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PAROMOMYCIN IN SHIGELLA AND SALMONELLA INFECTIONS
1073
patients requiring a femoropopliteal arterial grafting procedure and the results have been observed for up to six months. This limited experience has shown that the terylene grafts possess all the excellent qualities of the American counterpart and should be capable of yielding long-term results equal to those reported
Julian.
It is the purpose of this communication to draw the availability of the British product, but it is attention our belief that the proper assessment of the procedures for which it is likely to be used will require some years. Bifurcated abdominal grafts of similar material will be
by
to
available shortly. British-made terylene arterial prostheses may be obtained from Messrs. John Bell & Croyden, who also supply the imported American dacron arterial prostheses. Royal Victoria Infirmary, Newcastle upon Tyne. Hammersmith Hospital, London, W.12.
D. J. TIBBS. PETER MARTIN.
MONDAY-TO-FRIDAY WARDS SIR,-In your issue of April 30, Miss. Simpson suggests the possibility of Monday-to-Friday wards as a feature of hospital planning of the future. In the geriatric unit in this hospital, we have over the past few months been experimenting along these lines with certain of the longer-stay rehabilitation patients, as a logical extension of the principle of intermittent hospital care, of which the " six weeks in, six weeks out " scheme pioneered by Dr. John De Largy at Langthorne Hospital, E.11, is, a well-known example. We hope to report our experiences shortly, but in addition to easing the nursing load we feel it to be of value to this group of patients in particular, because it maintains their links with their homes and encourages the relatives to consider themselves part of a team responsible for the planning of long-term care of patients who might otherwise become depressing problems to themselves and their families, and indeed to the hospital staff who will ultimately have to care for them. Ystrad Mynach Hospital,
Hengoed, Glamorgan.
MORAG L. INSLEY.
PAROMOMYCIN IN SHIGELLA AND SALMONELLA INFECTIONS Sirfound the article of April 30 by Dr. Coles and his colleagues extremely interesting. I feel that if they had included more cases in which a chronic carrier state
developed, refractory to other forms of treatment, due to salmonella infection, then the evaluation of paromomycin activity would have been easier. As we all know, this type of case is the one which is most likely to block valuable hospital cots and beds. My experience in Fazakerley Hospital, Liverpool, using a different form of therapy, may be of interest. Under the guidance of Dr. A. B. Christie, I treated 10 children, between the ages of 18 months and 5 years, in whom the chronic carrier state due to Salmonella typhimurium, refractory to other forms of treatment, was well established with a combination of oral oxytetracycline (terramycin) (15 mg per lb. body-weight daily) and ’Enpac ’ (3-4 g. daily) for five days. 9 of these patients were cured (three negative consecutive rectal swabs). In the 10th case two negative swabs were obtained and then the organism returned. These patients had all been previously treated with oral oxytetracycline and most had also received a course of oral streptomycin and sulphaguanidine. A patient of 70 infected with S. newport was in hospital for nine months because of his chronic carrier state and the fact that he owned, worked in, and lived over a cafe. He was treated with a similar regime; and " cure " was obtained on two occasions using a criteria of six consecutive negative rectal swabs, but the organism always recurred on further testing. He finally sold his business and was then discharged from
hospital.
I consider that this
treatment
supplies resistant lactobaccilli disrupted by oxytetracycline. St. Vincent’s Hospital, Dublin.
is rational because the enpac replace the bowel flora
to
J. S. DOYLE.
FLUORIDATION SiR,—The replies of the medical officers of health to Dr. Dobbs seem to show that we have to fight not only for pure water but for common sense in public-health affairs. Can all our public-health experts approve of a general, indiscriminate, permanent increase in the intake of a well-known poison, and believe that the infliction of worry, indignation, and stress upon innumerable middle-aged people and invalids is the duty of the medical profession ? This insistence on coercion, and on a method which involves arousing the maximum possible public hostility, cannot arise from a sincere concern for the children’s teeth; it is clear that the fluoridation campaign is being used, by those few who really know what they are doing, to break down the principles of consent and of individual care and treatment, which are absolutely fundamental to medicine and to public confidence in the medical
imposing
profession. WINIFRED M. SYKES Secretary, Huddersfield.
National Pure Water Association.
HEMORRHOIDS SIR,-Your leading article of Feb. 20 on the treatment of hxmorrhoids and the correspondence which followed prompt us to record the results we have been obtaining with a comparatively new product. Although you recommend only injection or surgical removal, many milder cases do not warrant or the patient does not accept such treatment. Even in severe cases where hxmorrhoidectomy is contemplated, the patient’s suffering must still be relieved during the waiting period. Patients with hemorrhoids of varying severity were given a of ’Proctosedyl ’ (Roussel) suppositories and/or ointment (each suppository and each gramme of ointment contains 5 mg. hydrocortisone, 10 mg. framycetin sulphate, and 5 mg. cinchocaine). They were instructed to apply the ointment and insert a suppository morning and evening. The results in 35 cases are summarised as follows: lst degree haemorrhoids: complete relief 14, helped 2, failed 1 (17)
supply
2nd degree haemorrhoids: 3rd degree haemorrhoids:
Only
complete relief 10, helped 1, failed 1 (12) complete relief 4, helped 1, failed 1 (6) 3 out of 35 patients received no benefit at all, but 32
received benefit of varying degrees, and 80 % obtained complete relief. Protoscopy was carried out at the first and subsequent visits to determine progress. All possible serious underlying diseases were also carefully excluded.. The patients were followed for periods of several months and those who did not return for final assessment were excluded. In fissure-in-ano results were also excellent, 4 out of 5 patients obtaining complete relief; but in the symptomatic treatment of pruritus ani, pruritus vulvx, and vulvitis results were
disappointing.
Bitterne, Southampton.
W. L. KERR T. E. S. STOWELL T. WADE WEST J. F. MULLAN.
SiR,—Ihave now treated approximately 50 patients with the preparationAlcos-Anal’, mentioned by Dr. Mustard (April 9), reserving it mainly for pregnant women with symptoms of haemorrhoids, including slight bleeding.
patients requiring a femoropopliteal arterial grafting procedure and the results have been observed for up to six months. This limited experience has shown that the terylene grafts possess all the excellent qualities of the American counterpart and should be capable of yielding long-term results equal to those reported
Julian.
It is the purpose of this communication to draw the availability of the British product, but it is attention our belief that the proper assessment of the procedures for which it is likely to be used will require some years. Bifurcated abdominal grafts of similar material will be
by
to
available shortly. British-made terylene arterial prostheses may be obtained from Messrs. John Bell & Croyden, who also supply the imported American dacron arterial prostheses. Royal Victoria Infirmary, Newcastle upon Tyne. Hammersmith Hospital, London, W.12.
D. J. TIBBS. PETER MARTIN.
MONDAY-TO-FRIDAY WARDS SIR,-In your issue of April 30, Miss. Simpson suggests the possibility of Monday-to-Friday wards as a feature of hospital planning of the future. In the geriatric unit in this hospital, we have over the past few months been experimenting along these lines with certain of the longer-stay rehabilitation patients, as a logical extension of the principle of intermittent hospital care, of which the " six weeks in, six weeks out " scheme pioneered by Dr. John De Largy at Langthorne Hospital, E.11, is, a well-known example. We hope to report our experiences shortly, but in addition to easing the nursing load we feel it to be of value to this group of patients in particular, because it maintains their links with their homes and encourages the relatives to consider themselves part of a team responsible for the planning of long-term care of patients who might otherwise become depressing problems to themselves and their families, and indeed to the hospital staff who will ultimately have to care for them. Ystrad Mynach Hospital,
Hengoed, Glamorgan.
MORAG L. INSLEY.
PAROMOMYCIN IN SHIGELLA AND SALMONELLA INFECTIONS Sirfound the article of April 30 by Dr. Coles and his colleagues extremely interesting. I feel that if they had included more cases in which a chronic carrier state
developed, refractory to other forms of treatment, due to salmonella infection, then the evaluation of paromomycin activity would have been easier. As we all know, this type of case is the one which is most likely to block valuable hospital cots and beds. My experience in Fazakerley Hospital, Liverpool, using a different form of therapy, may be of interest. Under the guidance of Dr. A. B. Christie, I treated 10 children, between the ages of 18 months and 5 years, in whom the chronic carrier state due to Salmonella typhimurium, refractory to other forms of treatment, was well established with a combination of oral oxytetracycline (terramycin) (15 mg per lb. body-weight daily) and ’Enpac ’ (3-4 g. daily) for five days. 9 of these patients were cured (three negative consecutive rectal swabs). In the 10th case two negative swabs were obtained and then the organism returned. These patients had all been previously treated with oral oxytetracycline and most had also received a course of oral streptomycin and sulphaguanidine. A patient of 70 infected with S. newport was in hospital for nine months because of his chronic carrier state and the fact that he owned, worked in, and lived over a cafe. He was treated with a similar regime; and " cure " was obtained on two occasions using a criteria of six consecutive negative rectal swabs, but the organism always recurred on further testing. He finally sold his business and was then discharged from
hospital.
I consider that this
treatment
supplies resistant lactobaccilli disrupted by oxytetracycline. St. Vincent’s Hospital, Dublin.
is rational because the enpac replace the bowel flora
to
J. S. DOYLE.
FLUORIDATION SiR,—The replies of the medical officers of health to Dr. Dobbs seem to show that we have to fight not only for pure water but for common sense in public-health affairs. Can all our public-health experts approve of a general, indiscriminate, permanent increase in the intake of a well-known poison, and believe that the infliction of worry, indignation, and stress upon innumerable middle-aged people and invalids is the duty of the medical profession ? This insistence on coercion, and on a method which involves arousing the maximum possible public hostility, cannot arise from a sincere concern for the children’s teeth; it is clear that the fluoridation campaign is being used, by those few who really know what they are doing, to break down the principles of consent and of individual care and treatment, which are absolutely fundamental to medicine and to public confidence in the medical
imposing
profession. WINIFRED M. SYKES Secretary, Huddersfield.
National Pure Water Association.
HEMORRHOIDS SIR,-Your leading article of Feb. 20 on the treatment of hxmorrhoids and the correspondence which followed prompt us to record the results we have been obtaining with a comparatively new product. Although you recommend only injection or surgical removal, many milder cases do not warrant or the patient does not accept such treatment. Even in severe cases where hxmorrhoidectomy is contemplated, the patient’s suffering must still be relieved during the waiting period. Patients with hemorrhoids of varying severity were given a of ’Proctosedyl ’ (Roussel) suppositories and/or ointment (each suppository and each gramme of ointment contains 5 mg. hydrocortisone, 10 mg. framycetin sulphate, and 5 mg. cinchocaine). They were instructed to apply the ointment and insert a suppository morning and evening. The results in 35 cases are summarised as follows: lst degree haemorrhoids: complete relief 14, helped 2, failed 1 (17)
supply
2nd degree haemorrhoids: 3rd degree haemorrhoids:
Only
complete relief 10, helped 1, failed 1 (12) complete relief 4, helped 1, failed 1 (6) 3 out of 35 patients received no benefit at all, but 32
received benefit of varying degrees, and 80 % obtained complete relief. Protoscopy was carried out at the first and subsequent visits to determine progress. All possible serious underlying diseases were also carefully excluded.. The patients were followed for periods of several months and those who did not return for final assessment were excluded. In fissure-in-ano results were also excellent, 4 out of 5 patients obtaining complete relief; but in the symptomatic treatment of pruritus ani, pruritus vulvx, and vulvitis results were
disappointing.
Bitterne, Southampton.
W. L. KERR T. E. S. STOWELL T. WADE WEST J. F. MULLAN.
SiR,—Ihave now treated approximately 50 patients with the preparationAlcos-Anal’, mentioned by Dr. Mustard (April 9), reserving it mainly for pregnant women with symptoms of haemorrhoids, including slight bleeding.