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predominant, thus explaining their inability to relievethe hypoglycaemia with large doses of sucrose. Of.the endogenous form of sucrosuria, Elmer and hiscolleagues have only found two reported cases, inboth of which there were large amounts of sucrose inthe urine in spite of the complete withholding of thissugar from the diet. In one of these, sucrose-tolerancetests were carried out which showed that the ingestionof sucrose had no effect on the sucrosuria. In boththere was evidence of pancreatic disease. They putforward two possible explanations of this type ofsucrosuria, one being that the sucrose is a normalintermediate product of carbohydrate metabolism, andthat these patients cannot metabolise it beyond thisstage, so that it is eliminated as such in the urine.Their alternative and more probable thesis is that thesucrose is actually formed in the body, possibly fromthe phosphoric ester of glucose and fructose, knownas the Harden-Young ester, which is normally presentin the body. The fact that so few cases of thismetabolic abnormality have been reported does notnecessarily indicate a corresponding rarity of inci-dence, as sucrosuria per se does not produce anysymptoms. It is possible that, if more cases ofpancreatic disturbance were investigated from thispoint of view more examples would be found, thusproviding material for a thorough search for the causeof this interesting if harmless metabolic disturbance.

CREATINE AND CREATININE

SINCE Chevreul first isolated creatine from meatextract in 1836, the true function of this relativelysimple compound and of its internal anhydridecreatinine has baffled each generation of physiologistsin turn. There have been three distinct periods inthe investigations. The first dealt with the chemistryof the two substances and their occurrence in animalorgans and excretions. The second opened in 1905with Folin’s introduction of his now classical colori-metric method for determining the two compounds.This led to the compilation of an immense amount ofdata, particularly about the effect of age, sex andexercise on the excretion of the two bodies. Thethird period was introduced by the Eggletons and byFiske and Subbarow’s discovery that creatine wasnormally present in muscle combined with phosphoricacid, and that this compound played an integral partin the chemistry of muscular contraction. It is ratherunsatisfactory that after so much research our know-ledge should still be so meagre, and two recent con-tributions only serve to emphasise the uncertaintywhich still surrounds the real physiology of creatine.Hobson and Wang both report that creatine isoften to be found in adult male urine-Hobson indeedfound quite large amounts. If this is true, how wasit that so many other investigators using similarmethods failed to find it? 7 Hobson’s subjects weretrained athletes and eating large quantities of sugar.Hobson considers that both physical exertion and ahigh carbohydrate diet contributed to his results, butmakes only vague suggestions as to the way in whichthey could have done so. Wang has found that oneof the actions of thyroxin is to produce creatinuria,probably by reducing the amount of creatine phos-phate held by the muscles. The creatinuria of thyro-toxicosis diminishes when iodine is administered. Hehas also found creatinuria in cases of phlebitis andthrombosis of the deep veins, as after an appendicularabscess, and also in the paralytic stages of polio-myelitis. In the latter disease the creatinuriadiminishes as the muscles recover their function.

1. Hobson, W., Biochem. J. 1939, 33, 1425.2. Wang, E., Acta med. Scand. 1939, Suppl. 105.

The central problem of creatine and creatininemetabolism is the relation of one compound to theother in the animal body. Many attempts to find therelationship have been made, but so far without anycertain result. If this relationship could be establishedit is certain that many of the facts which are nowknown could be explained. It looks as though thisdiscovery would initiate the fourth and possibly themost fruitful period of research into the creatine-creatinine bodies. Let us hope that it will soon bemade.

ALFRED VOGT HONOURED

IT was a happy thought of the Festschrift committeeof the Swiss Ophthalmological Society to use theSwiss medical weekly as their medium in presentingProfessor Vogt with the customary bouquet ofophthalmic effloreseences on his sixtieth birthday. Forone thing it has obviated the appearance of one ofthose solid masses of specialist literature so likely taremain unread by all but the producers. By scatter-ing the papers of the symposium among a wider circleof interest, and by including papers linking ophthal-mology with other branches of medicine, the editorshave produced a couple of eminently readablenumbers. The subjects range over accounts ofophthalmic votive offerings, visual hallucinations,industrial eye diseases, veterinary ophthalmology,cerebral localisation and rare diseases as well as of themore familiar glaucoma and retinal detachment. Thepostmarks include Chicago, Lwow, Cairo, Eastbourne,Budapest, Vienna and Catania, and it is refreshingto find no reflection of the European tension. We mayhope that Switzerland will maintain her independentscientific thought as in the last war when she producedthe two greatest advances in ophthalmology since thetime of Helmholtz: the slit-lamp and the operativetreatment of detached retina. We have to thank Vogtfor the admirable Slit-lamp Atlas, which first appearedin 1921.

HEALTH SERVICES OF NEW YORK CITY

THE annual report for 1938 of Dr. John L. Rice,commissioner of health of New York City, is presentedas an attractive illustrated guide to the city’s healthservices under the title, " Health for New York City’sMillio’ns." During the past few years New York hasmade immense strides in its public health organisationand has achieved a uniform svstem of administrationfor its seven and a half million people, centred in aBoard of Health of which the commissioner is chair-man. Greater New York is now divided into 38

districts, corresponding in their powers and dutiesmore to our outer ring boroughs than to the metro-politan boroughs, to which the dispensation of servicesis delegated by the health board. The board itselfdiffers from the health committee of the LondonCounty Council in having complete central control ofall health and sanitary services and in covering thewhole metropolitan unit. The services provided arein the main similar to those available in this country,but the American system relies less on full-time healthofficers than does ours and has more intimate contactwith private practitioners, in America always calledphysicians. In Britain the medical functions ofpublic health arose piecemeal to give to the peoplemedical benefits which private medical practice didnot supply, or supplied indifferently or irregularly;but in the American cities public health is framed todispense the benefits through the private physicianswherever possible, by supplying them with materialand specialised help and coordinating their services.Consequently there is little friction between the health