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In acquiring more precise pharmacologic knowledge about chemicals used in medicine, the alert physician is able more satisfactorily to apply such information for the benefit of his patients, whether in the diagnosis, prevention or treatment of disease. In spite of the great numbers of useful new drugs being introduced into medicine for various purposes, the most important development of current pharmacology is theoretical, in connection with the establishment of general principles. An acquaintance with general principles of pharmacology, especially as developed by Clark, 1 is being recognized as increasingly helpful in the practical clinical use of drugs. It may seem peculiar to the hard-headed clinician not to offer any specific information in this discussion about any particular drug. He may ask what value it is to him in trying to help his patients to have some general ideas about time-concentration relationships, since what he wants to know is how much

To the Editor:— It is implied in the editorial comment (The Journal, February 3, page 415) on the 1939 report of the Committee on Tests for Intoxication of the National Safety Council, Chicago, that there is no question regarding the validity of chemical tests for alcoholic intoxication. While it is desirable to have clarity with respect to legal definitions of such phrases as "under the influence" and "intoxicated," it is also necessary to have confidence in the reliability of chemical tests involving concentrations as small as 0.05 per cent by weight of alcohol in the blood, urine, saliva or breath, if such tests are to be sanctioned legally. Biochemists and toxicologists who have had extensive experience with these tests are not convinced that they are as reliable as might be implied by the recommendation of the American Medical Association Committee to Study Problems of Motor Vehicle Accidents. Based on the

To the Editor:— Pertinent indeed are the editorial comments and the remarks of the Council on Medical Education and Hospitals regarding the financial aspects of the location of a medical school (The Journal, August 17, pp. 1281 and 1357). Medical schools would be wise to seek as close cooperation as possible with existing clinical facilities. The necessity for careful guidance of clinical practices and standards in order to meet the ideals of modern medical education frequently requires regulation to which impatient physicians may often object. For this reason medical schools should have full control of affiliated teaching hospitals or establish their own teaching hospitals. No matter where the medical school is located, it must receive adequate support if it is satisfactorily to fulfil its obligations in our society. Compromises to conserve funds inevitably result in compromises with ideals and standards. It is becoming increasingly apparent that larger sums than ever

Among the most noteworthy features of ethylene-oxygen anesthesia, as noted in the clinical report of Luckhardt and Lewis, 1 are the facts that recovery from the anesthetic is unusually prompt and that the subsequent postoperative condition is distinctly better than after ether. Less than half as many patients suffer from postanesthetic nausea and vomiting after ethylene-oxygen as in a comparable series after ether. These considerations led Dr. A. B. Hertzman and me to try to ascertain whether any differences might be noted between the effect of ethylene-oxygen anesthesia on the acid-base balance of blood and the now well recognized acidotic effect of ether. This action of ether may be a considerable factor in contributing to the postanesthetic complications following etherization. FACTORS INFLUENCING BLOOD REACTION IN ANESTHESIA Apart from the doubtful possibility that anesthetic agents may themselves exert a direct action on the acid and basic elements of bloods, variations in

To the Editor:— This is an earnest plea to all American physicians to support to the utmost the development of the Army Medical Library. Serving the profession in a more important way than any other single institution, this great library needs the personal interest and backing of all American physicians if it is to continue to maintain its activities in the manner expected of it. It is particularly important that American physicians support the effort of the Army Medical Library to acquire the permanent fireproof library building necessary to house its great treasures. Plans for such a building are in process, and a location for the new building has wisely been provided near the Library of Congress in Washington. This will assure maximum efficiency in the future development and use of the Army Medical Library for the benefit of the medical profession. It is important that individual physicians inform their

To the Editor:— Perhaps, for the record, it would be wise for you to publish a correction to the Dec. 5 issue. In my letter on "Drug Names" I was given an M.D. degree. I do not have a doctorate in medicine. Your original letter included no degree. I am sure that the manuscript editor was sufficiently aware of your interest in medicine over the years that she thought it would be proper to so honor you. I might well have had the same inclination, if this had been my responsibility.—Ed.

To the Editor:— Dr. Joseph Berkson's letter inThe Journal, Feb. 27, 1960, page 967, prompts me to report a little item relating to the controversy over cigarette smoking in relation to lung cancer. I am reporting in narrative form, without specific documentation or figures. In the summer of 1956, while in Moscow, I visited the Academy of Medical Sciences. There, at luncheon with Prof. V. N. Chernigovsky and Prof. V. V. Zakusov, I asked about the incidence of disease in Russia. They said that it was about the same as in the United States. I then asked about the incidence of lung cancer. Their reply was that an increase in the incidence of lung cancer in the large cities of Russia has been noted but no significant increase in the incidence of lung cancer in rural areas has occurred. I then asked what was thought to be the cause

To the Editor:— Many cancer patients from the United States have recently been attracted to Mexico City by reports of a new, allegedly successful method of treatment. We have taken occasion carefully to investigate the situation and we have prepared this statement of our opinion for the benefit of our colleagues who may be wondering about the matter. Personal investigations reveal a modernistic building for hospitalization with inadequate laboratory or other scientific facilities. The physician in charge has a courteous and considerate bedside manner. We think that he makes his patients feel better by virtue of his personality. There is no positive.evidence that he or his associates are successful by their peculiar methods in interrupting the usual course of a malignant process. The theoretical bases for the method of treatment are extraordinary. While they make use of current scientific concepts, they are not in accord in any way with established

To the Editor: —Protest should be entered against the apparently commercialized exploitation of the various unscientific and irrational mixtures proposed by George B. Pitkin, M.D., of Bergenfield, N. J. A few courageous workers were bold enough to call attention to the irrational mixture containing procaine, starch and strychnine proposed for "controlled spinal anesthesia" and exploited under the trademarked name of "Spinocaine" by the H. A. Metz Laboratories, Inc. Recently Dr. Pitkin proposed another irrational mixture of protein, lipoids and emetine, for intravenous injection in the treatment of peptic ulcer. Dr. Pitkin's report on this mixture was grossly uncritical, the exact composition of the mixture was not stated although meticulous directions for its administration were given, and it is obvious that whatever beneficial results were claimed in the report were due to the admitted use of what was essentially a Sippy diet along with this extraordinary intravenous medication. The H. A.

To the Editor:— The article by Dr. H. L. Kretschmer on "The Teaching of Drug Therapy" (The Journal, June 3, p. 326) calls attention again to the fact that the old problem of teaching prescription writing is by no means settled. Of course it is true that pharmacology is the basis for therapeutics, but pharmacology may also be applied to the diagnosis and prevention of disease as well as to the cure of disease and the alleviation of the symptoms of disease. Pharmacology as a science is the study of the action of chemicals on living things. It is largely a matter of tradition that prescription writing is taught as part of the course in pharmacology. This is unfortunate in many ways. It puts the teacher of pharmacology to a considerable disadvantage, since he rarely has the opportunity for supervising practice in prescription writing on patients. It would seem that

To the Editor:— Introduction of new chemical agents for clinical use involves a serious responsibility and requires the utmost care in skilful execution and interpretation of laboratory findings and sound judgment in evaluation of clinical results, as emphasized years ago (The Journal, Nov. 23, 1929, p. 1632). Both laboratory and clinical studies must conform to the best accepted standards for the specific types of experiments involved. The desirability of setting up a universally standard scheme of appraisal, such as that authorized "as a pattern" by the Council on Pharmacy and Chemistry inThe Journal, Dec. 9, 1944, page 958, may nevertheless be questioned. Aside from differences of opinion regarding the most valid technics for particular phases of a standardized appraisal, it is doubted that standardization of the experimental background for new drugs should be as detailed as that recommended. Ultimately the value of any chemical agent in treatment depends on

The usual treatment of amebiasis is unsatisfactory. Of the numerous drugs used and/or recommended, no single one nor combination meets the requirements for satisfactory therapy. These are that the drug shall be clinically nontoxic, shall be highly curative without adjuvants, shall be available for oral administration, shall interfere little if at all with the usual activities of the patient, and shall be of low cost. Such an agent might also offer hope of drug prophylaxis, which thus far has not been attainable. The seriousness of the therapeutic situation in amebiasis is apparent especially when one considers the relatively high incidence of the malady and the general disappointment with present methods of treatment. It is surprising that no systematic chemotherapeutic survey of the disease has been attempted until recently,1in spite of the long standing example of Ehrlich's2success in comparable protozoan infections. INCIDENCE Reports on its epidemiology generally

To the Editor:— The matter of names of new drugs continues to raise problems. For commercial protection, it is necessary for a drug manufacturer to trademark a name for a new drug. Such a name is usually made as short and as easy to remember as possible in order to maintain commercial advantage through use of the trade name, even after patent rights to the drug itself may have expired. On the other hand, it is against the dignity, prestige, and best interests of scientists and members of the health professions to use trade names of drugs in scientific and professional communications. There is no point in scientists or professional men becoming advertising agents for commercial concerns. As a consequence, generic names which may be publicly used without any fear of involving the legal aspects of trade names must also be provided. In view of the increasing flamboyance of commercial

To the Editor: —It is pertinent to keep the published record clear regarding the standards and ideals of scientists and physicians of the United States. Especially is this necessary in matters involving new and allegedly useful methods of handling disease. Distressing, therefore, is the spectacle of reputable scientific medical men promoting persuasive but dubious arguments and evidence on a material for use in cancer which has suspicious commercial association and on which satisfactory chemical analysis or pharmacological appraisal has not yet been issued in customary scientific or medical publications. Those who would like to know what technical procedures are available for the reasonably satisfactory introduction of new therapeutic agents may refer to the following publications: "The Pharmacologic Evaluation of New Drugs" ( J. A. M. A . 93: 1632 [Nov. 23] 1929); "Laboratory and Clinical Appraisal of New Drugs" ( J. A. M. A . 126: 958 [Dec. 9] 1944); "Current Pharmacology: General Principles

To the Editor:— I wholeheartedly agree with the comment by Dr. S. P. Leinbach ( J. A. M. A. 169: 69 [Jan. 3.] 1959) regarding the excellent help available to practicing physicians, if they will only take advantage of it. The A. M. A. Council on Drugs is one of the best sources of sound information that physicians can get on the tremendous number of new drugs that are now being offered by fast-talking detailmen and flamboyant advertisements from even the best pharmaceutical companies. Good medicine cannot be practiced if physicians do not give careful attention to the choice of the drugs they use. New drugs are carefully scrutinized by the Council on Drugs. Reports are made frequently inThe Journaland are included for description in New and Nonofficial Drugs. New drugs are so well appraised by the Council on Drugs and the reports are so well made on them

The administration of a drug to estimate abnormal structure or function of an organ in the body is becoming increasingly common as a diagnostic aid in medicine. Many of the drugs in use for this purpose are administered by a technical assistant and, through popular usage, have come to be looked on merely as playing a role in a laboratory procedure. Drugs so used, therefore, have tended to lose their identity in the minds of physicians as substances capable of inciting specific tissue and cellular activity. Although much has been added to our knowledge of pathologic physiology by their clinical application, their use is not without danger. The use of a chemical in diagnosis is not justifiable if its possible toxicity outweighs the value of the information which may be derived. For many years clinicians and physiologists have attempted, by the use of certain drugs, to devise means of determining