- Email: [email protected]
SAFETY CONTAINERS FOR MEDICINES
361
have received this treatment for periods of up to one year. So far no unwanted effects have been noted. We realise that our subjects differ from those of Dr. Hunter and his colleagues in that ours are receiving phenytoin; but in view of the rather alarming report, we should like to draw attention to our negative findings, which will be published later. F. B. GIBBERD Westminster Hospital, ANNE NICHOLLS. London, S.W.1
J. F. DUNNE D. M. CHAPUT
DE
SAINTONGE.
ASSESSING THE SPUTUM SIR,-I agree entirely with Dr. Lanyi (Jan. 31, p. 252) about the difficulties of assessment of bacterial infection in chronic bronchial disorders, and I have no doubt that his bronchial infectivity grading test is helpful. Unfortunately, the majority of patients with such disorders are managed, not in hospital, but in general practice, where it is quite impracticable to have such tests done routinely. In these circumstances it is essential to use a simple method to assess the likelihood of bacterial infection, and naked-eye inspection of the sputum seems to be the best at the present time. Caution is needed, however. I have previously1 drawn attention to the need to examine sputum very carefully in a good light (preferably daylight) and in a suitable container (transparent), and I would add two further points. First, not all patients expectorate pus throughout the day, and it is often necessary to inspect a 24-hour specimen to be certain that sputum is persistently mucoid. Secondly, the sputum in chronic asthma may contain sufficient eosinophils to give the appearance of plugs of apparent pus in a mucoid matrix. If such eosinophilia is suspected, microscopy is obviously called for. Department of Bacteriology, Institute of Diseases of the Chest, London S.W.3.
J. ROBERT MAY.
SAFETY CONTAINERS FOR MEDICINES SIR,-The possibility of introducing " child-resistant containers for medicines has been given some publicity recently. The Council of the Pharmaceutical Society, while welcoming the use of any container that would reduce the possibility of accidental poisoning, considers that there are several factors which merit careful consideration. Any container used to pack a medicine must protect the contents from normal mechanical and physical hazards; any safety container must be designed to retain its " childresistant " attributes for the required period of time; a closure which is designed to make the container difficult to open may also be difficult to replace properly, and the problems of elderly patients-in particular arthritic patientscannot be overlooked; it would be unwise to use safety containers for only a limited range of dispensed medicines since this might tend to lead members of the public to believe that medicines packed in other types of containers carried little risk. The construction of the closure on some safety containers is such that it wears during normal use, and there is need for information on how many openings and closings a particular container can withstand. Indeed, a standard covering child-resistance as well as pharmaceutical effectiveness should be considered if these containers are to be introduced for general use. There can be no substitute for the rule that all medicines should be kept out of the reach of children. In any publicity "
"
"
1.
May, J. R. Lancet, 1965, i, 959.
it should be emphasised that a safety container is merely an additional safeguard-the last line of defence when, despite all precautions, a child has managed to reach a medicine. D. F. LEWIS Secretary and Registrar, The Pharmaceutical Society of Great Britain.
APPEAL TO DOCTORS
SiR,-In Mr. Cook’s letter of Jan. 24 (p. 196) the following sentence appears: Science (including medicine) cannot "
make value judgments, but only factual ones."- A better rendering would probably be, In practising science (including medical science) people cannot make value judgments, but only factual ones. The personification of science has led to much confusion. Science does not do things; people do science. The identification of medicine with medical science is another misconception. Medical science is only a part of medicine, and those who practise medicine are constantly involved in making value judgments. There is a commonly held belief that value judgments can be turned into factual ones by physical discovery and the collection of more and more factual information. While medical science is very important, doing medical science tends to be used, not infrequently, and sometimes unwittingly, as an escape-route by those poorly prepared and ill-equipped to cope with value judgments; and their medical training has much to do with this, as Mr. Cook implies. F. A. BINKS.
FUTURE OF POSTGRADUATE MEDICAL EDUCATION SIR,-May I support Sir John McMichael’s plea (Nov. 22, p. 1132) for making certain that our plans for major reorganisation of the teaching in specialist hospitals in London will still enable us to meet the needs of overseas men and women who wish to come here for specialist training. Many doctors, including future teachers in their countries, continue to come to Great Britain, and particularly to London, not only from the Commonwealth countries but also from most of the countries of Europe, from Africa, and from North and South America. Many come to acquire an expertise in a particular branch of medicine or surgery, and to learn methods of research, enabling them to practise and teach this specialty on their return home. In Great Britain, and particularly in London, such training has been greatly facilitated by the concentration of work in our specialist hospitals, whose names are known all over the world. In addition, there are renowned specialised centres in some of our university professorial departments and also in Medical Research Council research units. The Todd Report recommends linking these small specialist hospitals with appropriate teaching-hospitals, and, with the collapse of the Chelsea and Holborn schemes for constellations of postgraduate institutes, this is the obvious alternative. An essential prerequisite will be to protect their
teaching and research opportunities from direct competition with the service claims of the big general hospital to which they are allocated, and so enable them to continue and even expand the academic work which has made such important contributions to our scientific reputation overseas. The example of our Medical Research Council units, and also the Hospital for Tropical Diseases, provide evidence of how such independence can be maintained within a larger general complex, and the Postgraduate Federation has demonstrated a means of supporting academic and scientific developments in the growing specialties, while exerting a balancing and regulating influence among their competing claims.
have received this treatment for periods of up to one year. So far no unwanted effects have been noted. We realise that our subjects differ from those of Dr. Hunter and his colleagues in that ours are receiving phenytoin; but in view of the rather alarming report, we should like to draw attention to our negative findings, which will be published later. F. B. GIBBERD Westminster Hospital, ANNE NICHOLLS. London, S.W.1
J. F. DUNNE D. M. CHAPUT
DE
SAINTONGE.
ASSESSING THE SPUTUM SIR,-I agree entirely with Dr. Lanyi (Jan. 31, p. 252) about the difficulties of assessment of bacterial infection in chronic bronchial disorders, and I have no doubt that his bronchial infectivity grading test is helpful. Unfortunately, the majority of patients with such disorders are managed, not in hospital, but in general practice, where it is quite impracticable to have such tests done routinely. In these circumstances it is essential to use a simple method to assess the likelihood of bacterial infection, and naked-eye inspection of the sputum seems to be the best at the present time. Caution is needed, however. I have previously1 drawn attention to the need to examine sputum very carefully in a good light (preferably daylight) and in a suitable container (transparent), and I would add two further points. First, not all patients expectorate pus throughout the day, and it is often necessary to inspect a 24-hour specimen to be certain that sputum is persistently mucoid. Secondly, the sputum in chronic asthma may contain sufficient eosinophils to give the appearance of plugs of apparent pus in a mucoid matrix. If such eosinophilia is suspected, microscopy is obviously called for. Department of Bacteriology, Institute of Diseases of the Chest, London S.W.3.
J. ROBERT MAY.
SAFETY CONTAINERS FOR MEDICINES SIR,-The possibility of introducing " child-resistant containers for medicines has been given some publicity recently. The Council of the Pharmaceutical Society, while welcoming the use of any container that would reduce the possibility of accidental poisoning, considers that there are several factors which merit careful consideration. Any container used to pack a medicine must protect the contents from normal mechanical and physical hazards; any safety container must be designed to retain its " childresistant " attributes for the required period of time; a closure which is designed to make the container difficult to open may also be difficult to replace properly, and the problems of elderly patients-in particular arthritic patientscannot be overlooked; it would be unwise to use safety containers for only a limited range of dispensed medicines since this might tend to lead members of the public to believe that medicines packed in other types of containers carried little risk. The construction of the closure on some safety containers is such that it wears during normal use, and there is need for information on how many openings and closings a particular container can withstand. Indeed, a standard covering child-resistance as well as pharmaceutical effectiveness should be considered if these containers are to be introduced for general use. There can be no substitute for the rule that all medicines should be kept out of the reach of children. In any publicity "
"
"
1.
May, J. R. Lancet, 1965, i, 959.
it should be emphasised that a safety container is merely an additional safeguard-the last line of defence when, despite all precautions, a child has managed to reach a medicine. D. F. LEWIS Secretary and Registrar, The Pharmaceutical Society of Great Britain.
APPEAL TO DOCTORS
SiR,-In Mr. Cook’s letter of Jan. 24 (p. 196) the following sentence appears: Science (including medicine) cannot "
make value judgments, but only factual ones."- A better rendering would probably be, In practising science (including medical science) people cannot make value judgments, but only factual ones. The personification of science has led to much confusion. Science does not do things; people do science. The identification of medicine with medical science is another misconception. Medical science is only a part of medicine, and those who practise medicine are constantly involved in making value judgments. There is a commonly held belief that value judgments can be turned into factual ones by physical discovery and the collection of more and more factual information. While medical science is very important, doing medical science tends to be used, not infrequently, and sometimes unwittingly, as an escape-route by those poorly prepared and ill-equipped to cope with value judgments; and their medical training has much to do with this, as Mr. Cook implies. F. A. BINKS.
FUTURE OF POSTGRADUATE MEDICAL EDUCATION SIR,-May I support Sir John McMichael’s plea (Nov. 22, p. 1132) for making certain that our plans for major reorganisation of the teaching in specialist hospitals in London will still enable us to meet the needs of overseas men and women who wish to come here for specialist training. Many doctors, including future teachers in their countries, continue to come to Great Britain, and particularly to London, not only from the Commonwealth countries but also from most of the countries of Europe, from Africa, and from North and South America. Many come to acquire an expertise in a particular branch of medicine or surgery, and to learn methods of research, enabling them to practise and teach this specialty on their return home. In Great Britain, and particularly in London, such training has been greatly facilitated by the concentration of work in our specialist hospitals, whose names are known all over the world. In addition, there are renowned specialised centres in some of our university professorial departments and also in Medical Research Council research units. The Todd Report recommends linking these small specialist hospitals with appropriate teaching-hospitals, and, with the collapse of the Chelsea and Holborn schemes for constellations of postgraduate institutes, this is the obvious alternative. An essential prerequisite will be to protect their
teaching and research opportunities from direct competition with the service claims of the big general hospital to which they are allocated, and so enable them to continue and even expand the academic work which has made such important contributions to our scientific reputation overseas. The example of our Medical Research Council units, and also the Hospital for Tropical Diseases, provide evidence of how such independence can be maintained within a larger general complex, and the Postgraduate Federation has demonstrated a means of supporting academic and scientific developments in the growing specialties, while exerting a balancing and regulating influence among their competing claims.