- Email: [email protected]
MISTAKES WITH INJECTION SOLUTIONS
306 their practice because their fees are
so high, and naturally enthusiastic. However, no-one has yet make out a case against the employment of trained technician-prosthetists working under supervision. The Dental Board, in its evidence to the Teviot Committee, advised that if, in the public interest, the Dentists Act had to be amended to allow more delegation, then this sort of delegation should be permitted. R. B. D. STOCKER. London, N.W.6.
they are not attempted to
MISTAKES WITH INJECTION SOLUTIONS Sin,—The distinctive tinting of solutions for injection suggested by Mr. Dodd (Feb. 7) as a safeguard against might, I fear, only introduce a new hazard. How many people have a sense ot colour perception and a memory for shades sufficiently acute to allow them safely to differentiate between perhaps twenty to thirty colours? I imagine that this number of shades would be required if one wished to cover the commonly used injections. There would be the further problem, moreover, pf identifying different concentrations of certain solutions. I doubt if there is any way of increasing safety in administration of injection solutions other than by observing the precautionary measures already in force. Of these; the most important are : (1) that the manufacturer or pharmacist shall label the solutions clearly, and (2) that the doctor or nurse administering the injection shall first read the label. If a label has become detached and one cannot be sure of the nature of the solution, it should not be injected. Glaxo Laboratories Ltd., H. M. WALKER. Greenford, Mddx.
mistakes
FOOD FOR OLYMPIC ATHLETES SiR,-Dr. Leyton’s letter {Jan. 24) raises an important point. He asks for 3750 calories, and especially for more fat and protein, in order to avoid staleness and muscle
breakdowns.
Indeed, Olympic athletes seem to like ample food. Schenk1 has found that at the 1936 olympiad the average consumption was 800 g. meat, 2-3 eggs,. 100-150 g. butter, and 1 litre milk, apart from plenty of sugar and other carbohydrates, fruit, and vegetables. Is this calorie intake of 4000-5000 a day really necessary, or is it perhaps only an easily acquired, and enjoyable habit ? There is no experimental evidence, and we must remember that -competitive games and athletics are carried on with remarkable results in European countries which are much It may well be that muscular worse fed than we are. work carried to the limit of endurance calls for different supplies ; there is, however, just as little evidence for this as for the statement that staleness and muscle breakdowns are caused by their lack. Our deplorable ignorance in this field is due to the fact that very few members of the medical profession have shown an active interest in it. Even the organisation committee of the Olympic games do not seem to be keen to stimulate such interest, since they have rejected a- suggestion for a conference of physicians and physiologists during the coming games. It is to be hoped that individual initiative will overcome inertia one day and will give a new impulse to research into this most interesting subject. H. HERXHEIMER. London, W.C.I. HEALTH EXAMINATIONS
Sm,-In the ophthalmic sphere there is everything to be said for regular inspections ; and by that I mean proper tests-not merely a check on Snellen test type. The alarming percentage of adults with amblyopic eyes is due mainly to the lack of proper periodical inspection of school-children’s eyes. That this problem is not confined to children is shown by the results of Dr. Parnell’s pilot survey at Oxford (Dec 27), in which 55 % of the students examined were found to have visual defects. At one end of the scale, routine examinations would discover incipient squints at the time when they are
readily susceptible to treatment ; and in middle-age glaucoma would lose much of its terror, for treated early this
seldom
causes
much depreciation of visual acuity. S. BLACK.
Association of Optical Practitioners, London, W.1. 1.
Schenk, P.
Münch. med. Wschr.
1936, 83,
1535.
GERIATRIC THERAPY
S]IR,-In acknowledging congratulation on attaining octogenarian status, a relative sends the following list
of the treatments she is at present receiving. it read in, say, a further half century ? Thrice daily : Mist. sod. cit. et hyoscy.
How will
Stomach concentrate with iron and vitamin B. Once daily : Digitalis. Once or twice daily : Antidiarrhoea mixture. Nightly : 2 sedativetablets. As required : Pethidine. Sulpha pyridine (if the temperature rises).
Heemoplastif
’
serum.
Nikethamide.
Weekly : a liver injection. Northwood, Mddx.
ESTHER CARLING.
EFFECTS OF MYANESIN ON MUSCLES AND BLOOD SIR,-In view of the recent interest inMyanesin’ as a drug alleged to produce muscular relaxation, and in its apparently unforeseen haemolytic properties, we would like to record some observations made here some months ago. 1. Effect own Voluntary Power Doses of myanesin were given intravenously to two patients suffering from poliomyelitis that had caused extensive paralysis of the lower limbs, with painful limitation of certain joint movements, thought to be due to muscle spasm. One patient was a man of 33, the other a girl of 17 ; on account’of their extensive disability it was not possible to weigh either, but both were of normal build. The man received 35 ml. of the 10% solution, and the girl 20 ml., at the rate of 5 ml. per minute, with an interval of 3-4 minutes between each 5.ml. dose. The only other drugs given wereOmnopon’ gr. its and scopolamine gr. 11150 injected subcutaneously shortly before administration of the myanesin. The effects of the drug were almost identical in the two The pulse-rate remained steady throughout, though cases. during the injections there was flushing of the face in both cases and of the whole body in the girl. Voluntary power, whether in normal muscles or in those partially affected by
the disease,
was unchanged throughout. Electromyographic recordings (hamstrings in the girl, erector spinae in the man) were unchanged throughout. The painful limitation of movewas unaffected, as were all tendon reflexes. Both patients complained of blurring of vision during the injections. Both patients had intense hsemoglobinuria after the injections. No good or ill effects have been noted subsequently. 2. Effect ora Red Blood-cells and Plasma Protein In view of the observation that patients receiving myanesin developed haemoglobinuria, its action on human blood in vitro was investigated. Dilutions of myanesin were made (a) in normal saline and (b), in view of its acid pH, in isotonic buffered saline at pH 7-2. To 1 ml. of the full strength and diluted solutions was then added 0-1ml. of (1) fresh whole
ment
citrated blood, and (2) washed red cells in normal saline. The mixtures were incubated at 37°C. Complete haemolysis occurred in all tubes within an hour up to a dilution of 1/8. and 25% haemolysis occurred within 24 hours up to a dilution of 1/32. The haemolysis was as pronounced in the whole-blood as in the red-cell suspensions and in the buffered as in the unbuffered dilution. It was also observed that rapid precipitation of protein occurred in the whole-blood preparation up to a dilution of 1/4. A similar effect was obtained with human serum and plasma. The haemolytio effect of the drug was then tested in vivo as follows. A man with complete brachial-plexus paralysis, nacessitating amputation of the otherwise healthy arm, was selected as a suitable subject. A sample of venous blood collected from this limb showed no haemolysis. Before proceeding to the definitive operation the flaps were marked out at a point 7 in. below the acromial process and dissected proximally. The blood-flow through the cephalic and basilic veins was placed under control and one of the veins accompanying the brachial artery was occluded. The other vein was dissected free over a length of about’ 3 in., and after being divided superiorly was allowed to hang down and was occluded with a light spring clip. Thus, after occlusion of the other three veins, one could be reasonably certain of collecting most of the blood from the periphery of the limb by releasing the clip on the brachial vein. This having been done, 10 ml. of myanesin was injected into the brachial artery, and blood
so high, and naturally enthusiastic. However, no-one has yet make out a case against the employment of trained technician-prosthetists working under supervision. The Dental Board, in its evidence to the Teviot Committee, advised that if, in the public interest, the Dentists Act had to be amended to allow more delegation, then this sort of delegation should be permitted. R. B. D. STOCKER. London, N.W.6.
they are not attempted to
MISTAKES WITH INJECTION SOLUTIONS Sin,—The distinctive tinting of solutions for injection suggested by Mr. Dodd (Feb. 7) as a safeguard against might, I fear, only introduce a new hazard. How many people have a sense ot colour perception and a memory for shades sufficiently acute to allow them safely to differentiate between perhaps twenty to thirty colours? I imagine that this number of shades would be required if one wished to cover the commonly used injections. There would be the further problem, moreover, pf identifying different concentrations of certain solutions. I doubt if there is any way of increasing safety in administration of injection solutions other than by observing the precautionary measures already in force. Of these; the most important are : (1) that the manufacturer or pharmacist shall label the solutions clearly, and (2) that the doctor or nurse administering the injection shall first read the label. If a label has become detached and one cannot be sure of the nature of the solution, it should not be injected. Glaxo Laboratories Ltd., H. M. WALKER. Greenford, Mddx.
mistakes
FOOD FOR OLYMPIC ATHLETES SiR,-Dr. Leyton’s letter {Jan. 24) raises an important point. He asks for 3750 calories, and especially for more fat and protein, in order to avoid staleness and muscle
breakdowns.
Indeed, Olympic athletes seem to like ample food. Schenk1 has found that at the 1936 olympiad the average consumption was 800 g. meat, 2-3 eggs,. 100-150 g. butter, and 1 litre milk, apart from plenty of sugar and other carbohydrates, fruit, and vegetables. Is this calorie intake of 4000-5000 a day really necessary, or is it perhaps only an easily acquired, and enjoyable habit ? There is no experimental evidence, and we must remember that -competitive games and athletics are carried on with remarkable results in European countries which are much It may well be that muscular worse fed than we are. work carried to the limit of endurance calls for different supplies ; there is, however, just as little evidence for this as for the statement that staleness and muscle breakdowns are caused by their lack. Our deplorable ignorance in this field is due to the fact that very few members of the medical profession have shown an active interest in it. Even the organisation committee of the Olympic games do not seem to be keen to stimulate such interest, since they have rejected a- suggestion for a conference of physicians and physiologists during the coming games. It is to be hoped that individual initiative will overcome inertia one day and will give a new impulse to research into this most interesting subject. H. HERXHEIMER. London, W.C.I. HEALTH EXAMINATIONS
Sm,-In the ophthalmic sphere there is everything to be said for regular inspections ; and by that I mean proper tests-not merely a check on Snellen test type. The alarming percentage of adults with amblyopic eyes is due mainly to the lack of proper periodical inspection of school-children’s eyes. That this problem is not confined to children is shown by the results of Dr. Parnell’s pilot survey at Oxford (Dec 27), in which 55 % of the students examined were found to have visual defects. At one end of the scale, routine examinations would discover incipient squints at the time when they are
readily susceptible to treatment ; and in middle-age glaucoma would lose much of its terror, for treated early this
seldom
causes
much depreciation of visual acuity. S. BLACK.
Association of Optical Practitioners, London, W.1. 1.
Schenk, P.
Münch. med. Wschr.
1936, 83,
1535.
GERIATRIC THERAPY
S]IR,-In acknowledging congratulation on attaining octogenarian status, a relative sends the following list
of the treatments she is at present receiving. it read in, say, a further half century ? Thrice daily : Mist. sod. cit. et hyoscy.
How will
Stomach concentrate with iron and vitamin B. Once daily : Digitalis. Once or twice daily : Antidiarrhoea mixture. Nightly : 2 sedativetablets. As required : Pethidine. Sulpha pyridine (if the temperature rises).
Heemoplastif
’
serum.
Nikethamide.
Weekly : a liver injection. Northwood, Mddx.
ESTHER CARLING.
EFFECTS OF MYANESIN ON MUSCLES AND BLOOD SIR,-In view of the recent interest inMyanesin’ as a drug alleged to produce muscular relaxation, and in its apparently unforeseen haemolytic properties, we would like to record some observations made here some months ago. 1. Effect own Voluntary Power Doses of myanesin were given intravenously to two patients suffering from poliomyelitis that had caused extensive paralysis of the lower limbs, with painful limitation of certain joint movements, thought to be due to muscle spasm. One patient was a man of 33, the other a girl of 17 ; on account’of their extensive disability it was not possible to weigh either, but both were of normal build. The man received 35 ml. of the 10% solution, and the girl 20 ml., at the rate of 5 ml. per minute, with an interval of 3-4 minutes between each 5.ml. dose. The only other drugs given wereOmnopon’ gr. its and scopolamine gr. 11150 injected subcutaneously shortly before administration of the myanesin. The effects of the drug were almost identical in the two The pulse-rate remained steady throughout, though cases. during the injections there was flushing of the face in both cases and of the whole body in the girl. Voluntary power, whether in normal muscles or in those partially affected by
the disease,
was unchanged throughout. Electromyographic recordings (hamstrings in the girl, erector spinae in the man) were unchanged throughout. The painful limitation of movewas unaffected, as were all tendon reflexes. Both patients complained of blurring of vision during the injections. Both patients had intense hsemoglobinuria after the injections. No good or ill effects have been noted subsequently. 2. Effect ora Red Blood-cells and Plasma Protein In view of the observation that patients receiving myanesin developed haemoglobinuria, its action on human blood in vitro was investigated. Dilutions of myanesin were made (a) in normal saline and (b), in view of its acid pH, in isotonic buffered saline at pH 7-2. To 1 ml. of the full strength and diluted solutions was then added 0-1ml. of (1) fresh whole
ment
citrated blood, and (2) washed red cells in normal saline. The mixtures were incubated at 37°C. Complete haemolysis occurred in all tubes within an hour up to a dilution of 1/8. and 25% haemolysis occurred within 24 hours up to a dilution of 1/32. The haemolysis was as pronounced in the whole-blood as in the red-cell suspensions and in the buffered as in the unbuffered dilution. It was also observed that rapid precipitation of protein occurred in the whole-blood preparation up to a dilution of 1/4. A similar effect was obtained with human serum and plasma. The haemolytio effect of the drug was then tested in vivo as follows. A man with complete brachial-plexus paralysis, nacessitating amputation of the otherwise healthy arm, was selected as a suitable subject. A sample of venous blood collected from this limb showed no haemolysis. Before proceeding to the definitive operation the flaps were marked out at a point 7 in. below the acromial process and dissected proximally. The blood-flow through the cephalic and basilic veins was placed under control and one of the veins accompanying the brachial artery was occluded. The other vein was dissected free over a length of about’ 3 in., and after being divided superiorly was allowed to hang down and was occluded with a light spring clip. Thus, after occlusion of the other three veins, one could be reasonably certain of collecting most of the blood from the periphery of the limb by releasing the clip on the brachial vein. This having been done, 10 ml. of myanesin was injected into the brachial artery, and blood