NATIONAL SOCIETY FOR THE PREVENTION OF VENEREAL DISEASE

119 Five patients have completed 4-month courses, and number of others courses of up to 4-5 weeks. In each of the five cases which have received 4-month courses the amount given was 12-14 g. daily, in seven doses 3-hourly with one interval of 6 hours at night. In all of them further progress of the disease has been checked, though complete cure can be claimed in none. With one exception (case 4) the patients had the rapidly progressive, exudative form of the disease. They were severely toxic, with swinging temperature, high bloodsedimentation rate, and sputum loaded with tubercle bacilli; and monthly radiological .examination had revealed continuing spread despite absolute bed rest and all other therapeutic measures except streptomycin. The considerable improvement in general condition, increased appetite, gain in weight, and loss of toxicity have been well maintained in all these cases, 4 weeks after the completion of the course. The temperature has also remained normal, except in case 2 where the curve tended to creep up after completion of the first 8-week course ; here a pause of 4 weeks had to be interposed owing to supply difficulties, and the second 8-week course did not completely suppress the pyrexia. But even in this case the improvement in general condition and X-ray appearances has been maintained. In the other cases the X-ray appearances present a picture as hopeful as the clinical aspect. In all, progress of the disease has been checked ; the soft mottling has disappeared, and there is pronounced hardening of the major lesions with more-or-less definite fibrosis. No true sputum conversion could be demonstrated in any of these cases, though the bacilli have become very scanty and have commonly been absent from the weekly specimens for 6-8 weeks. The strain cultured with p-aminobenzoic acid added shows no increased sensitivity for P.A.s. against the HR 37 ; this conforms with Davis’s2 observations. Regarding laboratory findings, blood P.A.S. levels of 7-8 mg. per 100 ml. have been uniformly reached after 2 g., and up to 11 mg. per 100 ml. has been reached after 3 g. ; the blood-level sinks rapidly below 3 mg. per 100 ml. after 3 hours. The urinary concentration is also fairly constant at 45-50 mg. per 100 ml. It is estimated that about half the P.A.S. is excreted as such in the urine, from which the drug disappears within 20 hours of discontinuing intake. The concentration in the sputum varies from 1 to 5 mg. per 100 ml. ; a higher concentration is apparently present in purulent than in mucous sputum. No real toxic manifestations have been observed at daily doses of up to 25 g. ; but in a few instances nausea and even vomiting have set in, perhaps because the solution was given without sufficient dilution, or because it was not suitably flavoured. With attention to these points, the symptoms have always disappeared. Even small doses of aspirin inadvertently given may, however, precipitate symptoms of severe salicylate poisoning. In all cases where P.A.S. has been tried the picture has followed the same pattern-loss of toxicity, control of pyrexia and cough, increased appetite, and gain in weight. Some of the patients are now fit for surgical treatment. The remainder, unsuitable for surgery, will soon present the problem of what is to be done with them. Will they get along as inactive open cases, or will further courses of P.A.S. be needed to ensure a_reasonable span of life ? I feel that in earlier cases, with less gross destruction of the lung, P.A.S. may well afford a complete cure. It also seems that the daily dose must be greatly increased-to not less than 20-25 g.-and must be continued for at least 3 months if better results are to be achieved. Local treatment with 1-2 % spray should also be included. Probably a P.A.s. " umbrella " will reduce the risk of spread or reactivation through operation or during pregnancy. It thus seems that P.A.S. may be regarded as the beginning of an answer to the problem of tuberculosis ; but new and more promising compounds are already emerging from the laboratories. I am grateful to Dr. W. E. Snell for facilities at Colindale Hospital, and to Dr. George Day and Dr. E. C. WynneEdwards for similar courtesy at Mundesley Sanatorium. I am also indebted to Messrs. Ward, Blenkinsop & Co. Ltd., for free supplies of r.A.s. A. ERDEI. London, S.W. °

a

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2. Davis, H.

Mon. Bull. Min. Hlth, P.H.L.S. 1948, 7, 109.

NATIONAL SOCIETY FOR THE PREVENTION OF VENEREAL DISEASE latest SIR,-The report of the Ministry of Health has to acknowledge an alarming setback-in venereal disease that has dismayed everyone who understands its significance. The report says : " During the year 1945 the incidence of syphilis and gonorrhoea increased

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appreciably." This has happened after large sums of public money have been spent by the Government, through the Central Council for Health Education, in telling the public of the dangers of v.D., and in trying to conquer V.D. by fear and persuasion, coupled with treatment after the disease has developed. The public has not been allowed to learn the vitally important fact that a great deal of v.. is easily prevented. This is a scientific fact and it has been known for 40 years.

the great wars the fighting Services all over world, owing mainly to the persistent efforts of this society, were protected (more or less, according to the enthusiasm of the officer-in-charge) against these diseases by the preventive measures we have advocated for thirty years. But the civilian population all the time has been kept in ignorance, and so v.D. is on the increase.

During

the

The statement by the Government-appointed Trevethin Committee (1922) that " properly and promptly applied disinfection ... would almost certainly prove effectual " has been ignored, and up to .the present no Government has had the courage to translate these findings into action. It has been left to us, a voluntarily supported society, to work alone. And we have to fight not only disease, but very often violent prejudice as well. Our policy is threefold : (1) to educate the public with regard to the fact that v.D. can be prevented by simple, scientific measures ; (2) to supply all interested persons with details of such measures ; and (3) to secure the necessary alteration of the law to enable the preventive materials to be sold together with the necessary instructions. This society cordially supports any and every method whereby V.D. may be combated, but it is confident that v.D. will be eliminated only by practical prevention. Without practical prevention any campaign against V.D. is doomed to failure. About 100,000 men and women sufferers from V.D. will be treated at clinics this year, and there will be a great number of infected persons who will not go to clinics. We are planning a great campaign to set the people free from v.D. and from the prejudiced tyranny that has kept them in ignorance of the facts. The scope and magnitude of this great attack depends upon the support we receive from the profession and from the general public. Let us show you how you can help. HORDER President, National Society for the Prevention of Venereal Disease.

47, Nottingham Place, London, W.1.

CONTROL IN SCHICK-TESTING some of my original findings on the properties of Holt’s diphtheria toxoid (P.T.A.P.).l Since then I have encountered an unexpected difficulty, which I feel ought to be communicated to other workers. For many years it has been assumed that infants and children under five years of age very rarely indeed become sensitive to the protein substances present in diphtheria prophylactics. It was believed, and rightly so, that if a control injection were used in post-Schick tests in infants, it practically never revealed any acquired protein sensitivity. Consequently it was considered quite sound practice to dispense with the control injection in infants and very young children, reserving it for use in the over-fives. In the course of investigating various experimental samples of Holt’s P.T.A.P., I recently became disturbed at the number of faintly positive post-Schick readings I was obtaining in very young children. The number was not large but was beyond my expectations, and I became suspicious. From that moment I readopted the use of the control injection and found that most of the cases that I had been obliged to regard as feebly positive were, in fact, pseudo and negative. The

SiB,—ijast year you published

1.

Lancet, 1947, i, 286 ; Ibid, ii, 867.