23

radiography of the chambers of the heart is now a

practical proposition. Perhaps most startling of allto the orthodox clinician is the optical recording ofintracardiac pressure pulses by means of intracardiaccatheterisation.13 3

Annotations

THE MEDICAL PROTECTION SOCIETY

THE London and Counties Medical Protection Societyowes its name to the time, soon after its foundation in1891, when provincial committees were set up to sup-plement the central council. With a membership ofover 22,000, in all parts of the world except the UnitedStates, the society has long needed a more apt title;and at the general meeting on July 16 members will beasked to approve abbreviation to The Medical ProtectionSociety." With accumulated funds of over £ 112,000 the societyis in a strong position. During the past year, reviewed inthe annual report, 1894 new members were elected,compared with 1087 in 1945. Of the 1410 applicationsfor advice and assistance, many were concerned withthe implications of the National Health Service Act.Several topical subjects are covered by the society’ssolicitors, Messrs. Le Brasseur & Oakley, in their sectionof the report. It is not always understood, Mr. LeBrassesur says, that where a practitioner has retired or

died in the period between the passing of the Act andthe appointed day, and the goodwill of his practice hasnot been sold, that practitioner or his representativescan apply for compensation payable under the Act forthe loss of the right to sell the practice. Discussingproceedings for alleged wrongful certification under theLunacy Act, the solicitor comments : " It is surprisingthat even in the legal profession it is not fully appreciatedthat no such proceedings will lie except with the leaveof the High Court." He also recalls that coroners haveno power to impose an obligation to notify them of alldeaths occurring within forty-eight hours of admission tohospital. Most cases undertaken by the society involveallegations of negligence. Even when unjustly charged,some doctors are disposed to avoid further worry by settle-ment out of court ; but no settlement, says the report,is ever secret.Almost any member of our profession could find profit

as well as interest in the records of misfortune and error

given in this report.14 Thanks to the society, theymostly had happy endings-at least so far as its memberswere concerned.

’

SOUR MILK AND TUBERCULOSIS

THE search for an etticient therapeutic agent in humanpulmonary tuberculosis goes on intensively, but progressis difficult. For a drug to succeed in this field it has toovercome three obstacles over and above those presentin the chemotherapy of streptococcal infections. Thefirst is the relative resistance of the bacterium to drugs,possibly owing to its fatty constitution. The second isthe necrotic and non-vascular nature of the lesions,as compared with those in other infections and indeedwith those in experimental tuberculosis in animals,making them inaccessible to the drug. Lastly, in thischronic disease many drugs which are quite safe for thetreatment of streptococcal infections show disturbingevidences of latent toxicity. The sulphone compounds,such as.’ Promin,’ ’ Diasone,’ and ’ Promizole,’ willretard experimental tuberculosis and have been givenclinical trials but they are too toxic for general use inman. The same seems to be true of helvolic acid.

13. Bloomfield, R. A., Lauson, H. D., Cournand, A., Breed, E. S.,Richards, D. W. J. clin. Invest. 1946. 25, 639.

14. Obtainable from the secretary, Dr. R. W. Durand, at the society’soffice, Victory House, Leicester Square, London, W.C.2.

Streptomycin has given even more promising results inanimals, and has produced some startling remissions intuberculous meningitis and miliary tuberculosis, but sofar it has not fulfilled the early hopes in pulmonaryinfections.Now the humble domestic lactic streptococci which

turn our milk sour in hot weather may be pressed intoservice. In 1933 H. R. Whitehead noted that some milkstreptococci prevented the growth of the organisms usedin cheese making. Following this up at the NationalInstitute for Research in Dairying,’ Mattick and Hirschdiscovered a strain of gronp-N lactic streptococci thatcould kill, or render avirulent, a heavy inoculum ofhuman tubercle bacilli in milk. In this issue they givedetails of the purification and properties of Nisin,the antibiotic concerned. It is highly active againstgram-positive bacteria, much less so against the tuberclebacillus, and inactive against gram-negative organisms.In this it follows the common pattern for most anti-biotics. It keeps its activity in the presence of blood-a prime necessity for a therapeutic agent-and it isof low toxicity against leucocytes and in the intact animal,though the injection of impure preparations causes somenecrosis. Its chemotherapeutic activity in animals isvery striking. A single dose of 50 mg. saved mice whichwere in a moribund state twelve hours after 1000 lethaldoses of a streptococcus. Ten years ago this wouldhave appeared miraculous, but we have grown used tosubstances which can kill streptococci at incredibledilutions. In a preliminary experiment with impurematerial, nisin was found to limit but not preventtuberculous infection in animals.

Nisin is probably not the long-awaited answer to thetuberculosis problem, but it marks one more step forwardin man’s advance against this ever-present foe.

THE COST-OF-LIVING INDEX

WE have already noted 2 the projected changes in thecost-of-living index recently accepted in principle bythe Minister of Labour and National Service. He nowproposes to act on the proposals for an interim indexbased on the results of a sample survey of 10,000 working-class household budgets done in 1937-38. The interimnature of this index is emphasised in the explanatorynote announcing this decision 3 : as every woman knows,the range of choice in her purchases is now severelylimited compared with 1938 ; while, on the other hand,an index based on today’s purchases would, we ferventlyhope, be out of date fairly soon. Despite these limita-tions, the interim index, including as it does the near-necessities of modern life such as cinema tickets, soap-flakes, and children’s wellingtons, will be a much morerealistic indicator of the present pattern of expenditure.The inclusion of so many new items raises the question ofthe relative importance to be assigned to them in the calcu-lation of the interim index ; where in 1914, 60 % of thebudget was being spent on food, in 1938 food accountedfor only 35% of the family’s expenditure. This does notmean that less food was bought in 1938 ; indeed, greaterquantities of food were purchased, but the relativeproportion of the family budget spent on food was muchless. The new " weighting " for food in the interimindex thus becomes 35 instead of 60. Similarly, 24% ofthe " weighting " is now accounted for by items notcovered in the 1914 index.

Such considerations may seem a trifle academic atthis stage ; but cost-of-living indices could have an

urgent personal importance to doctors in the new healthservice. If" for example, remuneration scales were tiedto cost-of-living indices, a decrease in the cost of meeting1. Mattick, A. T. R., Hirsch, A. Lancet, 1946, i, 417.2. Lancet, 1947, i, 455.3. Interim Index of Retail Prices. A short explanatory note.

Ministry of Labour and National Service. H.M. StationeryOffice. 1947. Pp.7. 2d.