47

undernourished individuals can make adjustments byrestricting their diet and taking light work, while theirapathetic bowels, once vigorous, lose the power to makeeffective protest.

Professor Wells and Mr. MacPhee, by focussing atten-tion on the afferent loop, have made a substantialcontribution. It is to be hoped that the conception of" neurotic attacks" 1 will now cease to bedevil theserious and growing problem of the post-gastrectomysyndrome.

Harrogate. A. J. GLAZEBROOK.A. J. GLAZEBROOK.

1. Any Questions. Brit. med. J. 1952, ii, 1006.2. Lancet, 1952, ii, 746.3. Stephens, C. A. L. jun., Yeoman, E. E., Holbrook, W. P.

Hill, D. F., Goodin, W. L. J. Amer. med. Ass. 1952, 150, 1084.4. Steinbrocker, O., Berkowitz, S., Eholich, M., Elkind, M., Carp, S.

Ibid, p. 1087.

PITUITARY EXTRACT IN OBSTETRICS

W. C. W. NIXON.

H. O. SCHILD.

Obstetric Unit, University CollegeHospital Medical School.

Department of Pharmacology,University College, London, W.C.1.

SIR,—The report of the Emergency Obstetrical Servicein the Manchester area 2 is disturbing since it revealsthat whole posterior pituitary extract (the preparationmentioned was ’ Pituitrin ’) is still being used in

domiciliary obstetric practice.We firmly believe that whole posterior pituitary

extract should not be used in obstetrics since it containsnot only the oxytocic but also the toxic vasopressorfactor. Admittedly the purified oxytocic fraction

(injectio oxytocini, B.P.) contains some vasopressorsubstance, but its vasopressin content per unit activityis not more than 1/20 of whole extract (injectio pituitariiposterioris, B.P.) ; hence the latter is much more toxic.Vasopressin constricts the coronary vessels and producesimpairment of the action of the heart. In a woman whohas already lost blood this may produce shock or evendeath.

.

BUTAZOLIDINE

W. A. BOURNE.Hove, Sussex.

SiR,-To the reports of toxic effects following theadministration of butazolidine I would like to add twoobservations which I have not seen described in publica-tions in this country. They seem noteworthy amongothers I have seen, which include the usual digestive,cutaneous, purpuric, and haematuric incidents, and three-cases of jaundice, apparently obstructive. I cannotat present give their proportional incidence, as they haveoccurred in three hospitals and in private practice.One patient went into left ventricular failure complicat-

ing generalised cedema. This complication was mentionedby Stephens et al.3 and Steinbrocker et al.4Another patient had characteristic oedema with

extensive patches of cedematous erythema on limbs andtrunk, progressing to peeling of the face and limbs andmaculate purpura on the trunk, after taking one tabletonly. There was no evidence that this patient had hadthe drug before.

I may add that I am taking the drug myself with muchrelief of the pain of my rheumatoid arthritis.

SUFFERING FROM PERNICIOUS ANÆMIA

D. P. LAMBERT.Giggleswick,Settle, Yorks.

SIR,—Patients with pernicious anaemia, suffer moreat the hands of doctors than the failure to reassure

them mentioned by Dr. Todd (Dec. 20).Recently an applicant for entry to the teaching profession

was medically examined and found physically fit in all respects.She gave a history of pernicious anaemia, successfully treated ;and this was entered on the official form as a minor conditionnot likely to interfere with the performance of her duties,Her application for entry to two teachers’ training colleges hasbeen rejected on medical grounds, because of pernicious anaemia.Had she not told the examining doctor about her ansemia

it would not have been diagnosed clinically ; so she is beingpenalised for giving an honest history, and her whole careeris jeopardised unfairly. What remedy has she ?

If I had to be ill I should rather have " pernicious "anaemia than " benign " tertian malaria or a

"

benign "

adenoma. Would it not be better to give up the

adjective " pernicious " and talk about addisoniananaemia, as many already do ? ’?

1. See Lancet, 1952, ii, 1222.

Public Health

Deaths During the Fog -

THERE were 4703 deaths registered in Greater Londonin the week ended Dec. 13 when, during the first half ofthe week, smoke-laden fog covered most of the area.!The figures for the preceding two weeks were 1902 and2062, and deaths in the corresponding week of 1951were less than a third of this year’s total. Deaths frominfluenza and pneumonia, increased from 89 in the weekended Dec. 6 to 380 in the week of the fog ; and manymore deaths from respiratory or cardiac disease werereferred to coroners than in normal weeks.

First reports on the chemical content of the fogindicate that there was more sulphur dioxide and carbonin it than usual. The Ministry of Health suggests that" these increases are for the present better regarded asa measure of fuel consumption, principally coal, ratherthan as an index of ’ atmospheric vitriol.’ " The Ministrysays that an analysis of the information given on thedeath certificates is being made, pathologists’ reportsare being examined, and further investigation of theconstituents of the fog and srnoke is in hand. Noconclusions can be reached until this work is completed.

Saving Fuel in HospitalsThe Northern Ireland Hospitals Authority, examining

the reasons for the rising cost of the hospital and specialistservices, has been paying particular attention to meansof reducing fuel consumption- in its hospitals. Theauthority’s report for the year ended March 31, 1952,says that an engineer and a stoker-demonstrator havebeen visiting some of the hospitals in Northern Irelandto test the fuel-burning plant, and to make recommenda-tions for improving efficiency. It is estimated fromtheir reports that expenditure on fuel in the generalhospitals visited (1740 beds in all) can be cut from£29.3 per bed per annum to £23.6—an annual saving of£9900. The changes needed to save this sum are beingmade wherever possible. All the hospitals in NorthernIreland will eventually be dealt with.

AppointmentsBOOTH, R. W., M.R.C.S. : appointed factory doctor, Cinderford

district, Gloucester..BRENTNALL, T. D., M.R.C.S. : appointed factory doctor, Oakham

district, Rutland.LOVE, S. H. S., M.B. Belf., D._. : consultant in anaesthetics, hospitals

of Belfast H.M.C.MILLAR, J. H. D., M.D. Belf., --NI.R.C.1. : part-time consultant

neurologist, Royal Victoria and Claremont Street Hospital,Belfast.

O’RioRDAtf, J. P., M.B. Dubl., D.P.H. : port M.o., Dublin.Colonial Medical Service :

BEDELL, F. E., L.M.S.S.A. : district M.O., Windward Islands.EASMON, C. 0., F.R.C.S. : surgical specialist. Gold Coast.GORROD, C’. E., M.B. Aberd., D.P.H.: M.O.H., Federation of Malaya.HALL, C. L., B.M. Oxfd : senior M.O., Tanganyika.JOHNSTON, H. M., M.B., M.P.H. : senior M.O.H., Jamaica.LUNKING, F., M.B. : M.O., Federation of Malaya.MCDONALD, W. H. B., M.B. Lond., D.T.M. & H. : senior M.O., Sduth

Pacific Health Service.MCGREGOR, ALAN, M.B. Durh. : senior M.O., Tanganyika.MAXWELL, R. BV. D., M.B., D.P.H. : deputy director of medical

services. South Pacific Health Service.MURCOTT, E. H., M.D. Edin., D.r’.H. : deputy director of medical

services, Xvasaland. ,

REECE. _ A., M.D. : M.O. (grade A), Trinidad. -

NYrcER, J. R. C.. M.B. Lond., D.O.M.S., D.T.M. R H. : specialist’ (ophthalmology). Gold Coast.

SUTHERLAND, E. S., L.R.C.P.E., D.P.H.: senior M.O.H., Jamaica.SWI8TER..,;KI, K. P., MED. DIP. Lwow : anaesthetist, Barbados

General Hospital, Barbados.North East Metropolitan Regional Hospital Board :Dow, J. R., M.R.C.P., D.ar.R.D. : consultant radiologist, Hackney

Hospital.HAMILTON, MARGARET, M.B. Leeds, D.A.-: part-time consultant

ansesthetist. Eastern Hospital.MORGAN, J. A. L’., -Nf.R.c.p. : consultant pathologist, Hackney

Hospital. _______