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have milk added to his home diet bv a mother

continually instructed in its value, while he who hasmilk at school gets no more at home ; in other wordsthe control is not an effective control.That possible complicating factor should, however,

not be present to the same extent, if at all, in thecomparison of the groups on equal quantities of rawand pasteurised milk, and the committee’s conclusionon this point is important. It is that whether com-

parisons be made of the increments of growth in thetotal of children, or in subdivisions by age, area, andclinical assessment, there is no consistent differencebetween children on i pint of raw milk and childrenon pint of pasteurised. The committee qualifythis statement by pointing out that the incrementsover the group on biscuits are so small that it isdoubtful whether slight differences between thenutritive values of raw and pasteurised milk in

supplements of the amount given could be revealedin measurements of height and weight, but as pointedout above the latter comparison may easily be amore sensitive one than the former. Actually, takingthe total group of children, boys with pint of

pasteurised milk increased their height over the yearby 2-25 inches and their weight by 7-11 pounds ;those on i pint of raw milk increased by 2.21 inchesand 7-16 pounds. For the corresponding group ofgirls the figures were 2-43 inches and 7-99 pounds inthe pasteurised group, against 2-42 inches and 8-30pounds in the raw group. The differences are clearlynegligible. In an addendum are some figures whichshow that the group on milk also surpassed thegroup on biscuits in their chest measurements andtheir strength of pull. The committee have obtainedfull details of school absences and other measures of

health and their final report should contain interestinginformation on the relation of the supplements togeneral health as well as to growth.An Advisory Medical Committee in CroydonThe Croydon typhoid tribunal in its report

suggested that in all large areas there should be acommittee representing local practitioners whichwould be available for pooling and distributinginformation if an outbreak arose. Croydon doctorswere asked to submit their observations on this

proposal and a joint meeting of the Croydon branchof the B.-;Y1.A. and the local medical and panel com-mittee resolved that an ad-hoc consultative committeeshould be set up by these bodies and that from thisa small executive should be appointed which thecouncil might consult when necessary. It was further

suggested that the borough council should be askedto coopt four medical men on to its public healthcommittee. The special typhoid committee of thecouncil considers that cooperation between localdoctors and the public health service can be securedwithout coopting non-members on to an importantspending committee of the council and suggestsinstead an advisory committee comprising fourmembers appointed by the local practitioners’organisations and six by the public health committee.This body would meet at regular intervals for dis-cussion and would submit its recommendations tothe public health committee. It is the opinion ofthe typhoid committee that the method would havethe advantage of preserving the statutory positionof the medical officer of health as the council’s adviseron public health matters, and the council has nowendorsed this view. °

CORRESPONDENCE

CHEMOTHERAPY OF PNEUMOCOCCAL ANDOTHER INFECTIONS

To the Editor of THE LANCET

SIR,-The results in the animal experiments(reported in your issue of May 28th by Dr. Whitby)on the treatment of pneumococcal infections with2-(p-aminobenzenesulphonamido)pyridine(M. & B. 693)have been tested clinically during the past threemonths in cases of lobar pneumonia in adults andbroncho-pneumonia in infants at Dudley-roadHospital, Birmingham.The final assessment of the clinical results requires

careful analysis before publication, but in a seriesof more than a hundred cases of pneumonia andbroncho-pneumonia the mortality has been verydefinitely lower than in a similar number of controlcases during that time, and toxic symptoms, even withlarge doses of the drug, have been conspicuouslyabsent.-We are, Sir, yours faithfully,

G. MARY EVANS,WILFRID F. GAISFORD.

Dudley-road Hospital, Birmingham, May 30th.

To the Editor of THE LANCET

Sin,-It was with great interest that we readDr. Whitby’s article and your annotation on theeffect of 2-(p-aminobenzenesulphonamido) pyridine(M. & B. 693) on coccal infections in mice ; forduring the past six weeks we have had the oppor-tunity of testing the effect of this new compoundon gonococcal infection in man. A supply of tablets,each containing half a gramme, was kindly madeavailable by Messrs. May and Baker Ltd., together

with laboratory data concerning tolerance by variousanimals.The drug has been administered to 36 adult male

out-patients and 7 children who were in-patients.In adults the customary dose was 3 grammes daily,and some cases have shown toxic symptoms as earlyas the third day on this dosage ; but other patientshave received as much as 50 g. during three weekswith no signs of intolerance. The usual instructionsfor the avoidance of sulphur-containing foods and

aperients were given. The trial of a larger daily dose ina few cases appeared to increase the incidence of toxiceffects without increasing the therapeutic value, andtrial of a dosage less than 3 g. daily is in progress.

Toxic effects were observed in 10 of the 36 adultcases and included two cutaneous eruptions (oneof photosensitivity and one of generalised maculardrug eruption) ; gastro-intestinal disturbance

(anorexia, nausea, vomitiii7g, and diarrhoea) was

encountered in 4 cases ; and 4 patients also complainedof headache, depression, and dizziness. Evidentlythis new compound will not prove to be withouteffect upon leucopoiesis, for we observed moderate

granulocytopenia in 4 cases, and doubtful cyanosisin 1. Sulphaemoglobin2emia or methsemoglobinsemiawas not detected in 22 complete blood examinations,and these also failed to reveal any definite depressionof the erythroblastic system. It is of interest thatthe patients exhibiting skin eruptions had both

previously shown a similar reaction to sulphanilamide.As regards the effect of this compound in untreated

cases of acute gonococcal urethritis, 11 out of 16under treatment showed no visible discharge and nosymptoms after two days. In the other 5 cases this

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state was not attained until the fifth day. Subsequentobservation for a period of two to three weeks fromthe cessation of this therapy has revealed no signof relapse and no complications of the gonococcalinfection. In all cases except 1, which received noadjuvant treatment, daily irrigation with potassiumpermanganate (1 in 8000) was also employed duringthe period of chemotherapy.

Of an additional group of 10 cases which had failedto respond to treatment with sulphanilamide, or

which had relapsed after it, a rapid response waseffected in 7. Since, however, the new compoundhas been given at a stage of the disease (3-16 weeks)when the gradual production of antibodies is likelyto be well advanced, any direct comparison of thesetwo drugs will be weighted against the one that wasfirst employed. The apparently superior efficacyof 2-(p-aminobenzenesulphonamido) pyridine musttherefore await further judgment in this respect.In 2 cases the gonococcal infection was not influencedand the remaining patient defaulted. -

The effect of this new preparation in gonococcalvulvo-vaginitis is also of interest. A group of 7children aged from twenty-two months to seven years,under the care of Dr. Morna Rawlins and Dr. D.Kathleen Brown of this clinic, were treated for fourdays with a dosage varying from 0-75 to 1-5 g. daily.The clinical signs of the disease disappeared in threedays in all cases and subsequent microscopicalexaminations have failed to reveal gonococci, whichwere numerous in each case at the commencementof this treatment. One of these infants had previouslyfailed to respond to two weeks’ therapy with sulphanil-amide. Vomiting occurred in 3 children who appearedotherwise in good health.. Complete blood examina-tions were carried out on 5 children, 1 of whomshowed a mild granulocytopenia. None of thesechildren have been observed for more than a fort-

night from the cessation of treatment but no relapsehas been noted up to date.

It is clear that this new compound, given by mouth,has a markedly beneficial effect in a considerable

proportion of cases of gonorrhoea. In view of thewell-known tendency of this disease to relapse itwould obviously be premature, however, to attemptto assess the value of the remedy on the basis of afew cases treated for a short time. Although Dr.Whitby’s paper indicated that the new preparationis relatively non-toxic in small doses in animals, ourexperience in man suggests that a dosage comparablewith that usually advised for sulphanilamide will

give rise to comparable toxic effects.We are, Sir, yours faithfully,

Venereal Diseases Department,Guy’s Hospital, S.E., May 30th.

V. E. LLOYD,D. ERSKINE,A. G. JOHNSON.

ASSISTANCE TO AUSTRIAN MEDICALSTUDENTS

To the Editor of THE LANCETSiR,—As the matter is one which concerns the

profession as a whole, I enclose hereunder a letterwhich has been circulated to the deans of the medicalschools in the British Isles."We are all very naturally exercised about the

treatment and unhappy prospects of our colleagues inAustria. I think there is general agreement in theprofession that there is no longer room for any greatincrease in the number of foreign doctors allowed topractise in this country and that the best we can do,where possible, is to offer asylum to individuals.

" The question of the medical student seems tosome of us to be in a rather different category andI am wondering whether we might not make some

concerted effort to provide opportunities for a limitednumber of Austrian medical students in the BritishIsles for whom racial origins or political views havemade life in their own country no longer possible.

" The London Hospital, I understand from Dr.A. E. Clark-Kennedy, the dean, have generously under-taken to take one student free of charge for the wholeof his medical curriculum on the understanding thathis board and lodging can be privately provided.

" I would like to offer the suggestion that eachmedical school should undertake the free educationof one student in this way and on these conditions.You will appreciate that this is a very differentthing from allowing dilution with Austrian Jewishpractitioners who obtain a quick qualification insome university in this country. By the time he isqualified, a student entered from the beginning ofhis course would be eligible for naturalization. Bythat time also we may anticipate that the highfigures of entry into the profession will in allprobability have fallen off.

" I shall be most grateful if you could bring thissuggestion to the notice of your school council."

If a medical education from the first year couldbe assured for a group of students in the mannerindicated, lives at present deprived of hope andprospects would again have meaning. Homes wouldalso be needed, but it is not to be doubted thatmedical men and others in a position to do so wouldbe gladly forthcoming as adopters.

I hope and believe that the example of the LondonHospital will be followed elsewhere.

I am, Sir, yours faithfully,Cambridge, May 30th. JOHN A. RYLE.

" ALCOHOLIC " BERI-BERI

To the Editor of THE LANCETSiR,—I was greatly interested in the cases of con-

gestive heart failure following bouts of heavy drinkingmentioned by Dr. Soltau in his letter published inyour issue of May 7th. I think there can be littledoubt that such cases are essentially similar to theone recorded by me (THE LANCET, April 9th) and tothose of severe type described by Weiss and Wilkins,all of whom were addicted to alcoholic excess.Dr. Soltau suggests that the symptoms may be

due in part to the direct poisoning effect of alcoholon the cardiovascular system rather than to deficiencyof vitamin B 1. It is of course difficult to refute this,nor I think is there any need to do so provided thatit is recognised that avitaminosis plays the majorpart. Some of the evidence in support of this con-tention may be recapitulated briefly as follows.

In the first place there is the undeniably closeclinical similarity to " wet " beri-beri in the orient.The lowering of the diastolic blood pressure andaudible arterial bruit present in Dr. Soltau’s cases

are a particularly striking feature in the ordinaryberi-beri heart and form the basis of the adrenalinetest which Wenckebach and Aalsmeer regard as

pathognomonic. Reversible cardiac enlargement anda shortened P-R interval may afford additional pointsof similarity. Secondly, there is the rapid dis-

appearance of cardiac signs both in alcoholic andendemic beri-beri following injections of vitamin B1.Thirdly, it has been shown by Joliffe and Colbert thatan adequate intake of vitamin B protects againstcardiac and neural damage even although largeamounts of alcohol are consumed daily. Repeatedconfirmation of Shattuck’s original premise makes theevidence so strong at present that it is difficult tobelieve that direct poisoning by alcohol can havemore than a minor influence in the genesis of thissyndrome. I am, Sir, yours faithfully,

Clifton, Bristol, May 22nd. N. L. PRICE.