PROPRIETARY AND APPROVED NAMES

251

the surgeon’s rubber gloves. The results of the spottest compared unfavourably with those obtained with theusual scrub and alcohol wash. There were also differ-

ences in the sensitivity of the flora of different personsto Gil. Price’s conclusion is that G11 soap. has been

greatly overrated, and that unless its limitations arerealised its use may create a false sense of security. He

recommends that the surgeon should wash his handsand arms with ordinary soap without a brush for threeminutes, trimming and cleaning the nails ; the hands

should then be dried with a sterile towel and washed for60 seconds in 70% alcohol, with the use of gauze or awash-cloth. In discussion, a number of surgeons rose indefence of the Gl technique and gave figures in supportof their views. Some of these figures, which showedmarked reduction in bacterial counts of the hands afterthe use of G 11, are subject to the fallacy that with thiscompound a bacteriostatic amount of antiseptic may bevery readily carried over to the culture medium. Othersconsisted of records of low infection-rates in hospitalsusing the soap-figures to which many other factorsclearly contribute. The value of Gil soap remainsundecided, but Price’s careful scientific approach mustcarry weight. It would seem safer for the present tofollow his recommendation, which does not differ

materially from that of Ogilvie,6 expressed in THE LANCETWar Primer on Wound Infection. Ogilvie advised theuse of a soft nailbrush for a preliminary 5-minute scrubin warm running water ; and he urged the use, after thealcohol wash, of dry-sterilised rather than boiled gloves,to minimise the dangers associated with accidentalpuncture.

6. Ogilvie, W. H. In The Lancet War Primer on Wound Infection.London, 1940.

7. Pharm. J. 1952, 168, 17, 23.

PROPRIETARY AND APPROVED NAMESAN address by Mr. F. Hartley, PH.D., on the Nomen-

clature of Drugs has drawn fresh attention to an

intractable problem. Manufacturers cannot be expectedto spend considerable sums on pharmacological andpharmaceutical research unless they are allowed to

recoup themselves by the temporary reward of propri-etary rights in the results. When they have broughttheir product to market under its chosen name, therefollows a stage at which variants or improvementsappear. The Trades Marks Act provides one kind ofstatutory protection and the Patents Act may or maynot provide another ; but often the same manufactureror his competitors will soon be marketing rather similarsubstances, with rather similar properties, under a

confusing diversity of labels. The physician must then.distinguish several ranges of probably polysyllabic andpossibly unrevealing nomenclature. If he prescribes onesubstance with disappointing results, it is conceivablethat he may turn to another without realising that it isno different. The pharmacist in his turn has to lock upcapital to stock his shelves with several brands of thesame product, competitive salesmanship inviting pur-chasers to demand one kind rather than another. Enter-prise in research deserves its reward, but it is hardlytolerable that, when a new drug is invented, twentydifferent manufacturers should market it under differentnamas. -

In Utopia the problem might be solved by grantingthe State a monopoly of chemical research ; but, perhapsfortunately for scientific progress, we have not yetreached this particular Utopia. As things are, we lookto see what can be done by the World Health Organisa-tion or by, the Pharmacopoeia Commission’s N omen-clature Committee. The latter has published lists of

" approved names " suitable for adoption by manufac-turers. - An approved name, as Dr. Hartley observes,should be distinctive and easy to pronounce and (over-. optimistic as the hope may be) easy also to write and

to remember. Memory might be aided if the nameconveyed some hint of the use of nature of the drug ;but the commission, as he says, have decided that a recom-mended approved name should preferably be free fromany anatomical, physiological, pathological, or thera-

peutic suggestion. His instances and reasons tellus why.

Research in many lands is increasing the discoveryof new drugs. The difficulty of naming them is enhancedby the possibility that names -will also be needed forclosely related chemical derivatives. Dr. Hartley sug-gests that the only feasible solution seems -to be to formnames by combining syllables from the scientific chemicalnames in such a way as to indicate the chemical groupingsof the molecules. This would help towards the subsequentnaming of the derivatives. But he has no illusions aboutthe prospect of obtaining names distinctive in sound andspelling, easy to pronounce and remember, and safe fromconfusion with existing names-and all this within, say,not more than four syllables.Even when a new drug receives an approved " generic

name in its country of origin, the difficulties are not atan end. For it remains possible for manufacturers abroadto register that name, or something very like it, for theirown exclusive benefit in their own countries, thus

profiting quite undeservedly from the internationalreputation it has gained. In a vigorous protest againstthis practice the Council on Pharmacy and Chemistryof the American Medical Association 8 give a- list ofnames that foreign manufacturers have registered (orhave applied to register) as proprietary-among .themcortisone, estradiol, heparine, neostigmin, procain, hexyl-resorcinol, and testost Jron. The council rightly hopethat " piracy of generic names for drugs ... eventuallymay be outlawed in the interests of universal scientificcooperation." We strongly share their opinion that" the generic status of nomenclature formally adoptedby recognized scientific groups of any country should beuniversally respected by pharmaceutical manufacturers."

8. J. Amer. med. Ass. 1951, 147, 1570.9. Prinzmetal, M., Corday, E., Oblath, R. W., Kruger, H. E.,

Brill, I. C., Fields, J., Rexford Kennamer, S., Osborne, J. A.,Smith, L. A., Sellers, A. L., Flieg, W., Finston, E. Amer. J.Med. 1951, 11, 410.

AURICULAR FLUTTER

THE cardiac cause of a rapid, regular pulse-rate isnot always brought to light by electrocardiography.Sinus tachycardia, paroxysmal auricular tachycardia,auricular flutter, and more rarely nodal tachycardia maygive virtually identical electrocardiographic patterns ;their distinction will depend on clinical observation andon response to vagal stimulation and exercise- tests. Inborderline cases of auricular arrhythmia, if we rely onthe usual criteria of differentiation, the diagnostic problemcan be especially difficult ; but Prinzmetal’s 9 work seemsto explain this difficulty. -

Prinzmetal believes that the various electrocardio-

graphic and therapeutic disparities between auriculartachycardia and flutter relate to variations in auri-cular rate and not to any fundamental difference inauricular mechanism ; in other words, there is no sharp lineof demarcation between tachycardia and flutter. He hasshown that each results from the same disturbance in theauricles-namely, the discharge of impulses from anectopic focus at a rate greater than the rate of dischargefrom the sinus-node and lower than the fibrillationthreshold. At slower auricular speeds within this rangethe characteristics of tachycardia tend to appear, andat more rapid rates those of flutter. His conclusions arebased on experimental work in which high-speed cinema-tography recorded the motion of the auricle induced toflutter by electrical stimulation and by local applicationof aconitine, and the flutter-waves were recorded bydirect-lead electrocardiograms. He extended his investi-