1424 TISSUE CULTURE IN STUDY OF THE VITAMINS

changes which evoke it are succeeded by irreversibleanatomical changes-such as fat accumulation-which maintain it.

If exophthalmos is difficult to explain, external

ophthalmoplegia associated with exophthalmic goitreis still more mysterious. It is uncommon. Dr. Brainattributes the first record of it to Dr. Francis Warnerof the London Hospital in 1882, and he himself hascollected 22 cases which lie presented to last year’sInternational Neurological Congress. Because he findsthe ophthalmoplegic complication rather often inmale patients and almost always in middle life, andbecause the accompanying hyperthyroidism is oftenmild and occasionally extinct, he regards the wholesyndrome as distinct both from " primary " exoph-thalmic goitre and from so-called " toxic adenoma "of the thyroid. This is perhaps straining the argumentrather far, but, since the ophthalmoplegia when itdoes occur is closely parallel to the exophthalmosboth in its degree and in its incidence in one or botheyes, it may readily be conceded that both ophthal-moplegia and exophthalmos demand a causal explana-tion other than hyperthyroidism. The ophthalmo-plegia need not be due to a central lesion ; it maybe a local lesion of the muscles or their nerves,produced like the exophthalmos by pressure changesin the vessels and fluid contents of the orbit. This

brings us back to the pituitary hypothesis, and theanimal experiments suggesting that thyrotropichormone can act through the sympathetic on theorbital contents-clearly the most inviting point ofattack for those who would investigate further theproblem of the pathogenesis of exophthalmic goitre.

IONISATION FOR HAY-FEVER

ZINC ionisation as a method of relieving hay-fevercame into prominence last Saturday when the news-papers announced that it has proved successful in’99 per cent. of cases treated at St. George’s Hospital.The procedure is to pack the nasal cavities withcotton-wool or gauze soaked in zinc sulphate solution,insert electrodes into the nose, and then pass anelectric current, through the solution, to an indifferentelectrode applied to the forearm. The result aimedat is a shrunken mucous membrane which will beinsensitive to pollen and other stimulants ofrhinorrhcea. The steps taken to achieve this objectare described in greater detail by Dr. Clive Shields,of the physiotherapy department at St. George’s, inthe May number of the Practitioner. Broadly speakinghe follows the technique employed by Philip Franklinfor many years,! but he packs the nose with 2-inchribbon gauze instead of cotton-wool and unless thenose is supersensitive uses 2 per cent. zinc sulphatesolution rather than 1 per cent. The nose is previouslysprayed with 2 per cent. cocaine, " as otherwise thetreatment is extremely uncomfortable for the patient,"and since there is usually much sneezing and rhinor-rhcea 2-12 hours later a sedative is often advisable.Dr. Shields finds that most patients with seasonalhay-fever are free from attacks for about a yearafter three or four treatments. " Two prophylactictreatments should be given yearly for the next twoyears and may then be safely omitted. Some cases

relapse, but it seems probable from cases observed since1931 that the attacks respond to one or two furthertreatments." Mr. Franklin, with his longer experi-ence, is not quite so confident, as will be seen fromhis letter on p. 1442. Though the use of ionisation forthis purpose finds many advocates in the United Statesand is clearly worth a trial when a person is seriously

1 Brit. Med. Jour., 1931, i., 1115.

disabled by hay-fever, it is evidently not appropriatefor slight cases that can be relieved by simpler means.Dr. Shields thinks it useless to attempt the treatmentin the presence of dental sepsis, infection of the

paranasal sinuses, and obstruction to the nasal

passages from organic causes such as deflected

septum, enlarged turbinates, and polypi. But evenif the patient is lucky enough to start with a cleansheet in these respects the final issue cannot, we under-stand, be foretold with complete confidence. A resultwhich is certainly to be avoided is the inadvertentdestruction of olfactory function, and with this inmind the patient should sit up, and not lie down,while the ionisation is in progress.

TISSUE CULTURE IN STUDY OF THE VITAMINS

A SOMEWHAT new approach to the study of vitamindeficiency was opened when Sir Robert McCarrisonand G. Sankaran 1 at the nutrition research laboratoriesof the Indian Research Fund Association at Coonoor,noticed that cultures of embryonic tissues grew muchbetter in plasma from normal animals than in plasmafrom fowls with beri-beri, suffering from deficiencyof vitamin B,. The work has now been carriedfurther by Sankaran in conjunction with McCarrison’ssuccessor at the laboratory, Dr. W. R. Aykroyd.2It is pointed out that the dietary of the beri-beripigeons was deficient in vitamin A as well as invitamin B1, and this time the growth of embryonicfowl spinal cord and rat cerebral tissue in plasmafrom fowls and rats suffering from vitamin-A deficiencyhas been investigated. Three types of plasma wereexammed: Diasma from normally fed animals:

plasma from animals on a basal diet deficient invitamin A ; and plasma from animals receiving thebasal diet supplemented by cod-liver oil. Examina-tion of the rate of growth of the cultures left nodoubt that there was a real difference between thedifferent types of serum. To eliminate all subjectiveinfluences, observers judged the cultures in ignoranceof their nature. The cultures in deficient plasmaalways gave poor growth, while those in normalplasma gave good or occasionally medium growth.The plasma from animals on the deficient diet,supplemented, gave an intermediate result. Thislast observation is in accordance with generalexperience that the most perfect synthetic diet," completely " supplemented, usually gives a biologicalresult inferior to that given by a complete normaldiet. The cause of the failure of the tissue implantsin plasma from A-deficient animals was not established.It may well be that there was an actual deficiencyof vitamin A in the serum. The possible relation-ship of these observations to E. Mellanby’s sugges-tion 3 that the nerve lesions are the primary onesin vitamin-A deficiency, and the epithelial ones

secondary, is of considerable interest.

1 Indian Jour. Med. Research, 1933, xxi., 187; 1934,xxii., 67. 2 Ibid., 1936, xxiii., 929.

3 Jour. Path. and Bact., 1934, xxxviii., 391.

MEDICAL TOUR IN GERMANY.-In connexion withthe Olympic games in Berlin a medical study tour of theuniversities and spas of Germany has. been arranged.The party will leave Berlin on August 17th, arriving inHamburg on the 30th, and visits will be paid to

Dresden, Nuremberg, Rothenburg, Munich, Tubingen,Baden-Baden, Heidelberg, Bad Nauheim, and Wiesbaden.The party will sail down the Rhine from Bieberich toCoblenz, and then make its way by Cologne, Leverkusen,and Bremen to Hamburg. Further information may behad from the Deutsche Gesellschaft fur arztliche Studien-reisen, Berlin, N.W.7, Robert Koch-Platz 7.