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POISONOUS PAINTS
115
Assuming that one important mechanism of ageing consists of the gradual accumulation of aberrant cells-with a net loss of chromosomal material and functional capacity--one may expect that a level would ultimately be reached where homoeostatic methanisms could no longer cope with primary and secondary metabolic dysfunctions, a level incompatible with survival. In contrast to unicellular organisms where karyotypic anomalies are subject to natural selection, a complicated multicellular organism may be compared to a civilised community which not only protects its deviant members but may even encourage their propagation. If there is some truth in the old concept that ageing and death are the penalties exacted for differentiation and complex organisation, then all of us would probably be glad to pay the price, given a choice between human frailty and amoebic immortality.
Experimental testing of these theoretical speculations is, of course, highly desirable. The prediction, for example, of an increased variability in chromosome number with age might be subjected to investigation. At the moment, the only chromosome data analysed with respect to age are those of Court Brown. According to his findings, which were interpreted somewhat differently,6 there was a definite tendency toward decline in chromosome number with advancing age. Perhaps some of your readers may be able to furnish data useful in the evaluation of the proposed working hypothesis. Department of Medical Genetics, New York State Psychiatric Institute, Columbia-Presbyterian Medical Center, New York.
LISSY F. JARVIK.
FIFTY YEARS OF RAMSTEDT’S OPERATION
SIR,-Iwas hoping that a surgeon would comment during 1962 that 50 years have now passed since Ramstedt devised his operation for congenital pyloric stenosis. It is doubtful if any operation has saved so many lives and the technique has remained virtually unchanged. The surgical mortality in this condition is now almost nil and this has been brought about in the last 20 years or so by earlier diagnosis and better preoperative managementthe surgery has remained the same. This is a wonderful achievement and babies can nowadays be safely discharged home the day after operation. For an operation to have stood the test of time in this way has won the gratitude of many thousands of children all over the world-this jubilee should not pass unmentioned. Department of Child Health, Llandough Hospital, Penarth, Glamorgan.
A. G. WATKINS.
ELECTROCARDIOGRAPHIC CHANGES ASSOCIATED WITH PHENOTHIAZINE SIR,-We have seen within the past year a number of patients of different ages, transferred to us from other hospitals where they had received treatment with phenothiazine for different periods of time. In approximately 30% we found characteristic features in the E.c.G. which we do not think have been described before. The most striking changes were: low voltage in the standard leads with widening of QRS complexes and flat or isoelectric T especially in AVL and inverted T in the right precordial leads. After treatment was stopped, the E.c.G. returned to normal. No known reason for this pattern, such as myocardial damage, myocarditis, electrolyte dis-
turbances, myxoedema, amyloidosis, pleural effusion, pneumothorax, emphysema, or deformities of thorax, could be found. Malben Hospital,
Shaar-Menashe,
I. TEITELBAUM.
Israel. 6. Court
Brown,
W. M. ibid.
ARTIFICIAL PACING FOR HEART-BLOCK SiR,—The fascinating paper of Dr. Leatham and his colleagues (Dec. 29) raises a small semantic side-issue. As they and others have observed, the electrocardiograms of patients with complete heart-block show a disproportionate frequency of apparent bundle-branch-block patterns. Are these better described as complete heartblock with a ventricular focus below the bifurcation of the bundle ? This postulates one lesion instead of two. St. Helier
Hospital, Carshalton, Surrey.
C. P. PETCH.
POISONOUS PAINTS have SIR,-We recently treated a young child who had eaten some emerald green artist’s water colour which she had squeezed out of a tube. The severity of the vomiting associated with the small amount of colour eaten suggested that the pigment was of high toxicity. Preliminary inquiries from the local art school suggested that the pigment was an arsenical compound of copper, and this was confirmed by analysis. Those of your readers who have to deal with the emergency treatment of poisoning may be interested to know that the manufacturers of artists’ colours issue a caution about the poisonous qualities of the following paints: (a) Cobalt violet (contains arsenate of cobalt). (b) Emerald green (contains aceto-arsenite of copper). (c) Mauve (prepared from an unspecified organic pigment). (d) Purple lake (prepared from synthetic alizarin lakes). The makers issue a booklet of notes on the Composition and Permanence of Artists Colours. This seems to be a further reference book which should be available in every
poisons
centre.
Emergency and Accident Department, Royal Infirmary, Preston.
M. H. HALL.
CONVULSANT EFFECT OF PENICILLIN ON THE CEREBRAL CORTEX SIR,-Ican find no published reference to the con-
vulsant effect of crystalline penicillin when applied to the cerebral cortex. I have inserted this substance after removing bone in open fractures of the skull, sometimes when the dura was torn, without ill effects, and I am therefore prompted to record the following case. An African, aged about 35, was admitted on July 9, 1962, with a swelling over the right parietal bone for 5 months, which had arisen spontaneously without any previous injury. The tumour was round, moderately hard, connected with the skin though not intimately adherent to it, and attached to the underlying bone. There were no localising signs of brain disease. An X-ray of the skull showed a defect in the right parietal bone 11/2 x 11/4 in. with an ill-defined, ragged edge. A leucocyte-count revealed 4300 cells per c.mm. (polymorphs 43%, lymphocytes 51%, and eosinophils 6%). Haemoglobin was 98%. A tentative diagnosis of secondary carcinoma of bone was made. Since the patient complained of severe pain, an operation After was performed under local anxsthesia on July 27. in of a burr-hole was 1 down a made in. scalp, flap turning front of the tumour and enlarged backwards to the edge of the defect through which the growth was protruding from the dura mater. The edge of the body defect was removed round the tumour, and a small incision was made into the dura, through which a probe could easily be passed beneath the tumour. The tumour was removed by snipping through the dura round it and dividing its attachments to the skin. 5,000,000 units of crystalline penicillin was sprinkled into the wound, and the scalp was closed without drainage. On the patient’s return to the ward, unconsciousness set in ’
Assuming that one important mechanism of ageing consists of the gradual accumulation of aberrant cells-with a net loss of chromosomal material and functional capacity--one may expect that a level would ultimately be reached where homoeostatic methanisms could no longer cope with primary and secondary metabolic dysfunctions, a level incompatible with survival. In contrast to unicellular organisms where karyotypic anomalies are subject to natural selection, a complicated multicellular organism may be compared to a civilised community which not only protects its deviant members but may even encourage their propagation. If there is some truth in the old concept that ageing and death are the penalties exacted for differentiation and complex organisation, then all of us would probably be glad to pay the price, given a choice between human frailty and amoebic immortality.
Experimental testing of these theoretical speculations is, of course, highly desirable. The prediction, for example, of an increased variability in chromosome number with age might be subjected to investigation. At the moment, the only chromosome data analysed with respect to age are those of Court Brown. According to his findings, which were interpreted somewhat differently,6 there was a definite tendency toward decline in chromosome number with advancing age. Perhaps some of your readers may be able to furnish data useful in the evaluation of the proposed working hypothesis. Department of Medical Genetics, New York State Psychiatric Institute, Columbia-Presbyterian Medical Center, New York.
LISSY F. JARVIK.
FIFTY YEARS OF RAMSTEDT’S OPERATION
SIR,-Iwas hoping that a surgeon would comment during 1962 that 50 years have now passed since Ramstedt devised his operation for congenital pyloric stenosis. It is doubtful if any operation has saved so many lives and the technique has remained virtually unchanged. The surgical mortality in this condition is now almost nil and this has been brought about in the last 20 years or so by earlier diagnosis and better preoperative managementthe surgery has remained the same. This is a wonderful achievement and babies can nowadays be safely discharged home the day after operation. For an operation to have stood the test of time in this way has won the gratitude of many thousands of children all over the world-this jubilee should not pass unmentioned. Department of Child Health, Llandough Hospital, Penarth, Glamorgan.
A. G. WATKINS.
ELECTROCARDIOGRAPHIC CHANGES ASSOCIATED WITH PHENOTHIAZINE SIR,-We have seen within the past year a number of patients of different ages, transferred to us from other hospitals where they had received treatment with phenothiazine for different periods of time. In approximately 30% we found characteristic features in the E.c.G. which we do not think have been described before. The most striking changes were: low voltage in the standard leads with widening of QRS complexes and flat or isoelectric T especially in AVL and inverted T in the right precordial leads. After treatment was stopped, the E.c.G. returned to normal. No known reason for this pattern, such as myocardial damage, myocarditis, electrolyte dis-
turbances, myxoedema, amyloidosis, pleural effusion, pneumothorax, emphysema, or deformities of thorax, could be found. Malben Hospital,
Shaar-Menashe,
I. TEITELBAUM.
Israel. 6. Court
Brown,
W. M. ibid.
ARTIFICIAL PACING FOR HEART-BLOCK SiR,—The fascinating paper of Dr. Leatham and his colleagues (Dec. 29) raises a small semantic side-issue. As they and others have observed, the electrocardiograms of patients with complete heart-block show a disproportionate frequency of apparent bundle-branch-block patterns. Are these better described as complete heartblock with a ventricular focus below the bifurcation of the bundle ? This postulates one lesion instead of two. St. Helier
Hospital, Carshalton, Surrey.
C. P. PETCH.
POISONOUS PAINTS have SIR,-We recently treated a young child who had eaten some emerald green artist’s water colour which she had squeezed out of a tube. The severity of the vomiting associated with the small amount of colour eaten suggested that the pigment was of high toxicity. Preliminary inquiries from the local art school suggested that the pigment was an arsenical compound of copper, and this was confirmed by analysis. Those of your readers who have to deal with the emergency treatment of poisoning may be interested to know that the manufacturers of artists’ colours issue a caution about the poisonous qualities of the following paints: (a) Cobalt violet (contains arsenate of cobalt). (b) Emerald green (contains aceto-arsenite of copper). (c) Mauve (prepared from an unspecified organic pigment). (d) Purple lake (prepared from synthetic alizarin lakes). The makers issue a booklet of notes on the Composition and Permanence of Artists Colours. This seems to be a further reference book which should be available in every
poisons
centre.
Emergency and Accident Department, Royal Infirmary, Preston.
M. H. HALL.
CONVULSANT EFFECT OF PENICILLIN ON THE CEREBRAL CORTEX SIR,-Ican find no published reference to the con-
vulsant effect of crystalline penicillin when applied to the cerebral cortex. I have inserted this substance after removing bone in open fractures of the skull, sometimes when the dura was torn, without ill effects, and I am therefore prompted to record the following case. An African, aged about 35, was admitted on July 9, 1962, with a swelling over the right parietal bone for 5 months, which had arisen spontaneously without any previous injury. The tumour was round, moderately hard, connected with the skin though not intimately adherent to it, and attached to the underlying bone. There were no localising signs of brain disease. An X-ray of the skull showed a defect in the right parietal bone 11/2 x 11/4 in. with an ill-defined, ragged edge. A leucocyte-count revealed 4300 cells per c.mm. (polymorphs 43%, lymphocytes 51%, and eosinophils 6%). Haemoglobin was 98%. A tentative diagnosis of secondary carcinoma of bone was made. Since the patient complained of severe pain, an operation After was performed under local anxsthesia on July 27. in of a burr-hole was 1 down a made in. scalp, flap turning front of the tumour and enlarged backwards to the edge of the defect through which the growth was protruding from the dura mater. The edge of the body defect was removed round the tumour, and a small incision was made into the dura, through which a probe could easily be passed beneath the tumour. The tumour was removed by snipping through the dura round it and dividing its attachments to the skin. 5,000,000 units of crystalline penicillin was sprinkled into the wound, and the scalp was closed without drainage. On the patient’s return to the ward, unconsciousness set in ’