- Email: [email protected]
ACUTE HEPATIC NECROSIS
158
mephenesin produced days.
relief and he
in ten
was
able to return to work
Although my results are not dramatic, mephenesin has proved useful in the treatment of these troublesome conditions and it is worthy of trial in stubborn cases. It is more effective in the larger doses and although the administration of 12 tablets daily might be considered tedious, no patients complained on this score. There were no
side-effects at all.
Bootle, Liverpool.
that it was a good deal easier for me to abstain from smoking than it had been before. At the end of a further three weeks, I again indulged in oversmoking for an evening, and consumed 12 cigarettes between 7 P.M. and 11 P.M. on Oct. 2. After this I again had a feeling of revulsion against tobacco, which lasted for about a week, and when that wore off I found that I had no craving to smoke. About the end of October I started to smoke an occasional cigarette as an experiment and found that I enjoyed each cigarette but had no urge to return to habitual smoking. I now smoke between 15 and 20 cigarettes per week, almost exclusively in the evenings, and only in company of smokers. On about 2 or 3 days each week I do not smoke at all-not from having made any resolution on the subject but rather from the lack of desire or inclination. -
,
R. LARKIN.
OPERATING-THEATRE INFECTIONS
SiR,-Still another report has been published (in your 28) indicating the dangerous condition of hospital operating-theatres in this country. Evidence issue of Nov.
I feel that with the assistance of the advice given in produced that air laden with pathogenic organisms Miss Beck’s article I have succeeded in turning cigarette. was poured into the particular theatre by the ventilation smoking-so far as I personally am concerned-from an system employed. It is true to say that no pharmaceutical unpleasant habit into an agreeable experience in which manufacturer could attempt to prepare parenteral I indulge only when I feel so inclined. Londonderry, drugs in the average operating-theatre of this country, H. P. SWAN. H. Northern Ireland. because materials so prepared would almost certainly fail to pass the sterility tests prescribed by the Ministry ACUTE HEPATIC NECROSIS of Health. If manufacturers can provide sterile condiSiR,—We feel we should reply to Dr. Latner’s letter tions, and if relatively unskilled repetition workers can of Jan. 2. In the first place, we must object to his remark successfully work in them, surely neither the cost nor that we were treating a case of so-called " acute hepatic the technique are outside the reach of the hospital service. necrosis. Both clinically and pathologically it fulfilleq The attention focused recently on proprietary pharmaall the criteria necessary to warrant such a diagnosis. ceutical preparations has also displayed the tremendous In the second place, he has missed the point of the amount of research and investigation undertaken by article, which never claimed that sodium glutamate manufacturers to produce better and cheaper forms of therapy had any effect on the course of the liver damage; known drugs and to discover new remedies and preparabut we did, and still do, feel that it had a definite tions. Undoubtedly they could and would willingly beneficial effect on the cerebral manifestations associated, contribute their knowledge to help remedy the state of in some cases, with this disease. Naturally, one can affairs described in Dr. Sevitt’s article and discussed in base no conclusions on a single case, and our sole reason your editorial. for publishing it was to stimulate interest in this form The Distillers Company of treatment, as an addition to the usual supportive JOHN J. H. HASTINGS (Biochemicals) Ltd. measures which are, and remain, essential. Technical director. Despite Speke, Liverpool. some published successes, the prognosis in these cases, in our view, remains extremely poor, and therefore we TOBACCO-SMOKING IB,—I read the article by Miss Beck in your issue of feel that any addition to our therapeutic armamentarium any rate worthy of more extensive trial. Aug. 22 with particular interest, for I was then making is at In reply to Dr. Latner’s last paragraph, we do not an effort to give up smoking. of this My handling any " enthusiast " who read our paper intelli. problem was considerably modified by what I read in feel thatwould ever resort to glutamate therapy alone gently her article, and your readers may be interested in my in liver damage, but we do hope that others will try experiences. and assess its effect on those patients who suffer from I had been a habitual smoker for 11-12 years, and by
is
"
the summer of 1953 I had reached a daily consumption of 30-40 cigarettes. For some time I had been considering giving up smoking, but my doubts about my ability to do this, and the unpleasant prospect of the rest of my life without the comfort of tobacco deterred me. Finally, on July 11, 1953, I took the plunge and renounced " the foul Virginian weed." For the next few days I had an almost continuous craving for a cigarette, but managed to alleviate my unpleasant feelings by sticking hard sweets. By the end of a week I no longer needed the sweets but still felt a strong sense of deprivation. As time went on, I gradually thought less and less about smoking, but I could not quite get away from the feeling that I was missing something pleasant and agreeable. My reaction on reading Miss Beck’s article was that the arguments seemed very reasonable, but I did not dare to risk my new-found status as a non-smoker by giving the suggested method a trial. I could never get away from the feeling that I would enjoy a cigarette and that if once 1 smoked I would again become an addict. Finally, on Sept. 10-that is after 60 days without smoking-I experienced an overwhelming desire to smoke. While smoking that first cigarette, which I did with great enjoyment, I thought of the article, and I decided to act accordingly ; so between 7 P.M. and midnight I smoked 15 cigarettes. I had the intention of oversmoking the next day, but in the morning the thought of smoking made me feel sick and I found the smell of tobacco smoke definitely unpleasant. Over the next few days the feeling of revulsion against smoking gradually wore off, and after this I found
cerebral manifestations and henatic necrosis.
Scarborough Hospital.
coma
associated with acute C. E. WOODROW KENNETH FROOME I. H. LAWRENCE.
NEPHROSIS TREATED WITH INTRAVENOUS T.A.B. VACCINE wish to draw attention to the use of intraSIR,-We venous T.A.B. vaccine instead of malaria for the production of pyrexia in the treatment of nephrotic oedema (type-n nephritis of Ellis 1). Aldrich2 and Ball and Evans3 observed that infection may be associated with remission, and this led to the
of measles by Janeway and Hutchins4 and malaria Gairdner5 and Byrne.6 It occurred to us that the use of intravenous T.A.B. vaccine-a simple and well-known method for producing pyrexia-would allow better controlled pyrexia. Wehave accordingly used this on an adult case very successfully at times over the last twelve months. The initial dosage is 2 million organisms; this is followed at intervals of three to five days by 6, 20, 40,
use
by
1. 2. 3. 4. 5. 6.
Ellis, A. Lancet, 1942, i, 842. Aldrich, C. A. Amer. J. Dis. Child, 1926, 32, 163. Ball, W. G., Evans, G. Diseases of the Kidney. London, 1932. Janeway, C. A., Hutchins, G. Amer. J. Dis. Child, 1947, 73, 242. Gairdner, D. Lancet, 1952, i, 842. Byrne, E. A. J. Ibid, p. 844.
mephenesin produced days.
relief and he
in ten
was
able to return to work
Although my results are not dramatic, mephenesin has proved useful in the treatment of these troublesome conditions and it is worthy of trial in stubborn cases. It is more effective in the larger doses and although the administration of 12 tablets daily might be considered tedious, no patients complained on this score. There were no
side-effects at all.
Bootle, Liverpool.
that it was a good deal easier for me to abstain from smoking than it had been before. At the end of a further three weeks, I again indulged in oversmoking for an evening, and consumed 12 cigarettes between 7 P.M. and 11 P.M. on Oct. 2. After this I again had a feeling of revulsion against tobacco, which lasted for about a week, and when that wore off I found that I had no craving to smoke. About the end of October I started to smoke an occasional cigarette as an experiment and found that I enjoyed each cigarette but had no urge to return to habitual smoking. I now smoke between 15 and 20 cigarettes per week, almost exclusively in the evenings, and only in company of smokers. On about 2 or 3 days each week I do not smoke at all-not from having made any resolution on the subject but rather from the lack of desire or inclination. -
,
R. LARKIN.
OPERATING-THEATRE INFECTIONS
SiR,-Still another report has been published (in your 28) indicating the dangerous condition of hospital operating-theatres in this country. Evidence issue of Nov.
I feel that with the assistance of the advice given in produced that air laden with pathogenic organisms Miss Beck’s article I have succeeded in turning cigarette. was poured into the particular theatre by the ventilation smoking-so far as I personally am concerned-from an system employed. It is true to say that no pharmaceutical unpleasant habit into an agreeable experience in which manufacturer could attempt to prepare parenteral I indulge only when I feel so inclined. Londonderry, drugs in the average operating-theatre of this country, H. P. SWAN. H. Northern Ireland. because materials so prepared would almost certainly fail to pass the sterility tests prescribed by the Ministry ACUTE HEPATIC NECROSIS of Health. If manufacturers can provide sterile condiSiR,—We feel we should reply to Dr. Latner’s letter tions, and if relatively unskilled repetition workers can of Jan. 2. In the first place, we must object to his remark successfully work in them, surely neither the cost nor that we were treating a case of so-called " acute hepatic the technique are outside the reach of the hospital service. necrosis. Both clinically and pathologically it fulfilleq The attention focused recently on proprietary pharmaall the criteria necessary to warrant such a diagnosis. ceutical preparations has also displayed the tremendous In the second place, he has missed the point of the amount of research and investigation undertaken by article, which never claimed that sodium glutamate manufacturers to produce better and cheaper forms of therapy had any effect on the course of the liver damage; known drugs and to discover new remedies and preparabut we did, and still do, feel that it had a definite tions. Undoubtedly they could and would willingly beneficial effect on the cerebral manifestations associated, contribute their knowledge to help remedy the state of in some cases, with this disease. Naturally, one can affairs described in Dr. Sevitt’s article and discussed in base no conclusions on a single case, and our sole reason your editorial. for publishing it was to stimulate interest in this form The Distillers Company of treatment, as an addition to the usual supportive JOHN J. H. HASTINGS (Biochemicals) Ltd. measures which are, and remain, essential. Technical director. Despite Speke, Liverpool. some published successes, the prognosis in these cases, in our view, remains extremely poor, and therefore we TOBACCO-SMOKING IB,—I read the article by Miss Beck in your issue of feel that any addition to our therapeutic armamentarium any rate worthy of more extensive trial. Aug. 22 with particular interest, for I was then making is at In reply to Dr. Latner’s last paragraph, we do not an effort to give up smoking. of this My handling any " enthusiast " who read our paper intelli. problem was considerably modified by what I read in feel thatwould ever resort to glutamate therapy alone gently her article, and your readers may be interested in my in liver damage, but we do hope that others will try experiences. and assess its effect on those patients who suffer from I had been a habitual smoker for 11-12 years, and by
is
"
the summer of 1953 I had reached a daily consumption of 30-40 cigarettes. For some time I had been considering giving up smoking, but my doubts about my ability to do this, and the unpleasant prospect of the rest of my life without the comfort of tobacco deterred me. Finally, on July 11, 1953, I took the plunge and renounced " the foul Virginian weed." For the next few days I had an almost continuous craving for a cigarette, but managed to alleviate my unpleasant feelings by sticking hard sweets. By the end of a week I no longer needed the sweets but still felt a strong sense of deprivation. As time went on, I gradually thought less and less about smoking, but I could not quite get away from the feeling that I was missing something pleasant and agreeable. My reaction on reading Miss Beck’s article was that the arguments seemed very reasonable, but I did not dare to risk my new-found status as a non-smoker by giving the suggested method a trial. I could never get away from the feeling that I would enjoy a cigarette and that if once 1 smoked I would again become an addict. Finally, on Sept. 10-that is after 60 days without smoking-I experienced an overwhelming desire to smoke. While smoking that first cigarette, which I did with great enjoyment, I thought of the article, and I decided to act accordingly ; so between 7 P.M. and midnight I smoked 15 cigarettes. I had the intention of oversmoking the next day, but in the morning the thought of smoking made me feel sick and I found the smell of tobacco smoke definitely unpleasant. Over the next few days the feeling of revulsion against smoking gradually wore off, and after this I found
cerebral manifestations and henatic necrosis.
Scarborough Hospital.
coma
associated with acute C. E. WOODROW KENNETH FROOME I. H. LAWRENCE.
NEPHROSIS TREATED WITH INTRAVENOUS T.A.B. VACCINE wish to draw attention to the use of intraSIR,-We venous T.A.B. vaccine instead of malaria for the production of pyrexia in the treatment of nephrotic oedema (type-n nephritis of Ellis 1). Aldrich2 and Ball and Evans3 observed that infection may be associated with remission, and this led to the
of measles by Janeway and Hutchins4 and malaria Gairdner5 and Byrne.6 It occurred to us that the use of intravenous T.A.B. vaccine-a simple and well-known method for producing pyrexia-would allow better controlled pyrexia. Wehave accordingly used this on an adult case very successfully at times over the last twelve months. The initial dosage is 2 million organisms; this is followed at intervals of three to five days by 6, 20, 40,
use
by
1. 2. 3. 4. 5. 6.
Ellis, A. Lancet, 1942, i, 842. Aldrich, C. A. Amer. J. Dis. Child, 1926, 32, 163. Ball, W. G., Evans, G. Diseases of the Kidney. London, 1932. Janeway, C. A., Hutchins, G. Amer. J. Dis. Child, 1947, 73, 242. Gairdner, D. Lancet, 1952, i, 842. Byrne, E. A. J. Ibid, p. 844.