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subsequent reporting by directing attention both to theparticular sign or symptom already observed, and to thepatients who have shown it. These results certainly lendsupport to your plea for caution in interpreting double-blind trials, and for further empirical testing of trialmethods.

F. LETEMENDIAA. D. HARRIS.Department of Experimental Psychiatry,

University of Birmingham.

1. Cortril ’, Pfizer.2. Ungar, G. J. Physiol. 1944, 103, 333.3. Greene, R. Proc. R Soc. Med. 1950, 43, 16.4. Ungar, G. Fndocrinology, 1945, 37, 329.5. Ungar, G. Personal communication, 1947. Quoted in ref 3.6. Bergel, F. Personal communication, 1947. Quoted in ref 3.7. Greene, R., Vaughan-Morgan, J., Gammon, J. Brit. med. J. 1952, i, 17.

SPRAY-PACK THERAPY IN DERMATOLOGY

NAPIER THORNE.

SiR,—I was interested to read Dr. Hodgson-Jones’letter of March 28. Some of my patients also experienceda severe burning sensation when the earlier sprayscontaining isopropanol as diluent were used and a fewwould not continue to apply them.With the spray now marketed my patients report freedom

from burning or stinging even when the treated areas are

acutely inflamed. Providing the instructions are followed thespray has proved extremely economical when used in the

treatment of large areas of eczema. Its use, however, must bestrictly limited to non-infected skin lesions, but in the presenceof even mild skin sepsis its application is likely to be followedby an acute flare-up of the eruption.

I consider that in moist eczema it is far safer to use an

application containing both hydrocortisone and either an

antibiotic or a bacteriostatic compound. This relatively newand harmless diluent opens up many possibilities for the

development of other propellant sprays designed for the

speedy and safe control of moist infected eczemas anddermatitis.

London, B’<’.1. NAPIER THORNE.

A REMEDY FOR AGEING?

RAYMOND GREENE.

SIR,-Your restrained and judicious annotation (March14) on the new Roumanian

’’ wonder drug " omits to

mention that a considerable amount of work on the sys-temic use of procaine was done at an earlier date in thiscountry. Whereas the Roumanian work is, you tell us,purely anecdotal, the work done in Britain suggests a

possible rationale, and also, unfortunately for those whoseek a cure, a likely limitation.The work of Ungar 2 led me to hope that procaine might

stimulate the output of corticotrophin and so of hydrocortisonein patients with rheumatoid arthritis, and in 1946 I begantreating patients with intravenous procaine hydrochloride.The results, which were moderately good for those days, werereported to the Section of Physical Medicine of the RoyalSociety of Medicine.2 Both corticotrophin and procainehydrochloride usually caused, when the treatment was success-ful, the disappearance from the blood of the substance calledby Ungar " splenin B " and the appearance, when it had

previously been absent, of " splenin A ". Splenin A, invariablyfound in healthy people/-’; decreases the bleeding-time of

guineapigs.2 ,7 Splenin B, which has the opposite effect, hasnot been reported in the blood of healthy people, but has beenfound in that of patients suffering from active rheumatoidarthritis, spondylitis, acute rheumatism, non-articular rheu-matism, thyrotoxicosis, scurvy, and various hsemorrhagic states.The advent of readily available corticotrophin and cortisone

caused me temporarily to lose interest in procaine, for it seemedlikely that these substances did the same thing more effectively.My use of intravenous procaine in a number of conditionsknown to be susceptible to corticotrophin has hitherto streng-thened this view. It has, however, never been finally establishedthat procaine works by stimulating the output of corticotrophinand it would be worth while to make sure about this. Ten

years ago the biochemical methods were not good enough.If indeed procaine works only because it stimulates the

production of corticotrophin, the remarks of Max Reiss 8about the general effects of corticotrophin in patientswith involutional melancholia become relevant. " Inevery case the skin began to look and feel to the touchmore supple and thicker ... the hair of the head regainedits lustre, losing some of its dry, brittle quality ". Wouldtherapeutic optimists call this rejuvenation ?

It seems clear that further research on the pharma-cology of procaine hydrochloride is needed. In themeantime it would appear to those who have used it to be

merely a mild activator of the pituitary-adrenal systemand certainly no panacea. Efforts by the lay press to" sell " it as such show a serious lack of responsibility.

London, B’B’.1. RAYMOND GREENE.

8 Reiss, M. Proc. R Soc. Med. 1950. 43, 19.

SOFT DRINKS

PERRIN H. LONGState University of New York.

Brooklyn, New York

SIR,-I note that Dr. Franklin Bicknell (March 14)seems very worried about " cola " drinks, especially ascertain of the syrups (I imagine he spoke primarily of’ Coca Cola ’) are imported from the United States andtheir ingredients are secret. Actually this is not truebecause the formular of these various cola drinks havebeen disclosed to the Food and Drug Administration ofthe Department of Health, Education, and Welfare onmany occasions. The only " drug " which is in coladrinks is caffeine. If Dr. Bicknell would look in theFederal Register of Dec. 9, 1958 (23, R. R. 9511, p. 2),he would tind that cola drinks contain from ;, 10 ’ grainof caffeine in a six-ounce bottle of the drink. I wouldfeel that Dr. Bicknell could sleep soundly at night.

PSYCHIATRIC SEMINARS FOR GENERALPRACTITIONERS

SIR,-I read with concern Dr. Lask’s letter of March 21about the refusal of the British Postgraduate MedicalFederation to give official recognition to the TavistockClinic seminars for general practitioners. Dr. Lask

will, I am sure, be interested to know that postgraduatepsychiatric training precisely along the lines he mentionshas been in existence at the department of child and

family psychiatry of the Ipswich group hospitals for

many years. The Tavistock Clinic is not alone in this

important field.Under Dr. J. G. Howells’ guidance, fortnightly seminars for

G.P.s were started in 1950; an annual five-day course for G.P.s;psychiatrists, and public-healrh medical officers has been III

existence for six years; a fortnightly discussion group of sixG.P.s is now in its second year. and a second group is shortly tobe formed. In addition regular courses are held for district

nurses, health visitors, &c.The most recent annual course has just ended, being

attended by 42 doctors from diverse spheres of medicine andfrom diverse places as far apart as Scotland, Wales, and theIsle of Wight. This year the G.P.s more than held their ownnot only numerically but also m their contributions to the

discussions, formal " teaching "

being kept to a minimum.It is encouraging to find that the annual course was. this

year, recognised by Cambridge University Medical School forthe purpose of grants under the Ministry scheme for G.P.s,and was indeed formally opened by Prof. J. S. Mitchell, regiusprofessor of physic at the University. The imaginative attitudeof the regional hospital board received a sympathetic responsefrom the University, and all concerned are to be congratulatedon their initiative. Their helpful attitude ’is perhaps partlyrewarded by the resounding success of the course, which