413

been ill effects. His opinion, incidentally, is at variancewith that of Professor Fleisch,l who concluded from hisexperience of rationing in Switzerland that the highpre-war consumption of fat (100 g. and more per day)was unnecessary. Dr. Leitner appears to ignore the factthat man can live in good health on diets containingvery little fat ; indeed, the instances I provided on thisscore in an earlier letter (Sept. 18) he brushed aside asbeing of " little help in establishing our minimum

requirement." It is surely only the sifting of evidencebearing on these issues that is of value in seeking todetermine the minimum human requirement of fat.Mitchell 2- in a striking paper has provided very

interesting evidence for the view that, within limits, mancan adjust himself to lower levels of nutrition, and thatwhen such adjustment has taken place the body mayreasonably be regarded as adequately supplied withfood. In the above-mentioned countries it is apparentthat a successful adaptation was achieved in changingfrom a relatively high intake of fat to one which,although lower, is still greater than what seems to bethe minimum requirement. -

Finally, in order that there should be no misappre-hension, I should like to repeat that I am certainly notadvocating the use of diets low in fat. But there issurely some comfort in knowing that, according to theavailable evidence, an involuntary reduction in theintake of fat, within limits, is not injurious to health.

Nutrition Unit, Council forScientific and Industrial Research,

South African Institute forMedical Research, Johannesburg.

A. R. P. WALKER.

VEGANIN

SIR,-Dr. M. C. Macqueen (Feb. 19) comments on thequicker rate of disintegration of Veganin ’ as comparedwith tab. codein. co. I have confirmed this by immersingsamples of the two preparations simultaneously, bothin tepid water and in a specimen of gastric juice (pH 58).The observation, however, is irrelevant, because tabletscontaining aspirin should be thoroughly pulverised beforethey are administered. Important gastroscopic studieson this subject have been published.3The rate of disintegration of a tablet is not the only

factor influencing the rate of absorption of its consti-tuents. The sole qualitative difference between tab.codein. co. and veganin is that the latter is stated tocontain codeine (solubility 1 in 120) whereas in the officialpreparation the alkaloidal salt is used (solubility 1 in3). If Dr. Macqueen is concerned about the rates ofabsorption of the two preparations, solubility is muchmore to the point than speed of disintegration of thetablets ; and he has unwittingly raised an issue whichargues the superiority of the official preparation.

Dr. Macqueen admits that it is not easy to provideevidence of the superiority of veganin over tab. codein.co. The following data may help to resclve the difficulty :

Tab. codein. co. Veganin(grains) (grains)

Aspirin .......... 4.0 .. 3-8.<5Phenacetin........ 4-0 .. 3-855Codeine.......... 0-096* .. 0-117

* As codeine phosphate 0-125 grain.

Compared with tab. codein. co., a veganin tabletcontains a minute excess of codeine (gr. 1/50) and a littleless aspirin and phenacetin (gr. 1/7 of each). Havingregard to the ordinary doses and the pharmacologicalacdons of the constituent drugs, and taking into con-sideration the many variables in clinical practice (body-weight, rate of emptying the stomach, pain thresholds,&c.) is it seriously suggested that these quantitativedifferences have any therapeutic significance ? A clinicalpharmacologist must be permitted to doubt if there isany need to undertake a therapeutic trial of the twosubstances. Notwithstanding Mr. Eliot Warburton’sindignation (Lancet, Dec. 4), I shall continue to teachthat the only material difference is that whereas 100 tab.codein. co. cost 4s. 6d., the same number of veganintablets cost 8s. 5d.

Department of Materia Medica,University of Glasgow. STANLEY ALSTEAD.

1. Fleisch, A. Schweiz. med. Wschr. 1946, 889.2. Mitchell, H. H. J. Amer. diet. Ass. 1944, 20, 511.3. Douthwaite, A. H. Brit. med. J., 1938, i, 1143. Douthwaite,

A. B., Lintott, G. A. M. Lancet, 1938, ii, 1222. Hurst, A.,Lintott, G. A. M. Guy’s Hosp. Rep. 1939, 89, 173.

TUBERCULOUS LYMPH-NODE PERFORATIONINTO BRONCHI

SiB,&mdash;In your review (Jan. 29) of my monograph Dieautomatische, endogene, lymphadeno-bronchogene Reinfek-tion in der Initial periode der Tuberkulose no mention ismade of lymph-node perforations into the bronchialsystem, though the whole work is consecrated to thisphenomenon. -

In the initial period of tuberculosis, swollen andnecrotic hilar and parabronchial lymph-nodes perforateinto the bronchial system, destroying the bronchial walland emptying their contents into the bronchi. Thusare formed typical pulmonary infiltrations, and sometimesalso cavities. Necrotic lymph-nodes often perforate alsointo the pleural, mediastinal, or pericardial spaces andinto the oesophagus. These findings are based on 213cases examined by myself, 85 of which are recorded inthe monograph in the form .of a table. The monographcontains 106 illustrations, 88 showing lymph-node per-forations into the bronchi and their consequences inhuman phthisis.

University of Istanbul. PH. SCHWARTZ.

A REGENERATION SUBSTANCE ?

SiR,-Shortly before the war I made an interestingobservation in my hospital in Solo (Soerakarta, Java)which in my opinion may be of some interest to workersin the field of antibiotics and related subjects. U nfO.J’7tunately I must -quote from memory, for I lost allpersonal papers by war and internment, and Solois still inaccessible owing to the present politicaldisturbances.

’..

My patient was an old man with a bedsore in one gluteusmaximus so extensive and deep that my nurse was eventuallyable to put her whole fist in it. For about four months wetried in vain to cure this wound. Then one evening I readin the Danish journal Politiken an article on A. Gurwitsch’sdiscovery of rays emitted by sprouting roots that shouldinduce increased mitosis in other living tissues in theirneighbourhood. I procured some sprouting roots by puttingsome Katjang-idjoe seeds between two thin layers of cottonwool, then damped and left them overnight (just as schoolboysdo to observe germination in yellow peas). The followingmorning I had germinated embryos. Now I cut a squareoff the cotton-wool layers with the embryos and put it intothe wound. When, four or five days later, my head nurseand I took off the bandage, we got a surprise so big thatour knees were shaking. The wound was filled to the brim,with granulations : the only thing missing was epithelisation,but this followed shortly afterwards. ’.

Katjang-idjoe-literally translated, " green beans "&mdash;arethe ripe seeds of Phaseolus radiatus Linn., a dwarf relativeof the European runner-bean, with small, globose, greenseeds, much like, but smaller than green peas. These seedsare an excellent food, and are known all over South-East,Asia (e.g., in Burma as " green gram ") as a remedy forberiberi, owing to their high content of vitamin Bl. Moreover,young seedlings, gathered three or four days after sowingon a wet cloth and cleaned of the empty seed hulls are, underthe Chinese name of Tao he, a well-known vegetable here.About two years after this incident I met the late

Ir. Booberg (director of an agricultural research station),who died during the war. He told me that in hisopinion the observed phenomenon was presumably dueto auxins. In the light of recent research by Boyse4-Jensen and others, however, auxins-i.e., plant hormones,generated in one part of the plant, transported by thesap, and acting on another part-can scarcely be inplay here, as the seedlings were not crushed. Thesubstances in question must be secretion or excretionproducts of the roots.That roots can produce biologically active material

was confirmed to me by Prof. (jrrevenstuk, pharmaco-logist at the University of Batavia, who in 1939, onevisit to the late Prof. Funke, then plant physiologistat the University of Ghent, saw there demonstratedhow European beans, germin ting on a wet cloththrough which clean water was slowly moving in onedirection by capillary force, influenced the germinationof seeds of the same kind, sown a few days afterwardsat their side. The seeds upstream, which got the freshwater, germinated normally, whereas-those downstreani;

414

drenched with water containing the root secretion-products of their older brethren, remained stunted orfailed to germinate at all. This is probably an instancein higher plants of survival of the strongest firstbornby means of an antibiotic directed against the weakerrivals of the same species. Whether this substance andthe substance acting in my own experiment are of thesame character, or even perhaps identical, is still unknown,but I think this question may be readily answeredexperimentally.With regard to the clinical facts observed, it is perhaps

best to give the wound-healing substance the provisionalname of regeneration substance. In my patient thewound was so quickly filled with cells that at first Iwas afraid I had brought about a malignant growth.Since then I have used the same treatment on severaloccasions with good results ; I noticed that if thewounds were infected the treatment sometimes quicklycaused a greatly increased flow of pus.

This observation is published in order to stimulateother workers who are in more favourable circumstancesfor serious research to give their attention to thisquestion, which seems to open up many new possibilities.

Tjikini 74, Batavia-C., Java. A. P. N. WEDEL.

>I< * We showed Dr. Wedel’s letter to ProfessorPulvertaft, of the Westminster Hospital medical school,who kindly provided the commentary which follows.-ED. L.

Since it is well recognised that the nature of thebacteria of soil is of primary importance in plant nutrition,it seems plausible to suggest that certain plants mighthave developed a mechanism controlling bacterialgrowth through their roots, either by discriminatoryenhancement or inhibition. Soil bacteriologists have infact stated that the flora adjacent to roots differs qualita-tively from that in the soil more distant from them ;indeed, since the physical conditions around roots mustdiffer in many ways from those of the general soil, somekind of change in soil flora might be expected.For some years I have tried to establish the presence

of an antibiotic mechanism of this kind, but withoutsuccess. In the first group of experiments plants weregrown for weeks or months by the so-called " hydro-ponic " technique-that is to say, in dilute solutions ofessential salts, aerated by a pump. The plants includedpeas, beans, potatoes, lettuce, and many others. Atweekly intervals the fluids in which the roots weregrowing were tested for bacterial inhibition or enhance-ment. In no case was it detected. In a second group ofexperiments certain seeds were germinated on moistcloth, and the fluid expressed from the cloth was testedwith negative results.

If roots, or indeed any parts of a plant, are crushed,the fluid obtained produces a very great enhancement ofbacterial growth when tested on shake cultures, usingcylinders, as in penicillin titration, especially whenplates are crowded. Boiling the extracts does not destroythis property. However, exactly the same type of resultis found when extracts of boiled yeast are used, and thephenomenon is surely to be explained by the action ofthe complex growth factors originally known as " Bios,"and now very fully analysed. As a matter of generalinterest it may be said that folic acid, when testedin this way, produces no changes, and 1 % ascorbicacid a marked ring of bacteriolysis around a zone of-enhancement.

Since results of medical interest were sought, the testorganisms were Staphylococcus aureus and Bacteriurn coli.The negative results do not, of course, prove that rootssecrete no antibacterial substances ; roots cannot beassumed to have humanitarian -objectives. From anagricultural point of view the root fluids should havebeen tested on soil bacteria.

Dr. Wedel quotes an authority as stating that seedswill not germinate well in fluid in which others havegerminated. For this there are many possible explana-tions, such as changes in pH ; but an analogy exists inmy own observations on bacteria grown in a flowingmedium in series of glass bulbs connected together.However rapidly the medium flows, the total growth isalways maximal in the first bulb, and minimal, indeedvery scanty, in the last. -

There are a great many plants in the world ; I remainintuitively convinced that some of them must havethought of a way of controlling their bacterial environ-ment, otherwise than by symbiosis. I can recommendthis type of research to all bacteriologists ; personally Igrow melons, as controls on soil in my experimentalgreenhouse, and can claim that not all my results aredisappointing.

R. J. V. PULVERTAFT.

PALLIATIVE SURGERY IN FACIAL PALSY

SiB,&mdash;In his letter of Feb. 19 Dr. Ritchie Russell hasput forward a timely warning against unnecessary opera-tions for facial paralysis, but he weakens his case byasserting that complete unilateral facial paralysis is notalways disfiguring.

. Many unnecessary operations on the facial nerve havebeen undertaken in the past because of the failure todistinguish between degenerative and non-degenerativelesions ; the rapid recoveries sometimes claimed fordecompression in Bell’s palsy cannot be due to regenera-tion of the nerve-fibres. The real problem, however,concerns the prognosis for spontaneous recovery in thepresence of a known degenerative lesion. Here confusionis inevitable unless facial palsy due to injury or diseasein the temporal bone is considered apart from Bell’spalsy. Decision for operation in degenerative lesionsfrom trauma or mastoid disease involves considerationof the nature of the injury or disease, the time andmode of onset of the palsy, and the condition of themiddle ear and labyrinth. These otological findingscan be reinforced by such evidence as may be obtainedfrom electromyography-repeated observations beingnecessary at times.

Otologists concerned with the treatment of facialparalysis are well aware that the result after regenerationof the nerve, whether this occurs spontaneously or afternerve-grafting or neurolysis, can never be perfect.Symmetry is marred less by mass movements, which areoften minimal, than by wasting of individual musclesduring denervation. Assistance from neurologists as

to the best means of limiting this wasting would bewelcomed.

I agree with Dr. Ritchie Russell that further researchon the natural history of facial palsy, particularly withreference to the pathology of Bell’s palsy, is needed.Such an inquiry into the onset and course of the con-dition would be valuable in view of the paucity of post-mortem observations and the varied findings reported atoperation. There is growing suspicion that a virusinfection acting on the nerve from the facial nucleus orthe geniculate ganglion may be responsible for manycases of spontaneous facial paralysis.London, W.I. J OSEPHINE COLLIER.

PROPHYLAXIS OF OPHTHALMIA NEONATORUM

SiR,-Your annotation of Feb. 19 on this subject wasmost interesting. At this hospital-a maternity hos-pital used in training pupil midwives and medicalstudents-this neonatal paediatric problem has been asource of some anxiety t -

From March, 1947, until November, 1947, using a

drop of 1 % silver nitrate as a prophylactic, of 1356newborns 223 (16-5%) were noted to have a discharging. eye on at least one occasion. Not all cases neededtreatment, for pathological investigation showed epithelialdebris only, or pus cells, and in some cases organisms(mainly staphylococci).From November, 1947, until October, 1948, penicillin

eye-drops (2500 units per ml.) were used prophylacticallvin 1750 births, and 266 (15-3%) of the infants were notedto have a discharge.

It was then decided to use no prophylactic eye-drops.and from October, 1948, to February, 1949, of 713 new-borns 58 (8-2 %) were noted to have a discharge. Inthis series our routine has been to do nothing at all tothe eyes or eyelids at any stage in the first 6-12 hours.In the cleaning-up process whi ch is then pursued (if theinfant’s general condition allows) the eyelids only arecleaned if necessary, but no drops are instilled. Theinfant is kept under daily paediatric supervision, and if