2
350 in the molar region will not be very successful, and it may even be necessary to wait until the pre-molars erupt. There is also a distinct advantage in expanding before the permanent laterals appear. Later treat- ment may well be successful, but it will have to be more elaborate and more prolonged. Although the majority of children do not resent orthodontic appliances, profound psychological difficulties may be provided by the parents. Mr. Pitts tells amusing tales of parents who interfered, more or less success- fully, with treatment which was causing their child no trouble whatever. He recommends the dentist to take the parents into his confidence, to explain to them as fully as possible the why and the wherefore of the treatment in its various stages. Dealing with the vexed question of fixed or removable applances, he holds that the wise dentist will use either according to the particular case. On the difficult problem of anchorage, he says that it is wise in every case to over-estimate the resistance of the teeth to be removed, and to under-estimate the resistance of the teeth to be used for anchorage ; it is far better to have an excessive anchorage than too little. Although it may be necessary to raise the bite deliberately as part of the treatment, this should be looked upon as an evil procedure likely to do harm in ordinary cases. Irretrievable damage has been done by capping a bite when this was not necessary, and Mr. Pitts’s advice to those who meditate this orthodontic crime is " don’t." He is a whole-hearted advocate of extraction, but with certain qualifications. He thinks that extraction should be regarded as an ancillary method of treatment, and usually combined with an appliance. A patient from whom a tooth has been extracted should always be watched carefully to be sure that the gap is properly filled in. Practical advice like this is invaluable to the dentist and of great importance to the medical man. If the family doctor does not hold sound views the dentist may not see the case until too late or may plead the necessity for treatment in vain. The general practi- tioner of both professions would profit by a study of Mr. Pitts’s paper. ____ THE HEALTH OF THE ARMY IN 1926. THE annual report of the health of the Army has just appeared and reveals a slightly higher invalid- rate, a lower number of constantly sick, and an identical death-rate with that of 1925. It was found that officers in India were less well protected by antityphoid inoculation than were the men, although there was an improvement on last year. Injury heads the list of causes of death among " other ranks," followed by pneumonia and diseases of the digestive system. There was a decrease in the number of deaths from both these natural causes. The principal cause of invaliding was middle-ear disease, which remains high and gives some cause for anxiety. Nearly a quarter of all the men invalided during 1926 suffered from ear trouble. The majority of men admitted to hospital were suffering from malaria, which was unusually severe in the Western Command in India. Influenza was very mild and only caused one death, but there were over a thousand more cases than in 1925. An interesting side-result of the coal strike was an increase in the amount of scabies, and the fact that each case lasted half a day longer than usual under treatment. This is attributed to the lack of hot water. Bermuda was the most healthy command and Malaya the worst. Venereal diseases diminished in frequency, but there is still a high incidence about the time of the Christmas furlough, when men expose themselves to infection without the preventive facilities that are available in barracks. It is hoped that a reduction in the incidence and an improvement in treatment may result from careful attention to these facts. The liability of uninoculated men to typhoid fever was seven or eight times greater than that of the inoculated, and the mortality ten times greater. We observed three years ago 1 that 1 THE LANCET, 1924, ii., 664. there was no discussion on the prevalence of tuber- culosis in the reports of either of the three services. This year we note that " the whole subject of pulmonary tuberculosis in the services is being investigated by a special committee and the relation of this disease to service conditions, its incidence,- invaliding, and attributability will be the subject of a report." We hope to deal with the figures of this report more fully in a later issue. PROTEIN TREATMENT OF DRUG-ADDICTION. , ABOUT a year ago A. Lambert and F. Tilneyl described a new treatment of drug-addiction with a preparation called narcosan, which consists of a solution of lipoids, non-specific proteins, and water- soluble vitamins. The treatment is based on an assumption that narcotics such as morphia cause toxic bodies to be formed in the body, and that these bodies neutralise the narcotic and, in so doing, are themselves neutralised. When the narcotic is withdrawn these toxic bodies cause withdrawal symptoms because they are no longer being neutralised. Lambert and Tilney therefore proposed that when a narcotic is withdrawn narcosan should be given instead, in the hope that the lipoids which it contains will neutralise the toxic bodies, and thus prevent symptoms. The authors of a recent paper 2 on drug-addiction consider that the results of narcosan treatment are not consistent with the hypothesis on which it is based, and quote evidence to show that drug-addiction is associated with hypo- function of the endocrine system, secondary possibly to disturbance of the sympathetic. According to this hypothesis, withdrawal symptoms are due to a func- tional upheaval in the endocrine system. They state that the results of treatment with various endocrine extracts and also by hypodermic injection of solutions of vegetable proteins, which are regarded as stimulants of the endocrine system, confirm this hypothesis, and they point out that one of the vegetable protein substances (alfalfa protein) which they used as an endocrine stimulant is also present in narcosan. It is suggested that the beneficial effects of the latter preparation are due not to its ability to neutralise toxic bodies formed in response to the narcotic, but rather to the stimulating effect of alfalfa protein on the endocrine system. Acting on this assumption they treated a series of drug-addicts with alfalfa protein and obtained results similar in every way to those obtained with narcosan. Withdrawal symptoms were slight and the patients remained in good physical condition. It seems probable, they say, that proteins prepared from millet, rape, and hemp seed will give equally satisfactory results, but recommend that all forms of protein treatment should be reinforced by synchronous administration of orchitic and ovarian extracts, on the grounds that sexual function is invariably affected in drug-addicts. An advantage of alfalfa protein over narcosan is that it is very much cheaper. ____ THE INCIDENCE OF GENERAL PARALYSIS IN view of the reports from all sides which indicate that mental disorder of every kind is on the increase in the United States, it is interesting to study the figures for syphilis and general paralysis recently issued by the United States Public Health Service to the Office International.3 The incidence of syphilis among the general population is, of course, uncertain, but the percentage of recruits giving a positive Wassermann reaction, out of a group of close on 12,000 in 1916 was 13, and out of 856 candidates for the Washington police 15. The consensus of opinion puts the figure at 10 per cent. for the whole population, but recent research has tended to lower it. The proportion of general paralytics to others in mental hospitals seems 1 Med. Jour. and Record, 1926, cxxiv., 764. 2 The Proteal Treatment of Drug Addiction, by M. G. Carter, T. J. Orbison, E. H. Steele, C. A. Wright, and E. H. Williams: Med. Jour. and Record, Sept. 7th, 1927, pp. 282-284. 3 Office International d’Hygiène Publique, Bulletin Mensuel, xix., 11.
