990

should be excepted, for the Spironema pallidumis known to succumb to a lower temperaturethan does the human body. Otherwise, the mostlikely factor is probably the increased rate ofmetabolism of the tissues, which may converta passive into an active resistance. It is note-

worthy that most of the conditions benefited arethose which become chronic.

INHIBITION OF ANTERIOR PITUITARYFUNCTIONS

Two articles in our present issue describe

attempts to influence non-reproductive functionsin human beings by administration of femalesex hormone. Both pieces of work are based on-and serve to test-the hypothesis that a singlehormone can so affect the anterior pituitary thatmore than one of its numerous functions is inhibited.Since MOORE and PRICE in 1930 suggested thatcestrin suppresses the gonadotropic function of theanterior pituitary, experiments on animals haveamply confirmed the supposition as regards theaction of large amounts of cestrin. On the otherhand, small amounts of oestrin appear to stimulatethe anterior pituitary. This assumption of

paradoxical action has reconciled apparentlycontradictory results recorded in this field of

investigation, but there is as yet no clue to thephysiological mechanisms involved. The inhibitionof the gonadotropic function by large doses ofoestrin has been demonstrated clinically by severalworkers, and examples may be drawn from Prof.BERNHARD ZONDEK’S paper in our issue ofOct. 10th and from the paper by Dr. JoNES andMr. MACGREGOR in the present issue. ZoNDEEobserved that menstruation was suppressed byinjections of 100,000 to 200,000 mouse units ofoestrin between the sixth and twenty-fourth daysof the cycle ; JoNES and MACGREGOR note that500,000 M.U. given during 20 days caused the

disappearance of gonadotropic hormone from theurine of elderly women.The conception of gonadal-gonadotropic

antagonism has been considerably extended,particularly by ZONDEK and by CRAMER andHORNING,1 to account for the effects of excessivecestrin on other endocrine functions controlled bythe anterior pituitary. According to CRAMERand HoBNiNG the ultimate functional effect ofthe prolonged application of oestrin is a conditionclosely resembling that following hypophysectomy.On the assumption that the chromophil cells areresponsible for secreting the specific hormonesof the anterior lobe, the general condition of

hypopituitarism and the extensive changes in theendocrine organs produced by oestrin are explainedby the disappearance of these chromophil cells.(ZorrnEA attributes it rather to "

blocking "of their secretion.) The possible clinical applica-tion is this : can we not use oestrin to inhibitanterior pituitary function-to bring about theequivalent of a partial hypophysectomy-andso relieve some endocrine organ from the excessivestimulation from which it is suffering ? 1 The

1 THE LANCET, 1936, i., 1056.

initial difficulty is that suppression of the chromo-phil cells by cestrin does not inhibit the productionof all the pituitary hormones equally. ZONDEKhas demonstrated particularly clearly the successionof effects, first on the gonadotropic function, lateron the growth hormone. The order in which otherfunctions are affected remains to be determined.The paper by JONES and MACGREGOR leads to theconclusion that the gonadotropic function ofthe anterior pituitary can be considerably disturbedwithout affecting the control of carbohydratemetabolism to such an extent that any change inglucose tolerance is perceptible.

Finally we come to Dr. SPENCE’S bold attemptto attack the cause of toxic goitre. This restson two assumptions-namely, that toxic goitre isdue to over-stimulation of the thyroid by excessof pituitary thyrotropic hormone, and that produc-tion of thyrotropic hormone by the human pituitarycan be appreciably depressed by the dailyadministration of 50,000 international units ofcestradiol benzoate over a period of two or threeweeks. The experimental studies on inter-relationsof the thyroid and gonads and anterior pituitary,which are well reviewed by SPENCE, fully justifyhis investigation, but his result is a clear negativeto the possibility of improving the clinical conditionby giving oestrin in the amounts employed. Itis still possible that the various links in the chainof hypotheses which led to this work are sound,and that thyrotoxicosis could be alleviated bycestrin, although perhaps in such massive dosesthat the pituitary functions would be reduced tochaos. Against this possibility we have the

preliminary statement of ZONDER that prolongedadministration of oestrin does not inhibit thyro-tropic function at all, but may indeed stimulate it.

AN EVALUATION OF ARTIFICIALPNEUMOTHORAX

CLINICIANS in general show a profound mistrustfor statistics compiled by their colleagues. In thelatest volume published by the Medical ResearchCouncil Dr. BENTLEY has taken care not tocommit any of the seven deadly sins of medicalstatisticians-as he aptly describes such errors

as paucity of material, selection of cases, pre-cipitancy, false control, equivocation in definition,failure to trace a sufficient number of patients,and lack of clinical detail. His report covers

677 cases treated at L.C.C. hospitals by artificialpneumothorax and followed up for a period of atleast three years ; 411 of them have been observedfor five years or more. The results classifiedaccording to age, sex, extent of disease, degree ofcollapse, condition of better lung, persistence ofT.B. in the sputum, and home conditions are com-pared with a conservative group of 3329 cases.

These are not looked on as a control group in anystrict sense but are regarded as more satisfactorythan the method of some writers of contrastingthe good effects of pneumothorax with the much

1 Artificial Pneumothorax: Experience of the LondonCounty Council. By F. J. Bentley, M.D., M.R.C.P., D.P.H.H.M. Stationery Office. 1s. 6d.