900

penicillins are used. In a recent W.H.O. survey of over 600,000patients, there was only 1 death from penicillin in 70,000treated; and in the W.H.O.-assisted venereal-disease-controlprogramme in Taiwan there was only 1 death in 44,000 treated.Many of the severe reactions have arisen in persons with a

previous history of allergy, especially to penicillin. It was

suggested that many fatalities can be avoided if a careful

preliminary history is taken. Important in the preventionof such reactions is the restriction of the use of the drugto only well-established indications and of its sale to the

production of a doctor’s prescription (antibiotics may bebought over the counter in many countries of the WesternPacific region). Some deaths can be prevented by resuscitatingdrugs, and all doctors who administer penicillin should haveon hand an emergency kit containing appropriate syringes,adrenaline, nikethamide, hydrocortisone, an anti-histamine

drug for injection, aminophylline, and, if available, penicillinase.

LIVER DISEASESA SYMPOSIUM on liver diseases was held in Lund and

Malmö, Sweden, on March 28 and 29, under the jointpresidency of Prof. J. P. SANDBLOM and Prof. J.WALDENSTROM.

Dr. H. VETTER (Austria) described the use of radio-active colloid materials in the estimation of liver blood-flow. This is based on the assumption that these sub-stances are removed from the circulating blood by thecells of the reticulo-endothelial system, which are mostlyfound in the liver. This removal is estimated by simplyplacing a counter between the thighs. Suitable radio-active substances are colloidal radiogold and heat-denatured human serum-albumin labelled with 1311.In cirrhosis of the liver, comparison of results obtainedwith colloidal radiogold with those for bromsulphaleinshowed that two-thirds of the diminished bromsulphaleinremoval was due to decreased liver blood-flow and not to

impaired liver-cell function. There was a significantnegative correlation between the liver blood-flow and theportal venous pressure.

Galactose is metabolised solely by the liver, and Dr. N.TYGSTRUP and Dr. K. WINKLER (Denmark) had giventhis compound intravenously and measured its removalfrom the blood. Liver blood-flow was then calculated.

Quite small amounts of alcohol diminished galactose re-moval. The mechanisms of this interference were obscure.

Dr. R. L. BLOMSTRAND (Sweden) had cannulated thethoracic duct and studied the lymph biochemically.10-50% of the thoracic-duct flow comes from the liver.The normal flow was 40-120 ml. an hour. A patient withcirrhosis produced 500 ml. an hour. This overproductionwould support the hypothesis that ascites is producedfrom liver lymph. Erythrocytes injected into the ascitescould be recovered from thoracic-duct lymph.

Dr. C. E. EKMAN and Professor SANDBLOM reportedtheir results for portocaval anastomosis in cirrhotic

patients with portal hypertension. 11 of 69 patientsdied after operation. Preoperative tests showed that 9of those dying had poor liver function and 2 goodliver function. This emphasised the importance of

reserving this operation for those with good hepaticreserve. 42 of 55 survived one year and only 2 had furthergastrointestinal haemorrhage.

Dr. H. KROOK (Sweden) had used the occluded

(wedged) hepatic vein technique to measure the portalvenous pressure. A raised pressure was diagnostic ofcirrhosis. The presence of vascular spiders correlatedwith the height of the portal venous pressure.

Dr. D. N. S. KERR (Britain) described 4 children withportal hypertension due to congenital fibrosis of the liver,a variant of polycystic liver. Biochemical tests were

virtually normal, apart from a raised serum-alkaline-

phosphatase. Microscopic examination of the livershowed a normal zonal pattern, the liver lobules beingsurrounded by dense fibrous tissue containing bizarrebileducts and very few portal veins.

Dr. M. SCHWARTZ (Denmark) had used 1311-labelledhuman albumin to measure the rate of serum-albumin

degradation. In normal people and in such conditions asnephrosis, albumin production seemed to follow theserum-albumin level, more being produced when serumlevels were low. In cirrhosis, however, the rate ofmetabolism was much less than expected, reflecting thediminished capacity of the diseased liver to synthesisealbumin.

Dr. F. SERIN (Sweden) reported a patient with mush-room (Amanita virosa) poisoning. A period of hepaticfailure followed the initial diarrhoea and vomiting, andthis was marked by jaundice and a rise in the serum-enzymes aldolase, glutamic oxaloacetic and glutamicpyruvic transaminase, and malic and lactic dehydro-genase. These were presumably released by the damagedliver. Disturbances in blood coagulation were shown bya fall in Christmas factor and factor v; antihxmophilicglobulin was unaffected, and was probably not of hepaticorigin.

Professor WALDENSTROM commented on the group ofadolescent patients, with cirrhosis, acne, and higherythrocyte-sedimentation rates, that he originallydescribed in 1950. Jaundice might not be present, andsuch a patient with predominant portal hypertensionhad benefited by portocaval anastomosis. Dr. S. SHERLOCK(Britain) had noted that these patients often showed anexcessive adolescent growth spurt. Dr. G. H. JEFFRIES(Britain) had seen steatorrhoea, which did not seem tobe of pancreatic or intestinal origin, and might be dueto diminished hepatic production of bile salts.

Dr. J. H. ARFWEDSON (Sweden) had studied 100

patients with pruritus in pregnancy. He had founddisturbed hepatic function in 87, especially in those withsevere symptoms. A slightly raised serum-bilirubinlevel and decreased serum-x-lipoproteins were thecommonest abnormalities. Differentiation must be madebetween gallstones, virus hepatitis, and the obscure intra-hepatic obstructive jaundice of pregnancy described byDr. L. THORLING (Sweden).

QUANTITATIVE METHODS IN HUMANPHARMACOLOGY

A SYMPOSIUM on Quantitative Methods in Human

Pharmacology and Therapeutics, arranged by the

Coordinating Committee for Symposia on Drugs andsupported by the British Pharmacological Society, thePhysiological Society, the Royal Society of Medicine,and the Biometric and Nutrition Societies, was held inLondon on March 24 and 25.

Sir CHARLES HARINGTON remarked that it had beensaid that the invasion of biology by mathematics hadrobbed it of much of its charm. But the quantitativeaspects of biology were vitally important, and those who,like himself, hankered after the days when workers couldbe content with qualitative observations had to recognisethat this feeling was a weakness to be sternly suppressed.