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helpers usually leads to dangerous short-cuts with seriousreductions in the boiling time and faults in the methods ofassembly.In our view, for mass inoculations in difficult conditions,

ready sterile dry syringes will prove to be particularly usefuland may indeed be the only practicable method of guaranteeinga separate sterile syringe and needle for each inoculation.-ED. L.

CHROMOSOME CONSTITUTION

OF MONGOLS WITH LEUKAEMIA

A. G. BAIKIEW. M. COURT BROWNP. A. JACOBS.

Medical Research Council Group forResearch on the General Effects

of Radiation,Department of Radiotherapy,Western General Hospital,Crewe Road, Edinburgh, 4.

SIR,—The occurrence of an abnormal chromosomeconstitution in mongols may have significance other thansimply in relation to the aetiology of mongolism.1-4 Thepossible role of the extra chromosome material in deter-mining the increased risk of mortality from leukazmiawhich has been found in mongols 5-7 may well be relevantto the general problem of leukæmogenesis. Such rele-vance seems the more likely in view of the demonstrationof chromosome abnormalities in some cases of acuteleukaemia. 9 We have been trying for over a year to studythe chromosome constitution of mongols with leukxmia.Such cases are, of course, fairly rare, but during thisperiod we have had the opportunity of studying two suchpatients. However, during the same period we heardof a further four cases only after death, and the cliniciansconcerned expressed regret that they did not know of ourinterest.

It is for this reason that we seek wider publicity forour wish to study mongols with leukaemia. Although theblood and bone-marrow samples for chromosome studiesrequire special handling immediately they are obtained,it must be emphasised that such samples can be taken atthe same time and in the same way as those required forordinary diagnostic purposes. We should be grateful forthe opportunity to study these patients anywhere inBritain.

NAMES OF DRUGS

H. C. M. WALTON.Beck Laboratory,Swansea Hospital.

SIR,—Surely it is time for some action on the names ofdrugs. Dr. Philip 10 suggested that a suitable registrationnumber for a drug could convey the more important dataconcerning it. Your review 11 of A Pocket Book of Pro-prietary Drugs said:

" It will be very useful in identifyingthe constituents of strange-sounding preparations."

It would be a start if all drugs had identifying lettersshowing their use-e.g., penicillin AB (for antibiotic)iodine AS (for antiseptic).The task of simplifying and reducing the number of

names of drugs might be undertaken by the JointFormularv Committee.

1. Lejeune, J., Gauthier, M., Turpin, R. C.R. Acad. Sci., Paris, 1959,248, 602.

2. Jacobs, P. A., Baikie, A. G., Court Brown, W. M., Strong, J. A. Lancet,1959, i, 710.

3. Polani, P. E., Briggs, J. H., Ford, C. E., Clarke, C. M., Berg, J. M.ibid. 1960, i, 721.

4. Fraccaro, M., Kaijser, K., Lindsten, J. ibid. p. 724.5. Krivit, W., Good, R. A. A.M.A. Amer. J. Dis. Child. 1956, 91, 218.6. Carter, C. O. Brit. med. J. 1956, ii, 993.7. Stewart, A., Webb, J., Hewitt, D. ibid. 1958, i, 1495.8. Ford, C. E., Jacobs, P. A., Lajtha, L. G. Nature, Lond. 1958, 181, 1565.9. Baikie, A. G., Court Brown, W. M., Jacobs, P. A., Milne, J. S. Lancet,

1959, ii, 425.10. ibid. p. 186.11. ibid. p. 602.

REDUCTION OF INTRACRANIAL PRESSUREWITH HYPERTONIC UREA

SIR The experience of Dr. John Stubbs and Mr. JoePennybacker (May 21) with hypertonic urea is most

interesting and helpful. I wish to support their claim of itsvalue. Indeed the reduction of intracranial pressure and

improvement in handling characteristics of the brain makethe use of hypertonic urea and invert sucrose one of thereal technical advances in intracranial surgery.The absence of local tissue necrosis at the point of

infusion speaks well for their technique of administration.Extravenous leakage is a very serious accident, and in one of

my cases was followed by severe tissue necrosis. Probably a

Above : One day after operation. Commencing necrosis.Below : One month after operation. Resulting ulcer.

large amount of the solution escaped into the subcutaneoustissue, for this is the only case in which diuresis and reductionof intracranial pressure did not occur-a fact continuallyremarked on during the operation. Necrosis declared itselfwithin 4 hours, and continued for 4 or 5 days.

Administration should, I think, be by an intravenous catheterand away from important nerve and artery concentrations. Thenecrosis seems to be caused not by the urea but by the productsof its breakdown. Leakage of the solution should therefore betreated by incision of the area, washing out the wound withsaline, and leaving it open for secondary suture.

Dr. Stubbs and Mr. Pennybacker do not say what theythink about the use of hypertonic urea with hypotension,nor (though basal aneurysms are specified among theiroperations) whether they have had experience of its usewhen renal filtration pressure is abolished. I have avoidedthe use of hypotension and hypertonic urea, but theirviews on this would be valuable because diuresis is

apparently not the only factor affecting the handlingcharacteristics of the brain.

I hope that the indiscriminate use of hypertonic ureain head injuries may be avoided. Nothing could be worsefor a patient with an extradural haematoma developingthan to have a dose of this very powerful medicine. As

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with almost everything else in surgery, discriminate andproper use is essential.

Birmingham.

SIR,—I am grateful to John Stubbs and Joe Penny-backer for stating that in a few neurological cases a

" tight"brain exists even when anxsthesia seems to be perfect.I am sure everyone engaged in neurosurgical anarsthesiahas encountered such cases. In my experience it hasoccurred in patients breathing spontaneously and in

patients undergoing controlled positive-negative respira-tion using curare-even with controlled hypotensivetechniques.From my limited experience I am sure that hypertonic

urea is going to be of help in these cases.

J. M. SMALL,

J. M. LEWIS.Morriston Hospital,

Swansea.

FLUORIDATION

DOUGLAS OF BARLOCH

A. J. DALZELL-WARD,Medical Director

Central Council for Health Education,London, W.C.1.

SIR,-It is indeed true that the Ministry of HealthReference Note no. 9 of 1955 asserted that there is " noscientific evidence that fluoride at a level of 1 part permillion has any deleterious effect on the health of adultsor children. " A more accurate statement would be thatthere is no scientific evidence that it is safe to have to

depend during a lifetime on water containing sodiumfluoride equivalent to 1 p.p.m. Unless and until thatstatement can be made, and proved, fluoridation involvesimposing an unknown degree of risk upon an unpredict-able number of persons for the sake of a dental benefitthe amount and duration of which is seriouslyquestioned.Doctors are entitled to ask individuals to accept risks in

surgical or medical treatment, although the judgment as towhether the risk is accepted is the patient’s. They are notentitled to impose risks upon some persons for the benefit ofothers. This is the fundamental objection to fluoridation.The Ministry of Health assertion is backed up by the state-

ment that in a community whose water-supply contained8 p.p.m. no important effect could be found in these people todifferentiate them from those in a similar community with a lowfluoride content in its water. Those familiar with the literatureof the subject will know that this anonymous reference is to theUnited States towns of Bartlett and Cameron. It is rather

interesting that the Councils on Drugs and on Foods andNutrition of the American Medical Association found thatthere was a significant difference in the deaths and added: "Onemight conclude that 8 p.p.m. of fluoride in water consumedconsistently was too high a dosage for safety. " It may be, ofcourse, that the Ministry of Health does not consider death tobe " an important effect."

London, S.W.ll.

SIR,-I would hasten to assure Mr. Capstick (May 28)that the Central Council for Health Education is playinga leading part in the campaign against lung cancer.

However, its role is that of educator rather than that ofa pressure group which is suggested by Mr. Capstick’sremarks. I cannot see why there should be any. com-petition between the reduction of lung cancer and thereduction of dental decay. Surely it is our duty to pro-mote preventive measures whenever possible whetherthese aim at preventing disease carrying a known fatality-rate or whether it is one which produces disability andavoidable suffering. The function of this Council is todisseminate knowledge and to cultivate public opinion,including professional opinion, and my letter was intendedto be a reply to Mr. Capstick’s views on the relativeimportance of dental health in our community.

The smoking issue seems to be an unusually large redherring containing a challenge which compels me, Sir,to ask once more for the hospitality of your columns.Our efforts in the field of fluoridation should not preventus making equal efforts to prevent lung cancer. In bothcases the preventive measures depend upon an informedpublic opinion, and our resources are sufficient to tackleboth problems-as well as many others.

RAPID NUCLEAR SEXING

ANN R. SANDERSON.Natural History Department,Queen’s College, Dundee.

SIR,-Aceto-orcein squash technique may be used forrapid nuclear sexing of oral mucosal smears. Aceto-orcein, generally employed as a stain for chromosomes,may also be used to demonstrate sex chromatin.The acetic acid (45%) fixes the cells and the orcein (syn-

thetic, 1%) stains with great clarity the sex-chromatin bodywhich can be recognised 30 seconds after obtaining the speci-men from the patient. Squashing flattens the nuclei and thisfacilitates scrutiny of the preparation. The outstandingadvantage of the method is its rapidity, and this derives fromthe ease not only of preparation but also of scrutiny. Themethod is completely reliable and preparations can be madepermanent if desired with little or no loss of cells.

Fine details of intranuclear structure can be made out withorcein, and in the male a slim heterochromatic crescent, smallerthan the sex-chromatin body of the female, can be seen at thenuclear membrane. The significance of this finding has stillto be established.

Obvious applications of this technique to nuclear sexinginclude the screening of large populations and the supplying ofinformation to clinicians when this is required urgently in thetreatment of individual patients.

Parliament

Professions Supplementary to Medicine BillIN moving the second reading in the House of Lords on

May 30 Lord ST. OSWALD said that as a consequence of thereport of the Simonds Committee the Government proposedat the committee stage of this Bill on June 28 to move anamendment to restore to the disciplinary committees to beset up under the Bill the express powers for the issue of writsof subpoena. These were struck out at the committee stage inthe House of Commons, shortly after the appointment ofLord Simonds’ Committee.Lord TAYLOR said that, in the past, doctors had been in

some doubt about their responsibility for the work done fortheir patients by these medical auxiliaries. Under this Billthe position was now clear. In another place, Miss EdithPitt, speaking for the MinisttEjr, had said that in future doctorswould not take responsibility nor be held responsible for workdone by these new professions. This was important particu-larly with regard to one of.these professions. The activitiesof these workers were mainly concerned with people who werenot in any great danger as to life or limb, but there was onegroup who were handling an exceedingly lethal weapon-theradiographers, whether doing therapeutic radiology or

diagnostic radiography. So far as he could see this Bill trans-ferred the doctors’ responsibility to the radiographer whilethe radiographer was doing his job. The Faculty of Radiolo-gists had been worried about this. Would it not be possibleto make sure that on the board of this particular professionthere could be guaranteed to be representation of at least onetherapeutic radiologist and one diagnostic radiologist.

Viscount SIMONDS said that the Bill established disciplinarycommittees with most formidable penal powers-a power to