Mayo Clinic type) for all bladder irrigations and aspiration after punch prostatectomy. Any air leak was noticed at once. There was a period during the late war when these syringes were unobtainable and we had to rely on all-metal syringes for the purpose. Four patients
after the other from reinjection of air before fault was discovered. Thereafter opaque syringes of any type were forbidden, and such stocks That was the end of as we possessed were destroyed. our employment of the urological equivalent of the bicycle pump. Let us hope that the day is not far distant when every textbook of urology will give prominence to a solemn warning never to use an opaque syringe for bladder
lavage. Cape Town, South Africa.
W. E. M. WARDILL.
PERFORATION AND HÆMATEMESIS SiR,-In his article of Feb. 11, Mr. Ives emphasised the rarity of hsematemesis and perforation occurring together. In the cases cited by him there is a certain lapse of time between those two incidents. In the following case perforation and hsematemesis occurred
The committee invites all those who annual
M. SHUN SHIN.
Moka Hospital, Mauritius.
SiR,-Medical practitioners who are taking part in the supplementary ophthalmic service or are interested in ophthalmic practice may like to know something about the N.O.T.B. Association, which was formed in January, 1949, to carry on the work of the old National Ophthalmic
is ;E1Is. M. H. ATKINS Secretary.
SiB,—In connection with your leading article of Jan. 28, I should like to mention briefly my experience at this hospital. Four cases of lepromatous type have been on sulphone treatment for the last two years ; they have had a 25% solution in arachis oil 3-5 ml. subcutaneously twice a week. Another four cases of similar type have had ’Sulphetrone as a 50% aqueous solution in normal saline 3-7 ml. sub-
cutaneously biweekly. A further three cases of similar type have had’Promocitin,’ six tablets per day for eight months.
In each of these three groups the clinical response has been good, but the bacteriological response poor. Government Pentland Hospital, Vellore, South India.
P. V. KARAMCHANDANI.
TRAINING FOR GENERAL PRACTICE
SiR,-The B.M.A. report on the Training of the General Practitionerincludes among the family doctor’s duties health education and preventive medicine." This led me to hope for proposals for incorporating a modicum of instruction on these subjects in the three-year training to be undertaken between qualification and entry into practice. I was not really surprised to find no further reference ; the customary lip-service had been paid. Professor Neale, in his letter of May 27, suggests that, for an all-round postgraduate course for general practitioners, the D.P.H. course-containing instruction in the epidemiologies of the home, the factory, the school, and even the hospital-cannot be bettered. In principle this is true ; but the D.r.H. is a statutory requirement for those specialising in public health, and it should be recognised as a specialist qualification. However, it is most impor tant that general practitioners should have a course of study in the principles and practice of preventive medicine and health education ; this should certainly be provided in the three-year preparatory training after qualification. "
P. A. TYSER.
SUBSTITUTES FOR CURARE
All ophthalmic medical practitioners whoe names are on the central professional list, and all dispensing opticians who are members of the Guild of British Dispensing Opticians, are eligible for membership ; the present medical membership is 662. The association is administered by a committee composed of 4 ophthalmic medical practitioners appointed by the Ophthalmic Group Committee of the British
Medical Association, 4 ophthalmic medical-practitioner members of the N.O.T.B. Association elected by the medical and 7
SULPHONES IN LEPROSY
Tavistock House North, Tavistock Square, London, W.C.1.
simultaneously. A stonemason, aged 44, was admitted to hospital one afternoon with a two-year history of pain in the epigastrium made worse by food, which caused vomiting. The history was typical of gastric ulcer. The next morning, at 7 A.M., he started vomiting blood, and immediately afterwards began to have intense abdominal pain. His pulse was very rapid and of small volume ; his abdomen was very rigid, and he had all the signs of peritonitis. His condition being too poor for surgical intervention and a suitable blood-donor being unobtainable, conservative treatment was started. He was given morphine and atropine and an intravenous glucose-saline drip. Continuous suction was applied to his stomach. The haematemesis did not recur. His general condition improved a little, but never sufficiently to allow a laparotomy. The next day he began to hiccup, and he died 36 hours after the perforation and haemorrhage.
support these objects by joining the association.
Guild of British Dispensing Opticians.
the medical carried out
appointed by It has
secretary and secretary, the day-to-day work being
by four subcommittees. Three medical members appointed by the committee represent the association officially on the Ophthalmic Group Committee. The objects of the association are : (1) to facilitate a medical eye examination for the general public ; (2) to preserve the liaison between ophthalmic medical practitioners and dispensing opticians ; (3) to encourage the
of adequately equipped and staffed eye throughout the country for the convenience of the general public in areas where the permanent eye service is not in operation ; (4) to act, if called on, in an advisory capacity in any difficulty which may arise centres
between members of the association ; and (5) to deal with any queries which may be raised, and to provide general information.
SiR,—In your leading article last week the statement made that " it is not yet clear that CIO possesses any advantages over the natural drug." It has been shown2 that CIO is in fact superior to d-tubocurarine hydrochloride, since in equipotent doses (as judged by degree of muscular relaxation) the former drug leaves the patient with a significantly greater vital capacity than does the latter. Moreover, CIO appears to be free from side-reactions, whereas most workers have had the common experience of bronchospasm and histamine release as concomitant effects of the action of d-tubocurarine hydrochloride. To my knowledge the evidence produced in support of these conclusions has not been challenged. Since that report appeared CIO, in association with thiopentone, has been used routinely at the Maudsley Hospital for modifying electrically induced convulsions. Between February, 1949, and February, 1950, 973 treatments were given to a total of 125 patients. The only untoward effect was undue cyanosis in 2 cases, due to faulty technique in the management of the patient while natural breathing was being re-established after the fit. Both patients made uneventful recoveries. One
Lancet, May 27, pp. 1001, 1008. L., Lewis, A. Ibid, 1949, i, 775.
2. Davies, D.