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STERILISATION OF BLANKETS
1331 must have been because the resistance of the " airway " less in my patient than in Dr. Spalding’s. Again, if we consider a point 0-1 sec. after the beginning of inspiration, air was flowing through the airway at 65 litres per min., but the pressure driving it was only 3 cm. H2O. Such possible variation in the airway resistance in healthy people is surely another reason why Dr. Spalding’s figure must not be misinterpreted as’being a physiological constant. I agree with Dr. Spalding that it is desirable that inspiration should be as short as possible and, to this end, the respirator should be able to feed in a lot of air quickly. The practical limit to the speed of inflow at the beginning of inspiration will be the resistance of the airway and the highest pressure which is considered permissible at the external end of the endotracheal tube. For a given peak or cut-off pressure, respirators vary a good deal in their ability to deliver big flows against
For those in whom attacks of the disease are commona low natural resistance-it would seem that a prophylactic amcebicide should be possible, and I am now trying a combined tablet of bisarsenate with chloroquine, two twice weekly. I believe that as the clinical diagnosis of this disease is comparatively easy, too much attention need not be paid to the stool findings, the difficulties of which have already attracted a wide literature.5 ROGER LANE. Calcutta.
i.e., those with
was
back-pressure.
Spalding rightly underlines the importance of the inspiratory phase in maintaining a low mean intrathoracic pressure and thus avoiding embarrassment to the circulation. It is worth mentioning that this end can also be served very effectively by applying- suction during the expiratory phase. Dr. short
Royal Victoria Infirmary, Newcastle upon Tyne.
E. A. PASK.
PERIODIC SYNDROME
SIR.,—With reference to Dr. Reimann’s letter last week on cyclical vomiting, his work on recurrent neutropenia is well known. With Dr.. C. T. de Berardinis he has describedthe condition, and similar cases have been seen in this country.2 Early in my research I thought that I had met with some myself. The patients had recurrent pyrexia, abdominal pain, and neutropenia. Some of them had arthritis and splenomegaly. However, the work of Barrett and Rickards3 led me to suppose that they may have been suffering from brucellosis
despite negative agglutination tests. Dalrymple-Champneys4 has pointed out that this condition may last for as long as forty years. It is most important in such cases to perform a brucellin skin test, and to determine whether this provokes a rise in titre of agglutination. Bath.
HUGH R. E. WALLIS.
TREATMENT OF CHRONIC AMŒBIC DYSENTERY SIR,—I have read the article by Lieut.-Colonel Inder Singh (March 12) and the subsequent correspondence (March 26 and June 11) with interest, but I have been struck by the complete absence of any mention of It has always struck me that the clinical findings. essential difference between amcebiasis, a disease, and amoebic infestation, a harmless parasitism, is that in the former there is always a massive invasion of the gut wall, which is easily detectable clinically by a gross thickening and tenderness of the caecum and colon. If this is present, whatever the stool findings may be, a course of systemic amoebicides must be given, which, if there is any liver tenderness on percussion, should include chloroquine. I wish it were possible to believe, as Dr. Andrade (June 11) implies, that one cannot contract the disease from one’s own harmless infestation. It seems to me more likely that the parasite, after ingestion, is forced to feed on the less favourable pabulum of bacteria because of a high host resistance ; if, however, this becomes lowered there is an immediate widespread penetration into the gut tissues by the amœba, in whatever form it may be multiplying at the time. For this reason, I think that if cysts are found, without evidence of the disease, they are best killed, and a week’s course of one of the bisarsenates usually seems adequate for this purpose. 1. Blood, 1949, 4, 1109.
2. Moncrieff, A. Arch. Dis. Childh. 1951, 26, 438. 3. Barrett, G. M., Rickards, A. G. Quart. J. Med. 1953, 22, 23. 4. Dalrymple-Champneys, W. Lancet, 1950, i, 429.
HEROIN
SIR,—Following the letter from Mr. Southwood in your issue of June 11deploring the action of the Government regarding heroin, you add an editorial annotation in which you refer, in perhaps a somewhat misleading manner, to the report of the representative meeting of the British Medical Association in the same issue. Would it not have given a fairer view of the question to have stated that the meeting passed a resolution protesting against, and asking for a reversal of, the ban on the manufacture and use (but not the export) of heroin ? Moreover, the same representative meeting passed a resolution wishing it to be made known that the B.M.A. had not been consulted or asked for an expression of its views in any way on the question of the abolition of the manufacture and use of heroin. Nor was the question of a ban on heroin referred to the Royal College of Physicians. Had it been, there is little doubt that a majority.of fellows would have given advice quite different from that tendered by the Central Health Services Council, which certainly cannot be regarded as representative of those in active medical practice. Incidentally had you, Sir, read the letter in The Times of May 18 from members of the staff of University College Hospital Medical School, it would have been obvious that any action taken in this country could have no effect on heroin addiction, in this country or elsewhere. J. J. CONYBEARE. London, S.E.1. ** An editorial on this subject appears on p. 1311ED. L. STERILISATION OF BLANKETS SIR,—The paper by Dr. Blowers and Dr. Wallace in your issue of June 18, as evidence of interest in the sterilisation of hospital blankets, is very welcome. Contrary to the opinion expressed in this paper, Fixanol C ’ has not an unpleasant odour, does not stain the blankets, and it does dissolve in water-perhaps not easily, but sufficient to give a dilute solution, which is all that is necessary. We were the first to recommend the use of ’ Lissapol ’ to remove traces of soap from blankets to be treated and to act as a cleansing agent to replace As Dr. Blowers and Dr. Wallace state, soap soap. antagonises the bactericidal effects of quaternary ammonium compounds : we also mentioned this effect in our 6 paper in your columns last year. St. Margaret’s Hospital, FRANK MARSH. ’
Epping, Essex.
ANTI-HISTAMINES AS HYPNOTICS
SIR,—To depart completely from the basic technique of the trials described in your annotation of May 7, more conclusive to carry out tests, in the subject who wishes to be wakeful ? That is, in any normal person (the nearer normal the better) during the day, while at work. I suggest that the omission of breakfast, and the substitution of the top dose of any anti-histamine drug with a reputation for marked soporific side-action, will leave the investigator in no doubts whatever as to its activity in this direction. Placebos could be included in such tests, the preoccupation with work mitigating any purely psychogenic response.
might it not be much for hypnotic action,
5. Lane, R.
6. Marsh, F.,
J.
trop. Med. 1951, 54, 198. Rodway, H. E. Lancet, 1954, i,
125.
For those in whom attacks of the disease are commona low natural resistance-it would seem that a prophylactic amcebicide should be possible, and I am now trying a combined tablet of bisarsenate with chloroquine, two twice weekly. I believe that as the clinical diagnosis of this disease is comparatively easy, too much attention need not be paid to the stool findings, the difficulties of which have already attracted a wide literature.5 ROGER LANE. Calcutta.
i.e., those with
was
back-pressure.
Spalding rightly underlines the importance of the inspiratory phase in maintaining a low mean intrathoracic pressure and thus avoiding embarrassment to the circulation. It is worth mentioning that this end can also be served very effectively by applying- suction during the expiratory phase. Dr. short
Royal Victoria Infirmary, Newcastle upon Tyne.
E. A. PASK.
PERIODIC SYNDROME
SIR.,—With reference to Dr. Reimann’s letter last week on cyclical vomiting, his work on recurrent neutropenia is well known. With Dr.. C. T. de Berardinis he has describedthe condition, and similar cases have been seen in this country.2 Early in my research I thought that I had met with some myself. The patients had recurrent pyrexia, abdominal pain, and neutropenia. Some of them had arthritis and splenomegaly. However, the work of Barrett and Rickards3 led me to suppose that they may have been suffering from brucellosis
despite negative agglutination tests. Dalrymple-Champneys4 has pointed out that this condition may last for as long as forty years. It is most important in such cases to perform a brucellin skin test, and to determine whether this provokes a rise in titre of agglutination. Bath.
HUGH R. E. WALLIS.
TREATMENT OF CHRONIC AMŒBIC DYSENTERY SIR,—I have read the article by Lieut.-Colonel Inder Singh (March 12) and the subsequent correspondence (March 26 and June 11) with interest, but I have been struck by the complete absence of any mention of It has always struck me that the clinical findings. essential difference between amcebiasis, a disease, and amoebic infestation, a harmless parasitism, is that in the former there is always a massive invasion of the gut wall, which is easily detectable clinically by a gross thickening and tenderness of the caecum and colon. If this is present, whatever the stool findings may be, a course of systemic amoebicides must be given, which, if there is any liver tenderness on percussion, should include chloroquine. I wish it were possible to believe, as Dr. Andrade (June 11) implies, that one cannot contract the disease from one’s own harmless infestation. It seems to me more likely that the parasite, after ingestion, is forced to feed on the less favourable pabulum of bacteria because of a high host resistance ; if, however, this becomes lowered there is an immediate widespread penetration into the gut tissues by the amœba, in whatever form it may be multiplying at the time. For this reason, I think that if cysts are found, without evidence of the disease, they are best killed, and a week’s course of one of the bisarsenates usually seems adequate for this purpose. 1. Blood, 1949, 4, 1109.
2. Moncrieff, A. Arch. Dis. Childh. 1951, 26, 438. 3. Barrett, G. M., Rickards, A. G. Quart. J. Med. 1953, 22, 23. 4. Dalrymple-Champneys, W. Lancet, 1950, i, 429.
HEROIN
SIR,—Following the letter from Mr. Southwood in your issue of June 11deploring the action of the Government regarding heroin, you add an editorial annotation in which you refer, in perhaps a somewhat misleading manner, to the report of the representative meeting of the British Medical Association in the same issue. Would it not have given a fairer view of the question to have stated that the meeting passed a resolution protesting against, and asking for a reversal of, the ban on the manufacture and use (but not the export) of heroin ? Moreover, the same representative meeting passed a resolution wishing it to be made known that the B.M.A. had not been consulted or asked for an expression of its views in any way on the question of the abolition of the manufacture and use of heroin. Nor was the question of a ban on heroin referred to the Royal College of Physicians. Had it been, there is little doubt that a majority.of fellows would have given advice quite different from that tendered by the Central Health Services Council, which certainly cannot be regarded as representative of those in active medical practice. Incidentally had you, Sir, read the letter in The Times of May 18 from members of the staff of University College Hospital Medical School, it would have been obvious that any action taken in this country could have no effect on heroin addiction, in this country or elsewhere. J. J. CONYBEARE. London, S.E.1. ** An editorial on this subject appears on p. 1311ED. L. STERILISATION OF BLANKETS SIR,—The paper by Dr. Blowers and Dr. Wallace in your issue of June 18, as evidence of interest in the sterilisation of hospital blankets, is very welcome. Contrary to the opinion expressed in this paper, Fixanol C ’ has not an unpleasant odour, does not stain the blankets, and it does dissolve in water-perhaps not easily, but sufficient to give a dilute solution, which is all that is necessary. We were the first to recommend the use of ’ Lissapol ’ to remove traces of soap from blankets to be treated and to act as a cleansing agent to replace As Dr. Blowers and Dr. Wallace state, soap soap. antagonises the bactericidal effects of quaternary ammonium compounds : we also mentioned this effect in our 6 paper in your columns last year. St. Margaret’s Hospital, FRANK MARSH. ’
Epping, Essex.
ANTI-HISTAMINES AS HYPNOTICS
SIR,—To depart completely from the basic technique of the trials described in your annotation of May 7, more conclusive to carry out tests, in the subject who wishes to be wakeful ? That is, in any normal person (the nearer normal the better) during the day, while at work. I suggest that the omission of breakfast, and the substitution of the top dose of any anti-histamine drug with a reputation for marked soporific side-action, will leave the investigator in no doubts whatever as to its activity in this direction. Placebos could be included in such tests, the preoccupation with work mitigating any purely psychogenic response.
might it not be much for hypnotic action,
5. Lane, R.
6. Marsh, F.,
J.
trop. Med. 1951, 54, 198. Rodway, H. E. Lancet, 1954, i,
125.