METHYLCELLULOSE FOR OBESITY

1316

disrepute, thereby eventually causing sufferers to be a valuable adjunct in the treatment of "rheu-

denied matic

"

disorders.

Worthing.

J. R. B. PECKOVER. P.ECKOVEB.

IDENTIFICATION OF PILLS Sin,—The letter from Dr. McQuitty in your issue of Dec. 5 raises an important question. Apart from exceptiona,l circumstances, patients should know the medicines they are taking, because mystery and magic are"unworthy of the physician who is a scientist and not a medicine man." For this reason chemists should write the name of the medicine on the label of the container, or leave the original name on a container of a proprietary brand of medicine. They should also return the prescriptions to the patients, who can thus follow more accurately the instructions of the physician-except, of course, in cases of dangerous drugs. In Continental countries chemists are obliged to label the name of the medicines (even the formulae of complex prescriptions) and to return the prescription. This also helps to avoid accidents, which are far from rare. Changes of habit are imperative from this point of view. Even Plato wrote in his Laws that the physician when dealing with free citizens must explain the medicines he prescribes, and only with barbaric slaves need he not I am interested to note that Dr. take this trouble. to put the name on the conthe chemist McQuitty got tainer by writing his instructions in Latin. I have written similar instructions in English for years without any result-I shall try Latin next time. A. P. CAWADIAS. London. W.I. METHYLCELLULOSE FOR OBESITY

Sm,-Like children who have been eating sweets before meals, obese overeaters who have been taking methylcellulose drinks beforehand cannot manage much either. If they are instructed to be selective about what they leave-bread, potatoes, &c.--they find their comes a down after while. at This, weight any rate, was the experience of 10 people who tried the experiment. Of the mtiological factors in obesity, overeating from To cut whatever cause is probably the commonest. down intake is easy enough in theory, but once overeating has become a habit or a " conditioned reflex," it is difficult, in practice, for the sufferer to eradicate i4, without help. A number of remedies have been tried, with varying success, ranging from advice to dextroamphetamine and minimal doses of sodium amylobarbitone, but the preparation I recommend is methylcellulose jelly, which has the advantage of being an indigestible bulk substance. A simple trial, lasting eight weeks, was made on 10 obese men and women whose overweight varied from 1/ to 4 stone. They were otherwise fit and doing a normal day’s work. The results were good, including loss -of weight of from 7 to 30 lb. without any significant side-effects. It was unusual to lose weight during the first week. Some people experienced feelings of faintness or hunger occasionally, but a sweetened drink corrected this. Some were given vitamin capsules, but those who did not have them are not showing signs of deficiency. Furthermore, some of the group claim that on stopping methylcellulose jelly, they no longer have the desire to overeat-in effect, a " reconditioning " to reasonable dietary habits appears to have taken place. Only time will tell how long this effect will last, but once overeating recommences a return to the overweight state is inevitable. As the trial was not strictly supervised and several people admitted forgetting their " dis-aperitif " on occasions, the results are

encouraging. Methylcellulose, a substance resembling " wood wool," swells up when suitably treated with water to form a jelly." It has been used as a bulk aperient in 221/2-grain doses and "

this aspect is well described in Martindale, with a caution about the possible formation of methyl alcohol in the intestine. For the same reason, I prescribe only a week’s supply at a time; but this fear may be unfounded. Mr. K. Gillanders,

M.r.s., kindly experimented to find a suitable form for dispensing. This was found to be methylcellulose gr. 71/2 with water to 1/2 fluid ounce (flavours as required, but it is best left unflavoured). The method of preparation is important, however : add to the required amount of methylcellulose

hot water, ensure that the mass is leave for about 30 minutes, make up to volume with " chilled " water, and stir. The patient adds a t,ablespoonful of the methylcellulose jelly to 1/2 pint of water (preferably) or other liquid. In water it is This is taken 1/2-1hour before colourless and tasteloss. meal times. It is necessary to tell the patient that the mixture must be made up to 1/2 pint with liquid and that he must experiment as to the time of taking it. He must not be discouraged if there is no loss of weight in the first week. The rationale of the treatment should be explained in simple terms : this is important, for an obese mentally defective patient (r.Q. 60), who was incapable of appreciating the rationale, gained 41/2 lb. during treatment. five times its

weight of

thoroughly wet,"

The cost of ingredient for the jelly for 3 weeks’ treatment is about 8d. wholesale, which compares favourably with

proprietary preparation in tablet vitamins) at 14s. retail for the same period. a

Botleys Park Hospital, Chertsey, Surrey.

form

(with

J. N. BADHAM.

GRADING OF S.H.M.O.s

SiR,-The whole profession is now aware of the widespread dissatisfaction and feeling of frustration among senior hospital medical officers in the Health Service. This letter is to present their case and to enlist sympathy and active support in their efforts to secure justice. The arbitrary splitting of the ranks of specialists into two distinct grades was the mistake. Gross injustices were done in the original grading, and indeed this was recognised by the fact that subsequent reviews were made. These, however, have themselves been the subject of criticism just as severe, and that there were still prima facie instances of injustice was admitted in Dr. Rowland Hill’s annual report at the Cardiff meeting of the B.M.A. in July. Apparently no proper basis was ever laid down for determination of grading. Therefore, assessments in different areas have turned out to be contradictory. This is well illustrated by the last and " final " review when all the S.H.M.O.S who applied for upgrading in the North West Region were successful ; yet, among those who similarly applied in the North East Region, not I believe one one was made up to consultant rank. in both areas was who worked upgraded in specialist the one and not in the other. There are three main groups of s.H.M.o.s:

(a) General-practitioner specialists. (b) Young specialists. (c) Older specialists.

(a) A member of this group is generally satisfied with his lot. He finds the interest of practising his specialty a welcome change from general practice, and, as he is not dependent on it financially, the question of salary is not important. Probably he is attached to a small and on its staff committee ; therefore he is hospital has reasonable control over the running of his department. (b) The young specialist who eagerly accepts the post of s.H.M.o. as a stepping-stone to consultant rank finds, on applying for a consultant post, that there are few such posts available and that he is faced with keen competition by registrars, perhaps from teaching hospitals, who may well have excellent testimonials from eminent medical authorities. As he fails to obtain one post after another he tends to drift into the last group. (c) The position of the older S.H.M.O.S is indeed hopeless under the present What committee is going to appoint a senior man at a higher salary for a short term of service when a younger officer is available with most of his professional life to comeMany of these S.H.M.O.S have worked for years under the old voluntary

system.