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462 Annotations THE INDUSTRIAL CONGRESS OPENS IN the early days of the Industrial Revolution machines were more valued than the men who drove them ; and it has taken us some time, as Mr. T. E. A. Stowell remarked at the opening session of the International Congress on Industrial Medicine, to realise the importance of conserving the industrial worker. Mr. G. A. Isaacs, Minister of Labour and National Service, mentioned that it is the Government’s policy to set up a national industrial health service, coordinated with the National Health Service, as soon as there are enough trained doctors and auxiliary staff to work it. Reviewing some stages in the growth of our industrial medical service, he recalled that Dr. Thomas Legge, the first medical inspector of factories, was appointed just 50 years ago, and was knighted for his success in proposing measures to counteract risks in industry, especially lead poisoning. Other countries have contributed important studies : South Africa, for example, has led in the study of silicosis. For thirty years the Industrial Health Research Board has been issuing important statistics which are ultimately translated into legal requirements and regulations benefiting health. Progress often seems slow ; Mr. Isaacs has found it so, he said ; but the ground is well prepared, and in the end we get good regulations and enforce them. That the rut of habitual thought may lock the wheel of progress for an unconscionable time, however, was nicely exemplified by Lord Moran’s story of a former Minister. Long before the late war the I.H.R.B. had collected figures relating production to hours of work-which were ignored when the pinch came. Yet when Lord Moran handed the harrassed Minister the proof that a man can produce more in 6 days than 7, he only provoked the indignant response : " Don’t you know there’s a war on ’? " But there are more reasons for a falling off in output than unduly long hours of work ; and Lord Moran was glad, he said, to see the changing conception of industrial medicine. Nowadays it is concerned not merely with the physical hazards of industry but with the mental and emotional hazards as well-with the proper study of mankind, in short. What makes a man stick to his job t " Work or want " has fortunately gone, in this country and for this time, as an incentive. What takes its place ? z? What industrial medical officer, he asked, is going to write an Anatomy of f Contentment ‘ If a man is contented his production is high, and efficient produc- tion means social security. As Dr. Lloyd Davies urges on p. 465, we must no longer think of work in terms of whether it is harmful but whether it is beneficial to free men with unfettered minds. The secret of a contented mind may be to do a job well. A PIPERAZINE ANTHELMINTIC To the growing list of anthelmintics has now been added a piperazine derivative. Formerly the piperazines were administered as urate solvents, and their reintro- duction follows the observation that some derivatives were effective against the filarial parasite of the cotton-rat. Of more than 1000 compounds tested by the Lederle Laboratories the one which was most effective and least toxic was I-diethylcarbamyl-4-methyl- piperazine, known more briefly as Hetrazan’ diethylcarbamazine. Extensive trials of hetrazan have confirmed that, with a few hundred milligrammes by mouth in divided doses over a period of 3-7 days, Wuchereria bancrofti quickly disappears from the blood-stream. It usually reappears a few days after the drug is discontinued ; but in patients receiving similar courses lasting altogether 3-4 weeks the parasite has sometimes remained absent for about a year. From the U.S.A. have come reports suggesting that the drug may cure bancrofti infections by killing the adult worm. In any event, the administra- tion of hetrazan for short periods is so effective in freeing the peripheral blood of micronlarise as to suggest the possibility of breaking the filarial cycle at the link between man and mosquito, for man is the only known host. Against other filarial infections of man this preparation seems to be less effective ; but trials are not yet complete. As often happens with new drugs, there has been some trouble with toxicity. Patients receiving hetrazan are not confined to bed ; and their chief complaints have been of headache, lassitude, and vague malaise. These symptoms come on within a few hours of the treatment being started, but usually disappear within 48 hours, even where administration is continued. The compound seems to be stable under a variety of climatic conditions. STREPTOMYCIN IN NON-TUBERCULOUS INFECTIONS THE serious toxic effects common in the cases of meningeal or other forms of tuberculosis treated with long courses of streptomycin need- not deter the clinician from using the drug for short periods in other infections. But at this stage, when information concerning dosage and indications is badly needed and supplies are relatively short, it is in everyone’s best interest that suitable cases should be treated in hospitals which are fully equipped with laboratory facilities, so that both diagnosis and treatment can be bacteriologically controlled. On another page Prof. Clifford Wilson summarises the main findings of the Streptomycin Clinical Trials (Non- tuberculous Conditions) Committee. The treatment of many of the conditions mentioned is still in the experi- mental stage, and it seems advisable to confine the use of streptomycin to the treatment of meningitis and septi- caemia due to gram-negative bacilli and other penicillin- resistant organisms which have been found to be streptomycin-sensitive. We understand that a small amount of streptomycin may be available for distribution in the regions for the treatment of these conditions. POSTURE IN ANÆSTHESIA MAN’S complex respiratory and circulatory mecha- nisms are adapted to the erect posture. They depend on a series of reflexes involving the voluntary muscles, often affecting muscle tone. In the operating-theatre, the patient is placed in one or other of several unnatural postures. Some of the effects of these postures are unavoidable. Others, equally distressing, follow improper supervision of placement on the operating-table. Three anaesthetists have lately underlined the effects of such unnatural postures. From observation on experimental animals and on man Gordh 1 confirms that deep anaes- thesia abolishes most, if not all, of the compensatory mechanisms involving vasomotor tone which are normally brought into play by change of posture. He emphasises the value, as a resuscitative measure, of a head-down tilt-to us the familiar Trendelenburg position. The increased venous return in this position ensures good filling of the right heart, which results, in accordance with Starling’s law, in slowing of the pulse-rate and rise in the blood-pressure. In animals the head-down position acts as an effective cardiac stimulant even after a few minutes of cardiac arrest. Hasler 2 draws attention to the reduction in the vital capacity so common in the anaesthetised patient. This is remedied by a moderate head-down tilt ; but when the tilt is excessive the effects are far from good. The extreme Trendelenburg position, so beloved of the 1. Gordh, T. Acta chir. scand. 1945, suppl. 102. 2. Hasler, J. K. Proc. R. Soc. Med. 1948, 41, 133.
