RETROPUBIC PROSTATECTOMY

547 INHALATION OF STOMACH CONTENTS SiB,—In his interesting article of March 12, Dr., Willcox concludes that " the custom of feeding patients in labour is therefore risky and should be abandoned." Surely it is a retrograde step to deprive a woman in labour of nourishment. Should it be necessary to anaesthetise a patient during labour, the anaesthetist should wash out the stomach contents if there is any suspicion of a full stomach. The conclusions to be drawn from Dr. Willcox’s article are that only skilled anaesthetists should be employed in maternity cases, and therefore that the custom of requiring junior obstetric house-surgeons to give anaesthetics should cease. SAMUEL LASK. London, S.E.13. VEGANIN his letter last week Mr. Warburton failed to SIR,-In provide evidence based on experimental investigation to show thatVeganin ’ is a more effective analgesic than tab. codein. co. His reference to the rate of disintegration of these aspirin-containing tablets is as irrelevant as Dr. Macqueen’s (Feb. 19). He now implies that the aspirin, phenacetin, and codein of Veganin are in some way superior to those of tab. codein. co. This contention is sheer nonsense. Next Mr. Warburton introduces the conception of " balance of the formula." If this mysterious property is inherent in a tablet of aspirin, phenacetin, and codein bearing the trade name Veganin, on what grounds is it withheld from tab. codein. co. ? The simple fact is that the attempted distinction cannot be maintained, and Mr. Warburton deserves the thanks of the profession for making this clear. STANLEY ALSTEAD. Department of Materia Medica, The University, Glasgow.

NITROGEN MUSTARD IN BONE TUBERCULOSIS

SIR,-I have found that nitrogen mustard has remarkable powers of accelerating the resorption of exudative fluids, and of stimulating the reticulo-endothelial system and consequently the natural resistance of the body and the growth of connective and granulation tissue ; it also exerts some bacteriostatic action on tubercle bacilli (Legezynski). I use nitrogen mustard in smaller dosage than usual -i.e., 0-05-0-2 mg. per kg. of body-weight for each course of treatment. The course, usually of 3-5 injections, is repeated if necessary up to four times at intervals of two to six weeks. By this method I have avoided the major toxic reactions which usually accompany the administration of nitrogen mustard. Moreover, I do not use any nitrogen mustard that has been stored for more than six months, since such samples become more toxic. I have given nitrogen mustard in 23 cases of tuberculosis of bone associated with cold abscesses and fistulae, and in 8 cases complicated by total paraplegia caused by the pressure of the abscess on the spinal cord. The therapeutic effect was manifest even after the first course of treatment. The cold abscesses clearly decreased in size, and the purulent content of the nstulae changed to serosanguineous and became much scantier. Subsequently the fistulse healed, the fever abated, and the erythrocytesedimentation rate became normal. The results were especially notable in the 8 cases of tuberculosis of the spine complicated by paraplegia. The paralytic symptoms improved remarkably within a few days of administration of nitrogen mustard, paralysis of the bladder being the first to disappear. In all 8 cases the pathological process had previously been progressive. This rapid reduction in the paralytic symptoms is in my opinion connected with the shrinkage of the cold abscess, resulting from the anti-inflammatory and resorption-accelerating actions of nitrogen mustard, which have not hitherto received sufficient attention. In this investigation Dr. J. Kowalczk (surgeon and pathoDr. R. Arend (neurologist), and Professor Legezynski and Dr. S. Slopek (bacteriologists) are collaborating.

logist), In

subsequent studies I,

in association with Prof. E. Dr. M. Jarema, and Dr. J. Bromowicz, of the neurological clinic of Cracow University, Prym. Dr.

Brzezicki,

Horodynski, and Dr. Szyszko, have observed the marked therapeutic action of nitrogen mustard in peripheralnerve disorders-polyneuritis, resistant syphilitic radiculitis, sciatica, and trigeminal neuralgia-where it effects a decrease in pain and paralysis. JULIAN ALEKSANDROWICZ.

Cracow.

RETROPUBIC PROSTATECTOMY

SiR,—Unlike Mr. Chapman I am not a resectionist. I reserve this operation for a minority of cases, and have had eminently satisfactory results with the retropubia operation described and practised by Mr. Millin. I consider, however, that Mr. Chapman is right to point out, as he did in his letter last week, that in many cases prostatic obstruction is not progressive. This fact was first brought home to me whilst a resident at St. Peter’s, and I have since had many opportunities of confirming what I was taught then. The presence of residual urine is the " sheet anchor " of prostatic surgery, and I feel with Mr. Chapman there is real danger that by making a plea for earlier operation in cases of prostatic obstruction, in their article of March 5, Mr. Millin and his colleagues may influence some surgeons to perform quite unnecessary prostatectomies. n_.-

H. K. VERNON.

St. James’ Hospital, London, S.W.12.

ARAB

REFUGEES

Sm,-The Jewish Society for Human Service is

con-

cerned for the Arab refugees, victims of the fighting in the Middle East and now said to number three-quarters " Their state," wrote the Times correof a million. spondent in Jericho on Feb. 21, " beggars description." In particular, there is a disastrous shortage of drugs. Of the larger donations promised by governments only the British 21million has been paid-a pound or so per head of refugees who must be fed, clothed, housed, cured. I have it on the authority of a Minister of the Crown that drugs are so short simply because food is the priority and there is not nearly enough money for everything. May I beg your readers to send a contribution for this purpose to the Jewish Society for Human Service, 14, Henrietta Street, London, W.C.2 ? As the society is collecting for many other needs of these refugees contributions should be earmarked " Drugs for Arab relief." VICTOR GOLLANCZ. London, W.C.2. HEROIN

SIR,-Owing to the risk of addiction, it has been proposed that the use of heroin should be discontinued altogether, as in the United States.’ That this would be a great pity will be the opinion of many who, having used the drug in common with morphine over a period of many years, have come to regard it as one of the sheet-anchors in therapy when all else has failed to produce the desired effect. In a linctus the amount of heroin is below the dose coming under the Dangerous Drugs Acts ; for intractable cough it is of great value, and one can assume that addiction is not a consideration here. For the gravely ill and the moribund heroin has many advantages over morphine. Chief of these is the absence of tendency to cause nausea and vomiting-particularly with cancer of the stomach and the rest of the alimentary tract. Both by mouth and injection it works rapidly and efficiently in much smaller doses. The exciting action mentioned in textbooks has not been observed in man, and tolerance seems to develop more slowly than with morphine. There is also much less depression ; and when the two drugs are used in conjunction far less morphine is needed to relieve pain and ensure rest and sleep. For the severe type of depression which often supervenes in the inoperable after long suffering and the administration of narcotics, a third narcotic--cocaineis used much less often than it ought to be. The response to this addition in such cases is remarkable for the great comfort and improvement in well-being, though death is imminent. For vomiting in these conditions morphine may not be tolerated and cocaine is of great value. One or two 1/12-grain tablets of heroin have often been used, without habit-forming, for very ill patients who are 1. See

Lancet, Feb. 5,

p. 235.