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BRITISH POSTGRADUATE MEDICAL SCHOOL
118 AMMONIUM CHLORIDE AS A DIURETIC
To the Editor
of
THE LANCET
paper on " A Mercurial (Novurit) Diuretic for Cardiac (Edema" Jan. (THE LANCET, 4th) Dr. Parkinson and Dr. Thomson also discuss the use of ammonium chloride as an adjuvant and mention that " there is difficulty in disguising its salty taste." This difficulty as well as the other drawback frequently seen with the use of ammonium chloride in the ordinary form-viz., the occurrence of digestive disturbances-have been overcome by the introduction in 1930 of a preparation called Gelamon, which has been prepared by Halpern under the auspices of Saxl and Erlsbacher and which contains the ammonium chloride in a special form. The main features are the adsorption of ammonium chloride on gelatin which is then hardened in formalin. When given in this form not only is the taste of ammonium chloride effectively disguised but also there is scarcely any incidence of indigestion, as gelamon is not, or only to a negligible extent, decomposed n the stomach. Since its introduction it has been used on a large scale in the First Medical Clinic of the University of Vienna, and on the ground of what I have seen in that hospital as well as in my private practice I can recommend it. Gelamon is manufactured as pastilles, each containing 0’4 g. of ammonium chloride ; 15 pastilles daily and spread over the day should be given (preferably after meals) during the 48 hours preceding the administration of the mercurial diuretic, during the day of the administration, and in some cases also during the first day following the administration. Our observation has been that not only can a considerable increase in the diuretic effect be obtained, but that also cases which did not respond to the administration of a mercurial diuretic or had become refractory may become responsive by means of the use of gelamon in the way indicated. I have been in communication with the makers of gelamon for the last few months and understand that gelamon will be obtainable in this country I am, Sir, yours faithfully, shortly. A. SCHOTT. Wimpole-street, W., Jan. 6th.
Sin,—In their Suppository as
a
AN ALUMINIUM KETTLE To the Editor of THE LANCET SiR,—Might I suggest to Dr. Elwell, whose letter appeared in your issue of Dec. 28th, that he should refer to a monograph I wrote in 1931, entitled the "Danger of Food Contamination by Aluminium," published by Messrs. John Bale, Sons and Danielsson, Ltd. In this he will see that I emphasised stiffness " as one of the most frequently recurring symptoms of aluminium artificially introduced into the system, and that I found this specially affected the back of the neck and head-similar symptoms, in fact, to those he describes in his patient. In the last five years, during which I have been working intensively on this subject from the clinical point of view, I have traced these symptoms in so many patients to aluminium that I can definitely assure Dr. Elwell that this metal was responsible in his particular case. I am, Sir, yours faithfully, R. M. LE HUNTE COOPER. "
Harley-street, W., Jan. 6th.
*** Dr. Elwell’s patient, who suffered from stiffness and pain in the back of the neck and head, had been in the habit of drinking daily some eight to ten breakfast cups of tea, the water for which was boiled in an aluminium kettle ; and the symptoms ceased
when the kettle was no longer used. Dr. Le Hunte Cooper is satisfied from similar experience of his own that aluminium was responsible in Dr. Elwell’s case, and he refers to a monograph which he wrote four years ago. At that time we found it difficult to attribute the groups of symptoms he described to the use of aluminium cooking vessels, especially as the work of the American authors whom he quoted in support of his deductions was not confirmed either in the U.S.A. or in this country. Dr. G. W. MonierWilliams, reviewing the subject last year for the Ministry of Health, agreed that there may be individuals who are susceptible even to small doses of aluminium, but found no conclusive evidence that this is so.-ED. L. BRITISH POSTGRADUATE MEDICAL SCHOOL THE organisation of the British Postgraduate Medical School provided for a dual teaching staff. There was to be a permanent and whole-time staff, usually referred to as " A staff," and a visiting and parttime staff referred to as " B staff." " B staff " were either to deliver courses of lectures or to take charge of wards for such periods as could be arranged. With the exception of a few lectures in the refresher courses, the whole work of the school since it began has been carried on by " A staff." With the beginning of the New Year a start will be made with the appointment of members to " B staff." To some extent the method by which the services of " B staff " can be utilised is at present experimental. It will be extended or altered in the light of requirements. In the department of medicine Lord Horder has agreed to take charge of a ward for a period of ten weeks from Feb. lst. During this period he will direct the work of the ward with the assistance of the permanent staff, and will conduct two teaching clinics weekly. He will be succeeded by Lord Dawson, who has consented to take charge of beds from May lst to July 15th. These clinics will be held on Wednesdays and Fridays from 2-4 P.M. In addition, the following courses of lectures have been arranged. Commencing on March 2nd Dr. Gordon Holmes, F.R.S., will give a course of lectures on cerebro-spinal syphilis. Subsequent courses of lectures are to be given by Dr. W. S. C. Copeman on arthritis, and Dr. R. A. Young on non-tuberculous pulmonary diseases. In the department of surgery Prof. E. W. Hey Groves will commence a series of lectures and demonstrations on fractures on Feb. 7th. These lectures will be given on Fridays commencing at 2.30 P.M. Later in the session Sir James Walton will lecture on the surgical treatment of dyspepsia, Sir Henry Gauvain on surgical tuberculosis, and Mr. Tudor Edwards on thoracic surgery. Each course will consist of about six lectures and will include some practical work as well as demonstrations of cases and of methods of treatment. During the course on surgical tuberculosis visits will be paid to Alton and Hayling Island. Full details of these courses will be published later. During the absence of Prof. G. Grey Turner at the International Surgical Congress in Cairo Sir Thomas Dunhill and Prof. G. E. Gask are in charge of the surgical wards and the clinical instruction of the school. Colonel L. W. Harrison has been appointed honorary consultant in venereal diseases at the school. ROYAL INFIRMARY, BRADFORD.-The board of management intend in the near future to institute a dermatological department at the New Royal Infirmary, Bradford, in connexion with which a new appointment of
dermatologist
will be made.
To the Editor
of
THE LANCET
paper on " A Mercurial (Novurit) Diuretic for Cardiac (Edema" Jan. (THE LANCET, 4th) Dr. Parkinson and Dr. Thomson also discuss the use of ammonium chloride as an adjuvant and mention that " there is difficulty in disguising its salty taste." This difficulty as well as the other drawback frequently seen with the use of ammonium chloride in the ordinary form-viz., the occurrence of digestive disturbances-have been overcome by the introduction in 1930 of a preparation called Gelamon, which has been prepared by Halpern under the auspices of Saxl and Erlsbacher and which contains the ammonium chloride in a special form. The main features are the adsorption of ammonium chloride on gelatin which is then hardened in formalin. When given in this form not only is the taste of ammonium chloride effectively disguised but also there is scarcely any incidence of indigestion, as gelamon is not, or only to a negligible extent, decomposed n the stomach. Since its introduction it has been used on a large scale in the First Medical Clinic of the University of Vienna, and on the ground of what I have seen in that hospital as well as in my private practice I can recommend it. Gelamon is manufactured as pastilles, each containing 0’4 g. of ammonium chloride ; 15 pastilles daily and spread over the day should be given (preferably after meals) during the 48 hours preceding the administration of the mercurial diuretic, during the day of the administration, and in some cases also during the first day following the administration. Our observation has been that not only can a considerable increase in the diuretic effect be obtained, but that also cases which did not respond to the administration of a mercurial diuretic or had become refractory may become responsive by means of the use of gelamon in the way indicated. I have been in communication with the makers of gelamon for the last few months and understand that gelamon will be obtainable in this country I am, Sir, yours faithfully, shortly. A. SCHOTT. Wimpole-street, W., Jan. 6th.
Sin,—In their Suppository as
a
AN ALUMINIUM KETTLE To the Editor of THE LANCET SiR,—Might I suggest to Dr. Elwell, whose letter appeared in your issue of Dec. 28th, that he should refer to a monograph I wrote in 1931, entitled the "Danger of Food Contamination by Aluminium," published by Messrs. John Bale, Sons and Danielsson, Ltd. In this he will see that I emphasised stiffness " as one of the most frequently recurring symptoms of aluminium artificially introduced into the system, and that I found this specially affected the back of the neck and head-similar symptoms, in fact, to those he describes in his patient. In the last five years, during which I have been working intensively on this subject from the clinical point of view, I have traced these symptoms in so many patients to aluminium that I can definitely assure Dr. Elwell that this metal was responsible in his particular case. I am, Sir, yours faithfully, R. M. LE HUNTE COOPER. "
Harley-street, W., Jan. 6th.
*** Dr. Elwell’s patient, who suffered from stiffness and pain in the back of the neck and head, had been in the habit of drinking daily some eight to ten breakfast cups of tea, the water for which was boiled in an aluminium kettle ; and the symptoms ceased
when the kettle was no longer used. Dr. Le Hunte Cooper is satisfied from similar experience of his own that aluminium was responsible in Dr. Elwell’s case, and he refers to a monograph which he wrote four years ago. At that time we found it difficult to attribute the groups of symptoms he described to the use of aluminium cooking vessels, especially as the work of the American authors whom he quoted in support of his deductions was not confirmed either in the U.S.A. or in this country. Dr. G. W. MonierWilliams, reviewing the subject last year for the Ministry of Health, agreed that there may be individuals who are susceptible even to small doses of aluminium, but found no conclusive evidence that this is so.-ED. L. BRITISH POSTGRADUATE MEDICAL SCHOOL THE organisation of the British Postgraduate Medical School provided for a dual teaching staff. There was to be a permanent and whole-time staff, usually referred to as " A staff," and a visiting and parttime staff referred to as " B staff." " B staff " were either to deliver courses of lectures or to take charge of wards for such periods as could be arranged. With the exception of a few lectures in the refresher courses, the whole work of the school since it began has been carried on by " A staff." With the beginning of the New Year a start will be made with the appointment of members to " B staff." To some extent the method by which the services of " B staff " can be utilised is at present experimental. It will be extended or altered in the light of requirements. In the department of medicine Lord Horder has agreed to take charge of a ward for a period of ten weeks from Feb. lst. During this period he will direct the work of the ward with the assistance of the permanent staff, and will conduct two teaching clinics weekly. He will be succeeded by Lord Dawson, who has consented to take charge of beds from May lst to July 15th. These clinics will be held on Wednesdays and Fridays from 2-4 P.M. In addition, the following courses of lectures have been arranged. Commencing on March 2nd Dr. Gordon Holmes, F.R.S., will give a course of lectures on cerebro-spinal syphilis. Subsequent courses of lectures are to be given by Dr. W. S. C. Copeman on arthritis, and Dr. R. A. Young on non-tuberculous pulmonary diseases. In the department of surgery Prof. E. W. Hey Groves will commence a series of lectures and demonstrations on fractures on Feb. 7th. These lectures will be given on Fridays commencing at 2.30 P.M. Later in the session Sir James Walton will lecture on the surgical treatment of dyspepsia, Sir Henry Gauvain on surgical tuberculosis, and Mr. Tudor Edwards on thoracic surgery. Each course will consist of about six lectures and will include some practical work as well as demonstrations of cases and of methods of treatment. During the course on surgical tuberculosis visits will be paid to Alton and Hayling Island. Full details of these courses will be published later. During the absence of Prof. G. Grey Turner at the International Surgical Congress in Cairo Sir Thomas Dunhill and Prof. G. E. Gask are in charge of the surgical wards and the clinical instruction of the school. Colonel L. W. Harrison has been appointed honorary consultant in venereal diseases at the school. ROYAL INFIRMARY, BRADFORD.-The board of management intend in the near future to institute a dermatological department at the New Royal Infirmary, Bradford, in connexion with which a new appointment of
dermatologist
will be made.