1427 CHILD POISONING AND TABLET CONTAINERS Gartside’s observation that a rapid increase in SIR,-Dr admissions of children for suspected poisonings in England and Wales corresponded to the change from standard screw-capped tablet bottles to bottles with easily pulled off caps (April 26, p. 886) should lead to changes in the packaging practices of pharmacists and pharmaceutical Dr Gartside’s conclusion, however, is manufacturers. unfortunate. He wrote: An investigation to determine whether suspected poisoning is associated with any particular type of container would be of great value, but it must be carried out rapidly before the picture is changed by the introduction of child-resistant containers, a ’technological advance’ which may be unnecessary." One could hardly hope for a more convincing investigation than the " cessation experiment " in the United States. As Barry observed, the number of childhood poisonings reported annually with " baby aspirin " (paEdiatric dosage tablets marketed for children in special flavours, colours, and containers) decreased dramatically after the voluntary adoption, by manufacturers, of bottles with safety closures for the dispensing of these products.l During the same time period, the annual number of reported poisonings "

striking that population-based rates and uniform definitions unnecessary in order to conclude that safety closures are advantageous. Gartside apparently doubts that safety closures are a technological advance, but he does not suggest that their use be delayed until appropriate investigations have been completed. The success of safety closures in the United States would render such a delay comparable to withholding antibiotics from a patient with meningitis pending results of culture and sensitivity studies. When the patient’s life may be at stake it is usually necessary to act on the basis of whatever information is readily available. are

Department of Psychiatry and Sciences, and Division of Forensic Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, U.S.A.

PARK ELLIOTT DIETZ.

HERPESVIRUS INFECTION AND CANCER SIR,—Dr Matas and his colleagues (June 7, p. 1277) suggest that the pathogenesis of lymphoproliferative tumours in transplant patients involves the reactivation of latent oncogenic herpesvirus. They suggest that seroepidemiological studies documenting an association of cancer and herpesvirus infections would be helpful in supporting their hypothesis. In a series of 100 patients with bronchial carcinoma we found that significantly fewer (21 out of 100) gave a history of recurrent labial herpes simplex than a control group (42 out of 100); the range of serum complement-fixing antibody titres to herpes simplex was similar in case and controls. From these findings we suggested that clinical recurrent infection might provide specific or non-specific protection against bronchial carcinoma.i These results seem to contradict the hypothesis of Dr Matas and his colleagues. However, it seems possible that, although previous recurrent herpes-simplex infection may provide some immunological protection against the development of bronchial carcinoma, the use of immunosuppressive agents in transplant patients may encourage the

oncogenic potential of latent herpesviruses. ------

Microbiology Laboratory, Ayrshire Central Hospital,

"Analgesics" England and Wales "Baby Aspirin" United States "Unspecified Aspirin" United States

"Adutt Aspirin" United States suspected poisonings among children under 5

Irvine KA12 8SS.

CONSTANCE A. C. Ross.

A

Number of of age.

PLASMA IRON AND IRON-BINDING CAPACITY Eastham SIR,— Dr (May 10, p. 1090) quotes average

years

Data from

England and Wales based on estimated hospital and data from United States based on reports to Poison Control Centers.2,3 admissions;

from unspecified types of aspirin also decreased, while that from " adult aspirin " remained stable (see accompanying

figure). Although Gartside emphasises poisonings with prescription medicines, the data he presents from England and Wales also show an increase in poisonings with analgesics (predominantly aspirin) following the change to bottles with easily pulled off caps (see figure). Assuming no important change in reporting practices or data collection, the differences between trends for aspirin poisoning in children in the United States and the trend for analgesic poisoning in children in England and Wales is sufficiently "

"

1. Barry, P. Z. Prev. Med. 1975, 4, 47. 2. U.S. Department of Health, Education and Welfare. National Clearinghouse for Poison Control Centers Bulletin, 1972, September-October. 3. Ibid. 1974. May-June.

coefficients of variation for the estimation of plasma iron and iron-binding capacities which have been taken from nationally used quality-control schemes and suggests, obtained for these estimations may therefore, that results be equivocal-i.e., " 95% of results obtained on a sample containing 300 µg. per 100 ml. (of iron-binding capacity) would fall in the range 200-400 µg. per 100 ml.". However, it is quite inappropriate to assume that, in any one department, the precision of these estimations is necessarily related to the precision obtained from results from as many as 300-400 different departments. Results obtained from a particular laboratory must always be related to the reference range of that laboratory and be interpreted in the context of the precision of the method in use. The precision obtained in many laboratories (e.g., by Dr Price and Dr Obeid) (May 17, p. 1140) is considerably better than might be inferred from Dr Eastham’s letter. Results from several laboratories which participate in a 1.

Ross, C. A. C., Tyrrell, W. F. Lancet, 1974, i, 871.

Letter: Child poisoning and tablet containers.

1427 CHILD POISONING AND TABLET CONTAINERS Gartside’s observation that a rapid increase in SIR,-Dr admissions of children for suspected poisonings in...
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