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B.C.G. PLUS PROTEASE I IN MALIGNANT MELANOMA
148 in the androgen group. Adjuvant androgen therapy seems to enhance the patient’s tolerance of chemotherapy and thus improves the therapeutic potential of cytotoxic agents. The report4 that androgens stimulate the proliferation of granulocyte precursor in mouse bone-marrow accords with our clinical observations. Department of Medicine, University of Minnesota School of Medicine,
Minneapolis, Minnesota 55455, U.S.A.
DAVID T. KIANG A. THEOLOGIDES I. FORTUNY B. J. KENNEDY.
similar recommendation has been made for a Minister in no action is forthcoming from the Government. One can only feel dismay that the Commons have finally succeeded in overcoming their more enlightened colleagues in the Lords and rejected a free family-planning service. a
Britain, but
Royal Infirmary, Edinburgh EH3 9YW.
D. M. PARKIN.
FLUOROCARBON PROPELLANTS IN AEROSOLS
B.C.G. PLUS PROTEASE I IN MALIGNANT MELANOMA SIR,- The findings of Professor Thornes and his colleagues (June 16, p. 1386) corroborate work I have been doing with transfer factor combined with B.c.G. vaccine. In my technique, transfer factor replaces brinase with its toxic effects. In 2 severely immunosuppressed patients with seronegative late-stage systemic lupus, B.C.G. vaccine was given in an attempt to improve cellular immunity. In both cases all 4 screening skin tests were negative. A series of six to eight B.C.G. injections was
poorly tolerated and produced virtual abscess formation. The purified-protein-derivative skin tests remained negative. These patients then received transfer factor from an ABO compatible donor. Neither of the donors had a positive tuberculin skin test, although both had skin tests positive to either one or all of Candida albicans, trichophyton, and mumps. Four days after receiving transfer factor the recipients were retested. Both had strongly positive tuberculin reactions with vesiculation. One was strongly positive seven weeks after transfer factor. The other remained so up to five weeks after transfer factor. Follow-up was lost. The third patient with stage-in malignant melanoma was totally anergic. This patient had received a series of B.C.G. vaccine, both intradermally and by the grid-scratch method of Mathé. Intratumour injections were given weekly. The patient evidenced no inflammatory reaction at any B.C.G. site. This was carried out over a period of three months. Repeated skin tests showed total anergy to the four antigens. The patient then received transfer factor from his mother, who carried a negative tuberculin skin test, a 3 cm. flare, and induration to mumps, although negative to monilia and trichophyton. Four days later this patient developed positive P.P.D. skin tests with 12 mm. induration. Seven weeks later it was still positive. The mumps skin test also became positive. B.C.G. vaccinations now produced, for the first time in three months, active inflamThe palm-sized group of chronic B.c.G. matory reactions. abscesses in the s.L.E. patient was 75% healed in two weeks.
From my observations, B.c.G. vaccinations at weekly intervals for at least one month, followed by transfer factor, will result in positive P.P.D. cellular immune response. The toxicity of brinase is avoided. Rockwood Clinic, 312 West 8th Avenue,
Spokane, Washington 99204, U.S.A.
S. K. MCILVANIE.
POPULATION AND THE N.H.S. BILL
SIR,-How interesting to see in your issue of July 7 an editorial (p. 29) on population problems and an account (p. 37) of the fate of the Lords’ amendment to the N.H.S. Bill. The restraints on population growth in the world are the ultimately limited amounts of food and natural resources which can be made available. Since Britain already consumes much more of these than Bangladesh, and Britain’s population continues to grow, it ill becomes us to urge population control there, whilst taking no action at home. UNROD recommends a Ministry of Population Affairs:
Reorganisation
4.
Canellos,
G.
P., Hess, S. M. Clin. Res. 1973, 21, 643.
SIR,-Dr Silverglade (June 9, p. 1325) mentions some on the subject of the cardiotoxicity of fluorocarbon compounds used as aerosol propellants. He con18 articles
cluded that the weight of evidence attests to both the safety and efficacy of the pressurised bronchodilator aerosols when properly used. Some of the articles, however, emphasise that the aerosol propellant compounds such as dibromotetrafluoroethane or trichlorofluoromethane are closely related in structure to halogenated hydrocarbons used in anaesthesia, such as halothane or chloroform. A degree of concern1 has been expressed about the inhalation of trace levels of halogenated anaesthetics by theatre workers, as this chronic exposure might be implicated in explaining the various abnormalities revealed in statistical surveys. If the halothane which is absorbed by theatre workers to blood-levels 2,3 of around 100 jg. per 100 ml. can be suspected of producing spontaneous abortions4 or liver damage, surely aerosol propellants with a very similar chemical structure and absorbed to equal or higher bloodlevels 5,6 must also be suspect ? Department of Clinical Physics and Bio-engineering, Western Regional Hospital Board, 11 West Graham Street, Glasgow G4 9LF.
IAN B. MONK.
DISPOSABLE SYRINGES FOR DIABETICS
SIR,-Regarding this correspondence (May 19, p. 1130; July 7, p. 41; and June 16, p. 1381) I should like to point out that, although disposable syringes are not generally diabetics on the National Health Service, in exceptional cases, where the general practitioner considers that disposable syringes and needles are needed on medical grounds, they can be obtained through hospitals, with the This applies agreement of the consultant concerned. chiefly to diabetic children, who often find the disposable syringes easier to manipulate. The British Diabetic Association has made several pleas to the Department of Health and Social Security for the provision of disposable syringes for diabetics generally on the National Health Service, but the decision of the Department remains that the expenditure involved cannot available
be
to
justified.
In answer to Professor Dundee (June 16, p. 1381), I should like to point out that a plastic spirit-proof container for the glass insulin syringe is now available on the National Health Service, which obviates the need for frequent 1. 2.
3. 4. 5. 6.
Lancet, 1972, ii, 519. Hallén, B., Ehrner-Samuel, H., Thomason, M. Acta anœth. scand. 1970, 14, 17. Nikki, P., Pfäffli, P., Ahlman, K. Lancet, 1972, ii, 490. Götell, P., Sundell, L. ibid. p. 424. Dollery, C. T., Draffan, G. H., Davies, D. S., Williams, F. M., Conally, M. E. ibid. 1970, ii, 1164. Paterson, J. W., Sudlow, M. F., Walker, S. R. ibid. 1971, ii, 565.
Minneapolis, Minnesota 55455, U.S.A.
DAVID T. KIANG A. THEOLOGIDES I. FORTUNY B. J. KENNEDY.
similar recommendation has been made for a Minister in no action is forthcoming from the Government. One can only feel dismay that the Commons have finally succeeded in overcoming their more enlightened colleagues in the Lords and rejected a free family-planning service. a
Britain, but
Royal Infirmary, Edinburgh EH3 9YW.
D. M. PARKIN.
FLUOROCARBON PROPELLANTS IN AEROSOLS
B.C.G. PLUS PROTEASE I IN MALIGNANT MELANOMA SIR,- The findings of Professor Thornes and his colleagues (June 16, p. 1386) corroborate work I have been doing with transfer factor combined with B.c.G. vaccine. In my technique, transfer factor replaces brinase with its toxic effects. In 2 severely immunosuppressed patients with seronegative late-stage systemic lupus, B.C.G. vaccine was given in an attempt to improve cellular immunity. In both cases all 4 screening skin tests were negative. A series of six to eight B.C.G. injections was
poorly tolerated and produced virtual abscess formation. The purified-protein-derivative skin tests remained negative. These patients then received transfer factor from an ABO compatible donor. Neither of the donors had a positive tuberculin skin test, although both had skin tests positive to either one or all of Candida albicans, trichophyton, and mumps. Four days after receiving transfer factor the recipients were retested. Both had strongly positive tuberculin reactions with vesiculation. One was strongly positive seven weeks after transfer factor. The other remained so up to five weeks after transfer factor. Follow-up was lost. The third patient with stage-in malignant melanoma was totally anergic. This patient had received a series of B.C.G. vaccine, both intradermally and by the grid-scratch method of Mathé. Intratumour injections were given weekly. The patient evidenced no inflammatory reaction at any B.C.G. site. This was carried out over a period of three months. Repeated skin tests showed total anergy to the four antigens. The patient then received transfer factor from his mother, who carried a negative tuberculin skin test, a 3 cm. flare, and induration to mumps, although negative to monilia and trichophyton. Four days later this patient developed positive P.P.D. skin tests with 12 mm. induration. Seven weeks later it was still positive. The mumps skin test also became positive. B.C.G. vaccinations now produced, for the first time in three months, active inflamThe palm-sized group of chronic B.c.G. matory reactions. abscesses in the s.L.E. patient was 75% healed in two weeks.
From my observations, B.c.G. vaccinations at weekly intervals for at least one month, followed by transfer factor, will result in positive P.P.D. cellular immune response. The toxicity of brinase is avoided. Rockwood Clinic, 312 West 8th Avenue,
Spokane, Washington 99204, U.S.A.
S. K. MCILVANIE.
POPULATION AND THE N.H.S. BILL
SIR,-How interesting to see in your issue of July 7 an editorial (p. 29) on population problems and an account (p. 37) of the fate of the Lords’ amendment to the N.H.S. Bill. The restraints on population growth in the world are the ultimately limited amounts of food and natural resources which can be made available. Since Britain already consumes much more of these than Bangladesh, and Britain’s population continues to grow, it ill becomes us to urge population control there, whilst taking no action at home. UNROD recommends a Ministry of Population Affairs:
Reorganisation
4.
Canellos,
G.
P., Hess, S. M. Clin. Res. 1973, 21, 643.
SIR,-Dr Silverglade (June 9, p. 1325) mentions some on the subject of the cardiotoxicity of fluorocarbon compounds used as aerosol propellants. He con18 articles
cluded that the weight of evidence attests to both the safety and efficacy of the pressurised bronchodilator aerosols when properly used. Some of the articles, however, emphasise that the aerosol propellant compounds such as dibromotetrafluoroethane or trichlorofluoromethane are closely related in structure to halogenated hydrocarbons used in anaesthesia, such as halothane or chloroform. A degree of concern1 has been expressed about the inhalation of trace levels of halogenated anaesthetics by theatre workers, as this chronic exposure might be implicated in explaining the various abnormalities revealed in statistical surveys. If the halothane which is absorbed by theatre workers to blood-levels 2,3 of around 100 jg. per 100 ml. can be suspected of producing spontaneous abortions4 or liver damage, surely aerosol propellants with a very similar chemical structure and absorbed to equal or higher bloodlevels 5,6 must also be suspect ? Department of Clinical Physics and Bio-engineering, Western Regional Hospital Board, 11 West Graham Street, Glasgow G4 9LF.
IAN B. MONK.
DISPOSABLE SYRINGES FOR DIABETICS
SIR,-Regarding this correspondence (May 19, p. 1130; July 7, p. 41; and June 16, p. 1381) I should like to point out that, although disposable syringes are not generally diabetics on the National Health Service, in exceptional cases, where the general practitioner considers that disposable syringes and needles are needed on medical grounds, they can be obtained through hospitals, with the This applies agreement of the consultant concerned. chiefly to diabetic children, who often find the disposable syringes easier to manipulate. The British Diabetic Association has made several pleas to the Department of Health and Social Security for the provision of disposable syringes for diabetics generally on the National Health Service, but the decision of the Department remains that the expenditure involved cannot available
be
to
justified.
In answer to Professor Dundee (June 16, p. 1381), I should like to point out that a plastic spirit-proof container for the glass insulin syringe is now available on the National Health Service, which obviates the need for frequent 1. 2.
3. 4. 5. 6.
Lancet, 1972, ii, 519. Hallén, B., Ehrner-Samuel, H., Thomason, M. Acta anœth. scand. 1970, 14, 17. Nikki, P., Pfäffli, P., Ahlman, K. Lancet, 1972, ii, 490. Götell, P., Sundell, L. ibid. p. 424. Dollery, C. T., Draffan, G. H., Davies, D. S., Williams, F. M., Conally, M. E. ibid. 1970, ii, 1164. Paterson, J. W., Sudlow, M. F., Walker, S. R. ibid. 1971, ii, 565.