2
80 will rapidly release the active medicament if the skin is broken. There is little evidence to show, however, that these bases are capable of penetrating the intact skin. Although they are not included in the B.P., mention should be made of the Carbowax ’ compounds in the formulation of penetrating ointments. These are polymers of ethylene glycol, and range from thin liquids to hard waxes, according to the degree of polymerisation. Carbowax 1500 is a semi-solid wax having a consistency and appearance similar to that of white soft paraffin. It is completely water-soluble and will itself dissolve many antiseptics, which may thus be applied to the skin in true solution but are not inactivated by the base. Since it is water-soluble, carbowax 1500 is very suitable for application to the scalp, and it has been used for the formulation of ointments for the treatment of ringworm of the scalp, where a vehicle is needed which is capable of carrying a fungicide into the hair follicle in order to destroy the mycelium and spores which have hitherto been inaccessible to ointments. An ointment containing 0-5% of phenylmercuric nitrate in a carbowax base was used by Brain et al.,l and Haber et a1.2 have successfully used 5% of salicylanilide in this vehicle for the local treatment of ringworm of the scalp without previous epilation by means of X rays. Other members of the carbowax series may be of use in the formula- tion of ointment bases. Carbowax 1540 is a solid wax similar in appearance to hard paraffin. The highest member of the series, carbowax 4000, is produced in fiakes and is a very hard, water-soluble wax-like substance, melting at about 40°C. Combinations of these higher members with carbowax 1500 can be used for the preparation of stiffer ointments, whilst dilution with propylene glycol can be used if a softer base is needed. The precise value of these compounds in dermatology cannot yet be assessed, but they seem likely to lead to advances in the treatment of scalp conditions. Much pioneer work on penetrating bases has been done in America, ’Intraderm’ being a well-known example though not an ointment. Not only have fungicides been carried deeply into the skin and follicles by the use of such vehicles, but they have also been used for carrying antigens into the skin to determine specific sensitivity. Their applications in dermatology will probably develop. CHOICE OF A SUITABLE OINTMENTS BASE Though the new emulsified bases present antiseptics in a more highly active form for topical use and are more pleasant, their employment demands caution and it may be necessary to reduce the concentration of the active therapeutic agent in an emulsified base. In some cases they are definitely contra-indicated : for example, ointment of dithranol of the B.P. consists of 0-1% of dithranol in yellow soft paraffin, in order to minimise absorption of the medicament and the occurrence of dermatitis. Another important consideration is the effect of the local application of the base itself. Since emulsifying wax is a powerful grease-removing agent, repeated use of ointment bases containing it may cause excessive degreasing of the skin and removal of the natural fats. This danger can be minimised by the inclusion of wool fat in combination with emulsifying wax. Occasionally individuals are found to have an idiosyncrasy, or to become sensitised, to one or more of the ingredients of emulsifying bases, so the patient’s reaction to his ointment should be critically observed. It is a useful rule when confronted with an extending lesion of the skin to consider first whether one’s treatment is the cause of the extension before deciding it is inadequate. 1. Brain, R. T., Crow, K., Haber, H., McKenny, C., Hadgraft, J. W. Brit. med. J. 1948, i, 723. 2. Haber, H., Brain, R. T., Hadgraft, J. W. Ibid, 1949 (in the press). SECOND WORLD HEALTH ASSEMBLY By a series of Sunday and night meetings, the Second World Health Assembly 1 managed to scramble home in the allotted three weeks. The general feeling was that it had done a good job. Compromises commanding respect, if not enthusiasm, had been reached on most of the important controversial questions, and there was a general atmosphere of give and take and much personal goodwill. The$8,000,000 programme for 1950, submitted by the executive board and the director-general, to be financed from the regular budget, was discussed in committee for more than a week, and came out sub- stantially unchanged-indeed, with half a million dollars’ worth of additions. But this was a battle with wooden swords, as a joint meeting of the programme and administration and finance committees set a ceiling of $7,500,000 on the budget, after rejecting proposals for 51/2 and 61/2 million put forward by Australia and New Zealand respectively. This meant a transfer of$1,000,000 of the programme from the regular to the " supple- mental " budget, the latter being financed by voluntary contributions from member governments, and notably from the U.S.A., through the programme for technical assistance to the economic and social council financed under Truman’s " Fourth Point " : the supplemental budget totals another$10,700,000, of which the amount eventually available may -range from almost nothing to a very substantial sum. W.H.Q. is therefore assured of funds for a programme in 1950 slightly larger than the programme which will be operating at the end of 1949, with possibilities of anything up to double that sum. The six priorities established by the previous assembly- malaria, tuberculosis, venereal diseases, maternal and child health, environmental sanitation, and nutrition- were maintained, though it was emphasised that they were neither permanent nor rigid. The programme of $174,000 for mental health was approved from the regular budget, and other new activities will include an expert committee on the training of nurses ; work on schistosomiasis ; and grants for the training of auxiliary personnel. From the " supplemental " budget, three health demonstration areas may be available. A small amount was provided to continue the help in anti-epidemic coordination among the refugees in the Palestine area. Limited funds were allocated for three types of medical supplies, a most controversial subject- i.e., for medical literature and teaching material ($75,000 in the regular budget and$175,000 in the supplementary) ; for supplies to carry on the W.H.O. programmes ; and supplies to governments for specific purposes, examined in detail and approved in advance by the executive board, the amounts available for the last two together totalling$115,000 in the regular and $385,000 in the supplemental budgets. A resolution condemning discrimination and secrecy in medical supplies and production, aimed at the U.S.A. by the Eastern Bloc, was accepted by Dr. Leonard Scheele and the assembly, with the insertion of a condemnation of any obstruction to free travel and exchange of doctors and scientists between countries. Delays by members in the payment of their contribu- tions, some of which at least may be temporary, because of constitutional and budgetary processes, have already brought W.H.O. into a precarious financial condition, as the external auditor, had pointed out. The director- general therefore pressed for, and obtained, a working capital fund of$4,000,000, against an Australian pro- posal to limit this fund to$3,000,000. The working capital fund remains the property of the members contributing to it, and must be replaced. The assembly noted with satisfaction the auditor’s very favourable 1. See annotation, Lancet, 1949, i, 1108.
