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STILBAMIDINE FOR TIC DOULOUREUX
723 in the admission ward I was living in a state of unreality with occasional lucid intervals. I imagined the
periodI spent
place was hell and the attendants demons, some better than others. My moods would change very rapidly. One moment
I would be extremely enraged at everyone and the next in I do not ever remember any a very silly state of elation. time for these fits of period of depression- It tookoff.a long For some reason, which I to wear and unreality anger am unable to explain, I did not emerge into a full realisation of reality till after the air encephalography test. After that the sensation of pressure in my head left me and I could see things and people for what they are." Hospital for Mental Diseases, MILO TYNDEL. Brandon, Manitoba, Canada. TRAINING THE DISTRICT NURSE
SiR,-The views expressed in your leading article (Sept. 10) deserve the wholehearted support of every
general practitioner. The Working Party majority
seem
to think that local
authorities have been asked to take over the nursing service, not simply to provide one for the general practitioner to use. Also, there does not seem to be any good reason for the training to be done by local authorities any
clinical cycle is important ; for otherwise discouragement may be felt during the first or second month, particularly after a good initial response. The delay in permanent improvement requires considerable patience on the part of both patient and doctor. Of 16 patients with tic douloureux who were treated with stilbamidine, 14 had had previous treatment of some type. Excellent results were obtained in 15 patients and a good result in 1, with periods of freedom from pain ranging from four months to twenty-five months. The patients who obtained the lesser amounts of relief were treated only a short time ago. 15 patients were given one course of treatment, and only 1 required a second before The corneal reflexes a decrease in symptoms occurred. remained in all 16 patients, being brisk in 14, possibly blunted in 1, and slightly decreased in 1 ; the degree of impairment was not significant. In 1 patient the blunting of the corneal reflexes was due to a combination of a previous operation on the same side and the effect of the stilbamidine.
than in the case of the midwife or health visitor. The nurses themselves strongly object to any reduction in the length of their training, as they fully realise that it is not the theoretical knowledge but practical experience that they need. Surely more weight should be given to the opinions of bodies which have nrovided and used the service. O. LL. LANDER.
more
STILBAMIDINE FOR TIC DOULOUREUX SiR,-The administration of stilbamidine intravenously apparently is an effective, safe, and inexpensive method for the treatment of tic douloureux,l2 a condition for which therapy has been diversified and largely unsuccessful. When properly prepared and administered stilbamidine is not toxic except for a late chronic neuropathy. The progressive sensory changes of paraesthesia and hypalgesia usually confined to the face appear about two to five months’ after the -administration of the drug. The mechanism of the neuropathy is not known. Stilbamidine 0.15 g. is dissolved in 200 ml. of a 5% solution of glucose in distilled water. Since the drug in solution is markedly affected by even short exposure to light, the solution must be prepared immediately prior to its administration. The solution is given intravenously and must be given slowly to avoid a transient shock-like reaction associated . with rapid administration of the drug. The course of treatment consisted of the injection of 0.15 g. of stilbamidine once daily for fourteen
The Johns Hopkins Hospital,
Baltimore, Maryland. Veterans Administration Hospital, Fort Howard, Maryland.
GEORGE W. SMITH. JOSEPH M. MILLER.
ELECTROPHORESIS OF PLASMA-PROTEINS SIR,-I would like to add some remarks to Dr. Milt6nyi’s letter of June 4 and to that of Dr. Christiansen
(June 11). In the serum of normal people the P2-globulins isolated by paperelectrophoresis form a substantially smaller part than the slightly faster moving pi-globulins. A clear demonstration of P2-globulins by this method is a relatively difficult procedure, but it is always possible.
It is incorrect to assume, therefore, that the normal it is two fractions is observed. We noted also that the increase of (32-globulin was accompanied by a decrease in pi-globulins. With the return of blood colloids to normal levels the ratio 1/2 increases.1 At present we are unable to explain the cause of this antagonistic behaviour of the (3 subfractions. These findings were confirmed experimentally.
P-globulins usually travel as a single band, and that only with abnormal sera that the splitting into
Experimental dysproteinsemia was produced by means of turpentine abscess in a rabbit. The serum-proteins were examined electrophoretically in the usual way several times during the activity and healing of the abscess. In contrast to human serum, the ex-globulins did not split under these experimental conditions. The (32-globulin fraction increased in the a
1. Wiedermann, D.
Schweiz. med. Wschr. 1954, 84, 1367.
days. Treatment was given to 14 outpatients, who were cautioned not to expose themselves unduly to sunlight. They carried on their normal occupations. The cycle of clinical events after the start of treatment with stilbamidine is characteristic. The patients noted that the attacks of pain were less severe and less frequent from the fourth to the eighth day. Exacerbation of the pain, however, was usually noted during the first one to two months after the start of treatment. A gradual decrease in the severity and number of attacks followed. Complete freedom from pain occurred from two to four months after the inception of treatment. Mild paraesthesise consisting usually in pruritus and formication involving both sides of the face, appeared most often in about the third or fourth month. They appeared first and were more severe in intensity on the side of the face involved by the tic douloureux. The pruritus lasted for about one and a half months. The mild paraesthesise did not inconvenience the patients. The recognition of this 1. Smith, G. W., Miller, J. M. Ann. intern. Med. 1953, 38, 335. 2. Smith, G. W., Miller, J. M. Bull. Johns Hopk. Hosp. 1955, 56, 146.
of rabbit serum (a) four days after injection of turpentine and (b) twenty-two days after injection of turpentine.
Electrophoresis
periodI spent
place was hell and the attendants demons, some better than others. My moods would change very rapidly. One moment
I would be extremely enraged at everyone and the next in I do not ever remember any a very silly state of elation. time for these fits of period of depression- It tookoff.a long For some reason, which I to wear and unreality anger am unable to explain, I did not emerge into a full realisation of reality till after the air encephalography test. After that the sensation of pressure in my head left me and I could see things and people for what they are." Hospital for Mental Diseases, MILO TYNDEL. Brandon, Manitoba, Canada. TRAINING THE DISTRICT NURSE
SiR,-The views expressed in your leading article (Sept. 10) deserve the wholehearted support of every
general practitioner. The Working Party majority
seem
to think that local
authorities have been asked to take over the nursing service, not simply to provide one for the general practitioner to use. Also, there does not seem to be any good reason for the training to be done by local authorities any
clinical cycle is important ; for otherwise discouragement may be felt during the first or second month, particularly after a good initial response. The delay in permanent improvement requires considerable patience on the part of both patient and doctor. Of 16 patients with tic douloureux who were treated with stilbamidine, 14 had had previous treatment of some type. Excellent results were obtained in 15 patients and a good result in 1, with periods of freedom from pain ranging from four months to twenty-five months. The patients who obtained the lesser amounts of relief were treated only a short time ago. 15 patients were given one course of treatment, and only 1 required a second before The corneal reflexes a decrease in symptoms occurred. remained in all 16 patients, being brisk in 14, possibly blunted in 1, and slightly decreased in 1 ; the degree of impairment was not significant. In 1 patient the blunting of the corneal reflexes was due to a combination of a previous operation on the same side and the effect of the stilbamidine.
than in the case of the midwife or health visitor. The nurses themselves strongly object to any reduction in the length of their training, as they fully realise that it is not the theoretical knowledge but practical experience that they need. Surely more weight should be given to the opinions of bodies which have nrovided and used the service. O. LL. LANDER.
more
STILBAMIDINE FOR TIC DOULOUREUX SiR,-The administration of stilbamidine intravenously apparently is an effective, safe, and inexpensive method for the treatment of tic douloureux,l2 a condition for which therapy has been diversified and largely unsuccessful. When properly prepared and administered stilbamidine is not toxic except for a late chronic neuropathy. The progressive sensory changes of paraesthesia and hypalgesia usually confined to the face appear about two to five months’ after the -administration of the drug. The mechanism of the neuropathy is not known. Stilbamidine 0.15 g. is dissolved in 200 ml. of a 5% solution of glucose in distilled water. Since the drug in solution is markedly affected by even short exposure to light, the solution must be prepared immediately prior to its administration. The solution is given intravenously and must be given slowly to avoid a transient shock-like reaction associated . with rapid administration of the drug. The course of treatment consisted of the injection of 0.15 g. of stilbamidine once daily for fourteen
The Johns Hopkins Hospital,
Baltimore, Maryland. Veterans Administration Hospital, Fort Howard, Maryland.
GEORGE W. SMITH. JOSEPH M. MILLER.
ELECTROPHORESIS OF PLASMA-PROTEINS SIR,-I would like to add some remarks to Dr. Milt6nyi’s letter of June 4 and to that of Dr. Christiansen
(June 11). In the serum of normal people the P2-globulins isolated by paperelectrophoresis form a substantially smaller part than the slightly faster moving pi-globulins. A clear demonstration of P2-globulins by this method is a relatively difficult procedure, but it is always possible.
It is incorrect to assume, therefore, that the normal it is two fractions is observed. We noted also that the increase of (32-globulin was accompanied by a decrease in pi-globulins. With the return of blood colloids to normal levels the ratio 1/2 increases.1 At present we are unable to explain the cause of this antagonistic behaviour of the (3 subfractions. These findings were confirmed experimentally.
P-globulins usually travel as a single band, and that only with abnormal sera that the splitting into
Experimental dysproteinsemia was produced by means of turpentine abscess in a rabbit. The serum-proteins were examined electrophoretically in the usual way several times during the activity and healing of the abscess. In contrast to human serum, the ex-globulins did not split under these experimental conditions. The (32-globulin fraction increased in the a
1. Wiedermann, D.
Schweiz. med. Wschr. 1954, 84, 1367.
days. Treatment was given to 14 outpatients, who were cautioned not to expose themselves unduly to sunlight. They carried on their normal occupations. The cycle of clinical events after the start of treatment with stilbamidine is characteristic. The patients noted that the attacks of pain were less severe and less frequent from the fourth to the eighth day. Exacerbation of the pain, however, was usually noted during the first one to two months after the start of treatment. A gradual decrease in the severity and number of attacks followed. Complete freedom from pain occurred from two to four months after the inception of treatment. Mild paraesthesise consisting usually in pruritus and formication involving both sides of the face, appeared most often in about the third or fourth month. They appeared first and were more severe in intensity on the side of the face involved by the tic douloureux. The pruritus lasted for about one and a half months. The mild paraesthesise did not inconvenience the patients. The recognition of this 1. Smith, G. W., Miller, J. M. Ann. intern. Med. 1953, 38, 335. 2. Smith, G. W., Miller, J. M. Bull. Johns Hopk. Hosp. 1955, 56, 146.
of rabbit serum (a) four days after injection of turpentine and (b) twenty-two days after injection of turpentine.
Electrophoresis