ANNOTATIONS - blood groupsANNOTATIONS - blood groups, Antropologia
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//-->Nov.1,1958UNMARRIEDPARENTHOODBRMTISH1091each;and 40,2childreneach.A localclergymanwho studiedthesubjectaboutthattimecame totheconclusionthat bothreligionandeducationhadfailedtotackletheproblemsofillegitimacy:amongthecauses,helisteddrink,seduction underpromiseofmarriage(rarelyfulfilled),insufficientsupervisionofservants,inadequatehouseaccommodation,concubinage,thetoleranceofpublicopinion,andtheprotectionofthe"maleoffender,"tosomeextent,bytheexistinglaw.Thematterhascontinuedtocommandattentioninmorerecenttimes.J.Spenceandhisco-workers3foundthatlessthanhalfof theillegitimatechildrenintheir Newcastleserieswerefirstbabies;manyofthesecondandthird infantswereborntoparentslivinginestablished,ifunofficial,families.InKil-marnock,B.Nisbet4foundthat30%ofthemothersofillegitimatechildrenwerecohabiting.Manyofthesefamiliesarelivingunderextremelybadenviron-mentalconditions,often incondemned property,withlittleprospectofgettingabetterhouse-cohabitatorsdonotrankhighinofficial housinglists.Inrecentstudiesofunmarriedparenthood,basedlargelyonthecaserecords oftheNationalCouncilfortheUn-marriedMotherandHerChild(ratherbiasedandin-complete material,as hepoints out),C.Greenland5concludedthatacombinationoffactors,suchasresidenceaway fromhome,andcertaintypesofemployment,particularlydomesticandclericalworkandnursing,appearto beassociatedwithanin-creasedriskofconceptioninyoungunmarriedwomen.InmanycasesthemotherhadappliedtotheCouncilforgeneralinformationandadvice; in13%shewantedadviceaboutanaffiliationorder;in9%shewasseekingemploymentandahome; whilein8%shewasconcernedprimarilywithwaysand meansofkeepingthechild.Greenlandfoundthatmenunder 20 yearsofage,marriedmen,ormembersofarmedForceswereoftenthefathersofillegitimatebabies,but hisfindingsdid notlendsupportto"theorieswhichregard putativefathersasahomo-geneous group having certainpsychologicalfeaturesin common."Thewelfareoftheillegitimatechildhaslonggivencauseforanxiety.Atonetimetheofficialattitudetoillegitimacywasmoreconcernedwithpossiblereper-cussionsonthe poorrate thanwith thewelfareofthechild.From1868 onwardstheofficersoftheBoardofSupervisionurgedparochial boardsinScotlandtoofferonlyindoorreliefto themothersofillegitimatechildren,hopingby thiscourseofactiontoreducethe burdenofpauperillegitimacy,thoughtherefusalofoutdoorreliefin thesecases often ledtothedeathof thechildren.Ithasbeen thegeneralexperiencethatthe prospectsofsurvivaloftheillegitimatechildaremuchlessfavourablethan thoseof thelegitimate.RecentlytheRegistrar-General'haspointedoutthatthemortalityratesofillegitimateinfantsaremuchlessaccuratethanthoseofthelegitimateinfants,partlybecauseaproportionofthe infantswhoareregisteredatbirthasillegitimateandsubsequentlydiearenotrecordedasillegitimateat death registration:itisprobable thatthis has theeffectofunder-estima-tingtheinfantmortalityofillegitimatechildrenbyabout16%.In1930-2thecalculatedillegitimateinfantmortalityratewas79% higher thanthelegitimaterate; by1949-53theexcesshad fallento36%and therehadbeenaswellasubstantialdeclineoverthatperiodin themortalityofinfantsineachsocialclass.But,apartfromconsiderationsofmortality,theillegitimatechildusuallystartslifewithserioushandicaps,social,emotional,moral,andlegal.TheLeagueofNationsstudy7of thelegalpositionoftheillegitimatechild and,morerecently,thejointreportoftheBritishMedicalAssociationand theMagistrates'Association8wereagreedthatchangesinthelawwereurgently necessarytoprotecttheunmarriedmotherand herchild, andthetime seemstoberipeforfurther action.BLOODGROUPSOFMUMMIESTheconsiderablesuccessachievedbyblood-groupingmethodsintheclassificationoflivinghuman popula-tions hasledfromtimetotimetoattemptstodeterminethebloodgroupsofhuman bonesandothertissuesobtainedfromarchaeologicalexcavations.Mostof theexperimentshavebeen limited to theantigensoftheABOsystem,andit isstillexceedinglydoubtful whetheritwilleverbepossibletodetecttheantigensof theothersystemsinpost-mortemmaterialwhichhasnotbeenspeciallypreserved.Itisofcourseimpossibletoobtainintactredcellsfromarchaeologicalmaterial,andtestsmusttherefore dependon theinhibitionof thegroupingsera bysamplesofthetissuesor byextractsorpreparationsfromthem.TheearliestexperimentswerethoseofW.C.BoydandL. G.Boyd,'whoperformedinhibitiontestswith muscletissues from EgyptianandAmericanIndianmummies.Since thenmethodshavebeensomewhatrefined,thoughnogreatadvanceshavebeenmade;P. B. Candela2appearstohavebeen thefirsttocarryouttestsongroundsamples ofbone,asubstancemuchmorewidelyavailablethan muscletissue.Theliteratureofarchaeologicalbloodgroupingupto1953 has beenreviewedbyA.E.Mourant.3Boyd,W.C.,andBoyd,LyleG.,Proc. Soc.exp. Biol.(N.Y.),1934,31,671.Candela,P.B.,Amer.J.Phys.Anthrop.,1936,21,429.3Mourant,A.E.,The DistributionoftheHumanBloodGroups,1954,Oxford.I21092Nov. 1,1958BLOOD GROUPSOF MUMMIES_~~~~~~~~~~EIABDICALTJOUAL__ATheresults of tests on series of ancientremains haveprovedgenerally consistent with those on the corre-sponding livingpopulations, but haveoftenshownanexcess frequency of group AB above that required forgeneticalequilibrium. It thus appears probablethatwhile,taken on a population basis, the results do givesomeindicationofgenetical constitution, mostifnotall seriesincludesomefalsepositives. Thisis not sur-prising,since all the specimens tested must containbacteria.Bacterialcontamination isalreadyknowntogiveriseforvariousreasonstoerrorsin thetestingevenofred cells only afewdays orweeksold.Somesuch resultsdependupontheThomsenphenomenon,whichis due to thedevelopment ofanantigennotclosely relatedto thebloodgroups.Thiscauses"false"positive agglutinationand hencewould give risetofalseresults in the detection of blood-group antigensbyinhibitionmethods.On the otherhandsomebacterialpolysaccharidesarecloselyrelatedbio-chemicallyandevenimmunologicallytotheblood-group substances and so might be expected to causeinhibition simulatingthat duetotheblood-groupGOITROUSHYPOTHYROIDISMRecent advancesinknowledgeofthyroidfunction haveemphasizedthediagnosticsignificanceofapalpablethyroidglandinahypothyroidsubject,whetherbaby,child,oradult.Theglanditself maybesoftorhard,smoothornodular,smallorlarge,butfrom itsenlarge-mentcertain conclusionsmay bedrawn:thatthethyroidissubjecttosomedifficultyinproducingthyroxineandtriiodothyronine,that thisdifficultyhasbeen present forsometime,andthat the deficientout-putofthyroidhormoneshasresultednotonlyintheclinicalstateofhypothyroidismbut alsoinanincreasedproductionofthethyrotrophichormoneT.S.H. intheendeavourtostimulateoutputofthyroxine.Thisattemptisunsuccessful,and thebestthat T.S.H.canachieveinthissituationisanenlargementoftheglandduetohyperplasia.Thethyroidglandisnotasarulewellpalpatedbymedicalstudentsorbyyoungclinicians.Thecorrectmethodofexaminationremainsamatterofopinion,butthemethodusuallytaughtofstandingbehindtheantigens.sittingpatientandblindlypalpatingwith both handsIf blood-grouptestsare tobe usedfor archaeological has littlebutcustomtocommendit.Fewright-handedpurposes,andiftheresultsare tocommand anyconfi-clinicianshavealefthandassensitiveas theright(thedence, it isclear thatexisting techniquesneedtobetrouble,asTrotterusedtoexplain, withsomeofusisrefinedconsiderably,or newmethodsdeveloped.Inthatwehavetwolefthands),andeveryoneuseseithereithercasethemethods,beforebeing appliedtoancienthandmoreexpertlywhenaidedbydirect vision.Thespecimens,mustbeshowntogivecorrectresults withmethodsofstandingalongside(totheright if right-recentcadavermaterial of whichthe bloodgroupishanded)thesittingpatientandpalpatingwithonehandknown.It maybe thattheblood-groupantigensareappearstoachieve better results when usedbythosetoounstableontheonehandortoosimilartocliniciansnotyetweddedtotheoldermethod.Inhypo-bacterialpolysaccharidesonthe otherforastandardofthyroidchildreninwhomnogland canbepalpatedinaccuracyever tobereached comparable withthattheusualsituationthepossibilityofdysgenesis'(imper-attainedinthetestingoflivingpersons ; butif reliablefectdescent)isworthremembering,and theexaminingresultscouldbeobtainedtheywould be of suchgreatfingersshouldexploretheneckon both sidesbelowthevalue to archaeologists that it is important thatrenewedeffortsshould be madetoimprovethemethodsoftesting.Thenewsisthereforewelcome thatablood-groupinglaboratoryforthesepurposeshasbeensetupattheBritishMuseum(Natural History).Work isbeingcarriedout by Mrs. Madeleine Smith in the Anthro-pologySection,ofwhich Dr.K. P.Oakleyhascharge.Thefirstobjectofthelaboratoryisthe developmentandcriticalassessmentofnewandmoreaccuratetestingmethods.It isproposed, however,toundertake almostimmediatelythetestingbothofacertainamountof"mummified"material(forexample, fromthe dry soilsofPeru)andofaselectionofbonesof ancient Etruscans,whichhavebeenpreservedunderdamperand presum-ablyless favourableconditions. Inthelongrunthereis littledoubtthat mummified material will yieldvaluableifnotcompletelyaccurateresults;suchresultswould of themselvesfullyjustifythe establish-mentof thelaboratory.Ifinaddition reliable methodscanbedevelopedfor thetestingof bonespreservedundermoistconditionsamostimportantadditionwillhave been madetothescopeofarchaeology,andagreatcontributiontothepossibilityofcorrelatingancient populationswiththoseofthepresentday.jaw.Furtherconclusionscanbedrawn fromthenatureof theenlargedglandinhypothyroidsubjectswhenthepatientandhisenvironmentareconsidered.The dis-coveryof asmall, eventiny, glandin ababywithcretinismorinachild withhypothyroidismsuggestsaninborndefectofthyroxine synthesis;thisiseven morefirmlyindicatedwhentheglandislargeandnodularandthepatientolder.Theenlargingglandin thethyrotoxicpatienttreatedbyantithyroiddrugs showsthat thepatientismovingovertohypothyroidism.The hardandenlargedglandofautoimmunizingthyroiditisisoftenassociatedwithmyxoedemainwomen.Butin thepresentstateofourknowledgewemustnotconcludethat,becausethethyroid glandisatrophicandimpalpablein thepresenceofhypothyroidism,theglandhasthereforenot been the seatofsimilar inborn defectsorofpathologicalprocesses.Itiseasytoconceivethat1McGirr,E.M.,andHutchison,J. H., J.clin.Endocr.,1955,15, 668.2Wyngaarden,J.B.,Stanbury,J.B.,and Rapp,B.,Endocrinology,1953,52,568.3Astwood,E.B.,Ann.N.Y.Acad.Sci.,1949,50,419.4Mosier,H.D.,Blizzard,R.M.,and Wilkins,L.,Pediatrics,1958, 21, 248.5Stanbury,J.B., andHedge,A.N.,J.clin.Endocr.,1950,10,1471.-Kassenaar,A.A.H.,Meijer,J.W. A.,andTerpstra,J.,ibid.,1955,15,1216.Stanbury,J.B.,Ohela,K.,andPitt-Rivers,R., ibid.,1955,15,54.Nov. 1,1958GOlTROUSHYPOTHYROIDISMMED.CBRITI1093aglanddestroyedbychronicthyroiditisisincapableofresponsetoT.S.H.,andremainsshrunken andatrophic;andthereisnowgoodevidence thatmyxoedemaisoften,ifnotalways,theresultof suchaprocess.It isalsopossiblethatthefoetalthyroidgland,asthe resultofsomeinbornenzymaticdefect,may alsofailtorespondtoT.S.H.Onegroupofantithyroid drugssuchaspotassiumperchlorateandthiocyanateactbypreventingtheup-takeofiodidebythegland,2andtheyareused also intheinvestigationofthyroidfunctiontoprocurethe dis-chargeofiodineunboundto tyrosinefromthegland.Anothergroup,thethiocarbamidessuchasmethylthiouracilandcarbimazole,preventtheiodination oftyrosine3(thesecondstepinthesynthesisofthyroxine).Threetypesofcongenital defectinthesynthesisofthyroxinehave now beenidentified.4The firstdefectoccursatthe stageofiodinationoftyrosine5(thestageatwhichthethiocarbamideshavetheir action).Theseconddefectis duetoafailureofdeiodinationoftheiodotyrosines,presumablyassociatedwithafailure oftheenzymedehalogenase.6Andthethirdisapartialinabilitytoformthyroxineandtriiodothyroninefromtheiodotyrosines.7Nodrugs areknowntointerferewiththelatestagesof thyroxinesynthesisatwhichthesecondandthirdof thesecongenital defects declarethemselves.Hypothyroidismwhich is duetothe use ofantithyroiddrugsrequiresthetemporarycessationoftherapy.Hypothyroidismwhichisdueeithertocon-genitaldefectsinthyroxinesynthesisor tochronicthyroiditisrequireslifelong thyroidtherapy-sufficientfortheneedsofthebody,sufficienttosuppressthefor-mationof T.S.H.,andsufficientto put theoveractiveorpathologicalglandat rest.InEnglandandWalesin1956therewere11casesofdiphtheriaamongtheimmunized with1 death,and40cases amongthe non-immunizedwith 2deaths.In1955 therewere34casesamongtheimmunizedwithnodeaths,and120among thenon-immunized with13deaths.InScotland,duringthe nineyears1949-57therewere 151confirmedcasesofdiphtheriaamongtheimmunizedchildren,withnodeaths;amongthenon-immunizedchildrentherewere665confirmedcases,with 35deaths.Thenumberofnotificationsofdiphtheriafellrapidlyafter thewidespreadintroductionofimmunization,from anannualaverage of about55,000in1933-42to40in1957,whilethe number ofdeathsfell fromanannualaverageof2,783in1933-42tosixin 1957. Thedistributionofcases wassporadic,and the largestannualnumberof casesinlocal authorityareas in 1955was19inUttoxeterR.D.,17inKingston-upon-HullC.B.,and14 inWest HamC.B.Kingston-upon-Hullhadthelargestannualtotalin 1956and1957,with 7 and 6casesrespectively.It isinterestingtonotethat, thoughfullswabbingoffamily, school,andothercontactswasper-formed inmostareas wherecasesoccurred,inonlyafewinstances werecarriers revealed;the sourceof in-fectionusuallyremainedunknown. Pastexperiencehasshown thatinschoolcommunitieswhereimmunizationratesarelowdiphtheriahas only tobeintroducedtospreadrapidly.Itisatschoolentrythatanopportunityexiststo raise thenumberofimmunizedchildren in thecommunity.Bl2ASSAYSINMEGALOBLASTIC ANAEMIAUncomplicatedvitamin-B12deficiencyinmanfrequentlygivesrise tomegaloblasticanaemia,which can bedifferentiatedfromthat seeninfolic-acid deficiencyorinscurvy12bythefactthatitiscuredbytreatmentwithvitaminB12'However,the lingualandneurologicallesionscausedbydeficiency ofvitaminB,2are some-timesfoundinpatients whoare notanaemic,345anddeficiencyofB,2andfolic acidmay occurtogetherinpatientswith intestinalmalabsorptionsyndrome.Insuchpatientsit maybeimpossibletodiagnosedeficiencyofvitaminB12 byclinicalandhaematological methodsalone.However,deficiencyofB,2canbedetectedinthesepatientsbyassayingtheamountofitinthe serum bytheuseofmicro-organisms,ofwhichEuglenagracilis67Jandl,J.H.,andGabuzda,G.J.,Proc. Soc.exp.Biol.(N.Y.),1953,84,452.Brown,A.,Brit.J.Haemat.,1955,1,345.:Badnoch,J.,Proc.rov.Soc.Med.. 1954,47,426.Arias,1.M.,Apt,L., and Pollycove,M.,NewEngl.J.Med.,1955,263,1005.'Adams,J.F.,Lancet,1957,1,1120.8Ross,G.I.M.,J.dlin.Path.,1952,5,250.Hutner, S.H.,Bach,M. K.,andRoss,G.1.M.,J.Protozool.,1956,3,101.8Rosenthal,H. L.,and Sarett,H.P.,J.biol. Chem., 1952,199,433.9Spray,G.H.,Clin.Sci.,1955,14,661.'°Mollin,D.L.,andRoss, G.1.M.,Proc. roy.Sor.Med.,1954,47,428.- -inVitaminB,2undIntrinsicFactor.1.EuroplischesSymposion,Hamburg,1956,editedbyH.C.Heinrich,p.413.FerdinandEnkaVerlag,Stuttgart.2Lear,A.A.,Harris, J.W.,Castle,W.B.,andFleming,E.M.,J.Lab.clin.Med.,1954,44,715.13Girdwood,R.H.,Quart.J.Med.,1956,25,87.14Meynell,M.J.,Cooke,W.T.,Cox,E.V.,andGaddio,R.,Lancet,1957,1, 901.med.Spray,G.H., andWitts,L.56Gardner,F.H.,NewEngi.J.J.,Brit.1958,J..1958.1,295.16258, 791.Med.,17Tasker,P.W.G.,Mollin,D.L.,andBerrimai,H.,Brit.J.Haemat.,1958, 4, 167.IMMUNIZATIONAGAINSTDIPHTHERIATheproportion ofchildrenindifferentparts of thecountryimmunizedagainstdiphtheriavaries widely.Thoughprecise figuresarenotreadilyavailable,itseemstorangefromunder30%toover70%inEnglandandWales,andtoaverageabout 70%inScotland.ThepresentoutbreaksinEssex andLondon,'thoughsmallby the standards of20 yearsago, are areminderthat ahighstateofimmunizationisthe surestbarriertotheepidemicspreadofthedisease.ThenumberofchildrenimmunizedinEnglandandWalesagainstdiphtheriainthe threeyears1955-7 was525,125,567,989,and546,776,respectively.The percentageofchildrenwhomayberegardedasremainingprotected-that is,chil-drenwhohadacourseofimmunization,primaryorbooster, duringtheprecedingfiveyears-fortheyears1953-7was48,48,49, 49, and 48.InScotlanditwasabout70%.Thoughthe percentagethroughoutthecountryvariesfrom placetoplace,it variesonly slightlyfromyeartoyearinanyarea.Inaspeechhemade lastweekDr.J.A.Stirling,thenewpresidentof theSocietyofMedicalOfficersofHealth,wiselyurgedhiscol-leaguestokeepparentswellinformed about theneces-sityofhavingtheirchildrenimmunized.1Brit.med. J., 1958, 2. 1051.1094Nov. 1,1958B12ASSAYSINMEGALOBLASTIC ANAEMIABRmSHMEDICALJOURNALandLactobacillusleichmannii89arethebestknown.Measuredinthisway,theB1,concentrationintheserumof patients with Addisonianperniciousanaemia10'15isalways lower than innormalsubjects.WhiletheB12concentrationintheserumofnormalsubjectsrangesfrom140to900,u,ug.perml.,mostpatientswithAddi-sonianperniciousanaemiahavelevelsoflessthan80,u,ug.perml. However,somecontrolsubjectsmayhavelevelsaslowas100ju/ug.perml. andafewnon-anaemic patients withAddisonianperniciousanaetniahave levelsupto110,u,g.perml.Onthe other hand,allpatients with subacute combined degeneration of thecord,evenwhen they havenoanaemia,have littleornomeasurableB12in theirserumwith theEuglenaassay.1011Thediagnosticvalueofsuchanestimationis clear.Inaddition, this observationsuggeststhatsub-acutecombined degenerationdoesnotdevelop until thetissuesarealmost completelydepletedofB12,andfurthermore thatthemegaloblastic anaemiainperniciousanaemiamaynot be duesolely todeficiency ofB12.TheincidenceofB2 deficiencymayalso beaccuratelyassessed inothermegaloblasticanaemias by this method.Forinstance,inpatientswithmegaloblastic anaemiaassociatedwithgastrectomyandwith anatomicallesionsof thesmallintestinetheB12concentrations in theserumarealmostalwayssubnormal,the levels beingsimilartothoseseeninAddisonianpernicious anaemia.Deficiency offolicacidrarelyoccursin these patients,forthey usuallyrespondcompletelytotreatmentwithvitaminB12'Subnormallevels ofB12in theserumarealsocommonintropicalsprue'6andin"tropicalmegaloblasticanaemia,"17but intheseconditionstheyare morefrequentlyassociated withdeficiency offolicacid,forthehaematologicalresponsestotreatmentwithB12areslower and lesscomplete.Subnormallevelsarealsofoundinabout50%ofthepatientswith idio-pathic steatorrhoea,101Iandinone-third of thesepatientsthe levelsareaslowasinpernicious anaemia,beinglessthan100/u,ug.perml.However, in suchpatientstheB12deficiencyisinvariablyassociatedwithfolic-aciddeficiency,fornoneofthesepatientsappeartorespondcompletelytotreatmentwithB12alone.Sub-normal levels ofB12in theserumarelessfrequent inmegaloblasticanaemiaofpregnancy,-1'5andinmostpatientstheconcentrationsarenormal.WhiletheevidencesuggeststhataB12concentrationin theserumof less than80/uqug.perml.indicatesclinicalB12deficiency,serumlevelsbetween80 and 120iuyg.perml.havebeenfoundoccasionallyinpatients whosetissuestoresofB12werenormal.11Though such findingsareveryrare,theysuggestthatborderlinelevelsofserumB12shouldbeinterpretedwithcaution.logist, combinedwith theenergyandresourcefulnessofthepharmaceuticalindustry, has letlooseafloodofnewandpowerfulremediestobeusedbydoctorsforthe benefitofpatients.Politiciansandadministratorsmoanabout thecostof thistothe NationalHealth Ser-vice.Atonetime the size ofthenationaldrugbillwasattributedtounrestrictedandfreeaccesstothesimpleremedies anddressingsin thechemist'sshop.Thentheblamefellonthepharmaceuticalindustryforhigh-pressuresalesmanshipofremedies, andcombinations ofremedies,thecostof whichwasregardedasexcessive.Noonehasbeenentirelyfreefromblame,least ofallthepoliticianswhoencouragedthewholepopulationoftheUnitedKingdominthebelieftheycouldtakewhatthey wantedoutof thechemist'sshopwithouthavingtopayforit.Butwithout thepharmaceuticalindustrymodernmedicinewould bepowerlesstodogoodwiththedrugsmodernscienceprovidesforit, drugs discoveredoftenenoughin thelaboratories ofthe industryitself.Informationaboutthesedrugsreaches thepractisingdoctorinanumberofways,andelsewherein thisissue Dr.AudreyBakerdescribestheresultsof herinquiryinto thevaluesetbydoctorsontheinformationgiven bypharmaceuticalhousesthroughthepost,bymedicalrepresentatives,andinthe advertisementcolumnsof medicaljournals.Some90%readtheadvertisementsfordrugsinmedicaljournals-64%oftenoralways,and26%seldom. That80%preferredtogettheirinformationondrugsbydiscussionwithfirms'representativessuggeststhattheindustryas awholemightlookmorecriticallyatthetypeofcopytheiragentssendtothemedicalpress.What is ofspecialinteresttousisDr.Baker's conclu-sionthatthere is"aBritishMedicalJournalreadershipofbetween 80%and90%," throughoutGreatBritain,arecord faroutstrippingthatof allother medicalperiodicals.Thisis gratifyingtousand,we mayassume,tothegrowingnumberoffirmsawareofthevalueofadvertisingtheirwarestotheB.M.J.'sreaders.NOBELPRIZEFORCAMBRIDGEBIOCHEMISTTheawardof theNobelPrizeforChemistrytoDr. F.Sanger,F.R.S.,isinrecognitionofhisoutstandingworkinanalysingthestructureofthe insulinmolecule.Thework tookabouttenyearstocompleteandwascarriedoutwithhiscolleaguesintheBiochemistryDepartmentatCambridge University during1945-55.Nowaged40,Dr.SangerwaselectedaFellowof theRoyalSocietyfouryearsago.Atthetimethisworkwascompletedtheinsulinmoleculewasthelargest proteinmoleculetohavehad itschemicalstructureelucidated.Thisgreatachievementwasanessentialpreliminarytoanychemi-calsynthesisofinsulinaswellasofanalogueswhichmaybe easiertoadministerinclinicalpractice.WerecordwithregretthedeathonOctober 24ofSirJohnMegaw, formerly professoroftropicalmedi-cineattheCalcuttaSchoolofTropicalMedicine andDirector-GeneraloftheIndianMedicalService fromADVERTISINGDRUGS"Youcancountthenumberofuseful drugsonthefingersofyourtwohands"onewell-knownphysicianusedtosaytohisstudentslittlemorethan thirtyyearsago.Sincethentherehasbeenarevolution in thedrugtreatmentof disease.Therevolutionisstillon.Thebrillianceofthebacteriologist, chemist, and pharmaco-1930-33. 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