CHRISTMAS GIFTS

CHRISTMAS GIFTS

585 Letters to previously treated with penicillin had been given either no intrathecal penicillin or intrathecal injections in inadequate amounts. ...

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585

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previously treated with penicillin had been given either no intrathecal penicillin or intrathecal injections in inadequate amounts. The one case (no. 2) which had adequate penicillin-sulphonamide treatment was proved to have a sterile c.s.F. before commencing streptomycin therapy. It is an open question, however, whether in this case complete restoration of health might not have resulted if streptomycin treatment had been started

the Editor

CHRISTMAS GIFTS SiR,—I appeal once more to members of the medical on others profession to help those who are dependent the for extra comforts. The beneficiaries of Royal Medical Benevolent Fund are in such a case. They are either aged or infirm practitioners, their wives, widows, or children, and, through no fault of their own, find themselves in need of help. I hope that subscribers to the fund will send donations to provide a little extra cheer at Christmas time, and I earnestly beg those who are not subscribers, not only to send Christmas.gifts but to become regular supporters of the fund. A special effort to obtain new subscriptions is urgently necessary because certain medical bodies, such as the panel committees, which used to make generous contributions, have gone out of existence with the National Health Service Act. Donations and subscriptions, marked " Christmas Gifts," should be sent to the Secretary of the Royal Medical Benevolent Fund, 1, Balliol House, Manor Fields, Putney, London, S.W.15, and will be gratefully

earlier in the illness. This comment is not intended to make a case for combined penicillin-sulphonamide treatment as against streptomycin therapy either alone or combined. All one is justified in saying at this juncture is that there seem to be special merits in each of the proposed forms of treatment. Further comparative work appears necessary for the evaluation of and the definition of indications for the various methods of therapy now available. K. ZINNEMANN.

Bacteriology Dept., School

of

Medicine, Leeds.

PROPRIETARY MEDICINES UNDER THE ACT SiR,—Mr. Godding’s article of Sept. 18 (p. 465) is interesting, but it leaves out many aspects of the case. First, I believe that the machinery for investigating excessive prescribing under rt.A.. was prompted by the acknowledged. WEBB-JOHNSON fixing of a total limit to the drug fund, and when the chemists’ accounts rose above this figure they were only President, Royal Medical Benevolent Fund. paid part. Consequently the chemists were particularly EXSANGUINO-TRANSFUSION IN ACUTE keen to see that the cost came down. Nevertheless, is there any evidence that this machinery has been abused LEUKÆMIA and tended to prevent proper medical treatment ? What SiB,—Dr. Maycock (Sept. 18) does not understand about the cases on adrenal cortical extract running into what I that " it is made the statement grounds on of pounds per annum per case ? In one of hundreds impossible to obtain very large quantities of blood at these cases the doctor wrote to the insurance committee any one time in England." My reason was a simple one : before prescribing and was assured that he could order the attempt was made and was unsuccessful. True this. Consequently I feel. that the manufacturers of enough, I did not apply to any of the regional transfusion proprietary preparations of the highest ethical standing. centres : I left that to a junior colleague. of this type have little cause for apprehension. If Dr. Maycock had read my preliminary communicaBut there is another class of preparation. The tion, he could not have failed to notice that I emphasised Chemists’ Federation appears to be trying to impose as far is the beneficial effect as that, yet known, standards on preparations it admits to its list, which are of exsanguination-transfusion is only temporary; but, of course less rigid in the case of ethical proprietary nevertheless, the fact that remission does occur suggests preparations because the doctor is expected to examine a number of fresh avenues of research. their formulae, &c., more closely than an uneducated I am, of course, grateful to Dr. Maycock for reminding patient would do. It does not, however, so far as I know, me of the difficulty of getting certain groups, but I must claim to have vetted all the previous inclusions to the assert that I am well aware of the elementary facts he list by the same measure, and, seeing that the federation so clearly sets out. It is, of course, true that the decision was principally founded both for price-protection and to try exsanguino-transfusion in acute leukaemia is limitation of sale of medicines to it cannot always a difficult one ; and, in fact, much of the onus completely serve both masters-i.e.,chemists, the trade and the has to be placed on the relatives. But what is meant by The question of standards should medical saying that " exsanguination-transfusions should always be dealt profession. with a separate body, free from criticism by be deliberately planned in consultation with the regional on this score, on the lines of the American Medical blood-transfusion officer " I frankly do not know. Surely, Association arrangement. it is the task of the physician to plan the treatment, Personally I am more interested in the standing of the always, of course, subject to the availability of the makers than in prescribing a proprietary article. If, for the blood. present case, therapeutic agent-in I order sulphanilamide I do not mind whose instance, A. PINEY. W.1. make is supplied, provided it is a reliable firm possessing full facilities to ensure that the preparation is proper. H. INFLUENZÆ MENINGITIS TREATED WITH I do not like a mixture of say quinine sulphate and STREPTOMYCIN quinine alkaloid being supplied for quinine alkaloid, SiR,—There are two statements in Dr. Smythe’s whatever the explanation of the offending firm; but here we are getting off the question of proprietary otherwise admirable paper of Sept. 25 which may lead to medicines. some misunderstanding regarding the value of penicillin Nor do I like the guarding which still occurs in the treatment in this condition. On p. 485 he writes, with regard to the 12 cases referred to the London Hospital formulae of some proprietary preparations. I am referring for streptomycin treatment : " In 10 of them penicillin to ingredients not in the B.P. or B.P.C. which on close or sulphonamides had. been administered before admisexamination appear to be extracts of mistletoe and sion ; but these drugs had not controlled the infection the like. What evidence is there that they have any and H. influenzce was still present in the cerebrospinal therapeutic effect ? fluid or blood." The interest of the federation is to promote the sale 490 contains the statement : Page " Though penicillin combined with sulphonamides does of its members’ proprietary articles. Is this the real not appear to be so effective as streptomycin it may yet interest of pharmacy ? If practitioners are to be prove useful in combined therapy." encouraged to prescribe proprietary preparations then From this it would appear (1) that adequate penicillin there is little necessity for pharmacists to be properly treatment had been given to 10 of 12 cases and that this and it is in effect a further development of trained, " form of treatment had failed where streptomycin sucmultiple " pharmacy. Should the chemist be encouraged ceeded ; and (2) that combined penicillin-sulphonamide to keep the raw materials in stock so that he can make, treatment is inferior to streptomycin therapy either on demand, the exact preparation required by the doctor, alone or combined. Neither of these assumptions is charging more for extemporaneous manufacture ? Or substantiated in Dr. Smythe’s or any other paper should he make the patient wait and obtain the preparapublished hitherto. As regards (1) it is evident from tion ready finished from his supplier ? The outcome of this argument is obvious, and is indeed partially the case-histories given that 7 out of the 8 cases HC

London,

.