1005CURRENT OPINIONS IN ENDOCRINOLOGY.

ments of British morphia to the Far East, and especiallyvia Japan into China, have engaged the attention ofthe Advisory Committee, and its recommendationswill be shortly before the Council of the League. Theannual report, which each Power is asked to make,will, it is hoped, include the names and addresses of thefirms which fabricate the dangerous drugs in questionand the amount of the annual output of each factory.Such disclosure should lead to that international andnational control of these drugs from their source totheir distribution which should do much to preventtheir diversion into illicit channels. It is also time to

bring to an end the traffic in " prepared opium," used

only for smoking purposes ; the Indian Governmentcondemns this as " essentially a social vice."

Finally, the Committee invites the pressure of publicopinion to expedite the execution of the Opium Con-vention, and, from the almost daily exposures in thepublic press of the unlawful and vicious use of cocaineand morphia, there is abundant evidence of the needto apply the remedy which, in the shape of the OpiumConvention, has been in existence, on paper, for morethan ten years.

Annotations.

CURRENT OPINIONS IN ENDOCRINOLOGY.

"Ne quidnimis."

IT is frequently forgotten that our real knowledgeof endocrinology is in an extremely rudimentarycondition ; there are few fundamental principles andthe difficulty of examining hypotheses experimentallyis great. In this respect the subject resembles psycho-logy ; like the latter, it is liable to be exploited and toabound in wild theories hard to gainsay. " The LewisCarroll of to-day," said Harvey Cushing recently," would have Alice nibble from a pituitary mushroomin her left hand and a lutein one in her right, andpresto ! she is any height desired." Such words ofwarning, however, have little effect-the tide of

knowledge and the mud of nonsense are as yet inex-tricably mixed, and only time will bring about propersedimentation.The " Endocrinology Number " of the New York

Medical Journal, published in April last, gives asymposium on the subject, and the assortment ofpapers, though of varying value, do give some ideaof the present direction of thought on this subject.Dr. W. Langdon Brown (London) contributes a

thoughtful article on the lines of the late W. H. Gaskell ;his thesis is that the endocrine glands are modifiednephridia, exceptions being the adrenal medulla, theislets of Langerhans, and the pineal. Primitivechemical mechanisms of excitation become specialisedand housed in these disused structures and are broughtunder the control of the vegetative nervous system.Dr. G. W. Crile’s paper suggests that hyperthyroidismcan be controlled by digitalis and water, and it must beconsidered highly speculative. Dr. I. Geikie Cobb(London) gives a useful summary of the functions ofthe thyroid, and Dr. Sydney Pern (Melbourne) thelatest views of goitre. The relation of the thyroid to I,infections seems now to be strongly insisted upon.Dr. Smith Ely Jelliffe (New York) unites endocrinologyand psycho-analysis in the bonds of what appears tous an unholy matrimony. The thymus gland has itschampion in Dr. Leonard Williams (London), whoshows that it continues to grow up to or even beyondthe age of puberty, is subject to cosmic influences, andis, in fact, a sort of male thyroid ; moreover, statuslymphaticus is closely associated with enlargement ofthe thymus. The Diagnostic and Therapeutic Role ofthe Endocrines in Functional Diseases is the subjectchosen by Dr. A. S. Blumgarten (New York), who dealsespecially with the relation of the endocrines in gastric

neuroses, neurasthenia, functional gynaecological con-ditions, and " pituitary headaches "; periodic headacheswhich are usually supraorbital or bi-temporal maybe relieved by the administration of pituitary extract.Although the author describes these as

" one of the

most definite endocrine conditions," we cannot followthe line of argument which leads him to regard thepituitary as in any way connected with them. The

parathyroid glands are rapidly assuming a position offirst importance among the endocrines, and some reallydefinite knowledge is to hand concerning their relationto tetanic and spasmophilic conditions. F. S. Hammett(Philadelphia) shows how they prevent the accumula-tion of the toxic nerve irritant methyl guanidine, whicharises as a bye-product of muscular tone. A case ofparathyroid insufficiency, successfully treated by driedox parathyroid is reported by Dr. A. F. Hurst (London).

Prof. Louise McIlroy (London) considers the ovum(in the obstetric sense-i.e., the embryo with itsappendages) as an internal secretory organ, but offersno convincing arguments in support of her theory.We might grant that the physiological balance betweenthe endocrinous organs can be upset by the introductionof the ovum, but her authority for the statement thatthe ovum " pours unknown secretions into the bloodstream," or that " if the secretion.... of the ovumis in excess, the symptoms of toxaemia arise," is notobvious. As she states, however, much patientclinical and laboratory research is needed into thephysiological changes caused by the developing ovum ;theories can at most provide working hypotheses forits direction. That blessed word " anaphylaxis " isbrought forward by Dr. W. Neumann (Brooklyn) inconnexion with a case of cholecystitis ; his papercontains the comprehensive sentence

"

Endocrinologyembraces the study of all phases of human life and isthe science of all sciences." The article on Physiognomyand Endocrinology, by P. Fridenberg (New York)is most interesting, and well worth reading ; therelation of certain types of facies to the endocrineorgans is well known, and the author has spent histime well in describing some of the less obvious types." Our Problems in Endocrinology," by Dr. J. Gutman(Brooklyn) is a well-balanced account of the mainproblems, the dangers of rash enthusiasm being pointedout. Dr. E. Appelbaum (New York) closes the numberwith a description of a rare type of pituitary disturb-ance, the main features of which are acromegaly,cyanosis, exophthalmos, dilatation of the pupils,menstrual trouble, cardiac dilatation, and myasthenia.Such a symposium is useful. Its messages cannot

be considered authoritative, but the grouping of £considered views will assist progress.

SAFETY-LAMPS AND MINERS’ NYSTAGMUS.

THE importance of the quality of glass used forminers’ safety-lamps was discussed in the House ofCommons last week on a motion for the second readingof the Coal Mines (Temporary Provisions as to SafetyLamps) Bill. Mr. Bridgeman, Secretary of Mines,explained that during the war, when supplies of glassfor miners’ lamps from Germany and Austria hadceased, Mr. McKenna urged certain British glass-makers to undertake the manufacture of the necessaryquality of glass to satisfy the British demand, givingthem a pledge to refuse during a period of three yearsfrom the termination of the war to approve any lampscontaining glasses made in Germany or Austria. Themanufacturers had carried out their part of the bargain,but it was doubtful whether the Board of Trade hadpower to carry out the Government pledge. The Billwas designed to put the matter beyond doubt. Mr.Adamson, a Labour Member for a Scottish miningconstituency, voiced a general impression that miners’nystagmus had been on the increase, and inquiredwhether this increase could be traced to the use ofBritish-made glasses. Another Member attributed theincreased incidence of the disease to its earlier recog-nition by medical men. The Bill received furthercriticism and Mr. Bridgeman, though personally

1006

satisfied that British lamps were efficient, professedhimself willing to discuss the matter with representa-tives of the miners in the Ilouse. Eventually thedebate was adjourned.The recently issued report on miners’ nystagmusl

contains a criticism (p. 38) which probably refers to thetransition period before the British manufacturershad undertaken to pay special attention to the matter :"

During the war years the lamp-glasses supplied tothe lamp-makers have been of an inferior quality andfull of flaws which broke up the field into blotchesof irregular light." As to the increased number of casesduring 1919 and 1920, the Committee attributes thispartly to an accumulation of long-standing cases andpartly to a recertification or resumption of payment tomen who had failed after return to work. The numberof men who show nystagmus on examination certainlyvaries in different countries and also with the observer.For example, Sir Josiah Court, in a report to the Derby-shire Miners’ Association in 1891 gives the percentageas 34.75 of all coal cutters examined, whereas Llewellynin 19122 gives it as 22. The incidence of a disease ofsuch complexity wherein there is so large an elementof psychoneurosis, is always difficult to assess.

TREATMENT OF HÆMORRHAGE FOLLOWING

TOOTH EXTRACTION.

IN the Revue de Stomatologie (January, 1922) Dr.Th6s6e gives an account of a boy, aged 10 years, whosuccumbed to haemorrhage following the removal bythe boy himself of a right lower second deciduousmolar. The roots of the tooth were completelyabsorbed and the child pulled the tooth away withhis fingers. The attention of the parents was drawnto the bleeding on the third day; pressure was appliedto the bleeding area and injections of haemostyl weregiven. The haemorrhage continued, with remissions.The child was admitted to hospital and gelatin serum i

was injected, but his life could not be saved.Haemorrhage after the extraction of teeth may be

serious, and since the patient may not take alarmuntil several hours have elapsed, it often becomesthe duty of the nearest available doctor to treat thecase. Plugging the socket. providing it be accuratelyapplied, will generally suffice but may not be easy,and many styptics have been recommended as anadjuvant. Some of these, for example ferric chloride,give rise to subsequent sloughing, which more thanoutweighs their haemostatic action and are thereforeto be condemned ; others, like adrenalin, are so

quickly diluted by saliva or blood that they becomeineffective. Mr. F. St. J. Steadman. in an interestingpaper read before the Section of Odontology of theRoyal Society of Medicine, and published in theBritish Dental Journal for April 1st, advocates the useof oil of turpentine and states that over an experienceof 12 years he has not known it to fail. The method ofapplication is simple. The gauze is soaked in the drugand the socket packed ; if necessary it is kept in placeby stitching or by applying a pad over the gum andbandaging the jaws. Mr. Steadman gives notes offour cases in which the hæmorrhage was severe. Thepatients were all women and in each there was ahistory of a liability to bleeding ; the father of onepatient had died from hæmorrhage. The teeth wereremoved at intervals with great care and all went welluntil a canine was extracted. This bled profusely forseveral hours. The socket was syringed with cold waterand packed with gauze soaked in oil of turpentine,.and the bleeding ceased immediately. Another patient,a woman of 30, gave a family history of a mother witha tendency to bleed, the patient’s son died of haemor-rhage after circumcision at the age of 4, and herdaughter also had haemophiliac tendencies. Severalteeth were extracted without any bleeding, but profusehaemorrhage followed the removal of a molar. In this,case it was necessary to pack the socket on three

1 See THE LANCET, April 29th, p. 854.2 The Colliery Guardian, 1912.

occasions before the bleeding was finally controlled.Mr. Steadman remarks that although they were nottrue haemophiliacs, yet there was an abnormal tendencyto bleed in each case, so that the test of the efficacy ofturpentine as a local haemostatic was severe. In each ofthese cases calcium lactate had been given previously,but in the majority of Mr. Steadman’s cases calciumlactate was not given as the bleeding was unexpected.Mr. Steadman adds that oil of turpentine is a powerfulantiseptic, and that after the plug is removed thesockets retain a faint smell of turpentine and are cleanand free from infection. This is in striking contrast tothe usual experience after plugging, when the socketis generally septic and takes a long time to heal.

Oil of turpentine would appear to possess definiteadvantages over most other methods of dealing withhaemorrhage of dental origin, though in the BritishDental Journal for March, 1920, a case was reportedin which death resulted eight days after the removal ofthree teeth ; turpentine was used locally as advised byMr. Steadman, but even with transfusion of blood failedto save the patient. Mr. Steadman does not claimto have originated the use of oil of turpentine. It is,in fact, a very old method which has dropped out ofrecognition, although it still has an oral currencyamong older practitioners. S. J. Salter, in 1874,quotes John Hunter as advocating its use after dentalhaemorrhage and there can be no doubt that it hasproved a useful addition to the list of reliable localhæmostatics.

____

THE WAR OFFICE INQUIRY INTO

SHELL-SHOCK.

THE War Office Committee of Inquiry into Shell-shock held its fortieth meeting on May 10th, LordSouthborough presiding. The Committee has finishedtaking evidence, having had the benefit of the adviceof a large number of experts, both military andmedical. and is now considering the report. It isexpected that the report will deal in detail with theorigin and nature of shell-shock, and will suggestmeasures which may be expected to mitigate theincidence of this group of nervous and mental disordersin future wars, and also measures for the treatment ofpatients suffering from such disabilities. Shell-shock,in this last connexion, need not be taken as implyingonly shock from subjection to the risk of explosivemissiles, and the findings of the Committee are sure tohave valuable messages to medical men in the conductof civilian practice, especially where that practice ismainly in industrial circles.

BLOOD-PLATELETS IN RELATION TO

A-VITAMIN DEFICIENCY.

IN our correspondence columns last week Dr. S.Monckton Copeman set out the ingredients of a dietfree from A-vitamin, the possible influence of whichon patients suffering from malignant disease is beinginvestigated. It will be interesting to note whetherthe diminution of the number of blood-plateletsobserved by W. Cramer, A. H. Drew, and J. C.Mottram in the rat on a diet deficient in A-vitamin isnoticeable in the human subject. ’ In a paper com-municated to the Royal Society on May 4th theseinvestigators record that the absence of the fat-solublevitamin from the diet always leads in the rat to aprogressive diminution in the number of blood-platelets. This thrombopenia is the only constantlesion which has so far been found in every case ofA-vitamin deficiency, and is regarded by the authorsas the lesion characteristic of this deficiency, just aslymphopenia is characteristic of the B-vitamindeflciency.l Thrombopenia may even be found in ratskept on an A-vitamin free diet, when they do not yetshow any obvious signs of ill-health and are to allexternal appearances normal animals. When profoundthrombopenia has been established, addition of the

1 THE LANCET, 1921, ii., 1202.