PHENACETIN NEPHROPATHY

521 These facts make it seem likely that the maturation process of the foetal liver proceeds, from a haematological point of view, in two distinct phases. During the first phase the liver is mainly concerned with the production of a special type of Hb that is particularly well suited for the intrauterine life of the foetus.2During the second phase there is depression of this activity, and through the formation of certain enzyme systems the liver is being prepared for its function of conjugating and excreting the degradation products of Hb. It would seem that cessation of liver hxmatopoiesis is a prerequisite for the proper develcpment of this organ’s bilirubin excretory capacity. This preliminary report indicates that a very high relative proportion of foetal Hb in the blood of the newborn, apparently signifying the persistence of intense hxmatopoiesis in the liver, is associated with excessive neonatal jaundice. This might imply that the determination of this Hb fraction at birth might be used as a measure of the degree of liver maturity in terms of this organ’s capacity to excrete bilirubin. The correlation between the relative proportion and concentration of foetal Hb and neonatal jaundice not caused by blood incompatibility, as well as other implications of this finding, will be published elsewhere. Department of Women’s Diseases,

Karolinska Sjukhuset, and King Gustav V Research Institute, Stockholm 60, Sweden. Sweden.

BRODY. BRODY SAM SAM BRODY.

GLUCAGON AND BODY GROWTH IN DWARF MICE

SIR,-In a previous paper on the relationship between the pancreatic islets and growth I concluded that pancreatic glucagon can stimulate body growth in pituitary dwarf mice.! Further data suppoit this conclusion. Hypopituitary dwarf mice of the Snell strain, 4 weeks old, were treated with glucagon or somatotrophin in standard conditions. In order to avoid the stress of repeated injections, the hormones were incorporated in cholesterol pellets and the pellets implanted under the dorsal skin once weekly.2 Somatotrophin (Armour) or crystalline glucagon (Lilly, lot no. 258-234 B-54-2) were compressed in a pellet-making apparatus with cholesterol in order to obtain small pellets containing 100 g. of either hormone; control cholesterol pellets were prepared without hormones. It was ascertained that a week after the implantation the pellet was completely absorbed. The results are summarised in the xompanying table. EFFECT OF SOMATOTROPHIN AND

GLUCAGON

ON

BODY-WEIGHT

OF

HYPOPITUITARY DWARF MICE

mean per

cent.

variation in parentheses.

From the ’.f..ble it appears that both somatotrophin and glucagon, at the given doses, stimulated the growth of pituitary dwarf mice to about the same extent. Moreover, in comparison with our previous results, it appears that glucagon and, especially, somatotrophin are more active when given in pellets than by injection; this could be due to the repeated stress of injections and/or slower and continuous absorption of the pellets. Institute of Pathological Anatomy, University of Pavia, Italy.

CESARE CAVALLERO. Italy..

1. 2.

Cavallero, C. Ciba Found. Coll. Endocrinl. 1956, 9, 266. Ugrob, J. M., Lyons, W. R., Jordan, C. W., Jr., Li, C. H. Endocrinology, 1957, 61, 477.

STAPHYLOCOCCI IN HOSPITALS SIR,-Dr. Avery Jones (Jan. 24, Feb. 14) has drawn attention to the dirty state of the walls in many hospitals. The problem is especially difficult in the East End of London, since many steam trains traverse the district. The conditions are yet worse after many foggy days,

and especially so when influenza maids and porters.

incapacitates the ward-

of the walls of the of the other offices costs El 500. Even if the money were available (which it is not) to repeat the washing down, the problem would not be solved since the walls so soon get dirty. Washing the walls as far as the maids can reach is no solution and only draws attention to the grime. In the past year we have tried a different method. A short-handled mop impregnated with an oily solution has been used for all the ordinary dusting of the ward furniture; this adsorbs the dust and does not spread it around. A similar mop fixed to a long bamboo cane is now being used to wipe down the walls once a week. It is light and easily wielded by the wardmaid, and the tops of the walls can be reached. By this method, a recently painted or washed wall can be kept clean, but it is not possible to remove the ingrained dirt from a wall which has not been painted for many years. The walls of the long corridor are also wiped down once a week by a porter, and the mop becomes so dirty that it has to be washed at once and reimpregnafed. At the present time the corridor walls are very dirty as a result of the fogs and illness among the porters, but most of the grime will be removed when the influenza epidemic is over. The walls of the ward in which this method was first used were painted in 1956 and washed down in 1957; they are still clean, and the wardmaid takes pride in her work. Great credit is due to the matron, the ward sisters, the domestic supervisor, and the hospital secretary in this attempt to keep clean the walls of a hospital situated in At Bethnal Green

eighteen wards and

a

very

Hospital washing

some

dirty area. GEORGE GRAHAM

London, E.2.

Chairman, Central Group Hospital Management Committee.

PHENACETIN NEPHROPATHY

SiR,—Iam surprised that Dr. J. C. Eaton (Jan. 24) should express himself so strongly on the relative frequency of methxmoglobin and sulphsemoglobin when contradicting the statement in your annotation of Jan. 10 that methasmoglobinasmia is often the first sign of phenacetin intoxication. I know, certain differences between his results and while I worked in the Department of Medicine at my Glasgow Royal Infirmary, although discussed, have never In contrast to Dr. Eaton’s been satisfactorily resolved. observations I found in a smaller series of cases that, following the ingestion of both phenacetin and dapsone, methxmoglobinaemia is much commoner than sulphaemoglobinasmia, and that sulphaemoglobmasmia is rare without concomitant methaemoglobinsemia. Thus, in 20 patients with cyanosis suspected of being due to phenacetin, I found methxmoglobinaemia in 16 and sulphasmoglobinasmia in 4: in no case did sulphaemoglobin occur alone. In 45 tests on 19 patients treated with dapsone 12I found methaemoglobin 36 times and sulphasmoglobin 5 times: in only 2 cases did sulphsemoglobin occur without methaemoglobin. Under the circumstances, and especially in view of Dr. Eaton’s observations on routine blood samples sent to his department, I feel that even the brief report he gave should be accompanied by some reference to the methods used. Equally important is some indication of the anticoagulant used, the conditions of storage, and the delay between withdrawal of the blood and its examination. The in-vitro reduction of methxmoglobin in secondary methxmoglobinaemia is well recognised.3 So far

as

own

1. Alexander, J. O’D. Lancet, 1955, i, 1201. 2.. Alexander, J. O’D. Scot. med. J. 1958, 3, 212. 3. Finch, C. A. New Engl. J. Med. 1948, 239, 470.

522 In my own observations blood was taken into heparinfluoride anticoagulant and either examined at once or stored frozen. Estimations were performed by a modification of tie method of Evelyn and Malloy,4 using a Unicam SP 600 spectrophotometer. In an earlier study5 the method gave results in good agreement with the more rigorous techniques of gas analysis. My own experience and that of others6 has confirmed a previously expressed opinion5 that the Hartridge reversion spectroscope is unsuitable for observations on blood with methaemoglobin contents of less than 10% of the total

haemoglobin. M.R.C. Group for Research on the General Effects of Radiation, Western General Hospital, Edinburgh. 4. Edinburgh,

A G. A. G BAIKIE BAIKIE. 4. A. - BAIKIE.

TIGHT-COLLAR ANÆSTHESIA

SIR,-Ihave recently experienced an unusual symptom which I thought might interest your readers. Several months ago I became aware of an area of anaesthesia centred over my left clavicle. It occurred from time to time during the day, and would sometimes persist for two hours, although more often it was gone in thirty minutes. There was also a vague pain and discomfort in the area. At first I tried to ignore it, but it obtruded itself upon me so much that I had to take it seriously after a while. I thought in terms of hysteria, and, of course, multiple sclerosis, and again tried to forget it. It was only several weeks later, when I was passing the time of day, leaning on a laboratory bench on my left elbow, that I became aware that my numbness was coming on me again, and the cause was suddenly apparent. It seemed that my shirt collar, which was a particularly stiff one, was nipping

supraclavicular nerves running causing all my troubles.

my

over

the

clavicle,

and

It was no doubt remiss of me not to notice that my numbness occurred only when wearing a certain shirt, but at least it was all a reminder that a very simple cause for a symptom should always be sought first. Salisbury General Hospital, M B RICHARD M. ST BEST. Salisbury. Salisbury, Wilts.

used the entire eighty units without complications. It should be noted that reconstitution of the plasma gave a clear solution. My purpose is to arouse interest in further experimentation. Preservation of dehydrated plasma over several months will furnish a virus-free blood expander which will supersede many agents now in use. North Carolina, U.S.A.

Southport,

North

NORMAN M. HORNSTEIN.

PHENYLBUTAZONE AND PROLAPSED INTERVERTEBRAL DISCS SIR,-Previous letters 12 gave preliminary impressions of the usefulness of phenylbutazone in the treatment of disc lesions, and further controlled investigation was recommended. I can now report my subsequent findings.

The

following standard procedure

was

adopted:

(1000 mg.) of intramuscular (600 mg.) every other day, phenylbutazone, followed, after discharge, by twice-weekly doses of 600 mg. for Bed

rest

for 10

5 ml. and later 3 ml.

days with

six weeks from the district nurse. Thereafter three months to one year was arranged.

a

follow-up

patients with prolapsed lumbar discs and 8 with prolapsed cervical discs were treated with intramuscular phenylbutazone and compared with a similar number of controls (treated by conventional methods and taken at random from hospital records). 60

All patients in both series had most of the accepted symptoms and neurological signs of disc disorder, and 25% had positive X-ray findings. If the diagnosis was still in doubt the spinal fluid was analysed, and helped on two occasions to exclude neoplasm of the vertebrx. The groups were closely matched as regards age, sex, occupation, and environment.

The results

are

shown in tables

TABLE I-COMPARISON

OF

I

and

11:

PHENYLBUTAZONE AND

CONVENTIONAL TREATMENT IN LUMBAR-DISC LESIONS

FILTERED LIQUID PLASMA FOR TRANSFUSION

SiR,—The new method proposed by Dr. Ellis and Dudleyfor use of filtered liquid plasma by ageing

Mr.

plus kaolin filtration is another step towards preventing homologous-serum jaundice. The first practical and safe method for achieving this result was the storage of liquid plasma at 30-32°C for six months prior to use. This discovery was made by Allen et aI.,8 whose report is cited by Ellis and Dudley. Shortly afterwards I described a simpler method.99 Obviously if the same procedure of ageing could be applied dehydrated human plasma, a more stable product would be available. I believe that ageing of desiccated plasma at an elevated temperature would inactivate the virus causing hepatitis. The basis for this belief is my use of over eighty 500 ml. units of dehydrated plasma between 1949 and 1952. These units had been left in an abandoned Coast Guard hospital on Hatteras Island off the coast of North Carolina in 1946. Owing to distance and lack of communications I had to use several of these units later than the expiration date marked on the labels. These bottles of plasma had been subjected to temperatures of 37-110°F since 1946. No case of hepatitis followed. The Research Department of the National Institute of Health stated that the only objection to using this old plasma was the possible deterioration of the rubber stoppers on the bottles. These stoppers seemed in perfect condition, and I to

Evelyn, K. A., Malloy, H. T. J. biol. Chem. 1938, 126, 655. Baikie, A. G., Valtis, D. J. Brit. med. J. 1954, ii, 73. Newcombe, C. P., Dawson, J. ibid. 1958, i, 1396. Ellis, D., Dudley, H. A. F. Lancet, 1958, ii, 1355. Allen, J. G., Emerson, D. M., Barron, E. S. G., Sykes, C. J. Amer. med. Ass. 1954, 154, 103. 9. Hornstein, N. M. ibid. p. 854. 4. 5. 6. 7. 8.

of

TABLE II-COMPARISON OF PHENYLBUTAZONE AND

CONVENTIONAL TREATMENT IN CERVICAL DISCS

1. 2.

Steer, C. Lancet, 1956, i, 966. Gillhespy, R. O. ibid. p. 1069.