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Some may be quick to draw their own conclusions ;but-Dr. Pedersen enjoins caution : " In my opinion weare not entitled to draw far-reaching conclusions fromthese studies as to whether the tooth structure or the

carbohydrate factor plays the greater part.... I do notthink either that field studies of this kind will definitelysolve the caries problem. In all probability the finaleffort will have to depend on the pure experiment."

A VERSATILE REMEDY

AMPHETAMINE or &bgr;-phenyl-iso-propylamine, betterknown as ’Benzedrine,’ has been put to many usessince it was introduced in 1935. It was first applied tothe treatment of narcolepsy, for which it has provedunfailingly successful.2 Though popular in Britain, thedrug has received still more attention abroad, particu-larly in the United States; and reports testify to itsvalue in such diverse conditions as depression, fatigue,postural hypotension, alcoholism, postencephalitic parkin-sonism, epilepsy, obesity, sea-sickness, and behaviourdisorders of children. It . was soon apparent that thissympathomimetic amine was a central nervous stimulant,producing delay in the desire for sleep and subjectiveimprovement in mood ; and since one of its side-effectsis to decrease appetite it has naturally found favour inthe treatment of obesity. It has also been commendedas a remedy for the postalcoholic

"

hangover." Insome disorders, however, its value is still imperfectlydefined, as was shown by the correspondence followingan account in these columns of its use in pulmonarytuberculosis.3

.

Amphetamine’s place in the treatment of adult psycho-paths was discussed last week before the Society for theStudy of Addiction by Dr. Denis Hill and Dr. H. J. Shcrvon.Bradley and Bowen, and Cutts and Jasper 5 have shownthat amphetamine improves emotional control in childrenwith hyperkinesis, temper tantrums, and enuresis. Manyof these have an abnormal electroencephalogram,characterised by excess theta rhythm ; and Hill, postu-lating the same constitutional background, has treatedwith amphetamine adult aggressive psychopaths with a"

theta-persistent "

E.E.G. Among 8 patients studiedfor four years he has observed improvement in the

predominantly aggressive, bad-tempered, intolerant,easily frustrated, irresponsible psychopaths who are yetcapable of warm interpersonal relationships. The effectis particularly impressive in a smaller but well-definedsubgroup of aggressive psychopaths with the stigmataof very deep sleep, late cessation of nocturnal enuresis,excessive or morbidly excitable sexual appetite, andimmature E.E.G. Shorvon, unlike Hill, has also foundthe drug of value in some inadequate psychopaths.Both emphasise the amazing tolerance of the predomi-nantly aggressive psychopath to large doses; even suchamounts as 45-60 mg. daily do not disturb sleep ; duringtreatment libido is reduced and tempers are bettercontrolled. Hill makes the interesting suggestion thatthere may be a link between Myerson’s 6 anhedonicneurosis, with its " diminution, even to the point of

disappearance, of the satisfactions normally obtainedfrom life’s activities and loss or distortion of the appetitesand desires," and the beneficial effect of amphetaminein reducing libido, appetite, and aggression-that is," the appetitive drives." Mann and Quastel haveshown by in-vitro experiments that amphetamine stimu-lates by neutralising the inhibitory action of amines

during cerebral respiration ; the B.E.&. of the aggressive1. Prinzmetal, M., Bloomberg, W. J. Amer. med. Ass. 1935,

105, 2051.2. Sargent, W., Slater, E. An Introduction to Physical Methods

of Treatment in Psychiatry, Edinburgh, 1944, p. 94.3. Houghton, L. E., Corrigan, F. L. Lancet, 1946, ii, 864.4. Bradley, C., Bowen, M. Amer. J. Orthopsychiat. 1941, 11, 92.5. Cutts, K. K., Jasper, H. H. Arch. Neurol. Psychiat., Chicago,

1939, 41, 1138.6. Lesses, M. F., Myerson, A. New Engl. J. Med. 1938, 218, 119.7. Mann, P. J. G., Quastel, J. H. Biochem. J. 1940, 34, 414.

psychopath shows cerebral immaturity, and amphet-amine may produce a more mature expression of theprimary appetitive drives by its effect on corticaloxidation.

In the late war enormous quantities of amphetaminewere supplied to the Allied Forces, mainly for use inemergencies when it might be necessary to diminish

fatigue and to postpone sleep. At last week’s meetingProf. R. C. Browne reported that, while it combatedsome of the deterioration in the anoxaemic airman’s

performance and had a statistically significant actionon sleeplessness, it caused no consistent improvement inthe fatigued pilot’s performance ; with it, skilled functionwas; if anything, rather less good. Dr. H. Crichton-Miller and Dr. G. R. Rudolf agreed that amphetamine’seffectiveness against fatigue is enhanced by glucose ;but Crichton-Miller’s view that its main action " isassociated with the mobilisation of blood-sugar

" is notendorsed by other workers,8 most of whom have foundlittle or no rise in blood-sugar. Rudolf recommendsthat the glucose should be taken six or seven hoursafter amphetamine, to counteract the postponed fatigue.With judicious use, signs of idiosyncrasy or other

reactions are rarely seen. Acute hallucinosis 9 and a

paranoid or toxic psychosis have very rarely beenrecorded after continued large doses ; but most patients,such as narcoleptics and psychopaths, who take it

continuously for years, display neither toxic signs norincreased tolerance. They can, moreover, discontinuethe drug abruptly without craving or other withdrawalsymptoms.

METHYL ALCOHOL POISONING

THE war in Norway provided ample opportunitiesfor the clinical study of poisoning by methanol, and amonograph by Röe 10 is based on 82 cases treated invarious hospitals in or near Oslo. Though methanol doesnot as a rule provoke acidosis in experimental animals,Roe’s observations lead him to believe that in man theoutcome in cases of poisoning hinges entirely on the degreeof acidosis, and in treatment he puts much emphasis onbicarbonate. Another of his conclusions is that ethylalcohol counters the- effects of methanol: his case-recordsshow that the patients who suffered least were those whohad mixed their drinks. In this connexion he writes :" It has been ascertained that when methanol alone isconsumed, the latent period for the appearance of signsof poisoning is from 12 to 24 hours, usually 18 hours.Prolongation of the latent period beyond 24 hours is

always due to the consumption of ethyl alcohol." Alsohe has a tilt at the teaching that individual predispositionis a factor of greatimportance.

G.M.C. ELECTION

OWING to the death of Sir Kaye Le Fleming there isa vacancy on the General Medical Council for a directrepresentative of the medical profession in England.The following have offered themselves as candidates :

Dr. JAMEs BROWN, of Birmingham, member of the councilof the British Medical Association.

Dr. J. E. OUTHWAITE, of Leeds, barrister-at-law; whostood at the election last June as a nominee of the MedicalPractitioners Union.

Dr. ISAAC RosE, of Leeds, medical officer at St. Helen

Municipal Hospital. _______

Dr. P. S. Selwyn-Clarke, director of medical services,Hong-Kong, since 1938, has been appointed governorand commander-in-chief of the Seychelles. He has beena member of the executive and legislative councils ofHong-Kong.

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8. Peoples, S. A.. Guttmann, E. Lancet, 1936, i, 1107.9. Norman, J., Sheat, J. T. New Engl. J. Med. 1945, 233, 270.

10. Methanol Poisoning, its Clinical Course, Pathogenesis andTreatment. By O. Röe, first assistant at the eye clinic ofUllevaal Hospital, Oslo, 1946.