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to the mental depression usually associated with thelong and tedious course of the treatment, affectsadversely the well-being and equanimity of manypatients. They become irritable and non-cooperative,often at a time when full cooperation is imperative,and when the actual treatment is completed they hastenhome long before their reactions have subsided or theyare fit to go. As home often means a public shelter atnight, the chances of a debilitated patient succumbing toan intercurrent infection is high, and we have noted thedeath soon after leaving hospital of 2 patients whowould probably have survived had they remained inhospital until they were fit to go. For treatment ofcancer by irradiation to be effective regard must bepaid to the time over which the treatment is spread.Any appreciable interruptions or delays in the orderedcontinuity of treatment diminish its value. Severaltimes since September, 1940, patients have interruptedtheir treatment to return to their homes-or erst-whilehomes-because of a tragic domestic sequel to an air-raid. In a’ few cases when the patients have - notreturned to complete the treatment it is certain thatthey will succumb to their disease. Where the patientshave returned it is as yet too early to assess the preciseeffect the delay may have on the ultimate response totreatment.

We would like to acknowledge our gratitude to the membersof our staffs who have carried on their normal and abnormalduties under very trying circumstances, and have therebyenabled radium treatment to be continued in this hospital. In

particular we would mention Miss E. W. Glazebrook, sister inthe radium department and Dr. J. R. Clarkson of the physicsdepartment. The accessories to the borehole were constructedby Messrs. H. Hodt, senior and junior, technicians . to thephysics department. ,

INTERNATIONAL STANDARD FOR VITAMIN E

AN international standard for vitamin E has beenestablished and, as in the case of the international stand-a.rds for vitamins A, B1, C and D, the National Institutefor MedicaJ Research, London, acting on behalf of theHealth Organisation of the League of Nations, has under-taken its supply to laboratories, institutes and researchworkers throughout the world.

Synthetic racemic a-tocopheryl acetate (CgiHszOs)has been adopted as the international standard forvitamin E. The investigation of.the chemical, physicaland biological properties of this substance, its suitabilityfor adoption as the international standard and the man-ner of its application in biological assay was carried out,at the request of the Health Organisation of the Leagueof Nations, by the vitamin E subcommittee of theaccessory food factors committee of the Lister Instituteand the Medical Research Council. The subcommitteewere able to enlist the cooperation of experts in fourteenlaboratories in Europe and America, and have recom-mended the adoption of synthetic racemic ex-tocopherylacetate as the international standard. They furtherrecommend that the international unit for vitamin Eshould be defined as the specific activity of 1 mg. of thestandard preparation, this being the average amountwhich, when administered by mouth, prevents resorption-gestation in rats deprived of vitamin E.

In normal times the results of the cooperative investiga-tion would have been submitted for discussion at thethird international conference on vitamin standardisa-tion, which had been arranged for the autumn of 1939,but because of the war this conference was not held.The report and recommendations of the subcommitteehave, however, been placed before the members andofficers of the League of Nations’ Permanent Commissionon Biological Standardisation and of the InternationalConference on Vitamin Standardisation, who were avail-able, and they have accepted the responsibility of adopt-ing the proposed standard for vitamin E, accepting therecommendation defining the international unit, andauthorising the National Institute for Medical Researchto proceed with the distribution of the standard.The international standard for vitamin E is issued as

a solution in olive oil of which one international unit iscontained in 0-1 g. In countries where nationalcontrol centres have been established it will be supplied

to their directors for local distribution ; it will also besupplied to laboratories, institutes and research workersin this country, and in countries in which national controlcentres have not yet been set up. Application should bemade to the department of biological standards of theNational Institute for Medical Research, Hampstead,London, N.W.3.

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MEDICINE AND THE LAWIllness after Hotel Lunch

CATERING establishments do not guarantee the healthof every visitor to whom they serve a meal. Actions fordamages are sometimes brought by visitors who have feltill after eating at a restaurant or hotel. They do notalways succeed ; post hoc is not necessarily propter hoc.In the recent county court case of Braham v. GrandHotel, Birmingham, a lady gave evidence that, whileeating steak and kidney pie at the hotel, she found some-thing unexpectedly solid in her mouth. She thought itmight be a piece of tooth ; it turned out to be a chip ofcrockery. That night, she said, she woke in great pain ;there was medical evidence that she was suffering fromfood poisoning. She claimed damages for breach ofwarranty of the quality of food supplied ; alternativelyshe alleged negligence in allowing the food to becomecontaminated. On the other hand, the defendantsdenied that the food was defective or that their staff hadbeen negligent. There seemed no necessary connexionbetween the chip of crockery and fbod poisoning. Theyhad served nearly a hundred portions of steak and kidneypie that day, and this was the only complaint. The citybacteriologist found no poisonous organisms in the pie.The judge disregarded the crock. He found no indica-tion of slackness in the conduct of the hotel. The onlysuggestion against the pie was that the plaintiff was illafter eating it : it would be unsafe to say that the illnesswas due to the hotel luncheon. Judgment for thedefendants with costs.

NEW OFFICIAL NAMES FOR DRUGS

THE General Medical Council has issued a further list ofapproved names for drugs which are now produced orlikely to be produced in this country.

Approved name Other namesAmethocaine hydrochloride DecicainMenaphthone 2-methyl-l : 4-naphthoquinonePethidine hydrochloride Dolantin .

Soluble phenytoin Epanutin, Eptoin, sodium di-phenylhydantoinate, Solan-toin, Soluble Dilantin.

Sulphacetamide Albucid

The council hopes that these and the approved namespreviously published will be generally adopted.

ORTHOPÆDIC CONFERENCE AT ROEHAMPTONA CONFERENCE of the orthopaedic surgeons attached to the

Ministry of Pensions hospitals was held at Queen Mary’sHospital, Roehampton, on Sept. 24-26, Mr. G. R. Girdlestone,honorary consultant to the ministry, presiding. Clinicalrounds were conducted by Mr. Pomfret Kilner and Mr. GeorgePerkins, and Mr. Fraser demonstrated the methods usedby himself and Mr. Kilner in fractures of the jaws. Dr.R. D. L. Kelham, surgeon in charge of the limb-fitting depart-ment, assisted by Captain Maxwell, gave lecture-demon-strations on modern artificial limbs, and explained the

present-day sites of election-for an above-knee amputation10 in. below the tip of the greater trochanter ; for a below-knee amputation 5t in. below the level of the knee-joint onthe medial side ; for an above-elbow amputation 8 in. fromthe acromion process ; and for a below-elbow amputation7 in. from the tip of the olecranon. Surgeon Lieut.-Com-mander John Bunyan, R.N.V.R., showed a cinematographfilm of the results of treating burns by irrigation with electro-lytic sodium hypochlorite in the Stannard bag, and afterwardsdemonstrated his procedure on patients from the QueenAlexandra Hospital, Cosham, and other cases with septicamputation stumps and wounds. The conference providedan opportunity for exchanging views on orthopaedic treatmentand coordinating the work being carried out in ministryhosnitala.

1. See Lancet, 1940, 1, 804; 1941, 1, 614.