1356 was ordered was in fact so varied and generous that without necessarily subscribing to Dr. SPIRA’S theory many ulcer patients, and other dyspeptics, must with little doubt have often adopted it. Certainly the view that hot fats are harmful to ulcer patients has little novelty ; it has indeed lately received convincing support from the work of KAY,4 who has shown that, while uncooked fat has a depressant action on gastric activity, cooked fats stimulate both acid secretion and motility ; the longer the heating the more stimulant is their effect. Whatever may have been the mechanisms in Mr. PARR’S successful " cure," none will question that he has been freed of symptoms for 5 years ; perhaps a further volume after another 5 years may carry his inquiries and experiences further still. By setting out-on the whole fairly-the story of the search for the causes and cure of ulcer in a lucid and popular manner he will give some insight into their symptoms to many laymen suffering from this dis- ability. It may be questioned whether he has done a service to Dr. SPIRA, who may well find the publicity unwelcome, and who would doubtless be among the first to agree that methods of treatment other than his have been and continue to be successful. Such a book as Mr. PARR’s could have been written by many another ulcer patient, except that the vaunted remedy would be different. We have not found the answer yet, nor should the public be encouraged to think we have reached the end of the search. Annotations FLUORINE AND DENTAL CARIES IN the U.S.A. and Canada protracted investigations of the effect of artificial fluorination of drinking-water on dental caries have so far yielded satisfactory results 5 ; and the enterprise of Anglesea County Council in seeking authority to add fluorine to the water-supply 6 may mark the beginning of a great advance in the control of dental caries in this country. A pilot survey in England suggests that the optimum fluorine content for drinking- water is 1-0-1-2 p.p.m. Greater concentrations than this cause mottling of the enamel, which becomes severe at 5 p.p.m. ; at still higher concentrations toxic symptoms and bone lesions may arise. Brun and his colleagues 8 believe, however, that osteosclerosis will develop only with a daily fluorine intake of at least 28 mg. over many years. To protect teeth fluorine must be given during the first 8 years of life ; after this age and after eruption it has little or no effect.9 Opinions differ on the duration of protection. Weaver 10 assesses it as the equivalent of a delay of five years in the onset of caries, while some workers in the U.S.A. believe that the protection is permanent. In the English pilot survey three high-fluorine areas (North Shields, Colchester, and Slough) were compared with three low-fluorine areas (South Shields, Ipswich, and Reading) ; the inquiry was confined to mothers attending antenatal clinics and infant-welfare centres, and to children attending day-nurseries, infant-welfare centres, and nursery-schools. In the high-fluorine areas 4. Kay, A. W. Gastroenterologia, 1950, 76, 97. 5. See Lancet, Feb. 17, 1951, p. 399. 6. Times, June 14, 1951. 7. Forrest, J. R., Parfitt, G. J., Bransby, E. R. Mon. Bull. Min. Hlth P.H.L.S. 1951, 10, 104. 8. Brun, G. C., Buchwald, H., Roholm, K. Acta med. scand. 1941, 106, 261. 9. Klein, H. Publ. Hlth Rep., Wash. 1948, 63, 18. 10. Weaver, R. Proc. R. Soc. Med. 1948, 41, 284; Brit. dent. J. 1950, 88, 9. the water fluorine-content ranged from 0-8 to 1-45 p.p.m., and in the other areas from 0-07 to 0-3 p.p.m. No severely mottled teeth were found in the high-fluorine areas, and such mottling as there was could be detected only by careful clinical examination. In the high-fluorine areas the incidence of caries was lower in every age-group -by as much as 38% in those aged 21-25 years-with an apparent delay of 10 years in the onset of caries. It was also observed that fewer teeth were missing and that caries was less severe. With the children, whose ages ranged from 2 to 5 years, the reduction in the inci- dence of caries was already apparent at 2-3 years of age, and was as great as 59% at 2 years. It seems that the fluorination of water-supplies should play a great part in the fight against dental caries. Clearly, however, no one measure will ever conquer this disease. DRUG ADDICTION IN AMERICA DRUG-PEDDLING, an ugly crime by any measure, becomes peculiarly detestable when buyers are sought among children. The investigation into the drug traffic, which is being conducted in New York 1 by Mr. Nathaniel Goldstein, the attorney -general, has revealed the widespread use of drugs-marihuana, cocaine, heroin, and amphetamine-by boys and girls in the high schools of the city. Some of these children acquire the habit at ages as early as 12 or 13, usually beginning by smoking marihuana cigarettes-" reefers "-which are sold to them by older children in the school. Nor is it clear that these older children are necessarily the tools of adult vendors : some, at least, seem to have set up in business for themselves. Among the addicts whose recorded confessions were played back in the course of the inquiry, a woman of 25 told of a candy store where high-school children of 14 and 15 sold drugs after school hours; and the same children could be approached during morning break, when they would peddle drugs over the playground fence. A 17-year-old boy, who was running a successful business as a bookie in his school, spoke of a school-fellow who dealt in drugs among the children and made as much as$300-400 a day. Asked how much he himself made as a bookie the informant replied: " That’s my business." The inquiry revealed clearly the stages in which addiction is acquired : a reefer, or a " snort " of cocaine is given free at first, then a moderate charge is made ; once the child becomes an addict prices rise, and to get the necessary cash the young people spend money saved to pay for education or hospital treatment, steal, housebreak, or take to prostitution. It has been estimated that 1 in every 200 children in the city uses narcotic drugs, and one witness spoke of young parents who quiet their baby with a shot of heroin. In 1946, of 712 people arrested for offences against the narcotic-drugs laws, 3 were aged 16, and 30 were between 17 and 21. By 1950 the numbers of those arrested had risen to 2482, of whom 63 were 16-year-olds and 458 between 17 and 20. The numbers of those in their ’teens who were arrested had increased sixteenfold during this period. The plight of the young addict who wishes to be cured is very unfortunate : if he admits his trouble he is liable to be jailed for the offence of buying drugs. A girl of 19, who asked the help of the biology teacher in her school, was nevertheless obliged to go through the courts ; she was of the opinion that many young people would confess to their addiction if they could hope to be treated as patients, not as criminals. There are disquieting indications that some members of the New York police force countenance drug-traffic in order to collect bribes. Certainly the police can hardly have failed to know how very widespread drug.peddling is : one addict mentioned by name over forty bars, cafeterias, 1. New York Times, June 13, 14, 15, 16.
Transcript
1356
was ordered was in fact so varied and generous thatwithout necessarily subscribing to Dr. SPIRA’S theorymany ulcer patients, and other dyspeptics, must withlittle doubt have often adopted it. Certainly the viewthat hot fats are harmful to ulcer patients has littlenovelty ; it has indeed lately received convincingsupport from the work of KAY,4 who has shown that,while uncooked fat has a depressant action on gastricactivity, cooked fats stimulate both acid secretion andmotility ; the longer the heating the more stimulantis their effect.Whatever may have been the mechanisms in
Mr. PARR’S successful " cure," none will questionthat he has been freed of symptoms for 5 years ;perhaps a further volume after another 5 years maycarry his inquiries and experiences further still. Bysetting out-on the whole fairly-the story of thesearch for the causes and cure of ulcer in a lucid and
popular manner he will give some insight into theirsymptoms to many laymen suffering from this dis-
ability. It may be questioned whether he has donea service to Dr. SPIRA, who may well find the publicityunwelcome, and who would doubtless be among thefirst to agree that methods of treatment other thanhis have been and continue to be successful. Such abook as Mr. PARR’s could have been written by manyanother ulcer patient, except that the vaunted remedywould be different. We have not found the answer yet,nor should the public be encouraged to think we havereached the end of the search.
Annotations
FLUORINE AND DENTAL CARIES
IN the U.S.A. and Canada protracted investigationsof the effect of artificial fluorination of drinking-wateron dental caries have so far yielded satisfactory results 5 ;and the enterprise of Anglesea County Council in seekingauthority to add fluorine to the water-supply 6 may markthe beginning of a great advance in the control of dentalcaries in this country. A pilot survey in Englandsuggests that the optimum fluorine content for drinking-water is 1-0-1-2 p.p.m. Greater concentrations thanthis cause mottling of the enamel, which becomes severeat 5 p.p.m. ; at still higher concentrations toxic symptomsand bone lesions may arise. Brun and his colleagues 8believe, however, that osteosclerosis will develop onlywith a daily fluorine intake of at least 28 mg. over manyyears. To protect teeth fluorine must be given during thefirst 8 years of life ; after this age and after eruptionit has little or no effect.9 Opinions differ on the durationof protection. Weaver 10 assesses it as the equivalent ofa delay of five years in the onset of caries, while someworkers in the U.S.A. believe that the protection is
permanent.In the English pilot survey three high-fluorine areas
(North Shields, Colchester, and Slough) were comparedwith three low-fluorine areas (South Shields, Ipswich,and Reading) ; the inquiry was confined to mothers
attending antenatal clinics and infant-welfare centres,and to children attending day-nurseries, infant-welfarecentres, and nursery-schools. In the high-fluorine areas
4. Kay, A. W. Gastroenterologia, 1950, 76, 97.5. See Lancet, Feb. 17, 1951, p. 399.6. Times, June 14, 1951.7. Forrest, J. R., Parfitt, G. J., Bransby, E. R. Mon. Bull. Min.
Hlth P.H.L.S. 1951, 10, 104.8. Brun, G. C., Buchwald, H., Roholm, K. Acta med. scand. 1941,
10. Weaver, R. Proc. R. Soc. Med. 1948, 41, 284; Brit. dent. J.1950, 88, 9.
the water fluorine-content ranged from 0-8 to 1-45 p.p.m.,and in the other areas from 0-07 to 0-3 p.p.m. No severelymottled teeth were found in the high-fluorine areas,and such mottling as there was could be detected onlyby careful clinical examination. In the high-fluorine areasthe incidence of caries was lower in every age-group-by as much as 38% in those aged 21-25 years-withan apparent delay of 10 years in the onset of caries.It was also observed that fewer teeth were missing andthat caries was less severe. With the children, whoseages ranged from 2 to 5 years, the reduction in the inci-dence of caries was already apparent at 2-3 years of age,and was as great as 59% at 2 years.
It seems that the fluorination of water-supplies shouldplay a great part in the fight against dental caries.Clearly, however, no one measure will ever conquerthis disease.
DRUG ADDICTION IN AMERICA
DRUG-PEDDLING, an ugly crime by any measure, becomespeculiarly detestable when buyers are sought amongchildren. The investigation into the drug traffic, whichis being conducted in New York 1 by Mr. NathanielGoldstein, the attorney -general, has revealed thewidespread use of drugs-marihuana, cocaine, heroin,and amphetamine-by boys and girls in the high schoolsof the city. Some of these children acquire the habit atages as early as 12 or 13, usually beginning by smokingmarihuana cigarettes-" reefers "-which are sold tothem by older children in the school. Nor is it clearthat these older children are necessarily the tools of adultvendors : some, at least, seem to have set up in businessfor themselves. Among the addicts whose recordedconfessions were played back in the course of the inquiry,a woman of 25 told of a candy store where high-schoolchildren of 14 and 15 sold drugs after school hours;and the same children could be approached duringmorning break, when they would peddle drugs over theplayground fence. A 17-year-old boy, who was runninga successful business as a bookie in his school, spoke ofa school-fellow who dealt in drugs among the childrenand made as much as$300-400 a day. Asked howmuch he himself made as a bookie the informant replied:" That’s my business." The inquiry revealed clearlythe stages in which addiction is acquired : a reefer, or a" snort " of cocaine is given free at first, then a moderatecharge is made ; once the child becomes an addict pricesrise, and to get the necessary cash the young peoplespend money saved to pay for education or hospitaltreatment, steal, housebreak, or take to prostitution.It has been estimated that 1 in every 200 children inthe city uses narcotic drugs, and one witness spoke ofyoung parents who quiet their baby with a shot ofheroin. In 1946, of 712 people arrested for offencesagainst the narcotic-drugs laws, 3 were aged 16, and 30were between 17 and 21. By 1950 the numbers of thosearrested had risen to 2482, of whom 63 were 16-year-oldsand 458 between 17 and 20. The numbers of those intheir ’teens who were arrested had increased sixteenfoldduring this period.The plight of the young addict who wishes to be
cured is very unfortunate : if he admits his trouble heis liable to be jailed for the offence of buying drugs.A girl of 19, who asked the help of the biology teacherin her school, was nevertheless obliged to go throughthe courts ; she was of the opinion that many youngpeople would confess to their addiction if they couldhope to be treated as patients, not as criminals. Thereare disquieting indications that some members of theNew York police force countenance drug-traffic in orderto collect bribes. Certainly the police can hardly havefailed to know how very widespread drug.peddling is :one addict mentioned by name over forty bars, cafeterias,
1. New York Times, June 13, 14, 15, 16.
1357
luncheon places, and drug and candy stores where shehad bought narcotics or seen them bought. One at leastwas opposite a police-station. She described the tech-
nique of the salesmen, some of whom must be approachedwith a request, while some come over to ask if anythingis wanted or follow the customer out into the street.On the broadwalk of Coney Island it seems that peddlersopenly accost passers-by with offers of drugs.A statement by the Senate Crime Investigating Com-
mittee in Washington suggests that there, too, and inBaltimore, the trade in illicit drugs is busy, thoughprobably not as widespread among young people as inNew York. The results of these inquiries have been sogravely disturbing that a national investigation is likelyto be undertaken. Meanwhile the police of thirty-sixcountries, who met in Lisbon at the beginning of June,have agreed to intensify the safeguards against smugglingof narcotics by air.
THE LISTER INSTITUTE
THE latest report of the Lister Institute describes thegreat variety of work carried out there in the past year.The effect of inactivating vaccinia virus with ultravioletlight has been studied with a view to determiningwhether the treated virus is antigenic. A preliminarydose of an antigenic preparation of killed virus mightreduce the incidence of complications in those vaccinatedfor the first time at school age or in later life. The fateof the plasma substitute dextran has been investigated.It appears that, in the rabbit, in the first few weeksafter intravenous injection the dextran which is notexcreted is distributed throughout all the tissues, includ-ing the brain, spinal cord, and cerebrospinal fluid ; theheaviest deposits are found in the liver. In heavilyloaded animals dextran has been detected serologicallyin saline extracts of the following tissues : at six monthsafter injection, in the brain, spinal cord, bone-marrow,lungs, liver, kidney, skeletal and cardiac muscle, stomach,and lymph-glands ; at nine months after injection, inthe cerebrospinal fluid, bone-marrow, skeletal muscle,kidney, liver, and lymph-glands ; and at twelve monthsafter injection, in the brain, cerebrospinal fluid, liver,kidney, and lymph-glands.
In the biochemical division the gene product respon-sible for the ’’Lewis" Lea blood-group character hasbeen isolated and characterised. The material is a
mucoid very similar to the human group-A substancedescribed earlier. The main components-fucose, galac-tose, glucosamine, chondrosamine, and eleven amino-acids-appear to be common to both substances, and furtherstudies are being made to determine the amounts ofeach of the components present in the group substances.Preliminary experiments have been carried out on theoxidation of the Lea substance with the periodate ionin order to compare the behaviour of this substancewith that of the group-A substance under similar con-ditions. The blood-group research unit has been concernedwith finding " new " blood-group systems, and fillinggaps of knowledge in " old " ones. The first problemis being approached by testing serum of persons knownto have been immunised by pregnancy or transfusion ;it is in such sera that antibodies defining " new " antigenshave in the past usually been found. As a more activemeasure the unit is giving small injections of blood tomore than a hundred volunteers in the hope that someof them may respond by making antibodies to antigensyet unknown or only guessed at. In the filling of gapsin the knowledge of blood-groups, the unit was fortunatein being sent a sample of blood which served to answerthe problem of whether the three pairs of the Rh complexare separable or not. The blood sample, came from aperson who was found to lack two of the three parts,which parts are therefore evidently separable. Further,
the missing antigens presumably reflect a small deletionin the Rh chromosome. Deletion is a phenomenon familiarin species which have bee well studied genetically, butno good case has previously made out for its occurrencein man.
The Blood-group Reference Laboratory has continuedto supply blood-grouping serum of all kinds to theNational Blood Transfusion Service, and to other usersat home and abroad. Increased work has made it
necessary to increase the technical and maintenancestaff.
THE TOXICITY OF BERYLLIUM
THE story of beryllium and the part it plays in indus-trial toxicology is fascinating and contradictory. Fewpeople are completely sure that beryllium is the solecause of the illnesses ascribed to it. Yet Americaninvestigators, led by the late Dr. Leroy U. Gardner,have built up a strong case against it, despite the findingsof Fairhall and others 1 in 1943 that no specific toxicaction is attributable to the beryllium ion. The illnessesfound amongst beryllium workers fall into two broad
groups : an acute pneumonitis occurring amongst workersengaged in extracting the metal and its salts from theore, and a delayed or chronic condition variously termed" delayed chemical pneumonitis " or " pulmonarygranulomatosis," usually found among fluorescent-lampmakers. The latter condition has many of the featuresof acute or subacute silicosis, but may resemble otherconditions such as Boeck’s sarcoidosis and miliarytuberculosis. In the early stages of the investigationGardner, with the weight of his great authority,demolished the silicosis theory, which does not seemto have been seriously considered since then ; but this
may well be one instance in which Gardner was wrong.Both the acute and the delayed illnesses could be
explained without reference to beryllium. The acidradicals in beryllium fluoride and sulphate, to whichthe workers in the extraction processes are mainlyexposed, could account for the acute pneumonitis, whichsomewhat resembles oedema of the lungs. The powdersused for coating fluorescent lamps contain much moresilica than beryllium, and it seems illogical toascribe an illness caused by the inhalation of a com-posite or compound dust to the smallest ingredient.But as T. L. Shipman said in the Sixth Saranac
Symposium 2 :"it is significant that delayed chemical pneumonitis, ifit is not Boeck’s sarcoid, is closely similar ; that it has certain,characteristics in common with silicosis and that it caneven resemble tuberculosis enough to make one stop andthink. Because of the complexity of the problem, let mespeak a warning against hasty conclusions. Our taskdemands the humility which ensures an open mind."
Throughout this conference there-was a doubt, expressedand implied, whether beryllium was really the prime causeof both types of illness. But one speaker was prepared"to stick out his neck," as he put it, and pronouncecategorically that the cases of poisoning with which hehad to deal were in fact instances of beryllium poisoning.No-one, however, was equally prepared to state that
they were not. As regards terminology, the conferencecame to the conclusion that it would be unwise in the
present state of uncertainty to use the term " berylliumpoisoning " ; but that it would be better to call the acutedisease " acute pneumonitis of beryllium workers "and the chronic or delayed disease " pulmonarygranulomatosis of beryllium workers."
1. Hyslop, F., Palmes, E. D., Alford, W. C., Monaco, A. R., Fairhall,L. T. The Toxicity of Beryllium. National Institute of HealthBulletin no. 181. Washington, D.C. 1943.
2. Pneumoconiosis : Beryllium, Bauxite Fumes, Compensation.The Sixth Saranac Symposium. Leroy U. Gardner MemorialVolume. Editor : ARTHUR J. VORWALD, M.D. New York:Paul B. Hoeber. 1950. Pp. 659. $7·50.
