724

Besides being dehydrated, emaciated, and incapableof moving, the man had a Flexner infection which hadnot responded to sulphaguanidine-or, if it had, thediarrhoea persisted. Blood and plasma transfusionshad no effect. The patient was given glucose-salinedrip and crude liver extract -parenterally, and within24 hours was all smiles, claiming to feel perfectly well.A second case a few days later responded to the sametreatment in the same way.

EXPERIENCE AT BELSEN

Dr. JANET VAUGHAN described the experiences of asmall MRC team which arrived at a concentration camp14 days after its liberation. She paid tribute to thebrilliant and courageous work of the small Englishmedical team whom they found already on the scene.The task of the MRC team was to decide whetherhydrolysates worked, and whether it was practicableto give then. Under the conditions of the campsthe answer in both cases was no. For intravenous

treatment they, used Amigen,’ acid hydrolysate, con-centrated normal serum, and twice-concentrated serum.By mouth they gave oral hydrolysate and milk mixture.Laboratory conditions were good, hospital conditionsprimitive. The patients lay on wooden beds with strawpalliasses, in a German barracks which had been takenover in a state of filth. There were two cold taps, whichdid not always run, on each floor, and for a week afterher arrival there was no artificial light except from candles.By day nursing was done by the less-ill women of thecamp, by two orderlies, and by members of the Hun-garian army working under one English sister. Thefood came from central kitchens, where it was preparedby Hungarian soldiers under one Red Cross sister foreach kitchen. There was no common language, so thedoctors could not explain that their intentions were good.The patients cried out at the sight of the simplestapparatus, especially at a syringe, which they knew asthe prelude to death. This did not facilitate intravenoustherapy.The team chose emaciated men who were too weak

to get off the stretcher, and they tried to avoid typhusand tuberculosis cases. Dysentery cases could not beexcluded because all the patients had diarrhoea. Theytried to choose patients with gross oedema who wereclearly going down-hill. They found that after treat-ment the plasma protein fell because the plasma wasdiluted when dehydration was overcome. In 10 patientswith gross oedema the mean plasma protein was 3-84 g.,and the albumin 2-09 g., per 100 c.cm. In 14 with slightoedema the mean protein was 4-99 g., and the albumin2-79 g., per 100 c.cm. The haemoglobin was higher thanmight have been expected-an average of 66.5% in 21men. Of 5 patients given amigen intravenously 4did well ; one with severe oedema showed no improve-ment. Of 3 given intravenous hydrolysate, 2 did notimprove, and the third got much worse in a period of2t days ; he was then given 2 litres of twice-concentratedserum in 24 hours, and improved greatly. Three otherpatients given serum also did very well.

Dr. Vaughan thought serum preferable to hydro-lysate in that it allowed more protein to be given withrelatively little fluid ; too much fluid increases ascitesand oedema. If patients are given 1 litre of serum intra-venously, and what fluids they want to take by mouth,they get as much as they need. With hydrolysate thereaction rate is so high that it is not possible to injectenough to bring the patient into nitrogen balance.Hydrolysates given by mouth are so unpleasant that mostpatients seemed to prefer to die rather than to go ontaking them. Some vomited ; 2 took all they weregiven with serious clinical results. One of these, athoroughly cooperative patient with no diarrhoea,passed half a bucket of watery diarrhoea after oralhydrolysate and had severe colic. It could not be givenby gavage because of the dread of torture ; besides, anasal tube is difficult to pass on a patient with a driedatrophic nasal mucosa.Patients given dried skim-milk and glucose mixtures

in small frequent doses diid extremely well. They tookthe milk eagerly, but many of them had sore mouths, andafter a day or two it was evident that some flavouringwas needed to help them to get it down. Tea and coffeewere used, but other flavouring agents. such as vanilla

and strawberry, naturally suggested themselves, andare now being considered. Starving people crave foodand crave the familiar. They know milk, and they areready to take it ; and it is better to set the few nursesto giving them small frequent feeds than to set up dripswhich need constant watching and attention, especiallywhen working with patients whose veins are collapsedand small. She realised that she was speaking only forthe conditions under which the team has had to work :hydrolysates, she said, may none the less have a greatpart to play in the medicine of the future.

Captain J. A. F. STEvENoON described studies ofnitrogen balance made at Magill University. There isknown to be increased excretion of nitrogen in the urineimmediately after fractures and burns. About twomonths after such injuries there is a period of reducednitrogen excretion, when the body makes good its loss.Extra protein given to patients by mouth immediatelyafter burns or fractures does not influence the nitrogenbalance, merely augmentirig the nitrogen loss. Attemptswere made to bring such patients into nitrogen balanceby giving amino-acids intravenously, but amigen waswithout effect. Intravenous plasma, however, was moresuccessful. He pointed out that it makes little essentialdifference to the patient whether amino-acids reachhis systemic blood-stream by way of a syringe or by wayof his portal vein. Workers who have given amino-acidsto injured patients with good results, he said, weredealing with those who were in a bad way to start with-cancer patients after operation, for example. In suchthere is little change in the protein balance after injury.The fracture and burn cases were all in good healthbefore their injuries.

Prof. R. B. HAwES suggested that these variousstudies would help people to realise what protein shortagemeans, and would arouse their interest in the problem .

of surplus foods and their proper distribution.

Reviews of Books

The Science of Nutrition

HENRY C. SHERMAN, professor of chemistry, ColumbiaUniversity, New York. (Oxford University Press.

Pp. 253 15s.)-Professor Sherman’s name is so well known in the

nutritional world that any work by him gives pleasur-able anticipation, and such anticipation is not dis-appointed in this book. It is addressed to the generalpublic, though it presupposes somewhat more of scientificcuriosity, and of intelligent appreciation, than mostbooks on nutrition for laymen. Naturally enough the

author is mainly concerned with, and draws his illustra-tions from, the nutrition of the USA. This gives theBritish something to think about, because he seriouslyconsiders that a third or more of the best-fed nation ofthe world consumes a " poor " diet. What must theproportion be here ? He adds some intimate touches ;we learn, for instance, that the world’s championheavyweight, Joe Louis, stood in danger of rejectionfrom the service of the armed forces of the USA on thegrounds of his weight compared with his height, but wasaccepted on measurement of his-specific gravity. Hisexcess weight was due to brawn and not to fat.

°

The book is not merely a statement of the presentposition of nutritional science, but looks to the future,both in America and abroad. - Its trend is best illustratedby its last sentence : " The question, what particularthing does such nutritional improvement do ? hardlyadmits of a simpler or more specific answer than thatit offers us the option of a more liberal term of yearsof more efficient life with which to do%what we will."In short, that we may have life more abundantly.

Pharmacology ’

(2nd ed.) J. H. GADDUM, SCD, mrcs. (OxfordUniversity Press. Pp. 460. 218.)

Tms long-deferred second edition satisfies an educa.tional need. The basic facts of pharmacology are heredescribed in a manner well suited to the undergraduate,in a happy lucid style. Information is related in justperspective to laboratory experiment and to the practiceof medicine.