843

Te<%’6 that people would be altogether better if all doctors’*t5ib pensioned off -? We could then translate the :E400niiUi6n into houses, parks, schools, holiday camps, andthe 101 things which this nation would have been con-structing if its people felt themselves to be in the vanand not in the rear, in social welfare.

F.R.C.P.

DERMATOLOGICAL OUTPATIENTS

SiR,-I wonder how many patients have had thesame experience as some of those with whom I am

acquainted. These people, who go to a variety of hospitalsin and around London, complain that the dermatologicaldepartments are crowded ; that they see a different

specialist or assistant every time; that these specialistsare always in a hurry ; that the advice is disturbinglyconflicting ; and that, in short, there is no real continuityiR treatment or study of individual needs. Though someof these patients have, of course, a strong emotionalbackground to their dermatitis and to the complaint, Ihave nevertheless formed the impression that facilitiesfor their supervision and treatment are quite inadequate.The aggregate cost to industry and the National HealthService must be immense, quite apart from considerablehuman suffering.

Speaking from an industrial angle, is it not time thatorganisation and treatment facilities were improved ’?

M. E. M. HERFORD.

NOTIFICATION OF INFECTIVE HEPATITIS

SIR,&mdash;Your annotation of Oct. 6 says that " in this

country infective hepatitis is not a notifiable disease."

Although this statement is accurate as regards the

country as a whole, it is nevertheless misJeading in viewof the fact-perhaps not generally known-that thedisease is notifiable in counties of the Eastern regionunder the Jaundice Regulations of 1943.You mention that dissemination of the disease is rapid

when hygienic conditions are poor. Whilst this is

undoubtedly true, I found 1 a high incidence (13 per 1000estate population per annum) on a new housing estate,where the standards of environment were good but wherethe age structure of the population provided an unusuallyhigh proportion of susceptible persons. Children under15 years old are predominantly affected by the disease,and populations on new housing estates contain a highproportion of this age-group.

Health Department,West Hartlepool.

G. T. CROOKDeputy Medical Officer of Health.

OMISSION OF PRESCRIBED P.A.S.

SIR,&mdash;The two valuable tests for p-aminosalicylic acid(P.A.S.) in the urine described by Dr. Penman and Dr.Wraith (Sept. 15) may well disclose, as they suggest,surprising numbers of patients omitting to take the drug,and even explain some of the growing number of casesresistant to other tuberculostatic drugs which the P.A.S.is intended to minimise.

Dr. Gordon (Oct. 13) recommends the compound drug’Dipasic’ as an alternative to separate r.A.s. andisoniazid ; but this still leaves patients on other combina-tions such as P.A.S. and streptomycin.Although some 10 g. of P.A.S. has to be taken daily

to maintain a blood-level of, say, 40 g. per ml., this initself is not usually too formidable as the sodium orcalcium salts are neutral, and the cachets can be swallowedone at a time during meals. Nausea, when it does occur,is in my experience most often, though not always,associated with a slight yellow discoloration of the drugdue to its oxidation to the very irritant meta-aminonhenol. A deener colour. -presumably from the same cause,

1. Crook, G. T. Med. Offr, July 6, 1956, p. 6.

can be seen in the urine, and incidentally in laboratorymedia incubated with the drug.

In view of the serious risks indicated by Dr. Penmanand Dr. Wraith, and also by Dr. Gordon, when patientssurreptitiously discontinue P.A.s., it is worth warningagainst attempting to take cachets when they are nolonger white; and for individuals smaller packs mightbe prescribed.

Bacteriology Department,University of Glasgow. J. E. TINNE.

CHOLECYSTANGIOGRAPHY

SIR,&mdash;Your annotation (Sept. 8) omits to mention twoimportant aspects of cholecystangiography. The firstis the value of this method in demonstrating unsuspectedcongenital anomalies of the cystic and common bileducts. Whilst oral cholecystography still is the mostvaluable as a " scout " method, cholecystangiographyis invaluable in demonstrating the status of the commonduct and forewarning the surgeon- of any congenitalanomalies 1 (except vascular ones) that he may encounterat operation.

Secondly the value of cholecystangiography in the

diagnosis of the acute abdomen 2 is not mentioned. Themethod provides a rapid means of evaluating the patencyof the cystic and common bile ducts and forms a rapidmeans of excluding obstructive cholecystitis.

Johannesburg. ERIC SAMUEL.ERIC SAMUEL.

KLINEFELTER’S SYNDROME

SIR,&mdash;In view of the interesting findings of Plunkettand Barr 3 in connection with sex-chromatin patternsin Klinefelter’s syndrome, which suggest that it maybe due to an embryonic abnormality rather comparable tothat seen in Turner’s syndrome, in which other con-genital deformities such as disturbances of colour-vision 4may be found, and in view of the light which this maythrow on the possible genetic sex of these individuals,it appears to us that it would be interesting to test amoderately large group of cases of Klinefelter’s syndromefor these abnormalities.No one group of workers is likely to have many of

these cases at their disposal, and we are therefore writingto suggest that others interested in this subject who havepatients suffering from this condition might feel inclinedto collaborate with us, and we should be very pleased ifsuch workers would get in touch with us so that we coulddiscuss plans for carrying out the necessary simple

Guy’s Hospital,London, S.E.1.

P. M. F. BISHOPP. E. POLANIM. H. LESSOF.

BOOKS FOR INDIA

Dr. EILEEN R. BARTER SNOw, principal of the ChristianMedical College at Ludhiana, writes :The Christian Medical College, founded in 1894 as the first

medical school for women in India, now trains men and womenmedical students, who come to us from all parts of India andfurther afield. We are building up a good medical library,and I would like to ask authors and publishers of medicalbooks whether they would send a copy of each book publishedto Ludhiana. American authors are very kindly doing thisfor us, and I am anxious that British medical thought shouldbe well represented. We should be very grateful indeed forany such volumes donated. These may be sent direct to thecollege (Ludhiana, Punjab, India), or to the Secretary,Ludhiana British Fellowship, 12, Queen Anne’s Gate, London,S.W.1, who will acknowledge and forward them.

1. Samuel, E. Ann. R. Coll. Surg. Engl. (in the press).2. Samuel, E. Indian J. Radiol. 1956, Diamond jubilee no., p. 289.3. Plunkett, E. R., Barr, M. L. Anat. Rec. 1956, 124, 348.4. Polani, P. E., Lessof, M. H., Bishop, P. M. F., Lancet, July 21,

1956, p. 118.