816

encouraging poppy-growing and the abuse of narcoticdrugs in the territory under their occupation. It wasstated that in Nanking, where an opium monopoly hasbeen established, there are 6.0,000 addicts, and narcoticsform the chief source of revenue of the governmentinstalled by the Japanese. The figures for 1938 showthat the world manufacture and consumption of the fiveprincipal drugs corresponds to its legitimate requirements—42-7 tons of morphine, 611 kg. of heroin, 27-5 tons ofcodeine, 2-5 tons of ethyl morphine, and 3-8 tons ofcocaine. The advisory committee discussed at lengththe creation by the assembly of the League of a centralcommittee for economic and social questions to uniteand supervise all the technical activities of the League.Apprehension was felt by some members of the com-mittee lest its duties should be subordinated to the newcentral committee and that its direct responsibility tothe council of the League for the several’internationalopium conventions should be jeopardised. It was

resolved to make representations to the council urgingthat the technical independence of the advisory com-mittee should be maintained.

TESTING STERILITY OF DRESSINGS

PERIODICALLY in any hospital with surgical wards thebacteriologist is asked to test the sterility of dressings,usually because of a sudden increased prevalence in septicoperation-wounds, and because the surgeon, satisfiedthat his technique is beyond reproach, must find a

scapegoat. The circumstances of testing dressingsbacteriologically-the need for wide-mouthed containersand the manipulation of large pieces -of gauze-makeaccidental contamination very difficult to avoid, so thatthe bacteriologist may have to report that the dressingswere not, according to his tests, sterile and the surgeonfeels justified. To forestall such happenings it is-essential that the sterilisation of surgical dressings shouldbe under laboratory supervision so that the bacteriologistcan at regular-and irregular-intervals test the efficiencyof the steriliser by some recognised method ; his servicesare likely to be in demand now that Hayes has demon-strated that the sterilising technique in common use mayleave tetanus spores unharmed. Chemical tests withcolour changes are not reliable. Dry earth or the sporesof Bacillus subtilis in a sealed packet or test-tubewrapped inside a packet of dressings affords a reliablemeans of ensuring complete sterilisation, since the spores’of pathogenic bacteria-e.g., Clostridium welchii and Cl.tetani-likely to be present in dressings are much lessresistant than are those of the hay bacillus, which areusually killed by a pressure of 16-20 lb. (122-126° C.)for 15-20 minutes in a large steam steriliser. If,however, bacteriological tests are not being regularlydone, and it is a question of testing the sterility of the-actual dressings, the difficulties of avoiding accidentalcontamination must be realised both by the bacterio-logist and the surgeon. Savage 2 has analysed the factors- size and type of dressings, time taken in manipulationand exposure, dustiness of wrapping and electric charge-which may favour a laboratory contamination, and asa result of his findings recommends that a uniform

technique should be adopted. The area of the gauzeused for each test should be 4 sq. cm., and undue hurry inmanipulation must be avoided because air currents maycarry bacteria into the culture-tube. A series of tests

(say 10) should be done, and if a proportion (say 6) ofthese are sterile, sterilisation has been satisfactory. Headvises a control series of tests from dressings known tobe sterile. The chance of partially sterilised dressingsslipping through this test is small. Slow rate of growthand purity of culture in positive tubes suggest accidental:contamination. Savage does not recommend any par-

1. Hayes, S. N. Brit. med. J. Dec. 14, 1940, p. 825.2. Savage, R. M. Quart. J. Pharm. July-September, 1940, p. 237.

ticular medium, except that it be liquid ; sloppynutrient agar (0-1% agar) with 0-5% glucose in wide-mouthed screw-cap containers is perhaps the best.

A CURE FOR CRAMP

ONE of the most difficult complaints to relieve iswhat is known as night cramps, which affect the lowerlimbs at rest. The middle-aged or elderly patients whosuffer from them often show no clinical evidence of

peripheral vascular disease, and the pains are presumedto be due to tonic spasms of the muscles. They may ormay not be associated with intermittent claudication.On one view the spasms are akin to tetany and are pro-duced by alkalosis, and relief has been recorded. frombreathing in and out of a bag to cause retention of carbondioxide. Usually, however, the cramps prove resistantto any form of therapy short of opiates. Moss andHerrmann 2 have lately reported success with quinine sul-phate. This treatment was first suggested by Wolf andKennedy’s 3 work on the effect of quinine hydrochlorideon skeletal muscles in myotonia congenita and myotoniaatrophica, which has since been confirmed by variousworkers, including Briscoe.4 It is now fairly certain thatquinine acts at the myoneural junction as the antagonistof prostigmine, thus relieving spasm in the myotonias.In all the fifteen cases on which their report is basedMoss and Herrmann obtained relief of symptoms bygiving gr. 3 of quinine sulphate twice or thrice daily.Only four cases are reported in detail, but in all of thesethe occasional substitution of a placebo was alwaysfollowed by an exacerbation of symptoms. They say,however, that in others of their series the symptoms didnot return when the quinine was stopped. Quininesulphate had no effect on the intermittent claudicationin patients who had this as well as cramp at rest.

NEW GOVERNMENT POWERS

THE Minister of Health has decided that the final

responsibility of deciding whether children are to beevacuated or stay at home must continue to rest withtheir parents. But he has made one important excep-tion. He has issued a new order under which any child

thought to be suffering, or to be in such a state of healthas to be likely to suffer, in body or mind as a result ofwar conditions can be compelled to be examined by adoctor. If after examination a child is found to besuffering or likely to suffer, its removal under the Govern-ment evacuation scheme from ,the dangerous area willbe made compulsory. The parents will have the rightto appeal to a court of summary jurisdiction. But if no

appeal is made or if the appeal is rejected they will beliable to prosecution unless the order is obeyed. At

present the order, which does not apply to Scotland, willonly be enforced in the London evacuation area. Thehealth of the children who remain must also be protectedand, as a headmaster points out on another page,children who live in shelters have other dangers thanbombs to face. To protect them the Government hasarranged for the medical inspection of all children inshelters, so that their general health may be watched,diseases spotted in their early stages, and medical advicegiven directly to parents. The Government has alsotaken powers to compel any person visiting a publicshelter who is thought to be suffering from an infectiousdisease or infested with. vermin to be medically examined,and to insist on their isolation, removal to hospital, orcleansing as may be necessary. Medical inspections inschools have played an important part in improving thehealth of the nation. Perhaps it is now the turn ofmedical inspections in shelters to do their share.

1. Fitz, A. W. see Lancet, 1927, 1, 403. 2. Moss, H. K. and Herrmann, L. G. J. Amer. med. Ass. Oct. 19,

1940, p. 1358.3. Wolf, A. Arch. Neurol. Psychiat. 1936, 36, 382 ; Kennedy, F.

and Wolf, Ibid, 1937, 37, 68.4. Briscoe, G. Lancet, 1939, 1, 1151.