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intervals of about eight months; and this planned non-conformity to the calendar should ensure that nobodywill be repeatedly debarred from attending because

they always clash with his busiest month-or, for thatmatter, his annual holiday. Like all good conferenceslast week’s was oversubscribed; it was attended, after aballot, by 120 people. Those who could not be therewill be glad to know that the proceedings, including thediscussions, are to be published with little delay.

PROTECTION AGAINST THE STREPTOCOCCUS

IN an important controlled study, Mortimer et al. 1

have found that penicillin administered intensively for sixweeks to patients with rheumatic fever apparently reducesthe likelihood that valvular heart-disease will be presenta year later; the penicillin had no detectable effect on theacute manifestations, and Mortimer et al. suggest that theliving streptococcus continues to play a significant partin the development of valvular disease even after

symptoms of rheumatic fever have developed.The case for continuous penicillin prophylaxis against

streptococcal infections in patients who have had rheumaticfever has been solidly endorsed by experience, particularlysince the American Heart Association’s recommendations,now well known, were published in 1953.2 Manythousands of rheumatic children and young people in theUnited States, and an increasing number in this country,have received and are receiving this protection.

Miller et al.3 in Boston, Mass., made monthly observa-tions (supplemented by home visits) over a three-yearperiod on 235 healthy children-the siblings of 114

rheumatic-fever cases under outpatient care and prophy-laxis. During this period these siblings had 603 respira-tory illnesses, of which 76 (14%) proved to be group-Ahasmolytic streptococcal infections. In 81 children withoutsymptoms throat swabs were positive for group-A strepto-cocci at some time during the study; and, although allstreptococcal infections were adequately treated with

penicillin, both in the group with symptoms and in thegroup without symptoms 40% showed antistreptolysin-0titre responses. It is thus clear that these patients whohad had rheumatic fever were exposed at home to

considerable opportunities for streptococcal infection.Even the symptom-free " carriers

"

among the familiesmust have contributed significantly to the streptococcalenvironment-although, as Holmes and Williams 4 havesuggested, such people probably disseminate fewer (andperhaps less dangerous) streptococci than those with frankacute streptococcal pharyngitis. Nevertheless, in this

potentially infective domestic environment the prophylaxiswhich the rheumatic patients received was really pro-tective. Their infection-rate with streptococci was lessthan a quarter of that in their unprotected brothers andsisters; and there were only 2 recurrences of rheumatismthroughout the study.At school the need for protection may be even

greater, since the " carrier "-rate may be higher still,and here, as in other large communities, there are morepotential sources of infection: Dr. Taylor and Dr.McDonald 5 have lately described an epidemic in theR.A.F. of group-A streptococcal infection which was

1. Mortimer, E. A., Jr., Vaisman, S., Vignau, A., Guasch, J., Schuster, A.,Rakita, L., Krause, R. M., Roberts, R., Rammelkamp, C. H. New Engl.J. Med. 1959, 260, 101.

2. American Heart Association. Lancet, 1953, i, 285.3. Miller, J. M., Stancer, S. L., Massell, B. F. Amer. J. Med. 1958, 25,

825, 845.4. Holmes, M. C., Williams, R. E. O. J. Hyg., Camb. 1958, 56, 197, 211.5. Taylor, P. J., McDonald, M. A. Lancet, Feb. 14, 1959, p. 330.

apparently milkborne .4 4 In a survey of streptococcalinfection in a school population in Philadelphia, Cornfeldet al. found that during a school year as many as halfthe children may have throat or nose swabs positive forgroup-A streptococci, even though the rate of clinicalinfection remains quite low. They found, moreover,that this state of affairs was not very much improved byintensive penicillin treatment of those harbouring theorganism. It is wise to assume that in this country similar

epidemiological considerations still apply; a survey of

healthy schoolchildren in 1954 certainly indicated asmuch. Streptococci remain a considerable feature of ourbacterial environment; and children with a history ofrheumatic fever, whether in hospital, at home, or at school,are receiving less than adequate care if they are not con-tinuously protected against the dangers of infection.

GLUCOSE AND SUCROSE

MORE than thirty years ago Bennett and Dodds 8

showed that large quantities of liquid glucose were welltolerated and readily assimilated when taken by mouthand were of considerable therapeutic value in certain

pathological conditions. An extension of this earlier workis reported on p. 485. Sir Charles Dodds and his col-

leagues find that the oral ingestion of liquid glucoseresults in a rapid rise of blood-sugar, and, in this paper,they also make a comparison with dextrose and sucrose.

For many years now, solutions containing glucosehave been shown by clinical experience to be of some valuein the ward and sickroom, especially in patients sufferingfrom gastrointestinal disorders, febrile conditions, andliver disease (McDermott 9). Solutions of glucose area convenient way of providing, in an electrolyte-freemedium, a substantial proportion of the daily calorie

requirements of a resting patient. Here, the relative lack ofsweetness of glucose makes it more likely to be acceptedby the nauseated or anorexic patient.The present paper by Dodds and his colleagues at the

Courtauld Institute is of particular interest because themerits of glucose have recently been under discussion. Ina report 10 issued last week, the Food Standards Com-mittee concluded that, for oral administration, glucosehas no physiological advantage over sucrose. Thisview, based on a scientific note reproduced as an appendixto the report, stems chiefly from the conclusion thatsucrose can be metabolised more rapidly than can glucosewhen taken by mouth. The evidence for this opinionseems to be at variance with the most recent work ofDodds and his colleagues and is derived from work

published many years ago by Higgins," D.euel,12 Deuel etal.,13 Cole,14 and Rabinowitch,l5 not specifically designedto solve the present problem.

It appears then, that the true value of the long-established use of glucose is still a controversial subject.Contradictions may conceivably have arisen throughdrawing general conclusions from the study of carbo-hydrate metabolism in particular diseases, and furtherevidence will be required.6. Cornfeld, D., Werner, G., Weaver, R., Bellows, M. T., Hubbard, J. P.

Ann. intern. Med. 1958, 49, 1305.7. Holmes, M. C., Williams, R. E. O. J. Hyg., Camb. 1954, 52, 165.8. Bennett, T. I., Dodds, E. C. Lancet, 1925, i, 429.9. McDermott, W. V. Amer. J. Gastroent. 1958, 30, 51.

10. Ministry of Agriculture, Fisheries and Food. Food Standards Com-mittee: Report on Soft Drinks. H.M. Stationery Office. 1959. (Seep. 515.)

11. Higgins, H. L. Amer. J. Physiol. 1916, 41, 258.12. Deuel, H. J., Jr. J. biol. Chem. 1927, 75, 367.13. Deuel, H. J., Jr., Guilick, M., Butts, J. S. ibid. 1932, 98, 333.14. Cole, S. W. Lancet, 1935, i, 431.15. Rabinowitch, I. M. J. Nutr. 1945, 29, 99.