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RESISTANCE TO P.A.S.
878
Letters to the Editor RESISTANCE TO P.A.S. SiR,-Since 1947 we have treated more than 500 patients, with pulmonary and extrapulmonary tuberculosis, with p-aminosalicylic acid (P.A.s.). The results are most encouraging.1 In some cases, however, we have observed that the pulmonary lesions show regression for the first 4-5 months
of
treatment ; then are stationary for some time ; and later, about 6-8 months after the institution of P.A.S. therapy, progress again. Since January, 194-9, we P.A.s.
determined the sensitivity of tubercle bacilli to P.A.s. and streptomycin. (The determinations have been made at the State Bacteriological Laboratory by Dr. Brita Lagergren.) As is seen from the accompanying table, resistance to P.A.s. often appears after six months (the earliest being 112 days) of P.A.s. treatment. have
routinely
IN-VITRO RESISTANCE TO SODIUM SALT OF P.A.S. OF TUBERCLE BACILLI ISOLATED FROM UNTREATED PATIENTS AND FROM PATIENTS AFTER THERAPY
P.A.S.
therapy is dangerous, since resistance to after that time is not uncommon (53% of the cultures from patients treated for more than 178 days were resistant to P.A.s.). The clinical course of the disease agrees in most instances with the sensitivity of the bacilli to P.A.S. This will later be reported in detail. P.A.S.
Sollidens Sanatorium, Ostersund, Sweden.
BO CARSTENSEN
K. LINDE ANDERSEN.
BRITISH SPAS AND HEALTH RESORTS
SIR,—A group of medical men interested in physical medicine, and particularly in the therapeutic powers of the British health resorts and spas, have held some preliminary meetings at 11, Chandos Street, W.1, for the purpose of discussing the methods of study and development of these resorts. It was decided not to revive the pre-war British Health Resorts Association, but to create a new organism-an association including medical and non-medical men interested in this question. As hon. secretary of these meetings I was entrusted with the task of ascertaining the views on this subject of the British medical profession, and I should be grateful to receive any comments on this plan for the development of our spas and health resorts. Great Britain possesses some of the finest spas and health resorts of the world, and it is, in fact, in this country that modern climatotherapy originated. The renewal of interest in the methods of physical medicine, the difficulties of travel abroad, and the desire to bring into this country many overseas visitors are sufficient factors to stimulate us to more definite action for the development of these outstanding physical therapeutic
agents. 7, Wimpole Street, London, BY.1.
A. P. CAWADIAS.
THE REGISTRAR’S FUTURE
patients received 12-18 g. P.A.S. daily, and most of them one or more short courses of streptomycin (1 g. daily for 15-20 days). The table includes 11 cultures regarded as resistant to streptomycin. &dag er; Total of 171 cultures tested (from 148 patients). Expressed as maximal concentration of sodium salt of P.A.S. in Dubos fluid medium (mg. per 100 ml.), which permitted * The treated
growth. N.D.
=
not determined.
This has
already been reported by others.2 Combined with streptomycin and P.A.s. is valuable both because of the additional therapeutic effect and the possible delay or prevention of resistance to streptomycin.3 In the treatment of tuberculosis we use P.A.S. routinely, supplemented by short courses of streptomycin when serious complications are diagnosed or suspected, and as preparatory and preventive treatment before surgical procedures. The combination of P.A.S. with streptomycin in this way does not, according to our findings, prevent
treatment
the emergence of resistance to P.A.S. Thus it is important not to postpone necessary collapse treatment too long-i.e., more than 4-5 months of Carstensen, B., Sjölin, S. S. Svenska Läkartidn. 1948, 45, 729. Carstensen, B., Söderhjelm, L. Nord. Med. 1948, 40, 2039. Carstensen, B. Amer. Rev. Tuberc. (in the press). 2. Delaude, A., Karlson, A. G., Carr, D. T., Pfuetze, K. H. Proc. Mayo Clin. 1949, 24, 341. Widström, G., Swedberg, B. Nord. Med. 1948, 40, 2225. 3. Graessle, O., Pietrowski, J. J. Bact. 1949, 57, 459. Karlson, A. G., Pfuetze, K. H., Carr, D. T., Feldman, W. H., Hinshaw, H. C. Proc. Mayo Clin. 1949, 24, 85. 1.
SIR,—For some time the position of senior registrars vis-a-vis consultant posts has been causing many of us grave anxiety. If the position in England is similar to that shown by recently published figures for Scotland, the number of vacancies for consultants in the National Health Service during the next few years is likely to be very substantially less than the number of senior registrars completing their training. Not only is the number of registrars now in training larger than is necessary to provide for the filling of vacancies due to retirement and casualty, but also consultants have had their retiring-age extended to 65 under the Act, while newly appointed ones are a relatively young group; so retirements in the next 10 years will be fewer than in subsequent years. Steps are in contemplation to reduce registrar establishments to provide numbers of fully trained specialists not greatly in excess of requirements ; otherwise there will be many young men fully trained as specialists who, in their middle thirties, must try tofind some other form of medical employment. But these steps will be too late to help many who are now in the senior-registrar grade. There exists a serious shortage of specialists of many sorts in the medical services of the Fighting Forces, the Colonial Medical Service, the Sudan Medical Service, There are, moreover, vacancies for professors,. &c. readers, and teachers in the medical faculties not only of Colonial universities and university colleges, but in Egypt, Iraq, and similar Middle East countries where it is urgent that the tradition of British medical teaching should be maintained. The Services offer not only interesting work for which many of the senior registrars. now completing their appointments are particularly well fitted, but also a career. The university posts are comparable with those in teaching hospitals in this country, with the additional
‘
Letters to the Editor RESISTANCE TO P.A.S. SiR,-Since 1947 we have treated more than 500 patients, with pulmonary and extrapulmonary tuberculosis, with p-aminosalicylic acid (P.A.s.). The results are most encouraging.1 In some cases, however, we have observed that the pulmonary lesions show regression for the first 4-5 months
of
treatment ; then are stationary for some time ; and later, about 6-8 months after the institution of P.A.S. therapy, progress again. Since January, 194-9, we P.A.s.
determined the sensitivity of tubercle bacilli to P.A.s. and streptomycin. (The determinations have been made at the State Bacteriological Laboratory by Dr. Brita Lagergren.) As is seen from the accompanying table, resistance to P.A.s. often appears after six months (the earliest being 112 days) of P.A.s. treatment. have
routinely
IN-VITRO RESISTANCE TO SODIUM SALT OF P.A.S. OF TUBERCLE BACILLI ISOLATED FROM UNTREATED PATIENTS AND FROM PATIENTS AFTER THERAPY
P.A.S.
therapy is dangerous, since resistance to after that time is not uncommon (53% of the cultures from patients treated for more than 178 days were resistant to P.A.s.). The clinical course of the disease agrees in most instances with the sensitivity of the bacilli to P.A.S. This will later be reported in detail. P.A.S.
Sollidens Sanatorium, Ostersund, Sweden.
BO CARSTENSEN
K. LINDE ANDERSEN.
BRITISH SPAS AND HEALTH RESORTS
SIR,—A group of medical men interested in physical medicine, and particularly in the therapeutic powers of the British health resorts and spas, have held some preliminary meetings at 11, Chandos Street, W.1, for the purpose of discussing the methods of study and development of these resorts. It was decided not to revive the pre-war British Health Resorts Association, but to create a new organism-an association including medical and non-medical men interested in this question. As hon. secretary of these meetings I was entrusted with the task of ascertaining the views on this subject of the British medical profession, and I should be grateful to receive any comments on this plan for the development of our spas and health resorts. Great Britain possesses some of the finest spas and health resorts of the world, and it is, in fact, in this country that modern climatotherapy originated. The renewal of interest in the methods of physical medicine, the difficulties of travel abroad, and the desire to bring into this country many overseas visitors are sufficient factors to stimulate us to more definite action for the development of these outstanding physical therapeutic
agents. 7, Wimpole Street, London, BY.1.
A. P. CAWADIAS.
THE REGISTRAR’S FUTURE
patients received 12-18 g. P.A.S. daily, and most of them one or more short courses of streptomycin (1 g. daily for 15-20 days). The table includes 11 cultures regarded as resistant to streptomycin. &dag er; Total of 171 cultures tested (from 148 patients). Expressed as maximal concentration of sodium salt of P.A.S. in Dubos fluid medium (mg. per 100 ml.), which permitted * The treated
growth. N.D.
=
not determined.
This has
already been reported by others.2 Combined with streptomycin and P.A.s. is valuable both because of the additional therapeutic effect and the possible delay or prevention of resistance to streptomycin.3 In the treatment of tuberculosis we use P.A.S. routinely, supplemented by short courses of streptomycin when serious complications are diagnosed or suspected, and as preparatory and preventive treatment before surgical procedures. The combination of P.A.S. with streptomycin in this way does not, according to our findings, prevent
treatment
the emergence of resistance to P.A.S. Thus it is important not to postpone necessary collapse treatment too long-i.e., more than 4-5 months of Carstensen, B., Sjölin, S. S. Svenska Läkartidn. 1948, 45, 729. Carstensen, B., Söderhjelm, L. Nord. Med. 1948, 40, 2039. Carstensen, B. Amer. Rev. Tuberc. (in the press). 2. Delaude, A., Karlson, A. G., Carr, D. T., Pfuetze, K. H. Proc. Mayo Clin. 1949, 24, 341. Widström, G., Swedberg, B. Nord. Med. 1948, 40, 2225. 3. Graessle, O., Pietrowski, J. J. Bact. 1949, 57, 459. Karlson, A. G., Pfuetze, K. H., Carr, D. T., Feldman, W. H., Hinshaw, H. C. Proc. Mayo Clin. 1949, 24, 85. 1.
SIR,—For some time the position of senior registrars vis-a-vis consultant posts has been causing many of us grave anxiety. If the position in England is similar to that shown by recently published figures for Scotland, the number of vacancies for consultants in the National Health Service during the next few years is likely to be very substantially less than the number of senior registrars completing their training. Not only is the number of registrars now in training larger than is necessary to provide for the filling of vacancies due to retirement and casualty, but also consultants have had their retiring-age extended to 65 under the Act, while newly appointed ones are a relatively young group; so retirements in the next 10 years will be fewer than in subsequent years. Steps are in contemplation to reduce registrar establishments to provide numbers of fully trained specialists not greatly in excess of requirements ; otherwise there will be many young men fully trained as specialists who, in their middle thirties, must try tofind some other form of medical employment. But these steps will be too late to help many who are now in the senior-registrar grade. There exists a serious shortage of specialists of many sorts in the medical services of the Fighting Forces, the Colonial Medical Service, the Sudan Medical Service, There are, moreover, vacancies for professors,. &c. readers, and teachers in the medical faculties not only of Colonial universities and university colleges, but in Egypt, Iraq, and similar Middle East countries where it is urgent that the tradition of British medical teaching should be maintained. The Services offer not only interesting work for which many of the senior registrars. now completing their appointments are particularly well fitted, but also a career. The university posts are comparable with those in teaching hospitals in this country, with the additional
‘