METRONIDAZOLE IN ACUTE ULCERATIVE GINGIVITIS
1
1191 tubing of the Holter valve and the valve itself were patent, and had remained so for seven days after insertion. It became apparent to me, however, that the pressure differential between the peritoneal cavity and the inferior vena cava was insufficient to cause an adequate flow of fluid from the peritoneal cavity except during the actual pumping of the valve. A Holter valve is now available with an even lower opening pressure than the one I inserted and this might prove successful. However, I am rather sceptical of the value of the procedure, although theoretically it should have worked. I do not think Mr. Smith can be too sure that it is the Holter valve which has reduced the ascites in his patient. It is well known that ascites may regress naturally in portal cirrhosis. We have several patients treated with diuretics, spironolactone, albumin, and other medical measures, who have cleared their ascites, and remained clear for some time. I would therefore counsel your readers not to be too sanguine of the value of the Holter valve in the treatment of ascites, although I certainly intend to try it again myself, if a patient fails to respond to conservative measures. ERIC M. NANSON. Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. ORAL HYPOGLYCÆMIC DRUGS G. CARRARA.* ’ Private address: Corso Monforte, 36, Milan, Italy. University of Milan, Italy. SIR,-I was very interested by Dr. Riddell’s letter of April 21. He experimented with BH 135, a new hypo- giycasmic drug, but he concludes that it is no more effective than chlorpropamide, possibly partly because of its short biological half-life of 7 hours. Speculating on the site of the hypoglycsemic activity and of the metabolism in the molecule of the hypo- glycxmic sulphonylureas, I was able to prepare and test phenbutamide. 1 Judged by equal or higher activity, and by equal or less toxicity, this drug has a half-life at least 4 times longer than tolbutamide or chlorpropamide. These results were recently confirmed.3 3 I should be very glad to send Dr. Riddell and anyone else interested some samples for trial. METRONIDAZOLE IN ACUTE ULCERATIVE GINGIVITIS D. L. S. SHINN. King’s College Hospital Dental School, Denmark Hill, London, S.E.5. SIR,-A patient treated for trichomonal vaginitis with metronidazole (’ Flagyl’) (200 mg. t.d.s.) also had acute marginal gingivitis, and she declared at the end of a week that she had undergone " a double cure ". The vaginitis was completely cured and the gingivitis was rapidly relieved. Although it was realised that the simultaneous improvement might have been incidental, I was encour- aged to give metronidazole to six patients with Vincent’s infection. Metronidazole is known to be excreted by the salivary glands 4 and might have acted through the saliva as well as through the blood. All six patients showed rapid subjective and objective improvement, with relief of pain in a matter of hours. These observations were made at a time when the incidence of acute Vincent’s infection is at its lowest: but a trial in a larger series now in progress confirms the earlier findings, and will be reported in due course. Admittedly, existing methods of treating acute ulcerative gingivitis by topical application give excellent results, but this preliminary statement may encourage 1. Carrara, G., Beani, L., Zilletti, L. 1st Symposium on the New Anti- diabetic Drugs. Siena, May 17, 1957. Minerva Med. 1958, 49, 1539. 2. Carrara, G. et al. Meeting of the Société Française de Thérapie et Pharmacodynamie, Lyon, April 12, 1959. Thératie, 1959, 14, 866. 3. Nature, Lond. 1962, 193, 891. 4. Rodin, P., King, A. J., Nicol, C. S., Barrow, J. Brit. J. vener. Dis. 1960, 36, 147. others to test for themselves a new method of treatment that is both safe and time-saving. Parliament Health Visitors and Social Workers Bill On May 24, at the second reading of this Bill in the House of Lords, each speaker regretted that the new councils which it sets up would have no powers to give direct grants to students. Baroness SUMMERSKILL pointed out that candidates for social work were often women in their twenties and thirties who had no claim on a local education authority. The Treasury was willing to give hundreds of millions of pounds for drugs and the hospital service, yet it failed to recognise that an Exchequer grant to the student social worker would accelerate recruitment, and help to improve the domiciliary services. Lord AMULREE was doubtful whether two councils were really needed, especially now when in many local authorities the health and welfare committees were being merged. He also thought that the social workers themselves should have more representatives on the councils. Lord NEWTON said that the general rule was that further education was the responsibility of the local authorities, and in the Government’s view there was no case for treating social workers as an exception. QUESTION TIME A Department of Virology Mr. KENNETH ROBINSON asked the Chancellor of the Exchequer which London medical schools had applied through the university court to the University Grants Committee for funds to set up departments of virology; and what had been the result.- Mr. HENRY BROOKE replied: These are matters entirely within the responsibilities of the University Grants Committee and the University of London. It would be a breach of the established relationship between the Government and the universities if I were to inquire into them. Mr. ROBINSON: Is the Chief Secretary aware that virology is one of the growing branches of medicine, and that at least one London teaching hospital-Guy’s-has been trying desperately to set up such a department; that it has the skilled professional staff available, and needs only the financial support of the Uni- versity Grants Committee, which it cannot get as a result of the right hon. Gentleman’s policies ?-Mr. BROOKE: I have myself in years past been a member of the court of London University and I am absolutely clear that it would be quite wrong for the Government to interfere in the work of the court of the University of London, or in decisions taken by the University Grants Committee in regard to that body. Prescriptions Since the increased charge was introduced in February, 1961, the numbers of prescriptions dispensed each month in England and Wales (with comparable figures for the previous year) were as follows:
Transcript of METRONIDAZOLE IN ACUTE ULCERATIVE GINGIVITIS
1191
tubing of the Holter valve and the valve itself were patent, andhad remained so for seven days after insertion.
It became apparent to me, however, that the pressuredifferential between the peritoneal cavity and the inferior venacava was insufficient to cause an adequate flow of fluid from theperitoneal cavity except during the actual pumping of the valve.A Holter valve is now available with an even lower openingpressure than the one I inserted and this might prove successful.However, I am rather sceptical of the value of the procedure,although theoretically it should have worked.
I do not think Mr. Smith can be too sure that it is theHolter valve which has reduced the ascites in his patient.It is well known that ascites may regress naturally in portalcirrhosis. We have several patients treated with diuretics,spironolactone, albumin, and other medical measures,who have cleared their ascites, and remained clear forsome time. I would therefore counsel your readers notto be too sanguine of the value of the Holter valve in thetreatment of ascites, although I certainly intend to try itagain myself, if a patient fails to respond to conservativemeasures.
ERIC M. NANSON.Department of Surgery,
University of Saskatchewan,Saskatoon, Saskatchewan, Canada.
ORAL HYPOGLYCÆMIC DRUGS
G. CARRARA.*
’ Private address: Corso Monforte, 36, Milan, Italy.
University of Milan, Italy.
SIR,-I was very interested by Dr. Riddell’s letter ofApril 21. He experimented with BH 135, a new hypo-giycasmic drug, but he concludes that it is no moreeffective than chlorpropamide, possibly partly because ofits short biological half-life of 7 hours.Speculating on the site of the hypoglycsemic activity
and of the metabolism in the molecule of the hypo-glycxmic sulphonylureas, I was able to prepare and testphenbutamide. 1 Judged by equal or higher activity, andby equal or less toxicity, this drug has a half-life at least4 times longer than tolbutamide or chlorpropamide.These results were recently confirmed.3 3
I should be very glad to send Dr. Riddell and anyone elseinterested some samples for trial.
METRONIDAZOLE IN ACUTEULCERATIVE GINGIVITIS
D. L. S. SHINN.King’s College Hospital Dental School,
Denmark Hill,London, S.E.5.
SIR,-A patient treated for trichomonal vaginitis withmetronidazole (’ Flagyl’) (200 mg. t.d.s.) also had acutemarginal gingivitis, and she declared at the end of a weekthat she had undergone " a double cure ". The vaginitiswas completely cured and the gingivitis was rapidlyrelieved. Although it was realised that the simultaneousimprovement might have been incidental, I was encour-aged to give metronidazole to six patients with Vincent’sinfection. Metronidazole is known to be excreted by thesalivary glands 4 and might have acted through the salivaas well as through the blood.
All six patients showed rapid subjective and objectiveimprovement, with relief of pain in a matter of hours. Theseobservations were made at a time when the incidence of acuteVincent’s infection is at its lowest: but a trial in a larger seriesnow in progress confirms the earlier findings, and will bereported in due course. Admittedly, existing methods of
treating acute ulcerative gingivitis by topical application giveexcellent results, but this preliminary statement may encourage
1. Carrara, G., Beani, L., Zilletti, L. 1st Symposium on the New Anti-diabetic Drugs. Siena, May 17, 1957. Minerva Med. 1958, 49, 1539.
2. Carrara, G. et al. Meeting of the Société Française de Thérapie etPharmacodynamie, Lyon, April 12, 1959. Thératie, 1959, 14, 866.
3. Nature, Lond. 1962, 193, 891.4. Rodin, P., King, A. J., Nicol, C. S., Barrow, J. Brit. J. vener. Dis. 1960,
36, 147.
others to test for themselves a new method of treatment thatis both safe and time-saving.
Parliament
Health Visitors and Social Workers BillOn May 24, at the second reading of this Bill in the House of
Lords, each speaker regretted that the new councils which itsets up would have no powers to give direct grants to students.Baroness SUMMERSKILL pointed out that candidates for socialwork were often women in their twenties and thirties who hadno claim on a local education authority. The Treasury waswilling to give hundreds of millions of pounds for drugs andthe hospital service, yet it failed to recognise that an Exchequergrant to the student social worker would accelerate recruitment,and help to improve the domiciliary services.Lord AMULREE was doubtful whether two councils were
really needed, especially now when in many local authorities thehealth and welfare committees were being merged. He alsothought that the social workers themselves should have morerepresentatives on the councils.Lord NEWTON said that the general rule was that further
education was the responsibility of the local authorities, and inthe Government’s view there was no case for treating socialworkers as an exception.
QUESTION TIMEA Department of Virology
Mr. KENNETH ROBINSON asked the Chancellor of the
Exchequer which London medical schools had applied throughthe university court to the University Grants Committeefor funds to set up departments of virology; and what had beenthe result.- Mr. HENRY BROOKE replied: These are mattersentirely within the responsibilities of the University GrantsCommittee and the University of London. It would be abreach of the established relationship between the Governmentand the universities if I were to inquire into them. Mr.ROBINSON: Is the Chief Secretary aware that virology is one ofthe growing branches of medicine, and that at least one Londonteaching hospital-Guy’s-has been trying desperately to setup such a department; that it has the skilled professional staffavailable, and needs only the financial support of the Uni-versity Grants Committee, which it cannot get as a result ofthe right hon. Gentleman’s policies ?-Mr. BROOKE: I have
myself in years past been a member of the court of LondonUniversity and I am absolutely clear that it would be quitewrong for the Government to interfere in the work of thecourt of the University of London, or in decisions taken bythe University Grants Committee in regard to that body.
PrescriptionsSince the increased charge was introduced in February,
1961, the numbers of prescriptions dispensed each month inEngland and Wales (with comparable figures for the previousyear) were as follows:
