- Email: [email protected]
COLOUR TRANSPARENCIES FOR FIRST-AID TEACHING
1332 tion. After 35 days he remains very well and has shown no signs of transplant rejection. Drainage of the thoracic-duct lymph from the patient over a 4-day period resulted in the loss of about 6-1010
lymphocytes, or twenty times the total circulating number, These losses, however, did not seem to reduce the number of the circulating lymphocytes in the blood-an observation we have made in several other patients with thoracicduct drainage. The drainage of lymphocytes from the thoracic duct may perhaps have played a role in the smooth course of this transplantation. Serafimerlasarettet, Karolinska Institutet, Medical School, Stockholm, Sweden.
CURT FRANKSSON.
TREATMENT OF PARATYPHOID CARRIER
aged 74, was admitted to the North Wales Hospital, Denbigh, in July, 1924. In 1935 she was diagnosed as a carrier of Salmonella paratyphi B. SIR,-A
woman,
now
Since then repeated examinations of fasces have been positive. For the past 28 years she has remained in permanent isolation in a side-room. She has been treated unsuccessfully with chloramphenicol, tetracycline, erythromycin, and oral ampicillin. In February, 1963, it was decided to treat her with ’B.R.L. 1060’ (Beecham Research Laboratories Ltd.), a broad-spectrum antibiotic similar in some respects to ampicillin, but more soluble, and, therefore, suitable for injection. B.R.L. 1060 was given by deep intramuscular injection 500 mg. 6-hourly for 14 days. Immediately before treatment was begun, six specimens of faeces on consecutive days were positive for S. paratyphi B. Since the completion of the course 14 months ago, repeated cultures of fxces have yielded no S. paratyphi B. The bacteriological investigation was performed by Dr. W. C. Harris, late of the Royal Alexandra Hospital, Rhyl. Our thanks are due also to Dr. J. H. 0. Roberts, late medical superintendent, Dr. T. Gwynne Williams, physician-superintendent, and Dr. D. N. Parfitt, consultant psychiatrist, for their help and encouragement; and to Mr. T. Lloyd Jones, pharmacist at this hospital. C. PAUL O’TOOLE North Wales Hospital, DAVID E. JONES. Denbigh.
DIHYDROTACHYSTEROL Dr. L. GOLDMAN, medical director of the
Bayer Products Company (Surbiton-upon-Thames, Surrey), writes: " Two recent modifications of ’A. T .10’ (dihydrotachysterol) may have led to some confusion in the minds of practitioners and patients : the preparation is now produced from pure crystalline dihydrotachysterol (U.S. Pharmacopeia, 1960) instead of by hydrogenation of irradiated ergosterol; and the reference standard against which each batch is assayed has been changed from our house standard to that of the U.S. Pharmacopeia. The product is now stated to contain the equivalent of 0’25 mg. dihydrotachysterol per ml. and not, as formerly, 1-25 mg. per ml. This change is, however, apparent and not real, since it is the standard for assay that has been changed and not the actual potency of the drug per unit of volume. The volume of the dose of the new A.T.10 preparation should remain unchanged from that of the old preparation unless the condition of the patient warrants a change. Doctors are therefore advised to ignore dosage recommendations for A.T.10 from old literature and textbooks based on weight and to rely upon volume of dose, which should be the same as that previously used. We are taking steps to withdraw all old batches and to replace them by the new formula."
COLOUR TRANSPARENCIES FOR FIRST-AID TEACHING Dr. A. WARD GARDNER (Applecross, Fawley, Hampshire) writes: " In the belief that one picture is worth many words, I have been using pictures for teaching first-aiders. I should like to request the loan of suitable transparencies, showing any new injury, and help in taking such pictures which could be given by those whose work brings them in contact with injuries. Such colour transparencies would be carefully handled and returned as soon as possible, after duplication. Any assistance in forming the nucleus of a collection for general use would be much
appreciated."
Medicine and the Law
Hysterical Condition Not Caused by Accident A WORKMAN was injured at his employers’ factory when SIR,-I enjoyed reading Dr. Riley’s article,! but a sheet of steel, which he was taking from a stack, fell and would like to correct the view expressed about the cut his wrist. When the workman received treatment for involvement of tissue mast-cells in anaphylactic pheno- his wrist, he was given penicillin and antitetanus injections. mena in all mammalian species. He had a serum reaction to the antitetanus injection, and It is entirely wrong to assume that, because tissue masthe was warned by a doctor against having such injections. cells in guineapigs disrupt during anaphylaxis and so release in the future. As a result of the warning, the workman their contents which then produce bronchoconstriction and developed a post-traumatic hysterical condition which death, tissue mast-cells always play a role in this shocked took the form of aches and pains. He sued his employers state. Riley quite rightly cites the findings that these cells for damages for negligence and breach of statutory duty. in dog liver break up when the antigen-antibody reaction The employers denied liability and, on the question of occurs in the live animal, but tissue mast-cells in other locadamages, contended, inter alia, that the workman’s tions in the dog (e.g., skin, where there are many) show only minor changes in anaphylaxis.2 Furthermore, reported hysterical condition had not been caused by the accident. evidence shows that rat mast-cells in all the locations studied Mr. JUSTICE MEGAW said that the employers were in do not fully participate in anaphylaxis in vivo, though they breach of their duty to the workman. Regarding the may do so in in-vitro tests.3 A similar story applies to mice. question of damages, the workman’s hysterical condition More recently, we have shown that tissue mast-cells in the could not be said to have been caused by the accident. If skin of cats undergoing anaphylactic shock also do not he had been given an antitetanus injection in any other degranulate or disrupt.55 circumstances and had received a warning by a doctor These observations may be directly relevant to anaafter a reaction, he might have been subject to a hysterical phylaxis in man and illustrate that histamine is not condition. The employers’ breach of duty was the always the released agent which causes the damage. occasion when the workman’s idiosyncrasy was discovered. Other substances, such as bradykinin or slow-reacting Accordingly, there would be judgment for the workman substance, may be much more important. for a small sum, E40, for the pain and suffering attributDepartment of Pharmacology, School of Pharmacy, able to the cut wrist and the reaction to the injection. G. B. WEST. University of London. MAST-CELLS AND ANAPHYLAXIS
1. 2. 3. 4. 5.
Riley, J. F. Lancet, 1964, i, 1155. Akcasu, A., West, G. B. Int. Arch. Allergy, 1960, 16, 326. Sanyal, R. K., West, G. B. J. Physiol. Lond. 1958, 142, 571. Gelfand, M., West, G. B. Int. Arch. Allergy, 1961, 18, 286. Akcasu, A., West, G. B. ibid (in the press).
Hilton v. Lancashire Dynamo Nevelin Ltd.-Queen’s Bench Dimsion: Megaw.7. June 3, 1964. Counsel and solicitors: G. N. Parry (Montagu’s & Cox & Cardale for D. Forsyth, Oxted, Surrey); C. Dehn (Hextall, Erskme &
Co.).
H. STEINBERG Barrister-at-Law.
lymphocytes, or twenty times the total circulating number, These losses, however, did not seem to reduce the number of the circulating lymphocytes in the blood-an observation we have made in several other patients with thoracicduct drainage. The drainage of lymphocytes from the thoracic duct may perhaps have played a role in the smooth course of this transplantation. Serafimerlasarettet, Karolinska Institutet, Medical School, Stockholm, Sweden.
CURT FRANKSSON.
TREATMENT OF PARATYPHOID CARRIER
aged 74, was admitted to the North Wales Hospital, Denbigh, in July, 1924. In 1935 she was diagnosed as a carrier of Salmonella paratyphi B. SIR,-A
woman,
now
Since then repeated examinations of fasces have been positive. For the past 28 years she has remained in permanent isolation in a side-room. She has been treated unsuccessfully with chloramphenicol, tetracycline, erythromycin, and oral ampicillin. In February, 1963, it was decided to treat her with ’B.R.L. 1060’ (Beecham Research Laboratories Ltd.), a broad-spectrum antibiotic similar in some respects to ampicillin, but more soluble, and, therefore, suitable for injection. B.R.L. 1060 was given by deep intramuscular injection 500 mg. 6-hourly for 14 days. Immediately before treatment was begun, six specimens of faeces on consecutive days were positive for S. paratyphi B. Since the completion of the course 14 months ago, repeated cultures of fxces have yielded no S. paratyphi B. The bacteriological investigation was performed by Dr. W. C. Harris, late of the Royal Alexandra Hospital, Rhyl. Our thanks are due also to Dr. J. H. 0. Roberts, late medical superintendent, Dr. T. Gwynne Williams, physician-superintendent, and Dr. D. N. Parfitt, consultant psychiatrist, for their help and encouragement; and to Mr. T. Lloyd Jones, pharmacist at this hospital. C. PAUL O’TOOLE North Wales Hospital, DAVID E. JONES. Denbigh.
DIHYDROTACHYSTEROL Dr. L. GOLDMAN, medical director of the
Bayer Products Company (Surbiton-upon-Thames, Surrey), writes: " Two recent modifications of ’A. T .10’ (dihydrotachysterol) may have led to some confusion in the minds of practitioners and patients : the preparation is now produced from pure crystalline dihydrotachysterol (U.S. Pharmacopeia, 1960) instead of by hydrogenation of irradiated ergosterol; and the reference standard against which each batch is assayed has been changed from our house standard to that of the U.S. Pharmacopeia. The product is now stated to contain the equivalent of 0’25 mg. dihydrotachysterol per ml. and not, as formerly, 1-25 mg. per ml. This change is, however, apparent and not real, since it is the standard for assay that has been changed and not the actual potency of the drug per unit of volume. The volume of the dose of the new A.T.10 preparation should remain unchanged from that of the old preparation unless the condition of the patient warrants a change. Doctors are therefore advised to ignore dosage recommendations for A.T.10 from old literature and textbooks based on weight and to rely upon volume of dose, which should be the same as that previously used. We are taking steps to withdraw all old batches and to replace them by the new formula."
COLOUR TRANSPARENCIES FOR FIRST-AID TEACHING Dr. A. WARD GARDNER (Applecross, Fawley, Hampshire) writes: " In the belief that one picture is worth many words, I have been using pictures for teaching first-aiders. I should like to request the loan of suitable transparencies, showing any new injury, and help in taking such pictures which could be given by those whose work brings them in contact with injuries. Such colour transparencies would be carefully handled and returned as soon as possible, after duplication. Any assistance in forming the nucleus of a collection for general use would be much
appreciated."
Medicine and the Law
Hysterical Condition Not Caused by Accident A WORKMAN was injured at his employers’ factory when SIR,-I enjoyed reading Dr. Riley’s article,! but a sheet of steel, which he was taking from a stack, fell and would like to correct the view expressed about the cut his wrist. When the workman received treatment for involvement of tissue mast-cells in anaphylactic pheno- his wrist, he was given penicillin and antitetanus injections. mena in all mammalian species. He had a serum reaction to the antitetanus injection, and It is entirely wrong to assume that, because tissue masthe was warned by a doctor against having such injections. cells in guineapigs disrupt during anaphylaxis and so release in the future. As a result of the warning, the workman their contents which then produce bronchoconstriction and developed a post-traumatic hysterical condition which death, tissue mast-cells always play a role in this shocked took the form of aches and pains. He sued his employers state. Riley quite rightly cites the findings that these cells for damages for negligence and breach of statutory duty. in dog liver break up when the antigen-antibody reaction The employers denied liability and, on the question of occurs in the live animal, but tissue mast-cells in other locadamages, contended, inter alia, that the workman’s tions in the dog (e.g., skin, where there are many) show only minor changes in anaphylaxis.2 Furthermore, reported hysterical condition had not been caused by the accident. evidence shows that rat mast-cells in all the locations studied Mr. JUSTICE MEGAW said that the employers were in do not fully participate in anaphylaxis in vivo, though they breach of their duty to the workman. Regarding the may do so in in-vitro tests.3 A similar story applies to mice. question of damages, the workman’s hysterical condition More recently, we have shown that tissue mast-cells in the could not be said to have been caused by the accident. If skin of cats undergoing anaphylactic shock also do not he had been given an antitetanus injection in any other degranulate or disrupt.55 circumstances and had received a warning by a doctor These observations may be directly relevant to anaafter a reaction, he might have been subject to a hysterical phylaxis in man and illustrate that histamine is not condition. The employers’ breach of duty was the always the released agent which causes the damage. occasion when the workman’s idiosyncrasy was discovered. Other substances, such as bradykinin or slow-reacting Accordingly, there would be judgment for the workman substance, may be much more important. for a small sum, E40, for the pain and suffering attributDepartment of Pharmacology, School of Pharmacy, able to the cut wrist and the reaction to the injection. G. B. WEST. University of London. MAST-CELLS AND ANAPHYLAXIS
1. 2. 3. 4. 5.
Riley, J. F. Lancet, 1964, i, 1155. Akcasu, A., West, G. B. Int. Arch. Allergy, 1960, 16, 326. Sanyal, R. K., West, G. B. J. Physiol. Lond. 1958, 142, 571. Gelfand, M., West, G. B. Int. Arch. Allergy, 1961, 18, 286. Akcasu, A., West, G. B. ibid (in the press).
Hilton v. Lancashire Dynamo Nevelin Ltd.-Queen’s Bench Dimsion: Megaw.7. June 3, 1964. Counsel and solicitors: G. N. Parry (Montagu’s & Cox & Cardale for D. Forsyth, Oxted, Surrey); C. Dehn (Hextall, Erskme &
Co.).
H. STEINBERG Barrister-at-Law.