be established in detailby research, but he believes that in any case they are notonly feasible but-in the light of our present knowledge- inevitable.From these primeval organisms it is a’far cry to the

physico-chemical diversity of function of protoplasm(he sketched some of the problems facing biochemiststhere), and still farther to the mind of Professor Bernal,speculating about it all. There is evidently still a greatdeal to do.

MEN WITH PNEUMOCONIOSIS

To learn one has a serious disease is always a shock ;and when a man has grown up in a community where thedisease is relatively common in all its stages, the badnews is bound to bring with it many unhappy images.The Social Survey, in 1946, carried out at the request ofthe Medical Research Council an inquiry into the employ-ment of men with pneumoconiosis ; and the report, 1by Mr. Geoffrey Thomas, was discussed in the M.R.C.memorandum published this spring,2 and has now

appeared in full. Mr. Thomas notes that for 13% ofthe 764 men interviewed the news that they had pneumo-coniosis had been totally- unexpected. The shock wassometimes severe, not merely because of the threat ofdisability and shortened life, but because most of themhad families to provide for. This initial distress was

equally common among those who later found employ-ment and those who did not.

Many of the men, the interviewers found, regrettedleaving mining and found it difficult to reconcile them-selves to the idea of other work ; but those who were themost ready to attempt anything at all were those whofound work most often. Not unnaturally, the youngermen, and those in the early stages of the disease weremore optimistic about what they could do than the oldermen and those in the later stages. The jobs foundincluded heavy, moderate, and light labouring work,pedestrian occupations (insurance agent, policeman,roundsman, coastguard), attendant’s work (shop assis-tant, cinema attendant, watchman, gateman), benchwork (fitting, assembly, welding, machinist, mechanic),and other work (clerical, driving a crane or lorry, sexton).Most of them had found their jobs through the employ-ment exchange or the Government training centres, or bymigration ; friends were usually responsible for findinglight jobs. Nearly two-thirds of all who had beencertified as pneumoconiotic in February, 1940, or later,had been in employment, anyhow for a time, by February,1946 ; 36% were working at the time of interview. Itso happened that from 1940 onwards plenty of work wasavailable. More than three-quarters of all the meninterviewed considered themselves fit for either full-timeor part-time work ; and though 42% of them were out ofa job at the time, nearly half of these unoccupied men werein the later stages .of the illness. Since this representativesample was interviewed a greater proportion of youngermen, and men in the early stages of the disease, have beencertified ; and Mr. Thomas thought it possible that morethan 78% of the present population of men with pneumo-1. The Employment of Men with Pneumokoniosis. London:

Central Office of Information, 1951. Social Survey Reportno. 73. Pp. 36.

2. Hugh-Jones, P., Fletcher, C. M. Social Consequences of Pneumo-koniosis among Coalminers in South Wales. Medical ResearchMemorandum no. 25. H.M. Stationery Office, 1951 ; and seeLancet, 1951, i. 626.

coniosis are fit for work. Since those in the sample hadsuffered severe financial loss through leaving mining, somehelp in finding suitable work would doubtless be welcometo them, and Mr. Thomas suggests that a body is neededto help men over their first anxiety and to bring to theirnotice the wide range of jobs that have been done bymen with pneumoconiosis, and the possibilities of workin their own neighbourhood. -

GROWING PAINS

IN medicine the swing of the pendulum from enthuQsiastic support to stern disapproval is well known. It isalso well known that diseases change in incidence,virulence, and manifestations. Fifty years ago growingpains were regarded as a manifestation of the rheumaticstate, and rheumatic fever was common; now theassociation is doubted, and rheumatic fever itself hasbecome comparatively rare.Some interesting facts have been brought to light by

Naish and Apley.1 A sample of nearly eight hundredschool-children were questioned, and those who com-plained of limb pains were carefully compared with acontrol group of children who had made no such complaint.Of the whole sample, 4-2% had growing pains. Previousmedical history and physical condition were essentiallysimilar in the affected group and the controls, and therewas no evidence that growing pains reflected an infectiveor rheumatic state. On the other hand, the affectedchildren showed a definitely higher incidence of some" rheumatic " condition in the family and of emotionaldisturbance.

Naish and Apley object to the term " growing pains."The pains were most common at a period of minimalgrowth and were not, in their opinion, connected withgrowth. Three types of pain were met : the first typewas ill defined and vague, the second type occurredduring the day following fatigue, and the third wasparoxysmal and nocturnal. The first type seemed to beentirely psychogenic in origin, and the second to beconnected with fatigue, faulty posture, and emotionalinstability ; the third type remains obscure and maypossibly be connected with nocturnal cramp. It seems,then, that growing pains still exist and may arise froma variety of conditions, but they are not connectedwith the rheumatic state. ’

B.P. UP OR B.P. DOWN ?

WHILE the rest of the world conscientiously appliesits ear to the stethoscope and records blood-pressureduring anaesthesia, in order to " maintain " it, in Britainthere is evident a desire to keep it down. In one operating-theatre the anaesthetist announces with alarm that theblood-pressure has fallen to 90, while next door his

colleague has a worried look because he cannot reduce itbelow 90. A low blood-pressure, even without haemorrhage.was formerly regarded as a key sign of shock ; whereasnow we may be told, as in the article by Mr. Lewis onan earlier page, that " shock was absent " although theblood-pressure was low indeed. .

When to a question reputable men give differentanswers the inference is not that they are all wrong,but that they are probably all right : each is lookingat the problem from his own particular standpoint.There is growing evidence that hypotension deliberatelyproduced by the administration of methonium compoundsdoes not do the healthy patient any harm, though- hemust be watched by a competent anaesthetist who knowshow to manage " controlled circulation " as well as

" controlled respiration," - The low blood-pressure so

produced may be of the greatest value to the surgeonin facilitating the operation, and to the patient -in pre-venting undue loss of blood. But it is only a short timesince these hypotensive techniques were ’ introduced,

1. Naish, J. M., Apley, J. Arch. Dis. Childh. 1951, 26, 134.