PROTAMINE INSULIN

828 PROTAMINE INSULIN

ARSENICAL INTOLERANCE AND THE TREATMENT OF TRICHOMONAS VAGINALIS INFECTION

To the Editor

SIR,-In your issue

Campbell reported

a

of THE LANCET of Sept. 18th Dr. C. G. H. case in which a generalised

exfoliative dermatitis followed the treatment of a Trichomonas vaginalis infection of the vagina with the pentavalent arsenical compound acetphenarsineStovarsol. A patient treated at the St. Mary’s Hospital venereal diseases clinic a short time ago exhibited a similar toxic eruption, and this case, too, may be of interest. The patient, aged 30, was treated for chronic vaginitis with Stovarsol vaginal compound. Two of the 4-grain tablets were inserted into the vagina every night for a fortnight, after which the dosage was reduced to one tablet every night. Seven weeks after treatment had begun, the patient appeared at the clinic with a severe and irritating papulosquamous dermatitis affecting the face, neck, trunk, and limbs, as in Dr. Campbell’s case. The stovarsol was stopped and the usual methods for elimination of arsenic employed, together with a fat-free diet and a sedative lotion for local application to the eruption. A fortnight later the condition of the skin had cleared, recovery being uneventful.

To the Editor

of

THE LANCET

SiR,-In response to a demand from users of protamine insulin (with zinc) for a preparation of higher unit value than the 40 units per c.cm., the four British firms engaged in its manufacture (Allen and Hanburys Ltd., Boots Pure Drug Co., Ltd., The British Drug Houses Ltd., and Burroughs Wellcome and Co.) have now made available a suspension containing 80 units per c.cm. This preparation is issued in one size only-i.e., 5 c.cm. vials containing 400 units (80 units per c.cm.). The original preparation containing 40 units per c.cm. will continue to be issued as at present in 5 c.cm. and 10

c.cm.

We

vials. Sir. vours faithfullv. ALLEN AND HANBURYS LTD., BOOTS PURE DRUG CO., LTD., THE BRITISH DRUG HOUSES LTD. BURROUGHS WELLCOME AND CO.

are.

Sept. 24th.

ŒSTRIN IN TREATMENT OF CUSHING’S SYNDROME

To the Editor

of THE

LANCET

This case differs from Dr. Campbell’s in that there SIR,-Dr. Morton Gill’s statements in your issue had been no previous arsenical treatment and that of Sept. 4th seem to me disputable, and I would the eruption appeared a considerable period after like to comment on them further. treatment had commenced ; also recovery was rapid (1) Dr. Gill was unable to reduce the raised blood once the administration of the stovarsol had ceased. pressure or the obesity in cases of Cushing’s syndrome Apparently, therefore, this patient was not hyper- by administration of Progynon B. I have stated that sensitive to the pentavalent arsenic but suffered from progynon B therapy, if administered intensively and the products of absorption. It is the practice at this for a longer period than he used, will reduce both clinic to instruct patients to use a vaginal douche the systolic pressure and the obesity. This is illustrated by the following case :every morning during treatment with the stovarsol This in the lived preparation. particular patient The patient was a woman aged 37, with hypertension country and also had not the privacy to carry outand regional obesity. The accompanying photographs these instructions. Hence there must have beenshow I her facial appearance before therapy (left), after continuous absorption of arsenic during the seven weeks. The preparation is used a great deal in the St. Mary’s Hospital clinic and this is the only case of its kind in the last eighteen months. I think it is reasonable to assume that cases showing such a reaction have been avoided by the routine of stovarsol tablets being used at night, followed by a cleansing douche. in the morning with no insertion of tablets again till the

night.

..

Campbell writes only of a hypersensitive patient, and one whose hypersensitivity had possibly been increased by the previous administration of arsenic. The case I have outlined suggests that his warning about the use of this kind of drug and its possible toxic effects applies also to the non-hypersensitive patient. In addition it may point to the Dr.

fact that routine treatment, as described, minimises any such likely effects and enhances the value of this extremely efficient preparation. It is with the kind permission of Dr. McElligott, director of the venereal diseases clinic, St. Mary’s Hospital, London, that I am able to report this case. I am, Sir, yours faithfully, M. C. W. LONG, Clinical Assistant, Venereal Diseases Clinic, St. Mary’s Hospital, W. Sept. 27th.

five months’ administration of progynon B (centre), and after another five months’ treatment with progynon B and proluton (right). (The scars and telangiectases were the result of X ray irradiation for facial hypertrichosis.) The improved appearance of the skin as well as the disappearance of the plethoric obesity of the face is apparent. Without diet regulation this patient lost 20 lb., and the systolic pressure was reduced from 168 mm. of mercury to 120 mm.

(2) I have not found it difficult to decide when should be occurring in cases of Cushing’s with amenorrhcea or irregularity of menstruation. The recurrence or the exacerbations of the headaches are informative. When ovulation should occur the less severe headaches appear or the existing headache exacerbates for a short period, menses

syndrome