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compared with atheroma elsewhere 1’ has not been sub-stantiated by subsequent work.18

It should also be emphasised that the postulated relation-ship between the pentose shunt and the polyol pathway,whereby increased N.A.D.H2 formation by the pentoseshunt could stimulate polyol formation (see fig. 1 of myreview 3), which in turn would promote arterial-wall

damage, is at present entirely conjectural. However,more detailed arguments for such a relationship as a causeof diabetic vascular disease have been advanced by Beau-mont et al.19

Department of Medicine,Groote Schuur Hospital and

University of Cape Town, South Africa. L. H. OPIE.

WITHDRAWAL OF PROPRANOLOL ANDMYOCARDIAL INFARCTION

SIR,-We were very interested in the letters by DrSlome (Jan. 20, p. 156) and Dr Nellen (March 10, p. 558)associating the rapid withdrawal of propranolol with theinduction of myocardial infarction.We have seen a similar association in a 66-year-old White male

with 9 months’ history of angina pectoris. He was treated with

propranolol, 20 mg. four times daily for 6 weeks, with considerableimprovement in symptoms. The day after propranolol wasstopped, he presented with precordial pressure lasting 45 minutesand not relieved by nitroglycerine. He was admitted to thecoronary-care unit. Serum-enzymes were raised (C.P.K. 1250,L.D.H. 375, and S.G.O.T. 150), and Q waves, with ST-segmentelevation, were noted in leads 11, in, and AVF of the electro-

cardiogram. He made an uneventful recovery. After dischargefrom hospital, the patient again had angina pectoris and wasagain placed on 20 mg. propranolol four times daily with con-siderable relief. The patient has now been followed for 4 monthswithout incident.

Patients with angina pectoris are at high risk for myo-cardial infarction. The association of the withdrawal of

propranolol and the development of myocardial infarctionis most probably a chance occurrence. However, it isalso possible that propranolol may reduce resting tissueoxygen requirements to levels which can be supplied bythe existing arterial circulation, and so protect againstmyocardial infarction. A sudden increase in oxygenrequirement associated with propranolol withdrawal mayprecipitate tissue necrosis. This possibility deserves

experimental and clinical evaluation.Division of Clinical Pharmacology,

Department of Medicine,New York Medical College,

1249 Fifth Avenue,New York, N.Y. 10029, U.S.A.

RUTH G. DIAZ

JOHN C. SOMBERGELLEN FREEMANBARRIE LEVITT.

IN SEARCH OF FLESH

SIR,-The reflections of a lexicographer (March 3,p. 479) concerning things of flesh made most entertainingand indeed instructive reading. I should like to suggestthat the myometrium of the human uterus is the tissuewhich best deserves to be considered as being flesh. Itscolour approximates to that of skin in the country wherethe language we call English originates. Its texture andfeel are truly " the soft substance of the animal body ".I read that the fibres of the smooth muscle which makes upits bulk contain sarcoplasm but have no sarcolemma.2oHowever, the organ has been known to produce a sarcoma.

Harbor General Hospital,Torrance, California 90509, U.S.A. DAVID ARROWSMITH.

17. Böttcher, C. J. F., Boelsma-van-Houte, E., ter Haar Romeny-Wachter,C. Ch., Woodford, F. P., van Gent, C. M. Lancet, 1960, ii, 1162.

18. Abdulla, Y. H., Adams, C. W. M., Bayliss, O. B. J. Atheroscler.Res. 1969, 10, 149.

19. Beaumont, P., Hollows, F. C., Schofield, P. J., Williams, J. F.,Steinbeck, A. W. Lancet, 1971, i, 579.

20. Foster, C. L. Hewer’s Textbook of Histology for Medical Students.London, 1960.

Parliament

Pensions, Benefits, and PovertyThe Government’s latest uprating of pensions and

benefits was condemned for not even fulfilling the modestpromise of price protection for the needy, when theNational Insurance and Supplementary Benefit Bill wasdebated in the House of Commons on April 30. Sir KEITHJOSEPH, Secretary of State for Social Services, said that theBill stemmed from the announcement first made by theChancellor of the Exchequer in his Budget speech; it pro-vided for the second of what were now annual increases inthe national insurance and supplementary benefits. Themain increase was the El a week in the single rate of retire-ment and invalidity pensions, widows’ pensions, andwidowed mothers’ allowances, raising the weekly rate fromE6.75 to E7.75. For a pensioner married couple theincrease would be El.50. There would be correspondingincreases in supplementary benefits. The Governmentwere confident that these increases would honour theircommitment to protect benefits against price rises.Mr BRIAN O’MALLEY said that the Secretary of State’s

optimism on the " significant improvements " that the Billwould make for the poor, the sick, the aged, and thedisabled should be seen against the background of policieswhich, over the last three years, had put vast sums of

money into the hands of the wealthy-those who receivedincome from investment, those who benefited from capitalgains, and those who benefited from reductions in the

payment of estate duty. If the Government were able inthe last financial year to give away E3000 million in taxrelease, they could have examined the possibility of sub-stantially increasing the Treasury supplement to theNational Insurance Fund. On the Government’s own

figures the pension for a single person would represent onlyabout 19 % of national average earnings, which was lowerthan the 1967 figure. The price of basic foods continued togo up, and meanwhile all that the Government could claimwas that the introduction of Value Added Tax had broughtdown the price of perfume and tennis rackets. The Secre-tary of State had explained that short-term benefits were torise by less than the long-term benefits-60p for a singleperson and f:1 for a married couple. But it was a misnomerto describe some of these payments as short-term benefits.On Feb. 12 this year, of those unemployed, 110,700 weremen and women who had been unemployed for between26 and 52 weeks-in other words, any earnings-relatedentitlement had disappeared completely-and 176,000, in-cluding 160,000 men, had been unemployed for more than52 weeks. It was intolerable that the Secretary of Stateshould deal with this class of claimants as short-termclaimants and attach to them a lower poverty line than wasattached to numbers of other national insurance andsupplementary benefit recipients. With regard to the broadquestion of family poverty, even the Government were nowbeginning to admit that the Family Income Supplementscheme was not a success, because the take-up over thewhole range of benefits was only 50%, and in the higherranges no more than 75%. There were probably 500,000children living in poverty or near the poverty line. Nothingshort of a radical reform and a fundamental redistributionof wealth would abolish poverty in Britain. Again,in this Bill, the Government had refused to face the

challenge.Sir BRANDON RHYS WILLIAMS said that members must be

disheartened by the fact that even when the effects of theBill had been felt there would still be a depressingly large

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number of people on supplementary benefit. No-one coulddeny that if the Government was to do what the nationwanted-provide larger pensions for old people-thenlarger contributions must be paid, but there was no reasonto believe that most people would not be willing to pay up.Mr MICHAEL MEACHER said that the Government’s con-

ception of fairness amounted to raising the pension by onepercentage point in relationship to national averageearnings, an increase which had in any case been madeperceptible only by downgrading the increases in the short-term benefits. This, he said, must be the cheapest con trickin the social security business for the present Government,whose self-praise for their benefit-cutting ingenuities wasso notorious. In fact there were now four poverty lines inBritain. They were, in descending order, for pensioners,for the unemployed and the sick, for the working poor onF.I.S., and for the 50% working poor who were entitled toF.l.S. but did not claim it. Another vital omission was theBill’s failure to take account of the changing role of womenin society. What equity now demanded was the award of ahome responsibility payment to women who were not em-ployed but who looked after young children or aged ordisabled relatives at home. If such a payment were madeat an untaxed rate of E4 a week it would cost the ExchequerE8 million. But it could very largely be paid for by with-drawing the married tax allowance from wives who neitherworked nor had these home responsibilities, which wouldsave the Exchequer E750 million a year. Replying for theGovernment, Mr PAUL DEAN, Under-Secretary of Statefor Health and Social Security, said that the Governmenthad been criticised because there had been no change in theratio of pension to average earnings over the past 20 years.But what had to be taken into account was that the ratio of

people of working age to those of pension age in 1948 wasabout 5/1; it was now 3/1. That had meant a massivetransfer of resources from the working population to thepensioner. With regard to all benefits, there was the harshreality of priorities which the Government had to consider.The Government were never satisfied that enough wasbeing done, but they believed that the present Bill repre-sented significant improvements.

Price of TranquillisersThe Regulation of Prices (Tranquillising Drugs) Order

received general support when it was debated in the Houseof Commons on May 3. Explaining the order, Mr PETEREMERY, Under-Secretary of State for Trade and Industry,said that its purpose was to give effect to the report of theMonopolies Commission, which had recommended sub-stantial reductions in the prices charged by the RocheGroup for certain drugs-mainly Librium ’ and ’ Valium ’(chlordiazepoxide and diazepam). The prices of medicinesprescribed under the National Health Service were con-trolled under the arrangements of the voluntary priceregulation scheme, whose terms were negotiated betweenthe Health Departments and the Association of the BritishPharmaceutical Industry. There had been difficulties aboutthe prices of librium and valium in the 1960s, when Rochehad made repayments to the Department of Health andSocial Security in respect of over-pricing, and since theninformation had come to light on the cost of the activeingredients of the drugs which had prompted the Govern-ment to refer the case to the Monopolies Commission. Thecommission had encountered difficulties in obtaining in-formation which it thought necessary to support the RocheGroup’s claims as to the proper charge for research ex-penditure, and it found the published accounts of the groupexceptionally uninformative. It thought that, at a con-servative estimate, profits implying a return on capital onthe trade in reference goods in excess of 70% had been

achieved. The commission did not accept that in thevirtual absence of price competition there was no limit tothe price and profit levels a manufacturer was justified insetting himself so long as he used the proceeds to expandhis research. The figures for research cost which thecommission had identified were substantially higher thancould be accepted as reasonable in relation to fair sellingprices. The Government accepted the report’s conclusionstogether with its main recommendation that the price oflibrium should be reduced to not more than 40% of the1970 price, and the price of valium to not more than 25%of the 1970 price, with corresponding reductions forcertain other less widely used drugs covered by the reference.The order did not touch on the question of repayments byRoche.Dr SHIRLEY SUMMERSKILL said that clearly there were

weaknesses in the voluntary price regulations scheme, andone could wonder whether the seriousness of the situationcould not have been revealed earlier. Doctors should beasked to consider the possibility of prescribing other tran-quillisers equally effective and cheaper which, preferably,did not have brand names; it had been shown that valiumand librium, which had brand names, were expensivepartly because of this property. Dr ToM STUTTAFORDasked what was considered to be a fair proportion of anyprofits from a drug which should be ploughed back intoresearch-research not into the current drug which wasmaking a profit at the moment, but for the next one comingalong which might save some other problem from afflictingthe world. Mr LAURIE PAVITT said that for seven yearsmillions of pounds had been paid unnecessarily by theNational Health Service, and he could not see why it wasnot possible to take action to recover a little of what hadbeen paid. Closing the debate, Mr EMERY said that theGovernment did not believe that the prices fixed in theorder included any element of recovery, but the Secretaryof State for Social Services was negotiating with Rochebecause the company itself might consider-as it had donein the past-that it had a duty to make repayments to theNational Health Service. The order was approved.

Obituary

RONALD BRAMBLE GREEN

C.B.E., M.A.Durh., M.B.Lond., F.R.C.S., Hon.D.C.L.Durh.

Prof. R. B. Green, professor emeritus of anatomyat King’s College, University of Durham, and deanof medicine in the University of Durham from 1937to 1960, died on April 27 at the age of 77.He received his medical education at University College

Hospital, London, graduating M.B. in 1921. He was demon-strator in anatomy at University College London, anddemonstrator and lecturer in anatomy in the Universityof Durham before being appointed professor of anatomyin 1927. He served on the General Medical Council for22 years and was a member of Newcastle Regional HospitalBoard from 1947 to 1965, during which time he was vice-chairman of the board and chairman of its planning com-mittee. He was G.M.C. representative on the GeneralDental Council for 5 years. He was a lieut.-colonel in theR.A.M.C. (T.A.) and officer in charge of the DurhamUniversity medical O.T.C. in 1939-45.He is survived by his wife and son.

C. H. T. writes:" As a demonstrator in anatomy at University College

London, R. B. Green was greatly influenced by Grafton