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POISONS INFORMATION SERVICE
592
probable. (Although verminous arteritis is in the horse, it usually affects the cranial, mesenteric, or iliac arteries, and there was no evidence of cardiac involvement.) Myocarditis was the only common pathological finding, and it was present in all the 17 horses with an abnormal electrocardiogram. seems
the
most
common
The
important conclusions
were
that horses whose
abnormal before their racing career began raced badly, and those which started their career with normal E.c.G.s that later became abnormal raced better when their E.c.G.s were normal. There seems to be no doubt that the desirable E.c.G., from a racing point of view, is one with a long P wave, long mean QRS interval, long QT interval, and a slow heart-rate. E.c.G.s were
invariably
Barbiturates, salicylates, and tranquillisers figured in about a third of the 857 inquiries concerning drugs and medicines. More than 30 related to monoamine-oxidase inhibitors. Quinine (usually taken as an abortifacient) was named in 12, and 2 of these accidents led to permanent blindness. Accidents involving agricultural products were few; and the Service was seldom asked to advise on industrial poisoning, since industrial medical officers would be familiar with the hazards in their factories. Children who ate a variety of wild plants and fruits came to no serious harm. But children are still the chief victims of accidental poisoning, and the special danger of drugs is very apparent. Unpleasant taste or smell is no deterrent: the only safe preparation is the inaccessible. Plainly, moreover, we must foster a poisons information service of this kind-a service which practice will perfect and which should be used to the full.
POISONS INFORMATION SERVICE
THE abundance of chemicals now in everyday use many possibilities of poisoning by accident. When a doctor wants to know urgently the composition of nail varnish or chemical fertiliser and the pharmacology of their constituents, he can turn to the National Poisons Information Service, which was started in 1963. An account of its first year’s working has now
BIOLOGICAL STANDARDS
create
appeared.1 The Service operates from centres at Guy’s Hospital, London, the Royal Infirmaries in Edinburgh and Cardiff, and the Royal Victoria Hospital, Belfast. At each, an index of potential poisons is maintained. Plants and products are listed alphabetically with details of their appearance, constitution, and toxicity; signs and symptoms of overdose are recorded, with an outline of the
recommended
Doctors faced with out-of-theway poisoning can telephone their nearest centre, at any time of day or night, to receive any relevant information there recorded. Problems not yet covered by the indexes are referred to the centres’ medical directors for advice. This help is extended only to members of the medical profession, since, in this country, the treatment of poisoning is quickly referred to them. Some manufacturers have disclosed the composition of their productson condition that it is not made public. Doctors who have sought advice from the Service are later asked to send a short account of the case, including the age and sex of the patient, the nature of the poison, the estimated dose, and the outcome after treatment. The aim is to gather experience for future reference; but the response-rate so far has been only about 60%. treatment.
In their first year the four centres have dealt with 2101 telephoned inquiries. Most of them were about poisoning by drugs or household products, and in 2 of every 3 incidents the patient was a child. Of 1257 episodes whose outcome was reported, 33 ended in death, and most of these were suicides. 26 of the deaths were caused by medicaments. Poisoning by household products tended to be upsetting and unpleasant rather than dangerous; and simple treatment-namely, dilution of the swallowed substance by copious drinks of water-generally sufficed. Two incidents involving ’Lysol ’, however, proved fatal. A surprisingly common mishap was that involving use of proprietary bisulphate lavatory cleaners with hypochlorite bleach: fumes evolved caused acute bronchial irritation that required prompt and vigorous treatment. 1. Mon. Bull. Minist. Hlth Lab. Serv.
1965, 24,
26.
THE biological activity of many substances cannot be measured by physical or chemical means: it must be
assayed biologically by comparison against a common stable preparation-a standard. If the substance is of importance in prophylaxis, therapy, diagnosis, or research, then an internationally accepted standard is desirable-a master standard against which national and laboratory standards are calibrated. The international unit is defined in terms of this standard, and it becornes the international yardstick for this activity. The first international standards (for insulin and diphtheria antitoxin) were established some forty years ago when the League of Nations allotted the task of setting up international preparations to departments at the State Serum Institute, Copenhagen, and the National Institute for Medical Research, London, under Prof. T. Madsen and Sir Henry Dale. In 1963, custody for standards of substances of veterinary interest was given to a third centre, the Central Veterinary Laboratory at Weybridge,
Surrey. Responsibility for these international preparations is borne by the World Health Organisation. The W.H.O. expert committee meets each year in Geneva to discuss the work of preparing standards and the large international collaborative studies necessary to characterise the materials. The past few years have seen an increasing expansion in this subject, and the committee’s report1 for 1964 lists some 60 new substances on which work is in progress. The report makes an up-to-date handbook for everyone interested in biological standardisation-a subject of increasing importance in a wide range of medical and other scientific disciplines. Biological substances are finding ever greater use as diagnostic and research reagents, and the committee recommended that a number of such reagents should be held for reference purposes by an international laboratory for biological standards. These substances will be called " international biological reference reagents " and will include anti-leptospira sera and several specific antisera used for identification of viruses and other micro-
organisms. Another
important function of the committee is the publication of sets of minimum requirements, to act as a guide for the control of manufacture of biological sub1. Wld Hlth Org. tech. Rep. Ser. 1964, H.M. Stationery Office, P.O. Box
no.
293. 6s. 8d. Obtainable from
569, London, S.E.I.
probable. (Although verminous arteritis is in the horse, it usually affects the cranial, mesenteric, or iliac arteries, and there was no evidence of cardiac involvement.) Myocarditis was the only common pathological finding, and it was present in all the 17 horses with an abnormal electrocardiogram. seems
the
most
common
The
important conclusions
were
that horses whose
abnormal before their racing career began raced badly, and those which started their career with normal E.c.G.s that later became abnormal raced better when their E.c.G.s were normal. There seems to be no doubt that the desirable E.c.G., from a racing point of view, is one with a long P wave, long mean QRS interval, long QT interval, and a slow heart-rate. E.c.G.s were
invariably
Barbiturates, salicylates, and tranquillisers figured in about a third of the 857 inquiries concerning drugs and medicines. More than 30 related to monoamine-oxidase inhibitors. Quinine (usually taken as an abortifacient) was named in 12, and 2 of these accidents led to permanent blindness. Accidents involving agricultural products were few; and the Service was seldom asked to advise on industrial poisoning, since industrial medical officers would be familiar with the hazards in their factories. Children who ate a variety of wild plants and fruits came to no serious harm. But children are still the chief victims of accidental poisoning, and the special danger of drugs is very apparent. Unpleasant taste or smell is no deterrent: the only safe preparation is the inaccessible. Plainly, moreover, we must foster a poisons information service of this kind-a service which practice will perfect and which should be used to the full.
POISONS INFORMATION SERVICE
THE abundance of chemicals now in everyday use many possibilities of poisoning by accident. When a doctor wants to know urgently the composition of nail varnish or chemical fertiliser and the pharmacology of their constituents, he can turn to the National Poisons Information Service, which was started in 1963. An account of its first year’s working has now
BIOLOGICAL STANDARDS
create
appeared.1 The Service operates from centres at Guy’s Hospital, London, the Royal Infirmaries in Edinburgh and Cardiff, and the Royal Victoria Hospital, Belfast. At each, an index of potential poisons is maintained. Plants and products are listed alphabetically with details of their appearance, constitution, and toxicity; signs and symptoms of overdose are recorded, with an outline of the
recommended
Doctors faced with out-of-theway poisoning can telephone their nearest centre, at any time of day or night, to receive any relevant information there recorded. Problems not yet covered by the indexes are referred to the centres’ medical directors for advice. This help is extended only to members of the medical profession, since, in this country, the treatment of poisoning is quickly referred to them. Some manufacturers have disclosed the composition of their productson condition that it is not made public. Doctors who have sought advice from the Service are later asked to send a short account of the case, including the age and sex of the patient, the nature of the poison, the estimated dose, and the outcome after treatment. The aim is to gather experience for future reference; but the response-rate so far has been only about 60%. treatment.
In their first year the four centres have dealt with 2101 telephoned inquiries. Most of them were about poisoning by drugs or household products, and in 2 of every 3 incidents the patient was a child. Of 1257 episodes whose outcome was reported, 33 ended in death, and most of these were suicides. 26 of the deaths were caused by medicaments. Poisoning by household products tended to be upsetting and unpleasant rather than dangerous; and simple treatment-namely, dilution of the swallowed substance by copious drinks of water-generally sufficed. Two incidents involving ’Lysol ’, however, proved fatal. A surprisingly common mishap was that involving use of proprietary bisulphate lavatory cleaners with hypochlorite bleach: fumes evolved caused acute bronchial irritation that required prompt and vigorous treatment. 1. Mon. Bull. Minist. Hlth Lab. Serv.
1965, 24,
26.
THE biological activity of many substances cannot be measured by physical or chemical means: it must be
assayed biologically by comparison against a common stable preparation-a standard. If the substance is of importance in prophylaxis, therapy, diagnosis, or research, then an internationally accepted standard is desirable-a master standard against which national and laboratory standards are calibrated. The international unit is defined in terms of this standard, and it becornes the international yardstick for this activity. The first international standards (for insulin and diphtheria antitoxin) were established some forty years ago when the League of Nations allotted the task of setting up international preparations to departments at the State Serum Institute, Copenhagen, and the National Institute for Medical Research, London, under Prof. T. Madsen and Sir Henry Dale. In 1963, custody for standards of substances of veterinary interest was given to a third centre, the Central Veterinary Laboratory at Weybridge,
Surrey. Responsibility for these international preparations is borne by the World Health Organisation. The W.H.O. expert committee meets each year in Geneva to discuss the work of preparing standards and the large international collaborative studies necessary to characterise the materials. The past few years have seen an increasing expansion in this subject, and the committee’s report1 for 1964 lists some 60 new substances on which work is in progress. The report makes an up-to-date handbook for everyone interested in biological standardisation-a subject of increasing importance in a wide range of medical and other scientific disciplines. Biological substances are finding ever greater use as diagnostic and research reagents, and the committee recommended that a number of such reagents should be held for reference purposes by an international laboratory for biological standards. These substances will be called " international biological reference reagents " and will include anti-leptospira sera and several specific antisera used for identification of viruses and other micro-
organisms. Another
important function of the committee is the publication of sets of minimum requirements, to act as a guide for the control of manufacture of biological sub1. Wld Hlth Org. tech. Rep. Ser. 1964, H.M. Stationery Office, P.O. Box
no.
293. 6s. 8d. Obtainable from
569, London, S.E.I.