- Email: [email protected]
ADRENALINE CREAM
698 and it is most important of this treatment should be confirmed as
administering phenobarbitone, that the
quickly
success as
possible.
ADRENALINE CREAM rationale for the treatment of muscular SIR,- The rheumatism with adrenaline cream, which I first advocated ten years ago, was criticised on five counts: (1) Adrenaline could not be stabilised in a fatty base. (2) It could not penetrate the skin. (3) Even if it did so the amount would be too small to be effective. (4) If it did have any effect it would reduce the blood-supply to the muscles because it would constrict the arteries supplying them and not expand them, as I claimed. (5) There was no anatomical or physiological evidence for the claim that much of the pain of muscular rheumatism emanates from " trigger-spots "—localised areas of muscle in spasm.
It can now be are unfounded.
justly claimed
seriously
advantage of having worked with the type of illustrated by Mr. Goodwin as well as my own, and support I think if he is able to make a similar practical comparison, he will agree that the design I have suggested has certain definite advantages. I have the
DENNIS PIRRIE.
Lewes, Sussex.
because the pressure of the thighs on the abdomen interferes with respiratory movements.
that all these criticisms
(1) Pharmaceutical tests specially devised for the assay of adrenaline cream have proved it has a substantial shelf-life. (2) By histochemical methods, Bourne1 has demonstrated that adrenaline in a fatty base penetrates living skin rapidly. (3) Work at the National Institute for Medical Research proved that the action of adrenaline on the arterioles2 of skeletal muscle is peculiar in that it relaxes them. The concentrate required to produce this effect is astonishingly small. (4) Bonica3 has confirmed the existence of trigger spots and their responsibility for rheumatic pain. Other authorities 4s have expressed their agreement. The few and, in my opinion, perfunctory clinical trials of adrenaline cream have given equivocal results but it can surely be claimed that criticisms of the rationale, and particularly against the claim that adrenaline can penetrate the skin, are unjustified. LOUIS MOSS. Moss. London, W. 1. LEG SUPPORT FOR USE DURING VAGINAL OPERATIONS in Dr. Goodwin’s letter of was interested SIR,-I March 8 criticising the type of leg support which I had previously described,6 and I should like to comment on his remarks. The abtluction of the thighs is obtained without any obvious lordosis, but it is part of my design that this abduction can be varied to suit the operator’s requirements, and it can be reduced to any required degree. The popliteal vessels are not compressed by the canvas support, as this is quite effective when it reaches only half way up the calf of the leg. With regard to the access by the assistant to the field of operation, I have repeatedly asked those who help me their opinion about this, and I am told that they find this no difficulty and even welcome the support of the strut to lean on without actually putting their weight on the patient’s
leg. Mr. Goodwin’s photographs show very clearly those points which I have endeavoured to avoid, particularly with regard to excessive flexion of the hip-joint. This flexion predisposes to thrombosis and backache, and my anaathetist dislikes it 1. Bourne, G. H. Nature, Lond. 1957, 180, 1488. 2. Swan, H. J. C. Brit. med. J. 1952, i, 1003. 3. Bonica, J. J. J. Amer. med. Ass. 1957, 164, 732. 4. Davis, P. S. Med. Pr. 1957, 238, 77. 5. Dittrich, R. J. J. phys. Med. 1957, 20, 233. 6. Lancet, 1957, ii, 577.
General Hospital, Ashton-under-Lyne.
T. B. FITZGERALD.
Medicine and the Law Death from Barbiturate and Alcohol IN 1956, 223 people died in England and Wales of accidental barbiturate poisoning—compared with only 54 ten years previously. Death may result from a moderate dose of barbiturate if alcohol is taken as well.1 This was shown again at a Sutton inquest on March 18.2 had been under heavy pressure of work, family doctor, insomnia had been a considerable problem " to him; he was accustomed to taking up to four capsules a night of a barbiturate, which his doctor agreed was a fairly heavy dose. He was found dead in bed one morning, and analysis of his stomach contents indicated that he had taken only his usual dose of barbiturate; but a bottle of whisky bought the previous night was only a quarter full, and the housekeeper said she had never known him drink as much before. The coroner said that it was not as generally known as it should be that a dose of barbiturate that was not normally fatal might be fatal if taken with alcohol. A man,
aged 50,
and, according
"
his
to
A previous inquest indicated that methylpentynol is also dangerous in conjunction with barbiturate.3 1. See 2. See 3. See
Lancet, 1953, i, 1140; ibid. 1953, ii, 554. Liverpool Daily Post, March 19, 1958. Lancet, 1955, i, 1332.
Parliament QUESTION
TIME
Persomnia Mr. JOHN RANKIN asked the Minister of Health if he was aware of the growing feeling in medical circles that’ Persomnia’ should not be on free sale across the counter but only on the prescription of a registered medical practitioner.-Mr. DEREK WALKER-SMITH replied: I am aware of the publicity that has been given to this preparation and of its alleged abuse in certain I have no official reports upon it, but I am consulting cases. with the Home Secretary as to whether a further reference to the Poisons Board of bromvaletone and carbromal, the principal ingredients concerned, would be desirable in the light of such general information as is now available. Refunds for In six years been refunded
some
Prescription Charges
E3,200,000 for prescription charges has
through
the Post Office to
needy
persons.
Appointments PINKERTON, J. R. H., M.D. Cantab.: consultant pathologist, Boston group of hospitals, Lincolnshire. SHARPE, OLIVE, M.D. Sheff., M.R.C.P., D.c.H.: consultant paediatrician, Royal Liverpool Children’s Hospital. Colonial Appointments: ATKINSON, P. 1., M.B. Calcutta: M.o., Northern Region, Nigeria. BRAHMAN, A. P., M.B. Madras: M.o., British Guiana. CHICK, J. H., M.B.: M.o., Tanganyika. DIGGORY, H. J. P., M.B., D.T.M. & H.: M.o. (grade C), Trinidad. DONNELLY, J. P., L.R.C.P.I.: M.o. (grade B), institutions, Trinidad. MOITRA, N. G., M.D. Rome, D.M.R.E.: radiologist, Trinidad. SLAWINSKI, KAROL,
WATTS,
M. B..
M.B.
Beirut, T.D.D.: M.O., Sarawak. Lond., D.OBST., D.C.H.: M.O., Sarawak. M.D.
administering phenobarbitone, that the
quickly
success as
possible.
ADRENALINE CREAM rationale for the treatment of muscular SIR,- The rheumatism with adrenaline cream, which I first advocated ten years ago, was criticised on five counts: (1) Adrenaline could not be stabilised in a fatty base. (2) It could not penetrate the skin. (3) Even if it did so the amount would be too small to be effective. (4) If it did have any effect it would reduce the blood-supply to the muscles because it would constrict the arteries supplying them and not expand them, as I claimed. (5) There was no anatomical or physiological evidence for the claim that much of the pain of muscular rheumatism emanates from " trigger-spots "—localised areas of muscle in spasm.
It can now be are unfounded.
justly claimed
seriously
advantage of having worked with the type of illustrated by Mr. Goodwin as well as my own, and support I think if he is able to make a similar practical comparison, he will agree that the design I have suggested has certain definite advantages. I have the
DENNIS PIRRIE.
Lewes, Sussex.
because the pressure of the thighs on the abdomen interferes with respiratory movements.
that all these criticisms
(1) Pharmaceutical tests specially devised for the assay of adrenaline cream have proved it has a substantial shelf-life. (2) By histochemical methods, Bourne1 has demonstrated that adrenaline in a fatty base penetrates living skin rapidly. (3) Work at the National Institute for Medical Research proved that the action of adrenaline on the arterioles2 of skeletal muscle is peculiar in that it relaxes them. The concentrate required to produce this effect is astonishingly small. (4) Bonica3 has confirmed the existence of trigger spots and their responsibility for rheumatic pain. Other authorities 4s have expressed their agreement. The few and, in my opinion, perfunctory clinical trials of adrenaline cream have given equivocal results but it can surely be claimed that criticisms of the rationale, and particularly against the claim that adrenaline can penetrate the skin, are unjustified. LOUIS MOSS. Moss. London, W. 1. LEG SUPPORT FOR USE DURING VAGINAL OPERATIONS in Dr. Goodwin’s letter of was interested SIR,-I March 8 criticising the type of leg support which I had previously described,6 and I should like to comment on his remarks. The abtluction of the thighs is obtained without any obvious lordosis, but it is part of my design that this abduction can be varied to suit the operator’s requirements, and it can be reduced to any required degree. The popliteal vessels are not compressed by the canvas support, as this is quite effective when it reaches only half way up the calf of the leg. With regard to the access by the assistant to the field of operation, I have repeatedly asked those who help me their opinion about this, and I am told that they find this no difficulty and even welcome the support of the strut to lean on without actually putting their weight on the patient’s
leg. Mr. Goodwin’s photographs show very clearly those points which I have endeavoured to avoid, particularly with regard to excessive flexion of the hip-joint. This flexion predisposes to thrombosis and backache, and my anaathetist dislikes it 1. Bourne, G. H. Nature, Lond. 1957, 180, 1488. 2. Swan, H. J. C. Brit. med. J. 1952, i, 1003. 3. Bonica, J. J. J. Amer. med. Ass. 1957, 164, 732. 4. Davis, P. S. Med. Pr. 1957, 238, 77. 5. Dittrich, R. J. J. phys. Med. 1957, 20, 233. 6. Lancet, 1957, ii, 577.
General Hospital, Ashton-under-Lyne.
T. B. FITZGERALD.
Medicine and the Law Death from Barbiturate and Alcohol IN 1956, 223 people died in England and Wales of accidental barbiturate poisoning—compared with only 54 ten years previously. Death may result from a moderate dose of barbiturate if alcohol is taken as well.1 This was shown again at a Sutton inquest on March 18.2 had been under heavy pressure of work, family doctor, insomnia had been a considerable problem " to him; he was accustomed to taking up to four capsules a night of a barbiturate, which his doctor agreed was a fairly heavy dose. He was found dead in bed one morning, and analysis of his stomach contents indicated that he had taken only his usual dose of barbiturate; but a bottle of whisky bought the previous night was only a quarter full, and the housekeeper said she had never known him drink as much before. The coroner said that it was not as generally known as it should be that a dose of barbiturate that was not normally fatal might be fatal if taken with alcohol. A man,
aged 50,
and, according
"
his
to
A previous inquest indicated that methylpentynol is also dangerous in conjunction with barbiturate.3 1. See 2. See 3. See
Lancet, 1953, i, 1140; ibid. 1953, ii, 554. Liverpool Daily Post, March 19, 1958. Lancet, 1955, i, 1332.
Parliament QUESTION
TIME
Persomnia Mr. JOHN RANKIN asked the Minister of Health if he was aware of the growing feeling in medical circles that’ Persomnia’ should not be on free sale across the counter but only on the prescription of a registered medical practitioner.-Mr. DEREK WALKER-SMITH replied: I am aware of the publicity that has been given to this preparation and of its alleged abuse in certain I have no official reports upon it, but I am consulting cases. with the Home Secretary as to whether a further reference to the Poisons Board of bromvaletone and carbromal, the principal ingredients concerned, would be desirable in the light of such general information as is now available. Refunds for In six years been refunded
some
Prescription Charges
E3,200,000 for prescription charges has
through
the Post Office to
needy
persons.
Appointments PINKERTON, J. R. H., M.D. Cantab.: consultant pathologist, Boston group of hospitals, Lincolnshire. SHARPE, OLIVE, M.D. Sheff., M.R.C.P., D.c.H.: consultant paediatrician, Royal Liverpool Children’s Hospital. Colonial Appointments: ATKINSON, P. 1., M.B. Calcutta: M.o., Northern Region, Nigeria. BRAHMAN, A. P., M.B. Madras: M.o., British Guiana. CHICK, J. H., M.B.: M.o., Tanganyika. DIGGORY, H. J. P., M.B., D.T.M. & H.: M.o. (grade C), Trinidad. DONNELLY, J. P., L.R.C.P.I.: M.o. (grade B), institutions, Trinidad. MOITRA, N. G., M.D. Rome, D.M.R.E.: radiologist, Trinidad. SLAWINSKI, KAROL,
WATTS,
M. B..
M.B.
Beirut, T.D.D.: M.O., Sarawak. Lond., D.OBST., D.C.H.: M.O., Sarawak. M.D.