ARTIFICIAL PNEUMOTHORAX

268 PHARMACY OF SODIUM p-AMINOSALICYLATE SiB,—I should like to comment on some of Dr. O’Connor’s observations in his letter of Jan. 31. The preparations referred to in my articlewere made in November, 1946, using some of the first material produced in this country ; and I am well aware that it was far from pure. Actually two samples, which differed in purity, were then obtained, and the less pure one dark brown, odorous powder which was not was a considered fit to use. The other sample, as described in my paper, consisted of cream-coloured crystals melting at 140°C (with decomposition). A recent sample obtained from Ward, Blenkinsop’s laboratories, which was a white crystalline powder and presumably intended to be the pure material, was also found to have a melting-point of 139-141°C (with decomposition)-not 150°C as Dr. O’Connor states. Several readings were taken by different A further sample workers to make certain of this. obtained recently from another firm was found to undergo some decomposition at 137 °C, but did not finally melt until 150°C. With regard to the method of preparation of the sodium salt, when my experiments were made there was no information in this country on the pharmacy of the drug, Lehmann’s paper merely stating that a 10 % The method then aqueous solution had been used. evolved was thought to be the most rational in the light of existing knowledge of the compound’s properties. I consider that Dr. O’Connor’s sweeping statements about the deleterious effects of strong alkalis should be substantiated by figures showing the difference in activity between solutions prepared by different methods, with details of the tests used. He states that excess alkali causes hydrolysis, but I fail to see what hydrolysis of the sodium salt can occur in alkaline solution. I have learned from later work that decarboxylation does occur on heating the drug, and I agree that autoclaving is not the best method of sterilisation, since after this treatment the pH of the solution rises to about 8. I doubt whether much decomposition takes place when the solution is in sealed ampoules and carbon dioxide "" cannot escape. Nevertheless, filtration appears to be the method of choice. The drug undoubtedly shows much promise, and, since most of the clinical work so far reported has been done with the brown " impure " preparations, Dr. O’Connor’s statement that solutions must be practically water-clear to be fully active cannot be accepted without further proof. It would be unfortunate if the value of the drug were reduced by faulty pharmaceutical technique, and further work is therefore essential. T. D. WHITTET University College Hospital, Chief Pharmacist. London, W.C.1. ARTIFICIAL PNEUMOTHORAX SIR,-The article by Dr. Maclean and Dr. Gemmill (Jan. 31) is of considerable interest to clinicians who have to cope with large numbers of patients in need of active treatment and for whom there is no immediate prospect of a sanatorium or hospital vacancy. Indeed, the present position (6 or more months’ wait before admission in many areas) compels a reorientation of outlook, and attention has naturally been increasingly focused on the possibilities of outpatient treatment. It has become obvious that a good deal can be accomplished, given certain limited resources. These include the reservation of hospital beds for the tuberculosis officer (under his direct control) ; means whereby a phrenic crush can be readily and competently performed ; an efficient car-hire service ; and the supply of home helps where needed. While it is of course perfectly feasible to initiate activetreatment in the patient’s own home, I feel that it is better that primary procedures should be undertaken in hospital, where facilities are better, especially in the event of an emergency. Refills can be performed either at home or in the clinic-preferably the latter since X-ray screening at fairly short intervals is desirable. It is as well, perhaps, to re-emphasise that pneumothorax therapy requires very particular care both in the selection of cases and in management, even under 1. Whittet, T. D.

hospital conditions. The dangers are tuu grave to be overlooked, and the fact that 3 patients died from spontaneous pneumothorax in the relatively small Glasgow series is a salutary reminder of the possible pitfalls. Fluid formation, with the ever-present risk

of empyema, is the other serious consideration. In view of the not inconsiderable risks associated with " outpatient" pneumothorax therapy many clinicians have resorted rather more often to diaphragmatic elevation by means of pneumoperitoneum, with on without supplementary phrenic crush, as a safer and more reliable method of active treatment for the patient with early cavitation. The results are often extremely satisfactory and serious complications are comfortingly rare.. The combination of diaphragmatic elevation and bed rest is in fact particularly suitable for many recently diagnosed cases of pulmonary tuberculosis, and while not in itself necessarily all that is required, it has at any rate the advantage of placing the patient in a more favourable position for subsequent measures should these prove necessary. Finally, for outpatient treatment the clinic staff must be sufficient ; and additional medical assistance may be required. NORMAN MACDONALD. Redhill Chest Clinic, Edgware, Mddx. ’

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SiB,—In your annotation on breast-feeding (Jan. 31) mention is made of shields to improve malformations of the nipple. I am said to " quaintly term " these " a ; simple orthopaedic appliance." But they are simple tù use ; they are applied to the breasts ; and my dictionary gives as a definition of orthopedics " the correction or ’ prevention of deformities in children, or in persons of any age." My description is thus accurate ; there is nothing quaint about it. I am so much in agreement with all the rest of the annotation that I trust you will not think me merely , touchy in asking leave to contradict your annotator on this point. But I fear his wording may produce an unfavourable impression of the appliance’s usefulness. HAROLD WALLER. Tunbridge Wellp.

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TEACHING APPOINTMENTS

SiR,-" M.R.C.P." chose badly when he instanced (Dec. 27) Sir William Osler’s career to support the case against appointing laboratory-trained workers to clinical teaching posts. As a young man of 28, and though a laboratory worker by training and experience, Osler was appointed professor of medicine at McGill. Osler spoke of it thus’: " Four years in the post-mortem room of the general hospital, with clinical work during the smallpox epidemic, seemed to warrant the Governors of the general hospital ’

in appointing me, in 1878, full physician, over the heads -it seems scandalous to me now—of the assistant physicians. The day of the election I left for London to take my M.R.C.P. and to work at clinical medicine."

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Three months later Osler started his career as a clinical teacher, simultaneously directing the newly That Osler was a opened physiological laboratory. successful teacher of medicine is beyond dispute ; in the 1870’s he could hardly have been a biochemist, but I think, we must count him a good lab. man. R. M. MAYON-WHITE. Cambridge.

TREATMENT OF LEPROSY the SIR,—At meeting of the Royal Society of Tropical Medicine and Hygiene reported in your issue of Jan. 31. several speakers directed attention to the lack of hospital facilities for people suffering from leprosy in this country. Emphasising this, the President, according to your report. said that in the past there was limited accommodation for lepers at the Seamen’s Hospitals but that such accommodation was nc. longer available. While agreeing that suitable accommodation for lepers is inadequate I think the remarks quoted do an injustice to the Seamen’s Hospital Society. During the last two years to my 1. Gushing, H.

Pharm. J. 1947, 105, 133.

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p. 166.

Life of Sir William Osler.

Oxford. 1925;

vol.

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