537

CHLORAMPHENICOL IN ERYSIPELOID OFROSENBACH

PAOLO MORONI.Dermatology Clinic,University of Bologna,

Italy.

SIR,—I have found that chloramphenicol inhibits inv-itro the growth of Erysipelothrix rhusiopathiæ, and I

recently gave the drug to 4 patients with erysipeloidof Rosenbach, 2 of whom had not responded to treatmentwith penicillin.

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Doses of 2 g. per day produced rapid resolution in3 cases ; in fact, after the first day of treatment, pain,oedema, and erythema quickly subsided, and after thethird day only pigmentation and desquamation remained.The 4th case was more resistant, and vivid-red erythe-matous areas persisted at the circumference of the lesion.But healing was complete after five days’ treatment. Sup-plementary local treatment with 2% chloramphenicol in abase of Carbowax ’ produced no local or general intolerance.

This is insufficient evidence for a definite con-

clusion, but it justifies further study of the drug inerysipeloid.

1. Schlesinger, B. Lancet, 1938, i, 593, 649.

MALARIA

PAUL F. RUSSELL.Division of Medicine and Public Health,

Rockefeller Foundation,European Office, Paris.

SIR,—I feel humble and appreciative in respect of

your review (Aug. 30) of my book on Ilalaria. Onepoint, however, disturbs me. I want to make it clearthat I have the highest respect for, and I accept, thework of Shortt and Garnham and their colleagues onthe pre- and exo-erythrocytic stages of malaria plasmodia.My term ’’ in the shadows," referring to these earlyforms of the parasite, seemed fair when I wrote it becausethe earliest development following the sporozoite hadnot been described by any observer. Even today,although further progress has been made, there remainpoints that are not clear. It was not my intention toreflect on the fundamental studies mentioned, to whichill fact I gave full credit in the short historical chapterof the hook.

SORE THROAT AND RHEUMATIC FEVER

R. E. SMITH.

SIR,—In his letter (Aug. 16) Dr. Collis asserts that"

Schlesinger’s contribution was his observation of thesilent period between the initial throat infection andthe subsequent rheumatic-fever attack, or relapse, andI lie effect on the subsequent attack of salicylate if givenduring the silent period."

Schlesinger, a, far as I know, has never claimed thatlie first observed the silent period, although he was ananh-nt advocate of salicylate therapy, as lie made clearin his Milroy lectures of 1938.1 J suggest that the chiefcredit for observing the silent period goes to C. Haig-Brown, who ill Tonsillitis in Adolescents (1886) wrote" An attack of acute rheumatism is very frequently pre-

ceded by one of acute tonsillitis, it may be by as long a timeas five or six weeks, but more usually ten days or a fortnight ;while, as has been already stated, the two may be coincidentIII time. In fact, it is rare to meet with a case of rheumaticfever which has not been recently preceded by a sore throat ;and though I am not prepared to say that tonsillitis is thefore-runner or the companion of every case of rheumaticfever, the last eleven cases of the latter which I have had totreat have, within six weeks of the onset of the joint-painsand fever, been under my hands with sore throats."

Thi" was probably not the original description, forHaig-Brown modestly says:- As ha; been observed by others than myself, it is very

frequently found that the subject of articular rheumatismthey had a - sore throat perhaps a month, but more commonlyten days or so, before he felt pain in his joints, or thatsimultaneously with the joint-affection, there is tonsillitis.’.

Hugby.

MEPACRINE AND RHEUMATOID ARTHRITIS

ARNFINN ENGESET.Medical Department.

Rogaland County Hospital,Stavanger, Norway.

SIR,—We have read with interest the preliminarycommunication by Dr. Freedman and Dr. Bach (Aug. 16).Since Page’s report appeared, we have used mepacrineon a limited scale in selected cases.

A young woman with acut-e lupus erythematosus wasdangerously ill when treatment with A.C.T.H. was started.She improved rapidly, but on account of side-effects of A.C.T.H.we tried mepacrine with apparently good results. The with-drawal of mepacrine was followed by deterioration. ,

We have given mepacrine to 11 patients with rheuma-toid arthritis. The longest period of observation is fivemonths and the shortest six weeks. All of the patientsdeclared that their pain gradually eased, and in 5 thereis already definite objective improvement. Treatmentwith mepacrine is not followed by eosinopenia or increasedexcretion of 17-ketosteroids ; nor is the erythrocyte-sedimentation rate or temperature influenced in our

experience.During the last two years, 2 patients with bronchial

asthma have been admitted to our hospital repeatedlyon account of status asthmaticus. Several times we havehad to use A.c.T.H. for short periods. Six months ago westarted giving these 2 patients mepacrine. Follow-upexaminations have shown that both are entirelv free ofsymptoms and signs of bronchial asthma.We agree with Freedman and Bach regarding dosage

and length of treatment. The variable course of rheuma-toid arthritis and bronchial asthma makes it verydifficult to differentiate between a spontaneous remissionand an effect of administering mepacrine. We hopethat extended trials of mepacrine will soon solve thisproblem.

1. Page, F. Lancet, 1951, ii, 755.2. Brit. J. Addict. 1949, 46, 47.3. See Ibid, 1951, 48, 72.4. Verbeeten, B. Med. Tijdschr. Geneesk. 1952, 96, 12.

AVERSION TO ALCOHOL

H. PULLAR-STRECKERHon. Secretary,

Society for the Study of Addiction.Wyke House. Isleworth.

Middlesex.

SIR,—The chance observation by Dr. Walker andDr. Boyd (Sept. 6) that a heavy beer drinker exposed totetraetiiyl lead (T.E.L.) abruptly stopped- drinking (andalso developed a voracious appetite) a few weeks beforebeing admitted to hospital for T.E.L. poisoning, is of

great interest to those engaged in the study and pre-vention of alcoholism. The same voracious appetite ajiddistaste for alcohol was observed in 1938 in a number ofworkmen exposed in a clay pit to hydrogen sulphide.2The advent of ’ Antabuse ’ (not ’ Antabus ’ as recentlyadopted by THE LANCET) has stimulated interest insubstances—of which there are quite a number’-causing aversion to or distaste for alcohol, which are not-the same things.

In the case of antabuse it is an-aversion, for one avoidscontact with alcohol because of the unpleasant symptomswhich then supervene. A similar aversion appears toexist in the initial stages of Hodgkin’s disease, wherepain, cough, and itching become intensified on takingeven small amounts of alcohol. 4 On the other hand,hydrogen sulphide appears to produce a distaste, no

other symptoms except the voracious appetite beingreported.

Chance observations such as these may help us

eventually to find a means of readjusting physiologicalimbalance as the cause of alcoholism. This society isanxious to collect further observations of the kind,especially on substances producing distaste or dit3-inclination for alcohol.