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maize proteins, seeing that a large part of theseconsist of zein, a protein which is deficient in theessential amino-acids tryptophane and lysine. Theresults of experimental work on this subject haveindicated, however, that if enough is eaten the otherproteins contained in the maize kernel, the gluteninsand globulins, will make good the deficiencies of thezein. Nor as regards the content of known vitaminsdoes maize seem to be inferior to wheat, for example.Vitamin A, of which only traces are found in wheat,is relatively abundant in the yellow variety of maize.The unmilled grains of both cereals are well suppliedwith vitamin Bl and contain fair amounts of thevitamin-Bg complex, with the exception of lacto-flavin in which both are poor and maize poorer thanwheat (Copping 1936). Lactoflavin deficiency, how-ever, does not appear to be connected with the causeof pellagra.

Nicotinic acid, which may now be regarded as anhitherto unrecognised dietary essential, is a relativelysimple compound, of composition CsHb02N (pyridene(3-monocarbogylic acid), and the work describedabove suggests that pellagra among maize-eatersmay be due to a deficiency of nicotinic acid in maize,as compared with other cereals. No chemical methodsare at present available for the estimation of smallquantities of nicotinic acid in such substances, whichwould afford a direct answer to this question, andfor the present the only evidence is that obtained frombiological tests. In the experiments on young pigsat Cambridge, referred to above, the diet was foundto be just adequate when the whole ground maize(83 per cent.) it contained was replaced by a mixtureof whole wheat and barley, or when the pigs receivinga diet of maize and purified casein were bedded onwheaten straw of which they consumed considerableamounts.As already stated, young rats will thrive on diets

composed almost exclusively of maize if the whole

grain be given; when milled maize is substitutedthe defects can be corrected by yeast extract butnot by nicotinic acid, nor can nicotinic acid or nico-tinic acid amide replace any of the separate B2 vita-mins required by the rat (Macrae and Edgar 1937,Cook, Clarke and Light 1937). Experiments onthe rat, with which so much important nutritionalresearch has been done in the past, have againafforded only misleading indications as to the

aetiology of pellagra. The rat is evidently unsuitablefor an investigation of the nutritive value of cerealsfor the human race, and the dog or pig seems to bea more suitable experimental animal for future workin this field.

SECONDARY PELLAGRA

A note is perhaps needed upon the relation of theabove argument to the aetiology of the sporadic casesof pellagra arising among populations which eat nomaize. These cases, usually known as " secondarypellagra," display symptoms similar to those of theendemic disease, and in the later stages may alsoshow some degree of mental disorder. Secondarypellagra develops after a long period of illness inwhich the absorptive capacity of the digestive tracthas been severely disturbed-e.g., after dysenteryor long-continued diarrhoea, in alcoholic addiction,or after operation or cancer involving the stomach orsmall intestine. Diarrhoea is also a common symptomof endemic pellagra and the infestation with internalparasites that is often present is held by some investi-gators to be an important contributory cause of thedisease (Ellinger, Hassan, and Taha 1937b). Manycases of secondary pellagra have been treated with

yeast and liver extract as successfully as those ofendemic pellagra, and an interesting example is

published in our present issue by Dr. Yudkin, Dr.Hawksley, and Prof. Drummond.The fruitful series of investigations by Spies and

his co-workers at Lakeside Hospital, Cleveland,were carried out chiefly on cases of "alcoholic"

pellagra. One may assume that in these cases thedisease is caused by defective absorption of theessential dietary factor from diets in which it is notabundant, and medication with yeast or liver extractseems to be a useful preventive measure. There is,however, no satisfactory explanation of the factthat in the United States, where pellagra is endemic,addiction to alcohol should often be followed by thisdisease, whereas elsewhere polyneuritis, which maybe curable by the antiberi-beri vitamin B,. (Joliffeand Colbert 1936), should be the more usual result.

Possibly a careful scrutiny of the diets might revealthe reason.

REFERENCES

Birch, T. W., Chick, H., and Martin, C. J. (1937) Biochem. J.31, 2065.

Chick, H., Macrae, T. F., Martin, A. J. P., and Martin, C. J.(1938) Ibid (in the press). (Reported at the meeting of theBiochemical Society on Jan. 14th.)

Copping, A. M. (1936) Ibid, 30, 849.Dann, W. J. (1936) J. Nutrit. 11, 451.Edgar, C. E., and Macrae, T. F. (1937) Biochem. J. 31, 886.Ellinger, P., Hassan, A., and Taha, M. M. (1937a) Lancet, 2, 1188.

— — — (1937b) Ibid, p. 755.Elvehjem, C. A., Madden, R. J., Strong, F. M., and Woolley,

D. W. (1937) J. Amer. chem. Soc. 59, 1767.Fouts, P. J., Lepkovsky, S., Helmer, O. M., and Jukes, T. H.

(1936) Proc. Soc. exp. Biol., N.Y. 35, 245.- Helmer, O. M., Lepkovsky, S., and Jukes, T. H. (1937)

Ibid, 37, 405.Harris, L. J. (1937a) Biochem. J. 31, 1414.- (1937b) Lancet, 2, 1467.

Joliffe, N., and Colbert, C. N. (1936) J. Amer. med. Ass. 107, 642.Koehn, C. J., and Elvehjem, C. A. (1936) J. Nutrit. 11, 67.Macrae, T. F., and Edgar, C. E. (1937) Biochem. J. 31, 2225.Ruffin, J. M., and Smith, D. T. (1937) Sth. med. J., Nashville,

30, 4.Sebrell, W. H., Hunt, D. J., and Onstott, R. H. (1937) Publ.

Hlth Rep., Wash. 52, 235.Smith, D. T., Ruffin, J. M., and Smith, S. G. (1937) J. Amer.

med. Ass. 109, 2054.Voegtlin, C., Neill, M. H., and Hunter, A. (1920) U.S. Publ.

Hlth Serv. Bull. No. 116.

PARIS

(FROM OUR OWN CORRESPONDENT)

MORE ABOUT THE 40-HOUR WEEK

THE hospital world is divided into two camps overthe effects of shorter hours on the morals of thehospital staffs. Monsieur Mourier, head of the publichospital services in Paris, is the leading figure in onecamp, and in his address to the Academy of Medicineon Dec. 21st he showed that the Paris hospitalmortality had fallen slightly since the introductionof the 40-hour week. In both camps there are nowsaid to be bulky dossiers of evidence, and howevertempting it may be to suspect that the Mourierdossier contains a soupcon of official whitewash, wealso have the declaration of Prof. Sergent, who,speaking with the retrospective impartiality of a

surgeon on the retired list, paid a glowing tributebefore the Academy to the remarkable devotionwith which the great majority, if not all, of the sub-ordinate members of hospital staffs fulfil their duties.

PROFESSIONAL SECRECY AND DEATH CERTIFICATES

The agenda of the annual meeting of the Confédé-ration des Syndicats Médicaux Francais put in anutshell the most pressing problems with which theFrench medical profession is confronted to-day.One of these is the vexed question of the wording ofdeath certificates. Article 378 of the penal code

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makes professional secrecy a duty and not merely aprivilege for the doctor. His, therefore, the risk ofsaying too much rather than too little when he givesevidence in a court of law, signs a death certificate,or in any other way is maladroit in letting the catout of the patient’s bag. On the other hand, thereis the scandal-not too strong a term by any means-of the many inaccurate and misleading death certi-ficates in the past. To employ that overworkedcliche, many of these documents are not worth thepaper they are made of as far as the requirements ofvital statistics are concerned. Hence the tighteningup of the system which found expression in thecircular issued by the Ministry of Public Health ayear ago. The resolution adopted by the Confédé-ration at its annual meeting seems to be a successfulcompromise between the public health official whowants nothing better than accurate vital statistics,and the general practitioner who wants nothing betterthan security against litigious persons anxious to

pay him out for lack of discretion in the wording ofthe certificate of death of some relative. The resolu-tion said, in effect, that the Confederation consideredexact vital statistics " eminently desirable," that suchstatistics can only be provided by the confident colla-boration of the doctor in the case, and that his assist-ance can only be invoked if he is assured that thesystem of notification adopted is at once practical,effective, and safe from the standpoint of litigation.

THE " OVERCROWDED " PROFESSION

Another problem discussed by the Confederationwas the congestion in the medical profession, and twosystems of weeding out undesirables attracted specialattention. The one is to begin their eradication quiteearly by an examination at the end of the first yearof the medical curriculum. The other is to keep theforeigner out. It was stated that the figures for thenaturalisation of foreign doctors were 83 per cent.higher in 1937 than in 1936, and 486 per cent. higherthan in 1935. With regard to the cruel competitionof unqualified practitioners, a ray of hope was shedby the statement that though Monsieur Sellier is nolonger Minister of Health, he is still a very live wirein the French Senate, and is bent on the promotionof a new law to deal with medical charlatanism.His views on this subject are said to be sound-inthe eyes of the medical profession. It is hoped thatone feature of the new law, if ever it materialises,will be State censorship of pharmaceutical publicity.What a Herculean job for the censor !

PENSIONS FOR DOCTORS

Yet another subject discussed was that of old-agepensions for doctors, and their compulsory retirement.It may be remembered that a certain MonsieurPomaret has drafted a law providing for the retire-ment from practice of all doctors on the attainmentof a certain age. The inherent injustice of thisscheme under present conditions was its undoing,but its discussion has promoted the cognate idea ofcontributory pensions, and it is now proposed thatthough doctors should be allowed to retire at anyage they please, they should be obliged to contributeto a pension fund. This fund might well be swelledif to each certificate they issued they were allowed toaffix a 5-franc stamp, the revenue from this sourceto be earmarked for the pension fund. Evidently,however, there is considerable hostility to the idea ofany pension scheme being involved in State machinery,and that the notion of linking up such a scheme withrevenues from pharmaceutical specialties is anathema.

A sliding scale of contributions to a pension fund,with the amount to be paid every year being propor-tional to a doctor’s declared income, also finds littlefavour. It is curious how many snags appear whenany pension scheme is discussed.

SCOTLAND

(FROM OUR OWN CORRESPONDENT)

SPEECH AND VOICE

A SERIES of lectures on the mechanics of speech andvoice is being given by Dr. Robert Curry and Dr.Douglas Guthrie at the Edinburgh School of SpeechTraining and Dramatic Art. In the first of themDr. Guthrie spoke of the importance of good speechand the need for a scientific study of speech, andpointed out that although there is a chair of musicin every large university, there is not even a lecture-ship in speech in this country. Teachers are by nomeans unanimous about voice production, and themethods adopted and taught ’are numerous andvaried, and sometimes even fantastic.

Dr. Curry described speech as a vital factor in theerection of human social systems. The division oflabour, and with it the whole working of humansociety, is due to speech. " While many animals arecapable of intercommunication by buzzing, whistling,or whining sounds, human speech varies from thesesounds by its great differentiation. When we tellsomeone the address of a house he has never seen,we are obviously doing something which no animalcan do."

In the second lecture Dr. Guthrie said that theproduction of the basic note of the voice by the vocalcords had been much studied and recently the instru-ment known as the stroboscope has furnished a moreexact record of the vocal-cord vibrations than anyprevious means of investigation. The vocal note ismoulded into the form of a speech sound in thecavities of the mouth and pharynx. The finishedsound emerges from the mouth and the nose playsa very minute part in speech-production. Whatevertheir influence upon resonance, and even that is

doubtful, the nasal sinuses cannot produce soundand their absence or destruction has no influence

upon voice or speech.

ACCOMMODATION FOR PAYING PATIENTS

I referred last week to the opening of the GlasgowRoyal Infirmary Auxiliary Hospital at Canniesburn,where there will be accommodation for 66 payingpatients. This is an important development forScottish voluntary hospitals and will be watchedwith keen interest The hospital at Canniesburn hasthe disadvantage that it is some distance from theparent hospital and cannot have quite as goodlaboratory and other services as are to be found iiithe main hospital. The managers of most voluntaryhospitals would naturally prefer that if a payingpatients block be constructed, it should be directlyattached to the main hospital so that all the elaborateservices available in the hospital are also immediatelyobtainable in the paying block. The difficulty ofcourse is that most of the voluntary hospitals havelittle or no adjacent ground on which they can

build and which would also be suitable for a payingblock. Many of them, however, could build upwards,and the great advantage of high hospital blocks is