SEPT. 26, 1959 TO-DAY'S DRUGS MEDICAL JOURNAL 577 convulsions. The electroencephalogram changes can be reversed and the convulsions stopped by the intravenous administration of sodium thiopentone. Correspondence Although at irst it was thought that bemegride had a specific action in antagonizing the depressant effects of Because of heavy pressure on our space, correspondents are barbiturates on the central nervous system, this view is now asked to keep their letters short. no longer held. Bemegride is looked upon as a non- specific stimulant of the central nervous system and beneficial in treating cases of poisoning by various other Isaac Wolfson Foundation's Fund narcotics (other than barbiturates), such as primidone and glutethimide, as well as barbiturates. `SIR,-I would like to thank you for your leading Therapeutic uses of bemegride are as follows: article on the subject of the recent magnificent grant to (1) In the treatment of acute barbiturate poisoning. Here, in the Royal College of Physicians (Journal, September 12, addition to the usual general method of dealing with a comatose p. 416) and for giving space to a description of the patient, a 5% glucose saline intravenous infusion is given slowly, important activities of the Isaac Wolfson Foundation and 10 ml. of 0.5% solution of bemegride (50 mg.) is injected (p. 427). This grant is indeed a historic gift which my into the tubing leading to the intravenous cannula every three and Medicine are not to to five minutes. Some clinicians'precede each injection with 1 ml. College British likely forget. of a 1.5% solution of amiphenazole (15 mg.). The bemegride What is not quite so obvious is that it will be also (and amiphenazole if used) is continued until the " safe state " is a historic gift to British architecture. In these reached-that is, return of all reflexes, including coughing and utilitarian times opportunities for the design and swallowing reflexes-and the patient shows signs of spontaneous erection of fine buildings are all too few. We look movements, though they are still unconscious. Administration is discontinued before the patient actually awakens in order to forward to a building worthy of the College, worthy reduce the possibility of producing any side-effects of the drug. of its setting in Regent's Park, and at the same time a Up to 2,000 mg. bemegride (and 600 mg. amiphenazole) can be fitting monument to the generosity of the benefactors.- given in two hours with safety. If the " safe state " is reached I am, etc., before this amount is given, then the drug is discontinued. Usually the patient recovers from the " safe state " spontaneously London, S.W.1. ROBERT PLATT. without further treatment, but occasionally in poisoning with the longer-acting barbiturates regression may occur-that is, the patient gradually sinks back into a deeper state of Risks of Immunization unconsciousness. Then further courses of treatment can be SIR,-Apart from its special merits, Dr. E. R. repeated, usually at intervals of 6 to 12 hours, until eventually Hargreaves's interesting letter (Journal, September 5, the patient does recover. Another method of administering the bemegride is by means of a continuous intravenous drip of p. 367) reflects a widespread concern and the need for 100 ml. normal saline containing 500 mg. bemegride (and 150 mg. authoritative guidance on all immunizations. amiphenazole if wanted) over a period of 30 minutes, and There have been endless variations on the same theme repeating this as required. published in the Journal during the last two years, and Side-effects of bemegride which may occur with this treatment are vomiting, convulsions, and delirium. The danger of vomiting many of them offer conflicting advice. Allowing for is the aspiration of stomach contents, with consequent pulmonary special considerations affecting individual cases, there complications. The patient is usually in the " safe state " by this must surely be enough scientific evidence and practice time and the drug is discontinued. Occasionally finger-twitchings experience available by now to make it possible for the occur, and they are an indication to reduce the dosage or rate of a administration of the drug or discontinue administration to avoid Ministry to give lead by issuing a sound authoritative the possibility of convulsions, which may, though rarely, follow. " guide " which would enable all doctors to speak with If convulsions do occur a small intravenous injection of 2.5% the same voice on these matters. The success of sodium thiopentone will rapidly eliminate them. At any time immunization programmes in the prevention of disease from recovering consciousness up to four days later the patient depends as much on public confidence in the measures may suffer mental disturbances. They take the form of restlessness, visual and auditory hallucinations, delusions, and advocated as on their efficacy and safety. The present occasionally epileptiform convulsions. Paraldehyde will usually bewildering diversity of opinion in the profession as help to control them. These disturbances, which are benign and to the order and age of administration of the various leave no permanent after-effects, seem to occur most frequently vaccines does nothing to inspire confidence. On the in patients who have previously become habituated to barbiturates or in patients who have been given too much bemegride and who contrary it tends to encourage fears and doubts in the may have shown side-effects during the course of treatment. lay mind-not to mention in some professional minds (2) In the treatment of acute poisoning by primidone and too.- am, etc., glutethimide, bemegride is given in the same way (sometimes with B Norfolk. W. H. CRICHTON. amiphenazole) as in acute barbiturate poisoning. eney, (3) It may be used for the termination of surgical anaesthesia for which barbiturates have been used. Here 50 mg. is usually SIR,-In discussing the risks of smallpox vaccination injected intravenously. we might profitably start by asking why should we (4) It may be used as an activating agent of the electro- vaccinate babies at all. We cannot pretend that we do encephalogram, for diagnostic purposes, to produce in epilepti- form patients the characteristic spikes in the E.E.G. without so in order to protect the infant from an imminent inducing convulsions. danger. The age distribution of notified cases in this N.H.S. Basic Price.-Injection, 0.5% w/v, 6x 10 ml. country over the last decade shows that small children 20s.; 6 x 30 ml., 36s. are less exposed to risk than other age groups. Taking the five-year period chosen by Dr. E. R. Hargreaves, for example (1953-7) (Journal, September 5, p. 367), " It is profoundly regrettable that in 1958 there were there was only one case of smallpox notified in England 300,000 persons killed or injured on the roads in Great and Wales in the age group 0-5 years though there were Britain. Deaths rose from 5,590 to 5,970. This is the worst toll for any year so far. There was an increase among all between 21 and 3 million unvaccinated small children classes of road users except for a small reduction among continuously at risk. riders of motor-assisted pedal cycles. A record number of For many years it has been established British 50,000 children were killed or injured; 10,000 of these child teaching that we vaccinate babies in order to reduce the victims were passengers in vehicles" (30th Annual Report, incidence of complications if the procedure has to be 19S8. Pedestrians' Association for Road Safety). repeated in later life. The assumption on which this