in england now

1124

J. D. RAYMOND and J. T. GALAMBOS (Atlanta) had studiedbilirubin clearance by the human liver and calculated that thenormal liver could handle up to ten times the normal bilirubinload with only slight increases in serum-bilirubin values. InGilbert’s syndrome of familial non-hsemolytic hyperbili-rubinsemia the value was consistently reduced approximatelytenfold.

Contrast media used for cholecystography cause Brom-sulphalein’ retention and sometimes hyperbilirubintmia.L. S. MoNROE and W. J. LONGMORE (La Jolla) had developedan in-vitro system consisting of bromsulphalein, the enzymewhich conjugates it, and glutathione with which it is conjuga-ted. The addition of iopanoic acid (’ Telepaque ’) resulted ina distinct reduction in the conjugation of the bromsulphalein.Under the conditions of study, non-competitive inhibition byiopanoic acid was suggested.With the exception of the volunteer, there is no reliable

experimental system for the study of human viral hepatitis.The latest attempt at transmission by A. W. HoLMES and co-workers (Chicago) has been into the marmoset, a small sub-human primate. Five groups of animals were inoculated

intravenously with sera from patients with hepatitis. In two

groups no abnormalities occurred. In another group one offour animals showed increases in serum-enzyme values. Inthe two other groups inoculation of serum was followed 27-42

days later by elevation of serum-enzyme values. Microscopicexamination of the liver showed a hepatitis, but not like thatseen in ordinary viral hepatitis in man.

Possible liver injury due to halothane was discussed byW. S. HAUBRICH (Detroit). Fifty million halothane anxstheticshad now been given; accounts of only 117 adverse liverreactions had been published, but in addition 33 had beenreported to the American Medical Association Council onAdverse Drug Reactions. Evidence of liver injury usuallyappeared within a week of the anxsthetic. The clinical featuresand laboratory findings closely mimicked severe viral hepatitis.The cumulative mortality-rate was 42%, death usuallyoccurring after an average of 8 days’ illness. 36% of adversereactions had followed multiple administrations; and theseshould be avoided, especially within a short time of oneanother.

P. J. ScHEUER and colleagues (London) described four

patients with a partial nodular transformation of the liver

causing portal hypertension. Scarring was slight, and noduleswere not delineated by fibrous tissue. The condition was thusdistinct from cirrhosis. The aetiology was obscure.W. H. J. SUMMERSKILL and co-workers (Mayo Clinic) had

studied the effect of angiotensin in a patient with cirrhosis andascites who had previously undergone total adrenalectomyfor Cushing’s disease and who therefore did not producealdosterone. A natriuresis was induced, suggesting thatthe effect of angiotensin was independent of aldosteronesecretion.

R. WILLIAMS and colleagues (London and Makerere) hadstudied splenic blood-flow in patients with tropical spleno-megaly and portal hypertension. One factor concerned in therise of portal pressure was an increased spleen and liver blood-flow. In some patients, however, a presinusoidal resistance toportal blood-flow was demonstrated, and this could not

be correlated with the degree of portal-tract infiltration or

lymphocytic sinusoidal infiltration found in liver-biopsysections.

H. TOBIAS and A. M. DAWSON (London) had fed alcohol tohealthy subjects and noted elevated plasma-triglyceride levelsassociated with decreased clearance of triglyceride in the plasmaand a decreased lipoprotein lipase activity. The decreasedclearance of triglyceride might be a significant factor in theproduction of alcoholic flyperlipxmia. Ethanol depressed free-fatty-acid flux from the plasma compartment and did notincrease palmitate incorporation into plasma-triglyceride.Increased free-fatty-acid mobilisation did not seem to play arole in the production of alcoholic hyperlipaemia.

In England Now

A Running Commentary by Peripatetic Correspondents

THE Man that hath his Data in a Computer hath givenHostages to Fortune ...Our new Programmer is tall, dark, handsome, and helpful.

She thought her side of the project would be straightforwardenough, and that a very few weeks would see the programme forit written. So we collected our data in June, turned it rapidlyinto punched tape, and handed it over to her full of hope.Towards the middle of August nothing had appeared:

inquiry indicated that the programme was proving trickierthan expected, but that success was imminent. About this timewe were asked to contribute in November to a local sym-posium on computers in medicine and rashly offered to talkabout the results of this project. Anyone who has ever doneanything of the kind before will know what happened next.September and October passed, and the programme developedmore and bigger snags. Came November, and nothing butsheets and sheets of palpable nonsense came out of the com-puter. Even up to the day before, we were still hoping: but stillwe drew blank.

It was too late to withdraw the paper, and anyhow theoriginal idea of the project seemed good enough to be worthputting up. So I talked, though it had to be a rather lame andapologetic affair without any results to show at the end, andI wasn’t by any means as polite as I should have been aboutthe wisdom of relying upon a computer. I sat down to theusual few dutiful handclaps. One query from the floor wasdealt with, and I was trying to hear what the next was sayingwhen something enormous and white loomed up into myperipheral vision. It was our Programmer, beaming all overher face and covered almost completely by a vast sheet of paper.The computer had relented and produced the results at thelast moment.

They were of course too late to be the slightest use that day,but as a coup de théâtre the scene could hardly have beenbettered if we had rehearsed it. The trouble is that no-one willbelieve that it wasn’t a put-up job. I suspect, if the truth wereknown, the idea originated, if anywhere, in the coil store of oldKDF 9 himself.

* * *

Fellow peripatets, to arms! Meseems we are cut about thecolumn, and our truncation to a half-page is not, it appeareth,the temporary affliction that used from time to time beset usand restrict the expression of our Muse, but a considered,continuing, and in this peripatetic opinion right dastardly, actof editorial policy. A double column of protest marchers willleave from Nelson’s ditto at 12.30 P.M. on Tuesday next tomarch on The Lancet offices (weather and any possible compet-ing demonstration by St. B-t’s junior staff permitting).Dress: sackcloth and ball-points.

* * *

Australia, like America, has worked a considerable changein the tongue that Shakespeare spoke. Verbalisation of nouns isfrequent: having farewelled my wife to Europe a few weeks agoI am now batching, a state of affairs little to my liking. It issaid that women are not mechanically minded, but they musthave some engineering and surgical skill to manage householdmachines. The cable of the electric mixer is subject to re-current volvulus; the spin-drier has had acute intestinalobstruction from a bolus that proved to be a rather unsavourysock; and perforation of the vacuum-cleaner’s paper diverti-culum resulted in generalised dust dissemination rather thanlocalisation. It will be a relief to go down to the hospital tosome simple surgery. I am the admeeding* surgeon tonight.

* * *

" The medical journal, The Lancet’, is to be put in thepublic reading room of Lowestoft library, Suffolk. For a

woman member said: ’ I like to frighten myself by reading it.’ "

-The People, Nov. 21, 1965.A Strine word reputedly derived from admit and emergency, but of

doubtful etymology.