355

This poses a triple problem : nrst, the relationshipbetween sterility and tuberculous endometritis ; secondly,the situation of the original tuberculous focus, whichmay, or may not, have been genital ; and thirdly, thesignificance and prognosis of the uterine disease. In a

previous article Halbrecht outlined the past historyof 18 cases of tuberculous endometritis ; of these, 2 hadhad pleurisy in youth, 2 had had tuberculous peritonitis,and 3 others showed signs of other tuberculous affections- persistent pararectal fistula, tuberculous adenitis, orhip disease. It therefore appears that the endometrium

provides a long-term sanctuary for the tubercle bacillus,in the same way that the gall-bladder harbours thetyphoid bacillus. The sequence is probably this : primaryfocus in lung or abdominal glands, systemic tuberculosisor dissemination to the pelvic peritoneum, exosalpingitisor endosalpingitis with tubal occlusion, and finallyresidual tuberculous endometritis.

In a final word of reassurance, Halbrecht says thatapart from the endometritis his patients were all fit byexternal standards, and that, except for obliteratingthe tubes, the disease remained stationary anduntrouble-some. For treatment he advises absolute conservatismwith complete abstention from surgical intervention.His conclusion that occult, subclinical tuberculous endo-metritis is one of the cardinal causes of sterility in generaland of tubal occlusion in particular may have come assomething of a shock to English workers ; and it willbe interesting to see whether, with further experience,similar reports appear in this country.

BOVINE PLASMA AGAIN

DURING the war there were several reports 7 on theuse of bovine plasma or serum, and bovine albumin,as blood-volume-restoring agents in man ; but none ofthe authors felt justified in proposing their unrestrictedum.

Any protein-containing substitute for human plasmamust obviously be non-antigenic, non-toxic, and freefrom agglutinins, and it should have at least the sameosmotic pressure as human citrated plasma. None of theworkers who have reported so far have been willing tostate unequivocally that the first condition has beenfulfilled, while the solutions of highly purified ox-albuminprepared in Cohn’s laboratory at Harvard and used byHeyl et al. alone appear to fulfil the second. Of thebovine material used, the ox-albumin seems least opento criticism, and publication of the final conclusionsdrawn from its trials-if in fact trials have been continued-will be very valuable. Meanwhile a report fromBarcelona on the preparation of bovine plasma and itsuse in man is published on another page of this issue.Dr. Massons has subjected his material to rigorous treat-ment to make it sterile and non-antigenic, but beforethe adoption of his bovine plasma can be recommendedhis claims must be substantiated by careful repetitionof his work, followed by controlled clinical trial. It is

unlikely that the osmotic pressure of Massons’ materialis equivalent to that of human plasma ; indeed it is

probably much less. His method of preparation is

simple compared with Cohn’s elaborate and expensivefractionation, but its extreme simplicity will itselfevoke criticism.The chief advantages of using a substitute for human

plasma are that it will remove the danger of transmittinghepatitis, and will lighten the burden of the many blood-donors who have given so faithfully. Unfortunately muchwork still remains to be done before this can happen.No protein-containing substitute for human plasmacan be employed until it has been clearly shown to benot only harmless but also as effective as human plasma.6. Lancet, 1916. i, 235.7. Edwards, F. R. Brit. med. J. 1944, i, 73.8. Heyl, J. T., Gibson, J. G., Janeway, C. A. J. clin. Invest. 1943,

22, 763.

CURARE IN NEUROLOGY

APART from anaesthesia, there are two outstandinguses for curare in medicine which may deserve more atten-tion. There is momlting evidence that it can be usedwith reasonable safety by intravenous injection tominimise the chances of fracture in convulsion therapy,especially in the elderly. Palmer has summarised thetechnique required. What may finally prove to be amuch wider field is in spastic or dystonic neurologicalconditions, where no radical treatment is possible, andspasm limits the value of all forms of physiotherapy.Results have been published, for example, in tetanus,status epilepticus, infantile spastic paralysis of severalkinds, parkinsonism, paralysis agitans, and Hunting-ton’s chorea. They have been dubious so far, for tworeasons. There have invariably been troublesome sideeffects--blurred vision, diplopia, general weakness, anddizziness--and the effect has been transient, and notsufficiently definite in proportion to the severity of thesymptoms to justify its routine use. chlesinger hasnow introduced a new factor by injecting the curareintramuscularly in a mixture of peanut oil and whitewax, and so obtaining slow absorption. He finds that itsaction is thus prolonged up to three days, and that theunpleasant side effects do not develop. Confirmation isrequired, but it may be that this modification in tech-nique will lead to welcome, although probably partial,relief for many patients who at present live many monthsfunctionally helpless. It should not be forgotten thata number of drugs, such as quinine methochloride,magnesium sulphate, and erythrine, are believed to havepharmacological effects similar to curare. There mightbe an advantage in achieving the same end with somesuch physiological analogue.

FOR AULD LANG SYNE

THERE can be few who served in the Forces during thewar years who do not find some pleasure in the recollec-tion. Perhaps memory is happily selective ; perhaps,again, the rigours of present-day civilian life lend fictitiouscharm to any alternative. Whatever the reason, thetedium, the irritations, the occasional danger, and thefrustration that largely compounded the life of theamateur soldier usually defer to happier memories.The life, though physically dangerous, was otherwisesecure, with food and pay assured without specialendeavour; many had the chance to see countriesthey would otherwise never have visited ; and thereturn to the schoolboy community way of living fosteredfriendships which, but for the common share of dis-comfort and danger, would never have been sealed.The value attached to these ties has been shown byletters in our columns in the last few months : for the

Army, a medical society has been proposed, and anairborne medical society is being formed. Mr. T. J.

Daly, a former major and quartermaster, R.A.M.C.,now writes to suggest an Army medical association tohold reunion dinners throughout the country ; he offersfuller particulars of a tentative scheme to anyone writingto 1, Lancashire Road, Bishopston, Bristol. Ideas ofthis sort will be warmly supported by those who seekto preserve the little good that has emerged from thelost years.

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1. Palmer, H. J. ment. Sci. 1946, 92, 411.2. Schlesinger, E. B. Arch. Neurol. Psychiat. 1946, 55, 530.

SYSTEMATIC research into the common cold is to be under-taken in the United States, as well as in Great Britain (seeLancpt, 1946, i, 822). In America, the investigation willbe made by the National Institute of Health (the researchdivision of the United States Public Health Service), directedby Dr. R. E. Dyer. Like the British workers, Dr. Dyeremphasises that it may be five or more years before sub-stantial progress can be recorded, even allowing for the

better understanding of viruses in the last decade. ’