Document QkDRYMkN4QYyByp4KG5pp0w78

'PoS^, \?) <a- 13T70T Dec. 15, 1962 ANTIBIOTICS AS HUMAN FOOD SUPPLEMENTS 1595BUTtSH Medical Journal i;<'estion of protein. On a fixed intake of 60 g. daily the lein content of the faeces was estimated by a method wnich also estimated amino-acids. This was found to be higher in patients who had had gastrectomy than in normal individuals. The administration of 50 mg. tetra cycline daily to patients who had had gastrectomy caused an immediate sleep fall in the protein content of the faeces from 3.5-4 to 1-1.5 g.%. accompanied by an average gain in weight in only five days of 1.2 kg. The alteration in the protein content of the faeces was less startling than may appear, because these percentages are based on wet weight, and both the bulk and the water content of the faeces increased during treatment, but it is nevertheless genuine, the actual reduction in protein con tent being about 40%. It therefore seems that small amounts of tetracyclines improve utilization of protein when gastric secretion is defective. Though there are weighty reasons for discouraging the extensive use of antibiotics in human medicine for other purposes than the treatment of serious infections, their administration to improve nutrition in a selected group of patients seems to be warranted provided the beneficial effects can be confirmed. FAMILY INFLUENCE ON SCHIZOPHRENIA The influence of family relationships on the onset and course of a schizophrenic illness of one of its members 'as long attracted interest. Y. O. Alanen1 in a study the mothers of young schizophrenics concluded that they were more often disturbed than controls, tending to be domineering, excessively possessive, and to lack understanding of the patient's needs and feelings. He went so far as to suggest that the mother's attitude played a causal role, and offered this as an alternative to the more orthodox genetic explanation of the familial tendency of schizophrenia. The effect of the family setting on relapse of schizophrenic illness was studied by G. W. Brown and colleagues.* who showed that the readmission rate of discharged long-stay patients was greater if they returned to their wives or parents than if they went to stay with more distant relatives or lived in lodgings. A further study is reported by G. W. Brown, E. M. Monck. G. M. Carstairs. and J. K. Wing3 of the fate of 128 male schizophrenics aged 20-49 years, mostly short-stay cases. The patients were examined at the time of discharge from hospital and were followed up for a year. A "key" relative, usually the wife or mother, was identified, and estimates were made of the amount of emotion, hostility, and "dominant or directive" behaviour shown by this relative and the patient to one another. Two hypotheses were tested. The first was that deterioration in the patient's condition would occur if he was discharged to a home in which he was exposed to 1 Alfcrven. Y O.. Arte f*xv> kiot iransi . I9<R. 11. 124/ * Bmwn. G W.. CiruRir*. Ci M.. *nd Tppinv. G.. Lanrrt. 1954. S. 6*5. _____M.*r*cV. F M Car.trv G M.. and Winn. J. K., Brit. J. pret.soc. Mr* . 19*2. !. *5 * Far* R E L-. r>unh*n>. H W.. Mental Disorders In Vrtxm Arras, 1439 Univer*r Pren. Chieom. `Hr E H./ mrnf S / . 1956, 101. 753. See Brit. med. J., 1962, 1. 102. strongly expressed emotion, hostility, or domineering behaviour. The second was that if he returned to such a home relapse would be less likely if the degree of personal contact with the family was small. A significantly greater proportion of patients returning to " high emotional involvement '' homes deteriorated (76%) compared with those returning to " low emotional involvement" homes (28%). When the criterion of rcadmission to hospital was used the figures were 56% and 21% respectively. The patients from "high emotional involvement" homes were subdivided into two approximately equal groups depending on the length of lime spent per week in contact with the "key" relative. In those patients showing a moderate or severe mental disturbance on discharge from hospilal high contact did indeed show a significant relationship to deterioration. Though the same proportion of patients discharged to lodgings deteriorated as among those returning to their wives or relatives, the authors believe that the home relationships did play some direct part in determining deterioration. R. E. L. Faris and H. W. Dunham1 in Chicago and E. H. Hare3 in Bristol observed that those city areas in which social isolation was most marked were peculiarly rich sources of schizophrenic patients. The social drift of potential schizophrenics to these areas is a likely reason for part of this high incidence, but many psychiatrists believe that social isolation in itself is an active agent in provoking the psychotic breakdown.* This paper of Brown and his colleagues suggests another possibility--that social isolation is sought as a form of prophylaxis, it also seems to contradict some of the current views on providing a therapeutic community, with its emphasis on increasing the social contacts of schizophrenic patients. Clearly further work is needed in this field. (possible carcinogenicity of plastic SPONGES Plastics such as polyvinyl sponge have many uses in surgery and may come to be used even more. One bizarre application has been the attempt to construct shapely breasts in cases of hypomastia by the insertion of carefully moulded implants of " ivalon " polyvinyl sponge between the mammary gland and the underlying pectoral muscle. A disadvantage of the method is that after some months the new " breasts " tend to shrink, and may have to be removed because they become hard and uncomfortable. Dr. Cuthbert Dukes and Mr. B. C. V. Mitchley have had the opportunity to examine eight implants removed from four patients from 4 to 18 months after insertion and to compare the histological changes with those produced experimentally by the subcutaneous implantation of pieces of ivalon sponge in rats.1 The changes in the implants removed from both patients and rats were remarkably similar, the inter stices of the sponge being filled with collagen-producing fibroblasts, phagocytes, and multinucleatcd giant cells, * Duke*. Cuthbm .. &nd Mitchfey, Bernard C. V., Bra. J. jUost. 162. is, 225. Mi'/AsS (hJhdjldL *r 1596 Dec. 15, 1962 POSSIBLE CARCINOGENICITY OF PLASTIC SPONGES Bum Mdical Journal and nourished by new capillaries. At the periphery development and concomitant urbanization. Despite the of the implants detached particles of sponge surroupded undoubted limitations on any scale of social classifica by collections of phagocytes and foreign-body giant tion intended to be valid for the nation there are cells were found in the surrounding tissue. In the important differences from one social group to another experiments on rats, 20 animals received " thin " in way of life and in prevailing pattern of disease. implants (20 x 20 x 2 mm.) and 20 received " thick " Eighty per cent of the children born into marriages of implants (20 x 20 x 5 mm.). Palpable tumours appeared completed fertility were born within the first ten years at the site of implantation, about 20 months later in the of marriage, but whereas the wives of salaried case of the thin implants, and some 6 months earlier in employees bore 89% of their children within ten years the case of the thick implants in the 14 rats which lived of marriage the wives of unskilled labourers bore only more than ten months. All of the tumours showed the 75% during the same period. Variations in infantile histological changes already described, but the 14 thick implants were invaded by spindle-cell sarcomata arising in the connective tissue outside the sponge. Only one of the thin implants was similarly invaded. There was no evidence of malignant change in any of the tissue removed from patients, but the implants bad been in position for only short periods in relation to the rat experiments. Because the tissue response to the sponge was essentially the same in the human being and the rat the authors raise the question whether the remote effect--that is, the development of malignant sarcoma-- might not also apply to the human species. Since the answer is not yet available they feel that the best advice they can give to plastic surgeons is to use sponges as thin and as porous as possible, and to remove them when their purpose is served. mortality with social class have long been recognized, and while of recent years the decline in infant mortality has run more or less parallel in each social class the decline in neonatal mortality has lagged in the lower social classes. There is a social-class gradient in the efficient use of health services as there is in the incidence of disease. Though poverty is much rarer in Great Britain than formerly extreme differences in physical environment still exist, and adverse environmental factors play an important part in the production of ill-health and personality disorder. The less-well-off people seem to experience illness not so much with greater frequency as with greater severity. Likewise the increase in volume of incapacitating sickness with advancing age is due not so much to increase in frequency of sickness episodes as to the longer period of incapacity associated with each episode.* Again, the recovery of a patient after discharge from hospital is profoundly influenced by his HEALTH AND SOCIAL CLASS role in his household and at work.* . Diseases, like persons, may exhibit social mobility: sometimes the Perhaps more than other social workers doctors are brought face to face with the complexity of forces which so often determine human welfare. The social aspects of medicine share fields of study with the social sciences, and the results from various fields may be needed to reinforce one another. The importance of thinking along these lines of combined approach is well exemplified in a recently published book, Sociology in Medicine,* of which the authors are respectively diagnosis rather than the disease may be mobile, for there are fashions in diagnosis. Social mobility, whether upwards or downwards, can lead to stress in the individuals concerned, sometimes even to suicide. There is need for further study of the consequences of social mobility. How does a society which puts a premium on individual achievement handle those whose aspirations are thwarted ? It has been argued that mental disorders are social lecturers in Manchester University departments of social and preventive medicine and social anthro pology. We need more efficient methods of using medical knowledge and of applying it to the changing social world. Medicine has a contribution to make in shaping the development of new communities and a new way of life, but these are matters in which medicine must co-operate with other social agencies. There is still no easy answer to the question. How best does one measure the degree of health, happiness, and efficiency in any social group or indeed in the individual ? Social rather than medical concepts.4 They define a class of people who cannot fit into the norms of behaviour expected by the society in which they live. There is general agreement that the old-fashioned mental-hospital system was bad in that it purchased a degree of social tranquillity outside the hospital by sacrificing individuals to a regime often open to serious criticism, and this, as was said recently in these columns,4 must be weighed against whatever social liabilities are entailed in maintaining a disabled person outside hospital, for this may place a considerable strain on the relatives. The and demographic changes are closely linked with economic change, such as the development of new processes at work, and there is inevitably growing psychiatrist seeks to help his patient: the sociologist can help him to do so to the maximum benefit of both patient and community. interest in the social stresses of modern industrial 1 Sumer. M. W.. and Wataon. W., Soctoiotr in Aledtdne. 1962. Oxford Umvertiiv Prem. London. Pepcn on Incapacitating Slcknett, Scotland. 1939. H.M.S.O., Lorrdo>4- Ho*tial and Community. Further Scottish Studies. 1962. Oxford University Prc*s London. 4i Wardei. C. J.. Snctal Fmctoet In the bAaioe functioned Ptychoitt, 1962. Rouitedce and ttexan Paul. London. Brit. med. J.. 1962. 2. 904. We announce with regret the death on December 8 of Professor R. F. Woolmer at the age of 54. He was professor of anaesthesia at the Royal College of Surgeons. s y ozsm 1 pJ