27 Maart 1954 S.A. TYDSKRIF VIR GENEESKUNDE 279
Doctors must, no doubt, have some favourite prescriptions, their Steinach held that vasoligation causes atrophy of spermatogenetic
belief in which may be of importance. This inexpensive book shows cells and consequent hypertrophy of the interstitial tissue. This
which prescriptions are still favoured in some of the qigger hospitals belief is erroneous. The seminiferous tubules do not degenerate
overseas, but more interesting and important is the discussion on after vasoligation, nor do Leydig cells hypertrophy. Some prostatec-
treatment which constitutes the main part of the book. tomised patients are stated to b::come rejuvenated if the vas is
N.S. interrupted simultaneously. One may submit, however, that
'reactivation' is attributable to removal of renal and cardiac
THE QUEST FOR YOUTH embarrassment and diminution of nycturia. Secondary infection
The Quest for YOllth. By George Ryley Scott, F.Ph.S., F.Z.S., excluded, non-vasectomised patients improve equally weil.
ER.A.I. (Pp. 157. 10s. 6d.). London: Torchstream Books, The bibliography contains hardly any reference to works written
1953. after 1941. Many beliefs held till then have been demolished since.
Contents: Section I. The Art of Living. 1. Senility and Its Causation. 2. The
Endocrine Glands and Their Functions. 3. The Work oflhe Testicles and Ovaries.
4. Antidotes to Senility. Section ll. The Preservation of Vitality During the Eli.MENTARY PATHOLOGICAL HlSTOL06Y
R~productive Years. 5. Impotence in Man: Its Various Forms and Their Causes.
6. Frigidity and Sexual Anaesthesia in Woman. 7. Sterility in Man and Woman. Elementary Pathological Histology. By W. G. Barnard, ER.C.P.
8. The Effects of Food on Sexual Power. Section Ill. The War on Senility.
9. Operative Reactivation: Testicular and Ovarian Transplantation. 10. Operative Third Edition. (Pp. 77 + x, with 185 figures, including ~ in
Reactivation: Vasoligature. 11. The New Science of Organotherapy. 12. Criti6 colour on 55 plates. 17s.6d.). London: H. K. 'Lewis & Co.,
cism~ of Operative Reactivation and Organotherapy. Section I V. Present
and Future Trends in the Science of Rejuloenation. 13. The Psychological Factor in
the Treatment of Impotence and in Reactivation. 14. Summary. Bibliography.
Index. Contents: J. Inflammation. 2. Wounds and Granulation Tests. 3. Pericarditis.
(pleurisy and Peritonitis). 4. Abscesses. 5. Bronchitis and Broncbo-Pneumonia_
The author maintains that 'the secret of virile old age is the cultiva- 6. Actinomycosis. 7. Appendicitis. 8. Diphtheria. 9. Lobar Pneumonia.
.10. Typhoid. It. The Specific Granulomata. 12. Tuberculosis. 13. Syphilis.
tion of an absorbing interest in life and living, the retention of 14. Acute Rheumatism. IS. Hodgkin's Disease. 16. Fibrosis. 17. Regeneration.
ambition, the fixing of a goal at which to aim', but neither he nor 18. Atrophy, Hypenrophy, Hyperplasia, Metaplasia. 19. Necrosis. 20. Infarcts.
anybody ebe can be certain as to which of the two (interest etc., and 21. Degeneration. 22. Amyloid. 23. Chronic Venous Congestion of liver.
24. Cell Proliferation. 25. Tumours. 26. Benign Connective Tissue Tumours.
virile old age) is cause and which is effect. Does senescent 27. Sarcomata. 28. Angeiomata. 29. Papillomata. 30. Adenomata. 31. Carcino-
Churchill's effectiveness result from his interest in life or from his mata. 32. Metastases. Index.
endowment with more durable vigour than the average person?
The book includes instructive information and is well written This book covers the first half of the medical student's course in,
and thought-provoking; it makes easy and absorbing reading. pathological histology, that related to so-called general pathology.
There are, however, certain demerits, which nevertheless do not This restricted field is adequately covered by the illustrations,
detract from the excellence of the book as a whole. mainly photomicrographs in black and white, technically of a high.
The potentialities of the gonads and of sublimation of the sex- standard and well selected and reproduced. With very few excep-
urge are overestimated-a trend usual amongst sexologists. The tions they are clear and instructive.
persistent enthusiasm for the Steinach and Vornoff operations, The text, however, falls short of this standard. It is to:> brief t(}
which after years of benevolent toleration have failed to deliver the give the author much scope, and the inevitable compression has
goods or substantiate their claims as useful therapeutic measures, resulted in a featureless summary, too elementary to.be of mucn
are not justified by clinical and other observations. value to the medical student.
DOMlClUARY TREATMENT OF PULMONARY TUBERCULOSIS numbers but, finding their health improving and seeing themselve
putting on weight, they are willing to stay in hospital as they never
To the Editor: I have read with great interest your Editorial on were before.
The Decline in Tuberculosis and also the report by Dr. E. D. . The crying need of the Native people in the Reserves is for moreo
Cooper. medical officer of health of Cape Town, on The Domiciliary accommodation in hospitals; and I would respectfully suggest
Treatment of Pulmonary Tuberculosis as a Public Service, both of that this can be most economically supplied by and in Mission
which appeared in the Journal of 6 March. hospitals. Domiciliary treatment, unfortunately just does not
Although it is perfectly plain that the reference in Dr. Cooper's apply in areas such as this.
report is to the treatment of pulmonary tuberculosis .in Urban R. L. Paterson
communities, I have. good reason to believe that even in certain Medical Superintendent
official Public Health quarters the idea is rather vaguely held that The. essie Knight Hospital
domiciliary treatment \vith modern drugs might also help to mlve Sulenkama
the problem of pulmonary tuberculosis in the African people in Qumbu, C.P.
the Native Reserves. 12 March 1954
As one who has had 27 years of experience working in the heart
of the Transkei-the largest 'ative Reserve in the Union-I would KWASHIORKOR
like to state very clearly and emphatically that domiciliary treat-
ment could not possibly be applied to Native sufferers from To the Editor, Dr. M. Gelfand 1 has just described in your columns:
tuberculosis living in a Reserve such as this; where the people do (6 March 1954) an additional case of kwashiorkor in a breast-fed
not live even in villages but in widely scattered individual kraals, infant. . This is not remarkable since the syndrome is well known
which would make it impossible to give even the bi-weekly injections to occur in breast-fed infants. In a monograph by Brock and
of streptomycin and the essential supervision by doctors or health Autret 2 the syndrome is described as occurring 'in the late breast-
visitors. which are pre-requiSites for the success of any such domi- feeding, weaning, and post-weaning ages'. Dr. Gelfand goes on,
ciliary treatment. however, to draw some inferences which are likely to confuse the
In our own hospital we have approximately 130 beds and nearly issue. He says, 'It is my belief, however, that the exact cause of
half of these are now taken up all the time by suflerers from kwashiorkor has not been satisfactorily established'. .
pulmonary tuberculosis. With this statement everybody working in this difficult field will
This is a recent development, for in the years prior to the intro- agree. He goes on, however, to say, 'Although most authorities.
duction of modern therapy the Native people, with their inherent accept a protein lack as its cause there are in my opinion at least
lack of resistance, finding themselves dying in any case-whether two other factors which still deserve consideration, viz. a deficiency
tbey were in hospital or not-preferred, quite naturally, to die at in the vitamins of the B group.or interference with their absorption
home. But for the last 3 years the situation has entirely altered; and utilization by the toxins of maize and .other cereals consumed
and now not only are they seeking admission t~ hQspita1 in great\:r by the African'. This statement i.rrIplies that belief in the importance
280 S.A. MEDICAL JOURNAL 27 March 1954
of protein lack is incompatible with belief in the role of deficiency syndrome had not been established. It is now generally accepted
of B-vitamins in the aetiology of the syndrome. The term 'protein that the reddish-brown dyspigmentation of the hair can occur in
malnutrition' is preferable to the term 'protein lack' used by deficiency-states to which the name kwashiorkor cannot be
Dr. Gelfand. legitimately applied and also that it is not a prerequisite for the
The Joint FAO/WHO Expert Committee on Nutrition at its diagnosis of kwashiorkor.
Third Session in 'ovember 1952 3 recorded its opinion that 'protein Whatever Dr. Gelfand may think about the importance of
malnutrition' was the essential cause of kwashiorkor. To quote vitamins of the B-group and about the toxins of maize and other
directly, the Committee stated: 'This term cannot at present be cereals needs to be fitted into the observed fact that the syndrome
defined within narrow limits. It is used here to indicate in general is easily curable by dried skimmed-milk. A large volume of careful
a state of ill-health occurring where diets are habitually poor in work is in progress at present in many parts of the world in an
protein, while they are more nearly adequate in calories. Clinically, attempt to define whether the curative factor contained in dried
protein malnutrition is most easily recognized when there is a skimmed-milk is simply protein, one or more amino-acids, or a
relatively high intake of calories from starchy foods together with vitamin known or unknown. Until this difficult question has been
an insufficient intake of protein. The concept includes the effects solved it is reasonable from the educative and administrative point
of deficiency in the quantity of protein consumed, of imbalance of of view to attribute kwashiorkor to 'protein malnutrition' as
amino-acids, and deficiency of factors, such as vitamin B.12, defined above. Such a use leaves wide open the scientific problem
commonly found in foods in association with animal protein and of 'whether kwashiorkor is due to protein deficiency or to a lack
concerned with protein metabolism'. of vitamins or to both'. The fact that some children develop
kwashiorkor while still suckling at the breast does not constitute
To quote again from Autret and Brock 4 : 'Each protein food is evidence one way or the other.
different in its amino-acid composition and is also the vehicle for J. F. Brock
other nutrients in varying combinations, the deficiency of which Department of Medicine
might, apart from amino-acids, play a part in the production of University of Cape Town
different features (both fundamental and accessory) seen in this 11 March 1954
syndrome'. From these quotations it will be seen that when the
term 'protein malnutrition' is correctly used it does not imply that REFERENCES
deficiency in the vitamins of the B group may not play a part in
the production of the syndrome. In pellagra it is now well establish- I. M. Gelfand (1954): S. Afr. Med. J., 28, 185
ed that deficiency of niacin is aetiological not in an absolute sense 2. Brock, J. F. and Autret, M. (1952): Kwashiorkor ill A/riCil.
but relative to its ratio in the diet to other nutrients, especially the WHO Monograph Series No. 8 and Bull. WHO,S, I.
amino-acid tryptophane. 3. Joint FAO/WHO Expert Committee on Nutrition. 1953.
The description given by Dr. Gelfand of his case would appear to Report on Third Session (1953): Wld. Hlth. Org. Techn. Rep.
justify the use of the term kwashiorkor. His patient's illness started Ser. 72.
at the age of 14 months while he was still at the breast but having 4. Autret, M. and Brock, J. F. (1954): Letter to Lancet submitted.
supplements of 'maizena' porridge, sadza, meat and vegetables. The 5. Commission for Technical Co-operation in Africa. Second
quality of the maternal milk: is reported but nothing is said about utrition Conf.erence, Gambia, 'ovember 1952. 1954 Report
the quantity which the child derived from the breast nor about the in Preparation_
quantity of meat fed to the child. It is notorious that in African
MATERNITY FLYING SQUAD
mothers the quantity of milk secreted by the breast in the second
year of lactation is often inadequate for the needs of a normally- To the Editor: I wonder how many medical practitioners in Cape
growing child past the age of I year. It is now realized that since Town and the Peninsula know that we have a very efficient 'Flying
the protein-content of human milk is considerably lower than that Squad' now functioning from the Peninsula Maternity Hospital.
of cow's milk it follows that when older children at the breast It is a unit for which Professor James Louw had worked hard for
receive starchy supplements the protein-calorie ratio of their most of the years that I have found myself working in Cape Town.
total diet tends to become very low. I would contend, therefore, I saw it do magnificent work within the last fortnight. The squad
that the conditions under which Bongo developed kwashiorkor came to the rescue in a case of very severe post-partum haemorrhage
are just those conditions in which he might be expected to be at the Magdalene Huis, Claremont. Two pints of blood were
suffering from protein malnutrition. administered before the case was reasonably fit to be moved.
What is more difficult to explain than the case recorded by I feel this excellent service has long been overdue in Cape Town
Dr. Gelfand is the occurrence of a syndrome closely resembling and now that we have it practitioners should be aware of its
kwashiorkor in children during the age-period 6.9 months while existence. I foresee the saving of many a mother's life in future.
they are still feeding fully at the breast. This occurs frequently in Too many women have in the past been moved to hospital in a
the Gambia and has been carefully studied by B. S. Platt. The state of exsanguination and shock. from which nothing could save
cases were referred to in the monograph by Brock and Autret 2. them.
The same type of case was carefully studied by the' Gambia D. P. de Villiers, M.B., F.R.C.S.(Ed.)
Conference in 1952 5 and there was difference of opinion as to Room 803
whether these cases should or should not be included under the Groote Kerk Buildings
term kwashiorkor. Although they had the reddish-brown dyspig- Adderley Street
mentation of the hair which is so common a feature of kwashiorkor Cape Town
the existence of other features regarded as characteristic of the 16 March 1954
ABSTRACIS : UIITREKSELS
Gianascol (1953): The Use ofProcaine Amide Hydrochloride in the The patient w:as then given 500 mg. of procaine amide hydro-
Treatment of a Penicillin Reaction, West Va. Med. J., 49, 98-99. chloride oraUy. Within 15 minutes there was a decrease in swelling
A coloured male, aged 20, with gonorrhea, was given an injection and in painful limitation of joint motion, and the patient reported
of 600,000 units of procaine penicillin oil with aluminum he felt markedly improved. He was able to leave the clinic unaided
monosterate, though he had previously been found allergic to although he had been able to come in only with the physica I support
penicillin. The intention was to control any symptoms of allergy of two friends, his joint symptoms having prevented normal
with pyribenzamine tablets but neither this nor benadryl proved walking.
effective in alleviating the complaint of swollen and painful joints, ~he patient was placed on procaine amide hydrocWoride 250 mg.
generalized urticaria, and pruritus which foUowed adminis.tration 4 tImes a day (orally) and when he returned to the clinic as directed
of the peniciJIjn. The 2antihistaminics were discontinued when it two days later he appeared asymptomatic, felt well, and seemed
was observed that the signs and symptoms, resembling serum quite normal on physical examination. When the drug was dis-
sickness, were progressing in spite of their use.
continued the patient continued asymptomatic.