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Leucine-aminopeptidase activity, estimated by the methodof Szasz and Kozak 4 (normal range 100-180U 5), was stillwithin the limits of normal in all 3 cases and increased onlylater, when the transaminase activity was decreasing. The rateof increase, however, remained far below that of transaminase(see table). Alkaline-phosphatase (King-Armstrong) andcholinesterase 6 showed normal activity.On the 5th day after the poisoning we determined the

electrophoretic picture of the serum-proteins : although thetotal reading for proteins was normal (6-7-7-2 g. per 100 ml.)y-globulin was considerably increased (1-9-2-9 g. per 100 ml.)at the expense of albumin (2-1-2-5 g. per 100 ml.). A weekafter the poisoning thymol turbidity was temporarily raised inall 3 patients, but only slightly above normal values. The

non-protein nitrogen content of the blood and the value of thegold-sol test remained normal all the time, and the initial mildicterus ceased in a few days.From our findings, slightly or moderately increased

leucine-aminopeptidase activity can scarcely be due to theacute lesions of the liver parenchyma caused by themushroom poisoning.

G. SzÁsz.Paul Heim’s Hospital for Children,Budapest, Hungary.

ICE-COOLED MELPHALAN FOR REGIONALINFUSION

F. E. WEALE.St. Bartholomew’s Hospital,

London, E.C.1.

SiR,-In discussing my communication of Jan. 4 theteam of seven Westminster correspondents (Feb. 8) drawattention to the merits of their apparatus which incor-porates at least nine pieces of electrical equipment and thecost of which was defrayed by three charitable bodies.My piece of unexalted plumbing was paid for out of running

expenses and can be maintained and run by anyone unwillingto indulge in the construction of complicated apparatus. It

surely has the virtue of simplicity. There are no alarms toalarm if alarms fail. It can be used without reference to

temperature tables. Bottles suspended from a pulley are easilychanged. There is no danger from air embolism. Your corre-spondents did not think it important enough to discuss airembolism in their own paper, although now they say that it isa danger; they are not entitled to attribute it so lightly to theapparatus which I describe. They have shifted their positionalso in relation to the theory of cold infusion. In their paper,giving no details how this might be achieved, they say that coldinfusions can be given through their syringe-driven device.Now they say that cooling is unnecessary because hydrolysedmelphalan can be replaced by adding extra drug. It seems a

change to a less easily tenable point of view.Our results for melanoma parallel Westbury’s with isolated

limb perfusion. They have been obtained with less risk, lesscost, and less trouble.

Public Health

Withdrawal of Insecticides at CoventrySix proprietary brands of insecticides containing mono-

fluoroacetic acid and its salts are being called in by Coventry CityCouncil.9 Three centres are to open this week to enable peopleto hand in the chemicals, sold under the names of Tritox,Megatox, Fluron, Vitux F15, Flac, and Fluorakil. House-holders have been warned that the substances could kill people,and should not be emptied into lavatories or drains or overgardens, because they could contaminate soil and water.4. Szász, G., Kozak, É. Orv. Hetil. 1962, 103, 971.5. Szász, G. Klin. Wschr. 1962, 40, 1256.6. Lang, W., Intsesuloglu, G. Klin. Wschr. 1962, 40, 312.7. Pegg, D. E., Trotman, R. E., Pierce, N. H. Brit. med. J. 1963, i, 1207.8. Westbury, G. Proc. R. Soc. Med. 1962, 55, 643.9. Times, Feb. 17, 1964.

Parliament

FluoroacetamideON Feb. 11, Mr. JOHN FARR drew the attention of the House

to the outbreaks of fluoracetamide poisoning at MerthyrTydfil’ and at Smarden 2 and asked what lessons could bedrawn from them. He welcomed the ban that had been placedon its sale for insect control and the restrictions on its sale forrodent control, but he was uneasy that it could still be put intosewers. He also asked whether factories producing fluoroaceta-mide and other chemicals should not be placed in the morebarren and isolated parts of the country, preferably near the sea,Mr. JAMES SCOT1’-HoPKINS, joint parliamentary secretary to

the Ministry of Agriculture, Fisheries and Food, reminded theHouse that the contamination of land at Smarden was notcaused by the use of fluoroacetamide as an agricultural spray orrat-killer but by the industrial wastes of the manufacturingprocess, which leaked into a farm ditch and from there to

farm ponds. The important step to be taken at Smarden wasto remove the original source of contamination, which consistedof about 2000 tons of soil, including sludge removed from theponds and ditches into which the poison seeped. The materialwa3 lying outside the factory premises and must be removedto a place of complete safety. The factory and the surroundingfarms in that part of Kent stood on Weald clay hundreds offeet deep and this was a soil which was extremely impermeableand difficult to drain. The Minister was advised that watercould not penetrate more than a very few feet at the most, andthis section of the soil would be removed. It was included inthe 2000 tons. The manufacturers had accepted advice to

deposit the contaminated material off the Atlantic shelf. Thesite had been recommended by Sir Rudolph Peters who hadworked with fluoroacetamide for many years. It would be

dumped off the continental shelf far from the fishing grounds,The movement of the material into containers would start nextweek under Government supervision. Trial fillings would

begin in the next day or so to determine the safest methods,Actual shipping would start in March.The Government would continue to maintain a close watch

on the situation at Smarden after the soil has been removed.Ditch and pond water was monitored by the Kent River Boardand the Government Chemist was undertaking the analysis ofsamples. This would go on as long as necessary, and if furtherremedial action was required, including, if necessary, theremoval of further soil, the Government would see that it wastaken promptly. The manufacture of fluoroacetamide at

Smarden was stopped in the middle of the third week of July,The Ministry’s local officers would provide advice to farmerson the land affected. The veterinary surgeons in the area

understood the position only too well. It was hoped that con.tinued sampling of the affected ditches and ponds, togetherwith the remedial action which was being taken, would showthat the resumption of normal farming need not be longdelayed. There was no evidence that contamination mighthave spread beyond the affected ditches and ponds and someof the fields immediately adjoining. Disposal of the poisonouswater at Dymchurch was approved because the dilution of thesubstance was so great. This had been approved by the rivKboard, which had been in very close touch and consultationthroughout.

Turning to the incident at Merthyr Tydfil, Mr. SCOTMHOPKINS said that this also involved an organofluorine com-pound, probably fluoroacetamide, but arose from a differentcause. A number of cats and dogs died last September ::

circumstances which suggested poisoning. This was tracd :0

the flesh of a pony sold as pet food. The pony had been founddead near a rubbish tip and sent by the police to a local knackeryA scientific investigation established that the pony’s neibcontained an organofluorine compound, possibly fluoroacem-mide. Despite careful inquiries, it had not been possible :2

establish how this poison entered the pony’s body. The most

1. See Lancet, 1963, ii, 682.2. ibid. Feb. 8, 1964, p. 337, Feb. 15, p. 389.

443

likely explanation-though this was not capable of proof-wasthat the pony picked up some rat bait, possibly on the tip nearwhich its body was found.Although there had been no evidence of any damage caused

by the proper use of this chemical in agriculture, nevertheless,because of these incidents, the Government had thought it

right to widen the safety margin. Its sale as an insecticide hadbeen banned, and, even for killing rats, had been placed undermore severe restrictions. Its use against rats had cleared com-plete sewer systems in this country for the first time in historyand there was a distinct possibility that whole towns could becleared, with great benefit to health and sanitation. There

might be other poisons capable of doing that, but this wasthe first poison which had accomplished it. Nevertheless, theMinister was anxious that no reasonable safeguard for thepublic should be neglected and the Advisory Committee onPoisonous Substances was again reviewing its use as a rat

poison.Warning Against Cigarettes

On Ash Wednesday, under the ten minutes’ rule, Mr.LAURENCE PAVITT was given leave to bring in a Bill to make itillegal to sell packets of cigarettes which are not clearly markedwith a warning of the health hazards which arise from smoking.The Bill’s other supporters include Sir Barnet Stross andDr. Dickson Mabon.

QUESTION TIME

Smoking in Cinemas and TheatresViscount MASSEREENE AND FERRARD asked H.M. Govern-

ment whether they would consider prohibiting smoking incinemas and theatres.-Lord NEWTON, joint parliamentarysecretary to the Ministry of Health, replied: The Governmentare strongly in favour of people not damaging their health bysmoking, wherever they may be, but this is a matter for

persuasion, not prohibition, and a health education campaignis being vigorously developed.Baroness SUMMERSKILL: Has the Minister examined the

public-health legislation of the country passed during this

century? He says that he relies upon persuasion, but he willfind in every field of public health, whether it is infectious

disease, tuberculosis, or even insisting that midwives should bequalified, that it has been necessary for the Government to

legislate and so compel people to conform because they wouldnot be persuaded.-Lord NEWTON: I would not set myself upas an authority on all the public-health legislation in the

country, but I am bound to say on this matter of smoking thatI do not take such an authoritarian point of view as does the nobleBaroness. I am quite certain that the policy which we havebeen pursuing is right-namely, the policy of doing everythingpossible to make the facts about the hazards of smoking knownto the public so that they can draw their own conclusions. Ido not believe that there can be many people in this countrytoday who are not aware of the facts; and whether they drawwhat the noble Baroness or I would think were sensibleconclusions on these facts is really a matter for them.

’ Tetralysal ’Sir BARNET STROSS asked the Minister of Health what

inquiries he made about the patent of the drug’ Tetralysala tetracycline preparation produced by Messrs. Carlo Erba ofMilan, before he allowed its purchase for use in British hos-pttds.—Mr. BARBER replied: I satisfied myself that Messrs.Carlo Erba’s patent for tetralysal was sealed on April 17, 1963,and that no objections were recorded.

Training Staff for Care of the SubnormalThe Minister of Health has set up a council to promote the

provision of training for the staff-including hospital staff-oftraining centres for the mentally subnormal, and to approvecourses of training. Lady Adrian is chairman and the medicalmembers are Dr. R. T. Bevan, senior medical officer, WelshBoard of Health; Dr. R. C. M. Pearson, M.O.H., Newcastleupon Tyne; Dr. J. A. Scott, M.O.H., London County Council;

and Dr. R. J. Stanley, consultant psychiatrist and medicalsuperintendent, Monyhull Hospital.

Insurance Contributions and the N.H.S.

The proportions of the cost of the National Health Service,excluding local-authority expenditure, met from the NationalHealth element in National Insurance contributions in 1951-52and from the separate National Health Service contributions in

1963-64-Budget estimate-were 9-2% and 16-9% respectively.

Obituary

JOHN NAIRN DOBBIEM.B. Glasg., D.P.H.

Dr. J. N. Dobbie died on Jan. 17 at Fairlight, nearManly, New South Wales, where he retired in 1948 aftera long career in the service of the London County Council.

After graduating and holding house appointments in Glasgow,Dr. Dobbie joined the R.A.M.C. in 1914, and served until 1919.Soon afterwards he joined the staff of the London CountyCouncil. In his early years with the Council his duties relatedto the school medical service and included the supervision ofthe Council’s rheumatism scheme from its inception in 1926.In 1930 he was transferred to work on the administration ofthe special hospitals which came under the Council’s controlunder the Local Government Act of 1929. His sphere of workwas still further expanded in 1934, when he was promoted tosenior medical officer and drawn into many schemes for the

enlargement and improvement of the Council’s general andspecial hospitals. In 1938 he was seconded for duty in theMinistry of Health with the Emergency Medical Service, andduring the early years of the war he acted as hospitals officerfor London. He returned to the Council’s service in 1941 inimmediate charge of the school health service, and he made anotable contribution to the solution of many urgent and

important problems caused by the evacuation of the schoolpopulation. He dealt with equal success with the reorganisationof the school health service under the Education Act of 1944.

A colleague writes:" On Dobbie’s retirement, the Council, in recording its

appreciation of his work, stated that his charm of manner,unfailing courtesy, and sincerity have earned him the highesteem of all with whom his duties have brought him intocontact; he has never failed to devote himself wholeheartedlyto the performance of his responsible and important duties ’.This well summarises the impression which he made on allthose who knew him well. To it was added a gaiety and joy oflife which always made him a stimulating companion."

Dr. Dobbie is survived by his widow and son.

OLIVER GRAY

M.B.E., M.A. Cantab., M.D. Glasg., J.P.Dr. Oliver Gray, who died on Jan. 28 at the age of 65,

was in general practice in Haslemere for over 30 years.He was born in Glasgow where his father, Mr. Albert Gray

was aural surgeon to the Victoria Infirmary. He was edu-cated at Glasgow Academy and Bootham School. During the1914-18 war, until he was old enough to enlist in the Navy,he drove an ambulance in the Italian Alps with a Frenchunit. (His first Italian phrase, he later recalled, was " myambulance has broken down "). On demobilisation he studiedmedicine in Glasgow and at St. John’s College, Cambridge.

After qualifying in 1924, he held house-appointments inGlasgow and spent two years in practice at Campbeltownbefore settling at Haslemere in 1928. Towards the end of thelate war he was called up and he served in hospital ships.During the Normandy landings his ship was torpedoed, andfor his bravery in rescuing the wounded he was appointed M.B.E.

Dr. Gray had always been interested in his father’sresearch into the labyrinth of animals, and after the war