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with torrential hmmaturia demanding secondary nephrectomy.A surgeon about to tie such a vessel might profitably ascertainwhether the urine is infected before coming to his final decision.

I see no reason why the testicle should behave differ-ently from any other organ or tissue... and I do notbelieve it does.

Barnet, Herts. V. J. DOWNIE.V. J. DOWNIE.

VALLERGAN

SIR,-Dr. F. Widlake (Feb. 21) describes a complica-tion of violent excitement which occurred in a childfollowing the oral administration of a new sedative,trimeprazine tartrate (’ Vallergan ’).During the use of this drug for premedication in some 500

cases at the Hospital for Sick Children, Great Ormond Street,I have never seen or been told of such unusual behaviour asDr. Widlake describes. An article by Dr. W. J. Glover andmyself which describes a trial of this drug in hospital is nowawaiting publication in your journal. From this trial I can

suggest that it seems just possible that Dr. Widlake’s patientreacted so unexpectedly owing to the chosen dose being rathertoo small to produce efficient sedation, only producing excite-ment in the same way that a mischosen or mistimed dose ofbarbiturate occasionally does.

Vallergan appears to me to be a " better promethazine

and if so then it would seem to be a very valuable pre-medicant drug for children.

University College Hospital, R W COPELondon, W.C.I. R. W. COPE.R. W. COPE.University College Hospital,London, W.C.1.

THE CRANBROOK REPORT

SiR,ŁI refer to last week’s letter from my very goodfriends Mr. Wrigley and Mr. Garland.The admirably constituted Cranbrook Committee was

appointed by the Minister, and, after thorough considerationof evidence from all relevant sources, recently reported to theMinister.On the other hand, Mr. Wrigley is one of two advisers in

obstetrics to the Minister; Mr. Garland is an active and

capable member of our largest regional hospital board. This

being so, I suggest that it might have been wiser or at leastmore appropriate for them also to present their opposing viewsto the Minister rather than to launch them upon a public ofwhich the vast majority can be only very partially informed.None of the Cranbrook recommendations has as yet been

implemented: there is plenty of time. °

Unfortunately, and all too paradoxically, any discussion ofthe affairs of midwifery is apt to arouse the vilest passior s;special pleading on behalf of sectional and parochial intere1t1ad nauseam obscures a main issue which should be so happ vin its outcome. Is it therefore too much to expect a measureof manifest agreement at the outset and at the centre ? Whetherwe like it or not Savile Row is the administrative centre in thiscountry. I only hope that it will at last prove itself worthy ofthe leadership entrusted to it (bearing in mind that leadershipconnotes a certain degree of discipline).My object in addressing you, Sir, is not to take sides

in the endless altercations as to who should deliver the

baby and where the baby is to be delivered. Rather doI wish to call the attention of everyone concerned tothe views expressed by Sir George Schuster and othersin Creative Leadership in a State Service,l which I

thoroughly endorse. Our maternity services at this junc-ture present a most important and serviceable illustrationand a very great opportunity.London, W.1. FRANK COOK.FRANK COOK.

SIR,-How refreshing it was to read the letter by Mr,Wrigley and Mr. Garland after the extreme disappoint-

ment evoked by the Cranbrook report, which broughtto mind the epitaph of old Sir Hugh:

"... In this case I confessSome reasons weigh more, and some weigh less.The case being so, we can hardly say no,And yet we hesitate, much, to say yes."

Surely the time has come to abandon the obviousinefficiency of tripartite control, and to unify the mid-wifery services under the vigilant eye of the obstetrichospital. This would bring every delivery indirectlyunder the guidance of the consultant.

Speaking as a future administrative doctor, I sincerelybelieve that the establishment of " local maternity liaisoncommittees " would be a retrograde step, causing aneven more Babel-like confusion where the single voice ofauthority is so clearly needed. And, speaking as a marriedwoman, I think I can say that most of my sisters wouldbe delighted to have hospital confinement, provided thatthey could be discharged within forty-eight hours. Onlythus can we provide (and here I use the very words ofthe Royal College of Obstetricians and Gynaecologists)" maximum safety for mother and child."London School of Hygiene and V IAN G EDWARDSTropical Medicine, W.C.I. VIVIAN G. EDWARDS.VIVIAN G. EDWARDS.London School of Hygiene andTropical Medicine, W.C.1.

ANTIBIOTICS AND THE COMMON COLD

SiR,ŁThe common cold presents a very real problemin industry, to both employer and employee. It is arecurrent cause of interruption of planned production onthe one hand, and of loss of earnings on the other. Inone of our factories in December, 1958, 13% of the popu-lation each lost an average of seven days owing to upperrespiratory infection.

Dr. Ritchie’s carefully planned work and his accurateanalysis of results were most encouraging and led us, inthis department, to look at the problem from a practicalstandpoint. We at once anticipated difficulties in carryingout specific antibiotic sensitivity tests annually on all ourstaff, even though we have a comprehensive bacteriologicallaboratory service. Professor Garrod (Jan. 3) raised onceagain the problem of inducing antibiotic-resistant strainsas a result of minimal antibiotic therapy. To overcomethese difficulties, and reduce by about 6/7 the incidence ofsevere colds as was done by Ritchie, it seemed to us thatthe following conditions needed to be satisfied:

1. We must have an antibiotic to which a high proportionof the population showed sensitivity of their normal oronasalflora. Under this circumstance, swabbing of every individualwould be unnecessary.

2. The possibility of creating resistant strains must beminimal and the consequences of such an occurrence negligible.An antibiotic which was insoluble and not absorbed, andtherefore not used in systemic infections, would meet theserequirements.Our work was conducted in two factories. The first was

a unit of 400 people approximately. We took nasal swabsfrom 120 people on a random basis and did antibioticsensitivity tests. The results were as follows:

* In some cases two of the antibiotics were equally effective and these havebeen included under two headings.

Thus 96% of the swabs were sensitive in some degreeto framycetin (’ Soframycin’), and in 86% of cases it was1. Acton Society Trust. London, 1959. See Lancet, Feb. 14, 1959, p. 349.2. Ritchie, J. M. Lancet, 1958, i, 615; ibid. p. 618; ibid. 1958, ii, 699.

520

the antibiotic of choice. On the basis of random sampling,the expected error of these two figures was rb3/z% and±6/2% respectively.We next considered the larger factory of some 2700

people, and took swabs from a random sample of thesepeople. Sensitivity tests in 98 people gave the followingresults:

* In some cases two of the antibiotics were equally effective and these havebeen included under two headings.

Thus our first experience was repeated, and we deducedthat if we applied framycetin in all cases of the commoncold we could confidently expect this to be the right anti-biotic in over 95% of cases. Furthermore, this antibioticwould not suffer the criticisms levelled at the other anti-biotics which have been recommended for this purpose.

In a further group of 60 people, penicillin was includedin the sensitivity tests. The results were:

These results would appear to confirm to some extentthe opinions expressed by Professor Garrod and Dr. Wood(Jan. 31). Our figures indicate that just under 50% ofcases were sensitive to penicillin; and that, when this wasthe case, in a high proportion of those sensitive penicillinwas the antibiotic of choice. Nevertheless, on grounds ofsensitivity, framycetin remained superior and had theother advantages already mentioned.We have now embarked on a clinical assessment in

which the standard treatment is 1 soframycin lozenge b.d.(each lozenge contains framycetin 10 mg. plus gramicidin100 {ig.) plus soframycin nebuliser b.d. for three days.It is hoped that results of this assessment will be availablein three months.The laboratory work in this investigation was carried out by

Mr. R. M. Allison in the company’s laboratory at Hayes, and we areindebted to Roussel Laboratories for supplies of ’ Soframycin ’.

T. Wall & Sons, Ltd., PETER R BAtlas Road, London, N.W.10. ETER . ATESON.PETER R. BATESON.T. Wall & Sons, Ltd.,

Atlas Road, London, N.W.10.

ORAL TREATMENT OF RINGWORM WITHGRISEOFULVIN

SIR,-Dr. Williams and his colleagues’ described 9cases of ringworm of the nails treated orally with griseo-fulvin..In connection with this I should like to describethe results of oral treatment with potassium iodide ofringworm of the scalp due to Trichophyton violaceum.

21 children aged 2-11 years recovered after being treatedorally with a 21/2% solution of potassium iodide for 2-5months. The doses ranged from 0-2 to 0-4 g. of potassiumiodide, according to age, three times daily. Some of the childrenreceived also a local application of betanaphthol ointment or3% tincture of iodine in an attempt to shorten the time oftreatment. The usual precautions with administration ofiodide were strictly observed. The complete recovery of thechildren was confirmed microscopically and by negativeculture.

Further investigations are needed to discover the

optimum dosage and the duration of treatment.Tel-Aviv,Israel. S. TULTCHINSKY-GOLDSTEIN.S. TULTCHINSKY-GOLDSTEIN.

1. Williams, D. I., Marten, R. H., Sarkany, I. Lancet, 1958, ii, 1212.

FŒTAL-TYPE HÆMOGLOBIN IN THE BLOOD OFTHE NEWBORN

SIR,-Foetal blood contains two different types of

hsemoglobin (Hb)-foetal and adult-which differ in therate of alkali denaturation 1 2 and in several other respects.2The foetal-Hb fraction gradually decreases during thelatter half of the pregnancy,.3-5 The scatter of the fcetal-Hbvalues is considerable for newborn infants of approxi-mately the same age. 6 6 Thus in my material figuresbetween 88 and 55% fcetal Hb of the total Hb wereobserved for infants at term (see figure).The physiological significance of the level of the relative

proportion of foetal Hb in the blood of the newborn isunknown. Inconnection with a

systematic studyof the relative

proportions offoetal and adultHb at birth I havemade some

observationswhich may throwsome light on

this problem.Blood samples

obtained from theumbilical cord im-

mediately afterbirth were ana-

lysed. The rate ofalkali denaturationwas determined spectrophotometrically, and the relativeamounts of the different types of Hb were calculated accordingto the method of Betke.2

Correlation between percentage of fretal

haemoglobin and postmenstrual age.The interrupted lines are the 95%confidence limits (Brody 6).

In five consecutive cases of severe neonatal jaundice(indirectly reacting bilirubin between 13-8 and 26-0 mg. per100 ml.), determination of the relative proportion of foetal Hbshowed impressively high values-between 86 and 93%.Every known form of blood-group incompatibility is ruled outin these cases, and they apparently represent a type of exag-gerated

"

physiological jaundice ". -

The experiments of Langley indicate that the liver is themain site for the production of foetal Hb, and that liver hsemato-poiesis is 3-5 times more intense in premature than in matureinfants. On the basis of these findings it is logical to concludethat the intensity of liver hxmatopoiesis is inversely propor-tional to the degree of maturity of this organ. Furthermore, itseems conceivable that the relative proportion of fcetal Hbin the blood reflects the intensity of the haematopoiesis in theliver, and may therefore indicate the degree of maturity of theliver.

Neonatal jaundice not caused by blood-group incompati-bility is considerably more common in premature than inmature infants. In most cases immaturity of the liver has beenconsidered the cause, and recently it has been clearly demon-strated that deficiencies of liver glucuronosyl transferase 11-11and uridine diphosphoglucose dehydrogenase 10 are essentiallyresponsible for the increase of serum-bilirubin levels in thenewborn. These enzyme systems are apparently formed duringthe latter part of the pregnancy.

1. Bischoff, H. Z. exp. Med. 1926, 48, 472.2. Betke, K. Biochem. Z. 1951, 322, 186.3. Beaven, G. H., Hoch, H., Holiday, E. R. Biochem. J. 1951, 49, 374.4. Zeisel, H. Z. Kinderheilk. 1951, 70, 190.5. Brody, S. Acta obstet. gynec. scand. 1958, 37, 374.6. Bancroft-Livingston, G., Neill, D. W. J. Obstet. Gynœc. Brit. Emp.

1958, 65, 4.7. Langley, F. A. Arch. Dis. Childh. 1951, 26, 64.8. Lathe, G. H., Walker, M. Quart. J. exp. Physiol. 1958, 43, 257.9. Grodsky, G. M., Carbone, J. V., Fanska, R. Proc. Soc. exp. Biol., N.Y.

1958, 97, 291.10. Brown, A. K., Zuelzer W. W., Burnett, H. J. clin. Invest. 1958, 37, 332.