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TREATMENT OF RHEUMATOID ARTHRITIS
326 we
wish to
bring
him to task.
We think that
our case,
THE RH HAPTEN
to warrant
sufficiently important a little consideration for these trivial anaphylactic rashes which appear early in streptomycin therapy. although
a rare
one,
was
Colindale Hospital, London, N.W.9.
SIR,—In recent annotation1 you expressed the hope that those who had been trying to repeat Carter’s work on the extraction of the Rh hapten from human erythrocytes would state their findings. We have followed both Carter’s original method and her modified method, using erythrocytes from a single donor and also pooled erythrocytes from a number of donors. In all cases Rh-negative cells were extracted at the same time as Rh-positive ones and used as a control. Particular care was taken to adhere closely to all the details of the technique described. Extracts had a very slight inhibitory effect on Rh antisera, but extracts from Rh-negative cells proved equally inhibitory and it was concluded that the phenomenon was of a non-specific character. In no case was effect observed. any specific inhibitory a
W. C. HARRIS.
TREATMENT OF RHEUMATOID ARTHRITIS
SiR,-For over two years I have been treating cases of rheumatoid arthritis with intravenous injections of procaine. I decided to try also -Lewin and Wassen’s new method’-1 of using ascorbic acid and deoxycortone acetate, with a view to comparing the results. In each of three cases’where the new treatment was given, there was a sense of well-being which continued after the injection for the rest of the day, and a slight decrease of pain. With procaine there is a sense of well-being, pronounced decrease of pain, and an increase in the range of movement of the affected joints. The injections have to be repeated daily at first, but as the condition improves they are gradually cut down to about one every ten days ; if treatment is stopped, relapse ensues. Each injection is of 1% procaine (without adrenaline) 5-10 ml. according to the individual’s tolerance. I find that this gives far better results, and I have seen no ill effects except for transient light-headedness after the injections. S. M. TALAAT. Kasr-El-Ainy Hospital, Cairo. -
-
-
F. STRATTON Blood Transfusion Service, Manchester.
RESISTANCE TO THE TUBERCLE BACILLUS
SIR,—Dr. Sutherland (Feb. 4) appears
.
SIR,—The effectiveness of the antihistaminic drug
&bgr;-dimethyl-aminoethyl benzohydryl ether 8-chlorotheophyllinate (’Dramamine’)- in motion-sickness was, described by Gay and Carliner and Rust and Fosbery.3 As this drug is a relatively weak antihistaminic agent2 and its ether base is known to have relatively little specificity toward histamine, the question arises whether its effect in motion-sickness is due to histamine antagoto another factor. on a voyage across the North Atlantic, on which dramamine was not available, we tried giving daily 0-025-0-05 g. N-dimethylamino-methylethyl-
nism
or
Recently
dibenzoparathiazine (3277 R.P. ; ’Phenergan’) prophylactically as well as for treatment of motion-sickness. This drug is a highly active anti-histamine with longlasting action.4 In almost every case we saw good results. One case was especially impressive. A woman suffering usually from motion-sickness even on land vehicles, and showing no improvement after administration of 0.6 mg.- hyoscine, was completely .relieved after receiving a combination of 0-6 mg. hyoscine with 0-025 g. phenergan. As phenergan caused considerable drowsiness, we tried combining 0-6 mg. hyoscine with 0-02 g. phenobarbitone, but this combination had no more effect than hyoscine alone. Placebos and occupational therapy were without effect. Prophylactically phenergan was effective alone.
These are, of course, merely a few observations, which might suggest that further, more exact, investigations with several specific antihistaminic drugs should be carried
As to the mode of action, it should be noted that Rosenthal and Minard5 and Kwiatkowski6 have already suggested the action of histamine on sensory nerves, while Ambrus, Ambrus, and Jacobhave shown that specific histamine desensitisation (tachyphylaxia) causes out.
analgesia in rats. Philadelphia, U.S.A.
JULIAN L. AMBRUS CLARA M. AMBRUS.
1. Lewin, E., Wassén, E. Lancet, 1949, ii, 993. 2. Gay, L. N., Carliner, P. E. Bull. Johns Hopk. Hosp. 1949, 84, 470 ; Science, 1949, 109, 359. 3. Rust, S. M., Fosbery, F. W. A. Brit. med. J. 1949, ii, 98. 4. Halpern, Ducrot. C. R. Soc. Biol. Paris, 1946, 140, 361 ; Bull. Soc. Chim. Biol. 1947, 29, 309. 5. Rosenthal, S. R., Minard, D. J. exp. Med. 1939, 70, 4175. 6. Kwiatkowski, H. J. Physiol. 1943, 102, 32. 7. In the press.
to take a someLet us, he seems to say, study the question of immunity and resistance ; let us forget (for the moment, at least) the tubercle bacillus. The relative importance of seed and soil may provide a fascinating ground for discussion, but meanwhile die who need not die. daily people The Prophit report did indeed say what Dr. Galen said in A.D. 80. In the intervening years it is surprising that so little notice has been taken of his remark. Surely, if it was made extremely difficult for anyone to come into contact with a tuberculous patient, fewer people would contract the disease. In America they have tackled the problem of bovine tuberculosis on these lines. In 1918 the campaign to destroy all tuberculous cattle was launched. Today the disease is rarely seen. In this country, where doubtless the subject will provide interesting matter for discussion in the years ahead, over 2000 children die and nearly 4000 are crippled yearly by the disease. Mass X-ray examination, good training and hygiene, as at Papworth, adequate provision of beds, and B.c.G. inoculation surely provide major- lines of attack on this terrible scourge. Such effective action would, incidentally, do something to make the present National Health scheme more worthv of its name and less of a salvage and cure service. M. E. M. HERFORD. Farnham Royal, Bucks.
what
-
MOTION-SICKNESS AND ANTI-HISTAMINES
P. H. RENTON.
peculiar
view.
POSTOPERATIVE PARALYSIS IN THE UPPER EXTREMITY
SIR,—The mechanical difficulties of supporting a patient in the steep Trendelenburg position during prolonged operative procedures have been well illustrated by recent correspondence. Attention has been focused principally on special supports for more or less prominent anatomical features, such as the shoulders and hips. I would like to draw attention to the effect of friction. The usual covering for operating-tables consists of a’Sorbo ’ rubber mattress
encasing
with
a smooth skin of rubber it. The whole is loosely attached in some way or other to the polished metal surface of the table. The total effect is somewhat similar to that of placing a loaded toboggan on the slopes of the Cresta run. If the rubber cushioning can be firmly fixed to the table surface, and its upper surface -i.e., that in contact with the patient-is given some
form of non-skid finish, the friction effect produced might well prevent 50% of the patient’s weight from falling on whatever other form of support is used. I am assuming, of course, that the skin of the patient’s back 1.
Lancet, 1949, ii, 1141.
wish to
bring
him to task.
We think that
our case,
THE RH HAPTEN
to warrant
sufficiently important a little consideration for these trivial anaphylactic rashes which appear early in streptomycin therapy. although
a rare
one,
was
Colindale Hospital, London, N.W.9.
SIR,—In recent annotation1 you expressed the hope that those who had been trying to repeat Carter’s work on the extraction of the Rh hapten from human erythrocytes would state their findings. We have followed both Carter’s original method and her modified method, using erythrocytes from a single donor and also pooled erythrocytes from a number of donors. In all cases Rh-negative cells were extracted at the same time as Rh-positive ones and used as a control. Particular care was taken to adhere closely to all the details of the technique described. Extracts had a very slight inhibitory effect on Rh antisera, but extracts from Rh-negative cells proved equally inhibitory and it was concluded that the phenomenon was of a non-specific character. In no case was effect observed. any specific inhibitory a
W. C. HARRIS.
TREATMENT OF RHEUMATOID ARTHRITIS
SiR,-For over two years I have been treating cases of rheumatoid arthritis with intravenous injections of procaine. I decided to try also -Lewin and Wassen’s new method’-1 of using ascorbic acid and deoxycortone acetate, with a view to comparing the results. In each of three cases’where the new treatment was given, there was a sense of well-being which continued after the injection for the rest of the day, and a slight decrease of pain. With procaine there is a sense of well-being, pronounced decrease of pain, and an increase in the range of movement of the affected joints. The injections have to be repeated daily at first, but as the condition improves they are gradually cut down to about one every ten days ; if treatment is stopped, relapse ensues. Each injection is of 1% procaine (without adrenaline) 5-10 ml. according to the individual’s tolerance. I find that this gives far better results, and I have seen no ill effects except for transient light-headedness after the injections. S. M. TALAAT. Kasr-El-Ainy Hospital, Cairo. -
-
-
F. STRATTON Blood Transfusion Service, Manchester.
RESISTANCE TO THE TUBERCLE BACILLUS
SIR,—Dr. Sutherland (Feb. 4) appears
.
SIR,—The effectiveness of the antihistaminic drug
&bgr;-dimethyl-aminoethyl benzohydryl ether 8-chlorotheophyllinate (’Dramamine’)- in motion-sickness was, described by Gay and Carliner and Rust and Fosbery.3 As this drug is a relatively weak antihistaminic agent2 and its ether base is known to have relatively little specificity toward histamine, the question arises whether its effect in motion-sickness is due to histamine antagoto another factor. on a voyage across the North Atlantic, on which dramamine was not available, we tried giving daily 0-025-0-05 g. N-dimethylamino-methylethyl-
nism
or
Recently
dibenzoparathiazine (3277 R.P. ; ’Phenergan’) prophylactically as well as for treatment of motion-sickness. This drug is a highly active anti-histamine with longlasting action.4 In almost every case we saw good results. One case was especially impressive. A woman suffering usually from motion-sickness even on land vehicles, and showing no improvement after administration of 0.6 mg.- hyoscine, was completely .relieved after receiving a combination of 0-6 mg. hyoscine with 0-025 g. phenergan. As phenergan caused considerable drowsiness, we tried combining 0-6 mg. hyoscine with 0-02 g. phenobarbitone, but this combination had no more effect than hyoscine alone. Placebos and occupational therapy were without effect. Prophylactically phenergan was effective alone.
These are, of course, merely a few observations, which might suggest that further, more exact, investigations with several specific antihistaminic drugs should be carried
As to the mode of action, it should be noted that Rosenthal and Minard5 and Kwiatkowski6 have already suggested the action of histamine on sensory nerves, while Ambrus, Ambrus, and Jacobhave shown that specific histamine desensitisation (tachyphylaxia) causes out.
analgesia in rats. Philadelphia, U.S.A.
JULIAN L. AMBRUS CLARA M. AMBRUS.
1. Lewin, E., Wassén, E. Lancet, 1949, ii, 993. 2. Gay, L. N., Carliner, P. E. Bull. Johns Hopk. Hosp. 1949, 84, 470 ; Science, 1949, 109, 359. 3. Rust, S. M., Fosbery, F. W. A. Brit. med. J. 1949, ii, 98. 4. Halpern, Ducrot. C. R. Soc. Biol. Paris, 1946, 140, 361 ; Bull. Soc. Chim. Biol. 1947, 29, 309. 5. Rosenthal, S. R., Minard, D. J. exp. Med. 1939, 70, 4175. 6. Kwiatkowski, H. J. Physiol. 1943, 102, 32. 7. In the press.
to take a someLet us, he seems to say, study the question of immunity and resistance ; let us forget (for the moment, at least) the tubercle bacillus. The relative importance of seed and soil may provide a fascinating ground for discussion, but meanwhile die who need not die. daily people The Prophit report did indeed say what Dr. Galen said in A.D. 80. In the intervening years it is surprising that so little notice has been taken of his remark. Surely, if it was made extremely difficult for anyone to come into contact with a tuberculous patient, fewer people would contract the disease. In America they have tackled the problem of bovine tuberculosis on these lines. In 1918 the campaign to destroy all tuberculous cattle was launched. Today the disease is rarely seen. In this country, where doubtless the subject will provide interesting matter for discussion in the years ahead, over 2000 children die and nearly 4000 are crippled yearly by the disease. Mass X-ray examination, good training and hygiene, as at Papworth, adequate provision of beds, and B.c.G. inoculation surely provide major- lines of attack on this terrible scourge. Such effective action would, incidentally, do something to make the present National Health scheme more worthv of its name and less of a salvage and cure service. M. E. M. HERFORD. Farnham Royal, Bucks.
what
-
MOTION-SICKNESS AND ANTI-HISTAMINES
P. H. RENTON.
peculiar
view.
POSTOPERATIVE PARALYSIS IN THE UPPER EXTREMITY
SIR,—The mechanical difficulties of supporting a patient in the steep Trendelenburg position during prolonged operative procedures have been well illustrated by recent correspondence. Attention has been focused principally on special supports for more or less prominent anatomical features, such as the shoulders and hips. I would like to draw attention to the effect of friction. The usual covering for operating-tables consists of a’Sorbo ’ rubber mattress
encasing
with
a smooth skin of rubber it. The whole is loosely attached in some way or other to the polished metal surface of the table. The total effect is somewhat similar to that of placing a loaded toboggan on the slopes of the Cresta run. If the rubber cushioning can be firmly fixed to the table surface, and its upper surface -i.e., that in contact with the patient-is given some
form of non-skid finish, the friction effect produced might well prevent 50% of the patient’s weight from falling on whatever other form of support is used. I am assuming, of course, that the skin of the patient’s back 1.
Lancet, 1949, ii, 1141.