THE BOMBS

1030 OXYTETRACYCLINE IN PYOGENIC SKIN INFECTIONS

Sycosis vulgaris (15) Folliculitis barbse (21) Impetigo (16)

..

..

...

Post-auricular

titis (12)

derma-

..

Otitis externa (10) Impetiginised seborrhoeio dermatitis (8) Furunculosis (8) ..

..

..

Septic pompholyx (6) Paronychia (5) Infected atopic dermatitis (2) ..

..

....

Instruction was given that the ointment should be applied three times daily to all lesions ; in sycosis, folliculitis, and furunculosis the ointment was applied to both nostrils twice daily for four weeks and to the skin lesions until completely healed.

(terramycin) in a wide variety of pyogenic skin infections. My experience is that oxytetracycline and aureomycin in ointment form are the most effective and rapid agents

we possess in the treatment of this group of dermatoses, and like Peterkin2I have found oxytetracycline more certain in its effect than neomycin. In the past fifteen months I have used an ointment of 3% oxytetracycline in a petrolatum base in a series of over 100 cases of pyogenic skin infection, and though a method of symmetrical paired comparison, with a control ointment, was not used it may be of interest to record my results, which are set out in the accompanying table. Oxytetracycline achieved an excellent and swift response in 86 of these 103 cases, a proportion of which were unpromising seborrhoeio conditions. The one allergic flare-up occurred in a case of seborrhceic otitis externa, a condition which is notoriously liable to reactions of this type. Oxytetracycline and aureomycin, at present, work extremely well in most cases of pyoderma. Their employment will be widespread when they are generally released and the temptation to use them will be great. What guide should the practitioner be given, and what is the appropriate case for their use ? PATRICK HALL-SMITH. Hove, Sussex. THE BOMBS

Guy’s Hospital,

SIR,-I do not think I misunderstood Dr. Alex Comfort. his

While

right to describe himself as a medical accepting if he sociologist personally considers that he possesses the necessary qualifications, I would nevertheless feel bound to question whether even a medical sociologist is entitled, still less obliged, to regard an attitude of neutrality the only possible one in the present tragic division of the world. Because we deplore the Cold War, we do not have to blind ourselves to the respective merits of the causes which divide the protagonists. As long as the avowed object of international Communism remains the ultimate domination of the world, with the forcible destruction of all opposition by violence or treachery, it is hard to see how a member of a reasonably humane and liberal society, challenged by this remain particular form of tyranny, can conscientiously " completely neutral. " Neutralism is in this context a very favourable soil for the malignant, ruthless, and energetic efforts of Communist infiltration. We are therefore inevitably faced with the distasteful necessity of deciding on which side our principles demand that we stand. Dr. Comfort’s own honesty of presentation compels him to reveal doubts as to whether Russian sociologists would be- permitted to express opinions as critical of their own country’s attitude towards atomic warfare, as those already publicly expressed by Lewis 2.

Peterkin,

G. A. G. Brit. med. J.

Mumford in the-Uriited States and quoted by Dr. Comfort in his letter. In fact, of course, Russian sociologists could not possibly express themselves publicly in any way contrary to the party line on this or any other matter. This is only one of the instances of the fundamental difference between tyranny and liberalism which it is the Communist’s business sedulously to confuse. Nevertheless there is no reason why Dr. Comfort should be confused by it ; nor can I believe that he really is, although in his first letter he links McCarthy and Beria in a context which certainly implied this kind of confusion, possibly arising out of the determinedly neutral attitude at which he aimed. The essential difference, which once again exemplifies the fundamental contrast in attitude towards the value of human existence on the two sides, is surely this : McCarthy’s aggressively intolerant and obnoxious behaviour has had to be displayed publicly and has inevitably led to a public inquiry, at which he has the right to call evidence and to defend his conduct, if he can, at the bar of American public opinion and constitutional procedure. Whatever the result of this inquiry, McCarthy neither stands to gain power of life and death over United States citizens comparable to that long exercised by Beria over the citizens of Soviet Russia ; nor if discredited will he be executed or imprisoned for life. Beria on the other hand for very many years held absolute power of life and death, including every measure of torture and intimidation between those two extremes which he or his organisation might choose. Moreover he exerted this over more than two hundred million people who had no hope of appeal to public opinion or independent judicial procedure. And this type of absolute despotism was, and remains, a normal _part of Soviet political organisation. When it was Beria’s own turn to disappear, his liquidation was as sudden, brutal, and entirely cynical as had been the fate of his innumerable victims. For many of us who do not lack experience of psychology, criminology, nor of the other disciplines to whose authority Dr. Comfort appeals in expressing his own views, there is a necessary distinction to be made between the merits of the two " cultures in conflict " as he describes them. If Dr. Comfort himself is unable to choose between them, his dilemma is certainly an unfortunate one. But it is not one which inspires unbounded confidence in his sociological judgment.

Feb. 27, 1954, p. 522.

London, S.E.1.

S.E.1.

D. STAFFORD-CLARK.

SIR,—I should like to support Dr. Comfort’s opinion that, in respect of hydrogen-bomb hysteria, the present

attitude-patterns of American society are more dangerous than those of Communist society ; and I would go further and extend the American attitude-patterns in greater or less degree to the whole of the democratic West. This morbid condition, in accordance with the principles of psychiatry, may be attributed to an unresolved conflict within the collective mind arising from an attempt to live and think according to the incompatible philosophies of Christianity and secular humanism. The bombs have brought about something of a crisis in this unhappy relationship, since the Christian conscience repudiates the amoral materialism of which they are to date the latest product. On the other hand, the Christian notion of the bombs as instruments of divine judgment upon a sinful world is totally unacceptable to secular humanist presuppositions. Seeing little future in progress, but determined also not to fall on its knees, Western society finds itself in an impasse from which a complete smash-up may seem the only way out. In Communist society, the conflict has been resolved, since the dominant party absorbs within itself the secular humanist tradition of which it may be a natural if not the inevitable fulfilment. All true Christians are at the

1031 same

time

as

explicitly,

if

silently,

in

opposition

ably

like to

see a

clear-cut

rejection

of

Christianity by

dominant opinion and a firm espousal of secular humanism as a means

to mental health. I recommend the

opposite

course.

JOSEPH V. WALKER

Darlington.

Medical Officer of Health.

APPOINTMENT OF REGISTRARS

SIR,—In

your issue of

May 1, six senior registrar posts are advertised by Guy’s Hospital

in various specialties and the South East Metropolitan Regional Hopsital Board. It is stated that preference will be given to applicants who have held a registrar post in the appropriate specialty in a teaching hospital. In your journal, not very many issues ago, the question of junior staffing in peripheral hospitals was discussed and it was agreed that one of the causes of the dearth of applicants for such junior posts was just this tendency to select for the more senior teaching-hospital posts those doctors who were already working in teaching hospitals. Are we now to assume that the South East Metropolitan Regional Hospital Board desire to stimulate this drift from the " country " One wonders how soon it will be before the other regions follow suit, if they have not already done so. It is also demoralising to speculate on the power of the " old school tie " philosophy in the regional boards, which blossoms forth in this type of

prejudice against the non-teaching hospitals. What makes the position more depressing is the present policy of making all senior registrar posts on an exchange basis between the parent teaching hospital and a group of peripheral hospitals. This gives the teaching-hospital boards

greater

power than ever before to influence the of all the senior-registrar posts in their

appointments region. I suggest, Sir, that there is something dubious in this senior-registrar exchange scheme, and that it is made apparent by the prejudice expressed in these advertisements.

REGISTRAR. TEXTBOOK ILLUSTRATIONS SIR,—In his letter of May 8 Mr. Engel really raises two " issues-namely, the supply of opaque " photographs, which lend themselves immediately to textbook illustration ; and sources of transparencies for teaching purposes. In relation to his suggested central library the two problems are slightly different in that the writing of textbooks generally represents individual effort, whereas

these have a common framework : factors must influence the selection of material. Even at the present time it is not difficult to view a reasonable supply of photographic prints of a given subject by contacting a number of photographic depart-

teaching should

copies are generally available. frequently done between departments informally, much to the surprise of medical staff who are unaware of this facility. Arrangements for specialised illustrative techniques may often be arranged on a similar basis. As has been suggested by your correspondent, collections of miniature transparencies would be simple to establish and maintain. This has already been done in America by a commercial firm ; slides being purchased from various departments after which they are duplicated and resold singly or in sets. The resulting turnover is reported to be in the region of 100,000 per yearobviously there is some demand for this service ! ments from which file

This is

Westminster Hospital Medical School. London, S.W.1.

PROLONGED ANURIA

as

when Tertullian contemptuously asked what Athens could expect to find in common with Jerusalem. ’Dr. Comfort, if he remains true to the sentiments expressed in his broadcast talks in 1949, would presum-

PETER HANSELL.

SIR,—We

were

interested in the discussion

on

the

management of prolonged anuria by Prof. Scott Russell and his colleagues in your issue of May 1. We have recently treated 3 similar cases on the same lines and by the infusion of hypertonic dextrose solution into the inferior vena cava via the saphenous vein at the groin. One of us has used this method of intravenous years in all cases where difficulty in has been anticipated—for the infusion maintaining example, while operating with a steep Trendelenburg

infusion for

some

position. In addition to the merits of this method of infusion mentioned in the article, we prefer it because it seems to us technically easier than infusion into the superior vena cava and also because it is appreciably more comfortable for the patient when infusion must be continued for some days. As regards technique, we do not consider it necessary to ligate the main tributaries at the upper end of the saphenous vein; we merely ligate the distal end. Similarly, we find that a gauze pad and ’ Elastoplast ’ gives quite adequate pressure both during infusion and when the catheter is removed. GAVIN SHAW Southern General Hospital, JAMES MAIR. Glasgow. CLINICAL TESTS FOR KETONURIA SIR,—We regret that Dr. Archer and Dr. Lehmann (May 1) were misled into thinking that we wished to decry the method of discovering ketonuria used hitherto. Our comments were directed towards the quantitative interpretation of essentially qualitative clinical tests. Our paper was not intended as a contribution to chemical pathology but rather to the use of these tests in clinical

practice. Dr. Archer and Dr. Lehmann do service to the historical

aspect of the subject in drawing attention to the important papers by Kennaway and Hurtley. One of- the latter’s most important contributions to the Rothera test was his demonstration of the sensitivity of the test to acetoacetic acid, which was unknown to Rothera. Hurtley’s own test, however, is not used in clinical practice. Although the concentrations of aceto-acetic acid and acetone in urine have been well known for many years, the numerous variations in technique in performing the clinical tests have, we believe, prevented a uniform interpretation in clinical practice and have made a standardised procedure desirable. We set out to compare the two classical tests with the tablet test, we made it clear that our sensitivity tests corresponded to those of previous workers, and we referred readers to the review by Friedemann. It is true that Kennaway’s " slow-weak " reaction and similar reactions have been regarded as of no clinical imporWe considered this point and tance by some clinicians. concluded that the significance of such results is still not clear. It is a dangerous assumption to regard them as of no clinical importance until more is known about the problem. A positive test for ketonuria should always be assessed in relation to the clinical state of the patient. Our references to various textbooks were intended not so much as a criticism of the methods described as an illustration of the various descriptions which are current. We agree that when Gerhardt’s test is performed, as described by Harrison, it is usually adequate. We believe, however, that many nurses and clinicians throughout the do not practise thorough boiling in a boiling-tube or open vessel. Indeed, we are certain that many of them possess neither a boiling-tube nor a beaker.

country

’

,

Dr. Archer and Dr. Lehmann conclude that because the tablet test is a " dehydrated," less sensitive Rothera test it has no advantages in the laboratory. We think that they should have more adequate reasons for what seems to us a hasty and illogical condemnation. We