698

administering phenobarbitone, and it is most importantthat the success of this treatment should be confirmed as

quickly as possible.Lewes, Sussex. DENNIS PIRRIE.DENNIS PIRRIE.

1. Bourne, G. H. Nature, Lond. 1957, 180, 1488.2. Swan, H. J. C. Brit. med. J. 1952, i, 1003.3. Bonica, J. J. J. Amer. med. Ass. 1957, 164, 732.4. Davis, P. S. Med. Pr. 1957, 238, 77.5. Dittrich, R. J. J. phys. Med. 1957, 20, 233.6. Lancet, 1957, ii, 577.

ADRENALINE CREAM

LOUIS Moss.

SIR,- The rationale for the treatment of muscularrheumatism with adrenaline cream, which I first advocatedten years ago, was criticised on five counts:

(1) Adrenaline could not be stabilised in a fatty base.(2) It could not penetrate the skin.

(3) Even if it did so the amount would be too small to beeffective.

(4) If it did have any effect it would reduce the blood-supplyto the muscles because it would constrict the arteries supplyingthem and not expand them, as I claimed.

(5) There was no anatomical or physiological evidence forthe claim that much of the pain of muscular rheumatismemanates from " trigger-spots "—localised areas of muscle inspasm.

It can now be justly claimed that all these criticismsare unfounded.

(1) Pharmaceutical tests specially devised for the assay ofadrenaline cream have proved it has a substantial shelf-life.

(2) By histochemical methods, Bourne 1 has demonstratedthat adrenaline in a fatty base penetrates living skin rapidly.

(3) Work at the National Institute for Medical Researchproved that the action of adrenaline on the arterioles 2 ofskeletal muscle is peculiar in that it relaxes them. The con-centrate required to produce this effect is astonishinglysmall.

(4) Bonica 3 has confirmed the existence of trigger spots andtheir responsibility for rheumatic pain. Other authorities 4 s

have expressed their agreement.The few and, in my opinion, perfunctory clinical trials

of adrenaline cream have given equivocal results but it cansurely be claimed that criticisms of the rationale, and par-ticularly against the claim that adrenaline can penetratethe skin, are unjustified.

London, W. 1. LOUIS MOSS.

LEG SUPPORT FOR USE DURING VAGINAL

OPERATIONS

T. B. FITZGERALD.General Hospital,

Ashton-under-Lyne.

SIR,-I was interested in Dr. Goodwin’s letter ofMarch 8 criticising the type of leg support which I hadpreviously described,6 and I should like to comment onhis remarks.

The abtluction of the thighs is obtained without any obviouslordosis, but it is part of my design that this abduction can bevaried to suit the operator’s requirements, and it can bereduced to any required degree.The popliteal vessels are not compressed by the canvas

support, as this is quite effective when it reaches only half wayup the calf of the leg. With regard to the access by the assistantto the field of operation, I have repeatedly asked those who helpme their opinion about this, and I am told that they find thisno difficulty and even welcome the support of the strut to

lean on without actually putting their weight on the patient’sleg.Mr. Goodwin’s photographs show very clearly those points

which I have endeavoured to avoid, particularly with regardto excessive flexion of the hip-joint. This flexion predisposesto thrombosis and backache, and my anaathetist dislikes it

because the pressure of the thighs on the abdomen seriouslyinterferes with respiratory movements.

I have the advantage of having worked with the type ofsupport illustrated by Mr. Goodwin as well as my own, andI think if he is able to make a similar practical comparison,he will agree that the design I have suggested has certaindefinite advantages.

Medicine and the Law

Death from Barbiturate and Alcohol

IN 1956, 223 people died in England and Wales ofaccidental barbiturate poisoning—compared with only 54ten years previously. Death may result from a moderatedose of barbiturate if alcohol is taken as well.1 This wasshown again at a Sutton inquest on March 18.2A man, aged 50, had been under heavy pressure of work,

and, according to his family doctor, insomnia had been " a con-siderable problem " to him; he was accustomed to taking up tofour capsules a night of a barbiturate, which his doctor agreedwas a fairly heavy dose. He was found dead in bed one morn-ing, and analysis of his stomach contents indicated that he hadtaken only his usual dose of barbiturate; but a bottle of whiskybought the previous night was only a quarter full, and thehousekeeper said she had never known him drink as muchbefore. The coroner said that it was not as generally knownas it should be that a dose of barbiturate that was not normallyfatal might be fatal if taken with alcohol.A previous inquest indicated that methylpentynol is

also dangerous in conjunction with barbiturate.3

1. See Lancet, 1953, i, 1140; ibid. 1953, ii, 554.2. See Liverpool Daily Post, March 19, 1958.3. See Lancet, 1955, i, 1332.

Parliament

QUESTION TIMEPersomnia

Mr. JOHN RANKIN asked the Minister of Health if he wasaware of the growing feeling in medical circles that’ Persomnia’should not be on free sale across the counter but only on theprescription of a registered medical practitioner.-Mr. DEREKWALKER-SMITH replied: I am aware of the publicity that hasbeen given to this preparation and of its alleged abuse in certaincases. I have no official reports upon it, but I am consultingwith the Home Secretary as to whether a further reference tothe Poisons Board of bromvaletone and carbromal, the principalingredients concerned, would be desirable in the light of suchgeneral information as is now available.

Refunds for Prescription ChargesIn six years some E3,200,000 for prescription charges has

been refunded through the Post Office to needy persons.

AppointmentsPINKERTON, J. R. H., M.D. Cantab.: consultant pathologist, Boston group of

hospitals, Lincolnshire.SHARPE, OLIVE, M.D. Sheff., M.R.C.P., D.c.H.: consultant paediatrician, Royal

Liverpool Children’s Hospital.Colonial Appointments:ATKINSON, P. 1., M.B. Calcutta: M.o., Northern Region, Nigeria.BRAHMAN, A. P., M.B. Madras: M.o., British Guiana.CHICK, J. H., M.B.: M.o., Tanganyika.DIGGORY, H. J. P., M.B., D.T.M. & H.: M.o. (grade C), Trinidad.DONNELLY, J. P., L.R.C.P.I.: M.o. (grade B), institutions, Trinidad.MOITRA, N. G., M.D. Rome, D.M.R.E.: radiologist, Trinidad.SLAWINSKI, KAROL, M.D. Beirut, T.D.D.: M.O., Sarawak.WATTS, M. B.. M.B. Lond., D.OBST., D.C.H.: M.O., Sarawak.