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HALLUX VALGUS
937
Among more than fifty compounds screened as possible prophylactics against isoniazid acute toxicity in mice, only barbiturates and some related central depressant agents appeared to offer therapeutically useful protection. Certain tliiol compounds, including dimercaprol (BAL), offered only a transient suppressive action in high doses. A large series of other agents, which included carbohydrate metabolites, amino-acids, and vitamins, failed to protect mice unequivocally against the acute toxic effects of isoniazid. These results are to be published in
SPECIALISTS AND PRACTITIONERS SIR,-A consultant has said it. Sir Heneage Ogilvie, in his most stimulating address (Oct. 25, p. 820), has in the present system clearly shown the dangers inherent of selecting specialists and the evils of over-specialisation. He sees the general practitioner as the one remaining member of the health service with enough general medical knowledge to view the patient as a whole. Thoughtful general practitioners will go a step further. If the present trend in the hospital world continues and the practitioner allows himself to become, as fear, many a sorting clerk to the hospital departments, will not the sick person be completely submerged in the deep waters of scientific medicineThose of us who have watched the flow of the tide have been in no doubt as to the outcome, and we have tried to meet it as best we Hence the clamour for increased status for the can. general practitioner ; hence the call for a College of General Practitioners. With the extinction of the great race of general physicians and surgeons-an extinction which seems inevitable-a vacuum will be formed which only the general practitioner can fill. To fill this gap with distinction-nay, even with ordinary competence-the general practitioner must prove his skill ; he must have freedom to use some hospital beds, access to pathological and radiological services, and, further, a corporate body to encourage and help him with advice and example. We should all be profoundly grateful to Sir Heneage Ogilvie for putting the case so clearly. R. M. S. MCCONAGHEY. Dartmouth.
detail elsewhere at
general
VITAMIN
B12
AND ISONIAZID
SIR,-Recently Ata and Tanakareported that a subcutaneous injection of vitamin Bl2 (0-30 mg. per kg. body-weight) appreciably diminished the acute toxicity of isoniazid in mice. In their experiments a definite increase in the subcutaneous L.D.50 dose of isoniazid was obtained when the above-mentioned dose of Bl2 was administered thirty minutes after the isoniazid injection. We have been unable to confirm their results using aqueous solutions of crystalline vitamin Bl2’ Even a 16-fold increase in the dose of Bl2 failed to protect against the acute toxic effects of isoniazid in male albino mice. Isoniazid was administered as a 2% aqueous solution and vitamin Bl2 was injected as a 0.002 or 0.032% aqueous solution. The Bl2 test solutions were checked for qualitative and quantitative content by infra-red and ultraviolet absorption measurements. Dose volumes of the Bl2 solutions injected were 0-30 ml. per 20 g. body-weight. Isoniazid control mice received equivalent volumes of physiological saline subcutaneously instead of B12 solution. The results are shown in the following table : EFFECT OF VITAMIN
19/20
B12 ON TOXICITY OF ISONIAZID IN ALBINO MICE
confidence limits 2 indicated in
parentheses.
Neither of the two
significantly
B12-isoniazid L.D.õo doses differed from the saline-isoniazid L.D.õo’
1. Ata, S., Tanaka, K. Lancet, Sept. 20, 1952, p. 589. 2. Litchfield, J. T. jun., Wilcoxon, F. J. Pharmacol.
a
later date.
Squibb Institute for Medical Research, New Brunswick, N.J., U.S.A.
BERNARD RUBIN JOHN C. BURKE.
HALLUX VALGUS
SiR,ŁI have read with great interest the article by
Hardy and Mr. Clapham.1 Here in the South of Madagascar I have very often observed hallux valgus in older people who have never worn shoes ; it is almost always associated with flat-feet. I have never seen hallux valgus in people under 20 years of age. Dr.
B. KALCEV.
Betioky, Madagascar.
WITHDRAWAL OF TEACHING SiR,-I agree that, as you implied in your leading article on Oct. 11, the abolition of the travelling film units of the Central Office of Information is an example
of
" penny wise and pound foolish." During the last few years the Ministry of Health has produced six films on the early diagnosis of cancer, specially in order to help general practitioners. These films, which were described in your leading article, have been shown at conferences in many European countries and in Africa, where they were much admired ; but I have not yet met a general practitioner in England ..
who has seen one of them, and to make matters worse the Central Film Library has removed the copies from the film department of the British Medical Association. I do not know how much money was spent in producing these films ; but if they are not circulated and seen by the practitioners of this country, the money has been
largely wasted. MALCOLM DONALDSON Chairman, Medical Committee,
London, W.14.
Scientific Film Association.
SiR,-May I join with Dr. Cardew in admiring your leading article on the damage done by the withdrawal of the C.O.I. mobile projection units and the Crown Film Unit. When the blow fell I wrote to the Times drawing attention to the fact that the harm would be felt most severely by those groups, whether of nurses or small study groups, whose financial resources are smallest and whose need for the broadening effects of the film is
greatest. Dr. Cardew pointed out that the money, time, and labour required to make a film, although great, are justifiably expended because the results can be shown to audiences all over the country for as long as the subject remains of interest. An elaborate and expensive film dealing with details of treatment, whether surgical or medical, is likely to have a much shorter useful life than a descriptive film dealing with the clinical appearances of a disorder. In other words, although it is relatively easy to make a well-composed film about a surgical operation, the time and trouble might be better spent tackling the more difficult subject of making films which would increase the clinical experience of medical students, and
improve their diagnostic ability. One wants to record the clinical history of rare disorders. I think the last cases of tetanus seen at Guy’s were in 1948 and seven earlier than that. Many so
years
1949, 96, 99.
1.
Hardy, R. H., Clapham, J. C. R. Lancet, 1952, i, 1180.
Among more than fifty compounds screened as possible prophylactics against isoniazid acute toxicity in mice, only barbiturates and some related central depressant agents appeared to offer therapeutically useful protection. Certain tliiol compounds, including dimercaprol (BAL), offered only a transient suppressive action in high doses. A large series of other agents, which included carbohydrate metabolites, amino-acids, and vitamins, failed to protect mice unequivocally against the acute toxic effects of isoniazid. These results are to be published in
SPECIALISTS AND PRACTITIONERS SIR,-A consultant has said it. Sir Heneage Ogilvie, in his most stimulating address (Oct. 25, p. 820), has in the present system clearly shown the dangers inherent of selecting specialists and the evils of over-specialisation. He sees the general practitioner as the one remaining member of the health service with enough general medical knowledge to view the patient as a whole. Thoughtful general practitioners will go a step further. If the present trend in the hospital world continues and the practitioner allows himself to become, as fear, many a sorting clerk to the hospital departments, will not the sick person be completely submerged in the deep waters of scientific medicineThose of us who have watched the flow of the tide have been in no doubt as to the outcome, and we have tried to meet it as best we Hence the clamour for increased status for the can. general practitioner ; hence the call for a College of General Practitioners. With the extinction of the great race of general physicians and surgeons-an extinction which seems inevitable-a vacuum will be formed which only the general practitioner can fill. To fill this gap with distinction-nay, even with ordinary competence-the general practitioner must prove his skill ; he must have freedom to use some hospital beds, access to pathological and radiological services, and, further, a corporate body to encourage and help him with advice and example. We should all be profoundly grateful to Sir Heneage Ogilvie for putting the case so clearly. R. M. S. MCCONAGHEY. Dartmouth.
detail elsewhere at
general
VITAMIN
B12
AND ISONIAZID
SIR,-Recently Ata and Tanakareported that a subcutaneous injection of vitamin Bl2 (0-30 mg. per kg. body-weight) appreciably diminished the acute toxicity of isoniazid in mice. In their experiments a definite increase in the subcutaneous L.D.50 dose of isoniazid was obtained when the above-mentioned dose of Bl2 was administered thirty minutes after the isoniazid injection. We have been unable to confirm their results using aqueous solutions of crystalline vitamin Bl2’ Even a 16-fold increase in the dose of Bl2 failed to protect against the acute toxic effects of isoniazid in male albino mice. Isoniazid was administered as a 2% aqueous solution and vitamin Bl2 was injected as a 0.002 or 0.032% aqueous solution. The Bl2 test solutions were checked for qualitative and quantitative content by infra-red and ultraviolet absorption measurements. Dose volumes of the Bl2 solutions injected were 0-30 ml. per 20 g. body-weight. Isoniazid control mice received equivalent volumes of physiological saline subcutaneously instead of B12 solution. The results are shown in the following table : EFFECT OF VITAMIN
19/20
B12 ON TOXICITY OF ISONIAZID IN ALBINO MICE
confidence limits 2 indicated in
parentheses.
Neither of the two
significantly
B12-isoniazid L.D.õo doses differed from the saline-isoniazid L.D.õo’
1. Ata, S., Tanaka, K. Lancet, Sept. 20, 1952, p. 589. 2. Litchfield, J. T. jun., Wilcoxon, F. J. Pharmacol.
a
later date.
Squibb Institute for Medical Research, New Brunswick, N.J., U.S.A.
BERNARD RUBIN JOHN C. BURKE.
HALLUX VALGUS
SiR,ŁI have read with great interest the article by
Hardy and Mr. Clapham.1 Here in the South of Madagascar I have very often observed hallux valgus in older people who have never worn shoes ; it is almost always associated with flat-feet. I have never seen hallux valgus in people under 20 years of age. Dr.
B. KALCEV.
Betioky, Madagascar.
WITHDRAWAL OF TEACHING SiR,-I agree that, as you implied in your leading article on Oct. 11, the abolition of the travelling film units of the Central Office of Information is an example
of
" penny wise and pound foolish." During the last few years the Ministry of Health has produced six films on the early diagnosis of cancer, specially in order to help general practitioners. These films, which were described in your leading article, have been shown at conferences in many European countries and in Africa, where they were much admired ; but I have not yet met a general practitioner in England ..
who has seen one of them, and to make matters worse the Central Film Library has removed the copies from the film department of the British Medical Association. I do not know how much money was spent in producing these films ; but if they are not circulated and seen by the practitioners of this country, the money has been
largely wasted. MALCOLM DONALDSON Chairman, Medical Committee,
London, W.14.
Scientific Film Association.
SiR,-May I join with Dr. Cardew in admiring your leading article on the damage done by the withdrawal of the C.O.I. mobile projection units and the Crown Film Unit. When the blow fell I wrote to the Times drawing attention to the fact that the harm would be felt most severely by those groups, whether of nurses or small study groups, whose financial resources are smallest and whose need for the broadening effects of the film is
greatest. Dr. Cardew pointed out that the money, time, and labour required to make a film, although great, are justifiably expended because the results can be shown to audiences all over the country for as long as the subject remains of interest. An elaborate and expensive film dealing with details of treatment, whether surgical or medical, is likely to have a much shorter useful life than a descriptive film dealing with the clinical appearances of a disorder. In other words, although it is relatively easy to make a well-composed film about a surgical operation, the time and trouble might be better spent tackling the more difficult subject of making films which would increase the clinical experience of medical students, and
improve their diagnostic ability. One wants to record the clinical history of rare disorders. I think the last cases of tetanus seen at Guy’s were in 1948 and seven earlier than that. Many so
years
1949, 96, 99.
1.
Hardy, R. H., Clapham, J. C. R. Lancet, 1952, i, 1180.