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State tuberculosis hospitals, he said, the invalid isthe principal wage-earner of the family. In additionto the recognised public health measures for thecontrol of disease the Government must concern itselfwith the general improvement of economic and

hygienic conditions and with the provision of financialaid to such families as have lost through sickness theprincipal wage-earner.

Dr. Robert E. Plunkett estimated that at least

50,000 additional beds are necessary to meet thestandard of 2 beds per tuberculosis death. He

emphasised the grave danger that lies in dischargingthe patient whose recovery has not reached a pointwhich may assure him of relatively good health andthe possibility of economic self-support. Betterfacilities were needed for education, training, andrehabilitation. Rehabilitation should include : (a)an extension of therapeutic assistance ; (b) continuedsegregation of positive-sputum cases ; (c) more

thorough conservation of the benefits of past treat-ment ; and (d) improvement in the socio-economicstatus of both the patients and their families.

Dr. William Siegal presented a number of tablesshowing which age-groups yield (1) the largestnumber of active cases of tuberculosis, and (2) casesin the earliest stages of the disease. Examinationsof children under 15 were the least productive andthe most expensive. When the average cost perexamination made in the New York State clinicswas ascertained, it emerged that it cost$4418 tofind each new case among the children,$121 foreach new case among all patients over 15,$91 foreach new case among new patients over 15, and only$77 for each new case among those over 45. Whena choice had to be made adult contacts should thusbe examined even to the exclusion of children.

Dr. William B. Brumfield, Jr., the director ofthe division of syphilis control of the State HealthDepartment, discussed the rapid development of thisbranch of the health service, and anticipated itsfurther extension as a result of the recent legislativeprovision for federal grants in aid of syphilis controlwork beginning at$3,000,000 per annum and risingto$25,000,000. There was a dearth of adequatelytrained personnel to conduct the control measuresthat have now become financially possible. TheState of New York was undertaking the preparationof three groups of special-ists : (1) full-time adminis-trators ; (2) part-timeclinicians ; and (3) publichealth nurses with specialtraining in the conduct ofsyphilis clinics and the

investigation of lapsedcases and of contacts.Courses were being heldat Johns Hopkins Univer-sity and at New YorkUniversity, where twelvephysicians at a timereceived special trainingwith scholarships providedfrom funds appropriatedunder the Social SecurityAct and allocated throughthe State Department ofHealth. Short subsidisedcourses of post-graduateinstruction for practisingphysicians whose expensesare refunded by the State

had proved very popular. When the present seriesof courses were completed, some 450 physicianswould have been trained. For public healthnurses a six weeks’ course was provided at

Syracuse University. Dr. Brumfield added that itwas not easy to find medical graduates with sufficientgroundwork of knowledge to be trained as specialists.Better courses in syphilology were needed in thecurriculum of the medical schools.

PARIS

(FROM OUR OWN CORRESPONDENT)

A NEW MIDDLE-CLASS HOSPITAL

THE Fondation Medicale du Mont Valerien, inthe Parisian suburb of Suresnes, which was officiallyopened last year, owes its origin to the efforts ofDr. Du Bouchet. who was in charge of an Americanambulance service during the late war. Soon afterthe war ended he began to collect funds for a hospitalfor middle-class patients who would not or could notenter the public hospitals, and who could not affordthe high fees of the private hospitals, and with Statehelp the money was ultimately found. The 340

private wards of the hospital are, however, still farfrom full, partly because the public has not yetwoken to the advantages offered and partly becausecertain Paris doctors object to an institution whichthey think may conflict with their own interests.Some of this opposition has been met by improvingthe facilities for practitioners to follow their cases inthe hospital, and a large panel of doctors has beenappointed with the right to continue to treat their

patients in the hospital provided they conform to acertain moderate scale of charges.The charges of the hospital are indeed amazingly

low-85 francs a day for a private ward, including thedaily visit of the doctor on duty, minor dressings,and ordinary drugs and laboratory tests. Extra

charges are made only for radiological examinations,complicated laboratory tests, pharmaceutical special-ties, special dressings, blood transfusion, specialcalls on the doctor, and any operation, large or small.A charge of 2500 francs is made for a confinement,including a fortnight in a private ward, fees of doctorand midwife, prenatal consultations, and so on.

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A few wards have been set aside for those who are

willing to pay more than the minimum fee and donot want to put themselves under too great an

obligation to the institution.

SCOTLAND

(FROM OUR OWN CORRESPONDENT)

PROF. COLLIP ON PITUITARY HORMONES

THE Cameron prize lecture was delivered before alarge audience at the University of Edinburgh onJune 16th by Prof. J. B. Collip, M.D., F.R.S.,professor of biochemistry at McGill University,Montreal. Prof. Collip began by speaking of theknown effects of removing the pituitary, and theactions of anterior-lobe extracts on normal and

hypophysectomised animals. He pointed out the

improbability that the three types of cells existingin the gland should secrete so many different sub-stances having so many different actions, and

suggested that some if not all of the active principlesof the anterior lobe exist as prosthetic groups in avery few individual protein substances. " The processof secretion from the normal intact gland could thenconsist in either the liberation of massive proteinmolecules, each containing active groups of specifichormone nature, or the liberation of the active

groups themselves from mother molecules byenzymatic or other action." He thought that thecomparatively pure substances arrived at by thevarious methods of extraction might not exist in

precisely the same form in the original gland. Theactive principles he divided into two types : first,there are those acting on the outlying glands andmodifying their functions (e.g., the thyrotropic,gonadotropic, and adrenotropic hormones), and

secondly, there are those apparently having a directaction on some general bodily function (e.g., the

growth-promoting factor). He felt, however, thatthis last anterior-pituitary principle might exert someinfluence on growth via the adrenal glands, since nogrowth hormone has been isolated that is free fromadrenotropic action. Crude extracts are more potentin growth factor than purified extracts. Anterior-

pituitary growth hormone is necessary for propergrowth of the body as a whole, but not necessarily forthe proliferation of tissue or the growth of individualorgans, since fibroblasts grow, and implanted tumourscontinue to proliferate, after hypophysectomy. Speak-ing of the thyrotropic hormone, Prof. Collip said thatthe active principle, extracted by differential iso-electric precipitation of protein, is destroyed byboiling at pH 8 but remains active after boiling atpH 4-5, as tested by retention of its actions in raisingthe metabolic rate of guinea-pigs, in increasing theweight of their thyroid glands, and in causing hyper-plasia of the glands. These three methods of assayshow close correlation. The bearing of the pituitary-thyroid association on clinical hyperthyroidism is byno means clear, but variations in the function of thethyroid may be the result of variations in the amountof thyrotropic hormone, or of differences in the

response of the thyroid gland to other stimuli.After discussing the isolation and methods of assay

of the gonadotropic, adrenotropic, and other factorsProf. Collip described in some detail work at presentin progress in his laboratory on the specific metabolism-stimulating principle. This principle, which hebelieves is probably formed in the pars intermedia,is separable from all other known factors except themelanophore factor. It produces after injection into

rabbits a rapid and short-lived reduction in the

respiratory quotient, and an increase in the metabolicrate, which are independent of the thyroid gland.The extract remains active after boiling at pH 10,after dialysis through fish bladder and collodionmembranes, and after electro-dialysis, in which ittravels to the cathode. The stimulation of meta-bolism can still be obtained after adrenalectomy.The same extract is found to produce ketonsemia innormal and adrenalectomised rats and to preventinsulin hypoglycsemia and adrenaline hyperglycaemia.He suggested that the melanophore, metabolism-stimu-lating, and ketogenic factors of the anterior pituitary,and also the factors neutralising the hypoglycaemicand hyperglycaemio effects of insulin and adrenalinerespectively, may be one and the same substance.

After paying tribute to the work of his collaborators,including D. K. O’Donovan, A. H. Neufeld, and 0. F.Denstedt, Prof. Collip closed his lecture with a referenceto antihormone substances. He recalled that, forexample, long treatment of female sheep with gonado-tropic hormone makes them resistant, so that withcontinued injections further increase in the size ofthe ovaries is not obtained and indeed recessiontakes place. The serum of such resistant animalsconfers resistance to gonadotropic hormone whenadministered to untreated animals. However, for ashort time, about 3-5 weeks after the start of hormoneinjections, the animals’ blood shows a synergisticaction with gonadotropic hormone whereby theadministration of hormone and serum to anotheranimal induces a much greater increase in the weightof the ovaries than did hormone alone.

HONORARIUMS FOR HOUSE PHYSICIANS

The Students’ Representative Council are hopingto persuade the managers of the Royal Infirmary ofEdinburgh to give a small salary to the resident housephysicians and house surgeons. The proposal theymake is that £ 2 should be given for six months’service in the infirmary, and one of the argumentsthey bring forward is that some of the best mendo not become residents because they cannot affordto live in the residents’ mess. This proposal is likelyto be considered sympathetically. An additionalreason for its support is that residents in the municipalhospitals are now paid, and as these hospitals becomemore highly developed the experience gained in themwill be almost as good as in the Royal Infirmary.

PROFESSOR OF MEDICINE IN EDINBURGH

The appointment of Dr. L. S. P. Davidson to thechair of medicine at Edinburgh in succession toProf. W. T. Ritchie, as announced in your newscolumns last week, comes as no surprise. Thoughthe appointment is not to be a whole-time post,it is understood that the new professor intendsto devote almost all his time to the work of his

department. He will be connected both with the

Royal Infirmary and the municipal hospitals, and animportant part of his work will be the developing ofteaching facilities in the latter : for he will directthe medical units in them. The experience he has hadin similar work in Aberdeen, where he has been regiusprofessor since 1930, will no doubt be of great value.

CHANGES AT ABERDEEN

Last week the Aberdeen university court approvedof an extensive reconstruction scheme in Marischal

College, the estimated cost of which is 144,000.The scheme has become possible through the removalof the medical school to Forresterhill, which will becompleted by September of this year. Arrangementsare being made for the accommodation of final-year