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cyclopropane, which appeared at the outset to have suchgreat promise, required five years of trial before it couldbe said to have passed the experimental stage. Curare,,which appears to be of even greater value than cyclo-propane, will probably require an even longer trial. I

hope that, unlike ’ Pentothal,’ it will not prove to bea drug " fatally easy " to administer.

(2) When we examine the dosage of drugs used inthis case, it would appear that the coroner’s verdict wascharitable. An old lady of 70, suffering for two daysfrom an acute abdominal infection, and with earlyperitonitis, was given morphine gr. 1/s and atropinegr. 11100’ I would presume to say that the former drugwas superfluous. This was followed by 1 g. of pentothal.In my opinion this was an excessive dose, even hadnitrous oxide been the only additional anaesthetic to begiven. With curare in a fit subject in first-class conditionI personally hesitate to give more than half this dosage.Prescott, Organe, and Rowbotham (Lancet, July 20,p. 80) have pointed out the danger of giving two suchrespiratory depressants together in full dosage. Thepresent case illustrates this danger. I am not surprisedthat the patient required continuous oxygen.

This was followed by’ Intocostrin ’ 9 c.cm.-180 units.Presumably this was given intravenously in a single dose.So far as I am aware. 100 units of this drug is regardedby authorities as a maximum single dose even in fitsubjects. In any case, we are warned that in the veryyoung, or the very old. or in bad risk cases, this dosemust be considerably reduced. I hope that those who aremore competent than myself to express an opinion willlet us know in your columns whether this dosage shouldbe regarded as excessive.

I have the deepest sympathy with the anaesthetist inthis case, of whose identity I am ignorant. " There,but for the grace of God, go I." But I should like toobtain the opinions of my colleagues on the followingfour principles :

(1) New anaesthetic drugs must be assessed in comparisonwith ether.

(2) Final assessment cannot be made until -many hundredsof thousands of administrations have been recorded.During this period of trial such drugs should be regardedas experimental.

(3) Such experimental drugs should not be given to badrisk cases.

(4) The dosage of such experimental drugs should be care-fully regulated according to the published recom-

mendations of senior anaesthetists.

It is only with the object of establishing these prin-ciples that, with humility and hesitation, I havesought the hospitality of your columns at such length.London, W.l. R. BLAIR GOULD.

SIGMOIDOSCOPY IN AMŒBIC DYSENTERY

SiR,—I should like to add a postscript to my article ofOct. 13, 1945 (p. 460). Two points call for revision inthe light of subsequent experience.The first of these concerns technique. I have since

found that the most satisfactory method of producinga " clean " lower bowel, whether for the diagnosticpurpose of a sigmoidoscopy or for the therapeuticpurpose of a retention enema, is by the simple administra-tion of a weak bicarbonate enema, after which a periodof 4-6 hours must be allowed to elapse. At the end ofthis period, regardless of the taking of meals mean-while, the lower eight inches of bowel are almost invari-ably clean and

"

dry," in the sense that all traces of

enema fluid have been evacuated or absorbed. Animportant point, and one often overlooked, is that theevacuant enema must be of just that volume which willproduce an effective call to stool: this will be onepint in some, considerably more or less in others. Thereare still undesirable methods in use involving the exhibi-tion of castor oil, &c., and I have known retentionenemata given within a few minutes of the evacuantenema, thereby reducing the strength of the medicamentused to quite ineffectual proportions. Such errors intechnique not only defeat their object but often involvea sore trial for the long-suffering patient.

Secondly, a point in diagnosis. Recently I have seena number of cases in which the ulcers are minute : withthe ordinary magnifying lens they catch the eye merely

as tiny points of extreme congestion. They are scatteredin small groups, and frequently only one such group canbe found. With a special magnifying attachment,first shown me by Lieut.-Colonel A. M. Khan, R.A.M.C.,it is possible to detect the actual tissue loss.

Keighley, Yorks. C. F. J. CROPPER.

NON-SPECIFIC EPIDIDYMITIS

SiB,—Dr. Whitwell’s letter of Sept. 7, recallingSlesinger’s suggestion that non-specific epididymitismay be due to stress reflux of normal urine, promptsme to describe an experiment carried out at my suggest,tion by Dr. G. L. Timms, pathologist to Kenya Govern-ment Medical Service. ’

A rabbit was anaesthetised and 5 c.cm. of urine withdrawnby vesical puncture. Of this, a part was cultured and provedsterile. Of the remainder, 0-5 c.cm. was injected into thepreviously exposed vas deferens on one side. As this wasdone the epididymis could be felt to inflate with urine. Theanimal remained clinically normal after this operation ; after10 days the testis and epididymis on both sides were removedand sectioned. They were all normal.As Handley says (Lancet, 1946, i, 779), the reflux

theory does not seem very feasible ; and this experiment-appears to show that normal urine is not an irritant inthe epididymis, at least in the rabbit.London, W.I. F. RAY BETTLEY.

TUBERCULOUS GLANDS AND CALCIFEROL

SiR,-With reference to the treatment of tuberculousglands with high dosage of calciferol (July 20, p. 88),there seems to be some evidence that such treatment,while helpful when sinus formation is present, has aclinically adverse effect on glands which have not brokendown. In the absence of more detailed investigationthis is little more than an impression, but it would be inkeeping with the observation that in the early stagesof treatment of lupus vulgaris with calciferol there isnot infrequently a local exacerbation of the disease.It would also be in keeping with similar observationson the influence of tuberculin in tuberculous lesions andof arsenic in untreated syphilis. Until further evidenceis forthcoming it would appear advisable to use thecalciferol treatment with caution when lung tuberculosisis present, since such a reaction in the lung might havedisastrous senuels.

London, W.l. H. J. WALLACE.

NEW WORDS ABOUT OLD AGE

SiR,—In your issue of August 10 (p. 214) Dr. Howelldiscusses " the nomenclature of old age." It would be abenefit to medicine if you would help to get the " newwords " fixed in correct form before it is too late.From pais (stem paid-) a child, we have " paediatrics,"

and from geron (stem geront-), an old person, we shouldhave " gerontiatrics," not " geriatrics." There is noword geria in Greek, though there is eugeria, meaning agood old age. Gerontiatrics therefore is the word for themedical care of the aged and eugeria is its goal.

Orpington, Kent. H. ST. H. VERTUE.

TECHNIQUE OF PREFRONTAL LEUCOTOMY

SIR,-In order to avoid incision of the grey matter,I suggest that prefrontal leucotomy might be performedthrough an approach from the midline underneath theangular gyrus by an incision of the corpus callosum inthe direction of its fibres. No doubt a special knifewould have to be designed and a new technique devisedfor the new approach.

- - - --

Taunton. T. F. G. MAYER.

** * We are informed that section from this anglewould carry an appreciable risk of damage to the opticnerves.—ED. L.

THE Medical Research Council have received from SirLeonard Rogers, F.R.s., a further addition to the endowmentfor research in tropical medicine with which he entrustedthem in 1926. The capital value of this fund is now about15,000, and the income is applicable to special purposeswithin the general field of tropical medical research.