chemical properties of p.a.s

773

cases streptomycin should be tried at least in the severetoxic group, where it may prove a life-saving measure.The dosage which usually seemed most suitable was

2 g. for the acute and 3 g. for the chronic cases, givenover 6-10 days, three-hourly before feeds dissolved insterile water or glucose solution.The details of this work will be published in the

Egyptian lIIedical Journal.

Children’s Department, Kasr-el-Aini,Faculty of Medicine, Cairo.

M. DIWANYZAHERA H. ABDIN.

TROPHIC AND TROPIC

SIR,—In reply to Professor Dible’s letter last week, Iwould point out that the arguments seem in favour of" trophic " rather than " tropic." Common scientificwords in botany are " geotropic " and "heliotropic,"which indicate a turning to the earth or a turning to thesun. The hormone from the anterior lobe of the pituitarydoes not turn to the thyroid gland, nor is it attractedby the thyroid gland, but it exerts a most importantinfluence on the development of the thyroid gland. Inits absence the thyroid gland diminishes to a very smallsize ; it undergoes " atrophy it does not undergo"atropy." Surely it is clear that the words "thyro-trophic " and " gonadotrophic

" are correct.

Department of Pharmacology,Oxford. J. HAROLD BURN.

REVOLT AT KINGSTON

SIR,—The letter from Dr. Stark Murray in your issueof Nov. 25 will, I am sure, not be accepted as a strictlyfactual survey of the position that has arisen at Kingston.

1. It is only beginning to be appreciated what autonomythe regional hospital boards possess, and it has been widelyknown for some time that they do not publish their plansin advance in order that they may be considered andcommented on by interested bodies generally. Recom-mendations of the board’s committees involving considerableand fundamental changes in the hospital arrangements of aparticular area are accepted by the board as its policy, andit is only thereafter that the area concerned is informed.

Representations of any sort, at any level, made subsequentlyappear to be unavailing.

2. Who is to decide on the best use of hospital beds in anyparticular district ? This question, I submit, is crucial inthe whole problem of hospital accommodation. Should aremote body, the regional hospital board, .or a local body,the hospital management committee, be the arbiter ? In thepresent

"

set-up " neither body seems to be really represen-tative of the people. The members of both are nominated,with the hospital management committee responsible to theregional hospital board, but the latter, according to the

Minister, actually responsible to no higher authority. Surely,in this age of democracy, a method of election by reallyinterested parties from below upwards is not beyond thewit of man ?

3. Dr. Murray is quite wrong in saying that the generalpractitioners exercised a close control on the number ofdoctors using the Victoria. True, the number was increasedin 1948 owing to a considerable influx of younger men afterthe war. Nevertheless, no general practitioner who hasapplied for admission has ever been refused.In 1938 the lay committee of the Victoria Hospital agreed

that Dr. Stark Murray should be appointed as pathologistfor three years. By 1941 the emergency pathological serviceof the Ministry of Health was in operation ; Dr. Murraywas in local charge of this service, which did the pathologyof the Victoria. The question of his appointment was notreopened, and in consequence he has not been a member ofthe " elected consulting staff " since that year.In his statement on the medical review of the region by

the board, Dr. Murray states he was a member of the reviewcommittee and that he also supplied evidence. In additionhe is a member of the regional board and its medical advisorycommittee. Now, it is an established axiom of British

jurisprudence that no-one can at the same time be witness,Member of the jury, and judge. But, by his own statement,this is what happened. This action provides incontrovertible

evidence for our demand for an impartial public inquiry’-the recommendation of which we are prepared to acceptin advance.

4. The board has not offered the general practitioners38 beds in exchange for the Victoria. It has offered a"

hospital " obsolete for fifteen years, with no facilities of

any sort worth talking about, and which is capable of holding,at most, 24 beds for acute sick. Despite inquiry, no informa-tion whatever of what consulting staff may be available hasbeen given. The hospital service of the area has alwaysbeen mainly based on specialists. Why de-grade the generalpractitioners from a position they have held since the foundingof the hospital in 1898 to one of considerably lower status ?It is through the present arrangement that the generalpractitioners are able to maintain a reasonably high standardin the domiciliary service they offer to the population generally.If this present arrangement is destroyed-and if Dr. Murray’sadvice is taken it will be destroyed-then the standard ofgeneral practice will inevitably fall, the patient will be theloser, and the service will suffer. Is it the policy ofthe regional hospital board to build up a hospital service at theexpense of the general-practitioner service ? If this is so,I am sure it is not what Parliament intended.

Dr. Murray is quite wrong in saying that in this groupthere are no beds solely under general practitioners. Apartfrom Kingston and Richmond, all the beds are solely underthe general practitioners, with, of course, specialist coveravailable. This is one of the features we are anxious to

preserve. The addition of " special unit " accommodation

does not in any way depend on the change of use of theVictoria.

5. To say that the staff of the Victoria has never held ameeting to discuss the question-who on earth is going tobelieve such rubbish ? Dr. Murray has never been invited,because, as I have pointed out, he is not accepted as beinga member of the staff.

Further, Sir, you will find that when the petitionwhich is at present being circulated is presented, a

large proportion of people in the boroughs of Kingstonand Malden will be shown as having expressed theiropinion against the proposal.

Indeed, wiser counsels must prevail. We have neverrefused " to sit round a table with those who have thearduous task of running the hospitals " to discuss thematter in its entirety ; in fact we have never beenasked to do so. We would be delighted to have theopportunity to put the case for the retention of the

general-practitioner hospital as an essential feature ofthe National Health Service. This type of inquiry is thatdemanded recentlv bv the British Medical Association.

New Malden, Surrey. T. W. MORGAN.

CHEMICAL PROPERTIES OF P.A.S.

SIR,—In the course of a study of p-aminosalicylic acid(P.A.S.), this substance was found to have certainchemical peculiarities which may be relevant to studiesof its bacteriostatic effects.

P.A.S. is a very strong reducing substance. Potassium

permanganate solution and potassium ferricyanate inthe Hagedorn-Jensen system are reduced far more by itthan by sodium salicylate. But P.A.S. has the followingchemical qualities, which sodium salicylate does not

possess : ’

1. It binds a large amount of iodine from an iodine solution.2. In the presence of sunshine it increases the separation

of metallic silver from the complex silver aminohydroxide ;and if this latter is mildly warmed, it selects a silver mirrorfrom it. It greatly enhances the separation by sunshine ofsilver from photosensitive silver phosphate. This is importantfor the estimation of urinary phosphatase.The urine of patients treated with P.A.S. reduces

Nylander solution, but Fehling’s solution it reducesnot at all or only very slightly. We find that the reducingsubstance is not a sugar. We have, however, foundglycuronic acid in the urine of patients treated withP.A.S.

Koltói Anna Hospital, Budapest.

Z. HORN

S. BOGSCH.