1095 gram stain in one); the other 2 patients had acute arthritis with a typical rash but negative bacteriological findings. HL-A 27 was absent in all 12 patients. These findings have more than theoretical interest. They have practical clinical value, in that the absence of HL-A 27 antigen in a given patient with acute urethritis and acute arthritis suggests that the cause may be gonorrhcea rather than Reiter’s syndrome. This is the same conclusion reached by Morris et al.66 Department of Medicine, Kaiser-Permanente Medical
Center, San Francisco, California 94115, U.S.A.
bizarre response after the first dose of a hypotensive drug, in the therapeutic range, is unique to prazosin hydrochloride and is perhaps unrelated to the prolongation of action of cyclic A.M.r. We suggest that the manufacturers produce a 0-25 mg. tablet which should be given to every patient ’before therapeutic doses are started. Such a small dose might produce a less drastic effect than the 2 mg. tablet in patients at risk of hypotension and unconsciousness. ROGER GABRIEL DAVID MEEK B. C. GHOSH. Royal Infirmary, Hull.
LUKE P. WAGNER W. J. FESSEL.
Parliament VITAMIN-E DEFICIENCY IN COT DEATHS SiR,—Iread with interest the letter by Dr Tapp and Mrs Anfield (Feb. 22, p. 467) on vitamin-E and selenium deficiency as a possible cause of the sudden-infant-death syndrome (cot deaths). We also became interested in this possibility because of the report of Money.7 In briefest summary, our studies of 18 instances of this syndrome showed that the vitamin-E and selenium levels were lower than those in adults, but no different from those in 35 other infants of the same ages. 8-12 University Hospital, 225 West Dickinson Street, San Diego, California 92103, U.S.A.
SIDNEY L. SALTZSTEIN.
COLLAPSE AFTER PRAZOSIN HYDROCHLORIDE
SIR,-Prazosin hydrochloride (’Hypovase’) is a hypotensive drug producing peripheral arterial dilatation: it delays the breakdown of cyclic A.M.P. by inhibiting the enzyme phosphodiesterase, and the presence of cyclic A.M.P. allows arterial smooth muscle to relax. Although both the manufacturers and the Committee on Safety of Medicines have warned that the first dose of prazosin may cause an apparent profound fall in blood-pressure, the condition does not seem to have been formally reported. We describe the first case we have seen. kg. 62-year-old housewife consulted her practitioner because of epistaxis. The blood-pressure was raised, and prazosin hydrochloride 2 mg. twice daily was prescribed. The first dose was taken at 15.45 hours with afternoon tea while the patient was watching television. At 17.45 hours, whilst washing up, the patient felt faint and fell to the floor. She had no recall of An 80
for about an hour. She vomited twice and was admitted to Hull Royal Infirmary. At 18.20 hours she was weak and sweating and the supine blood-pressure was 130/90 mm. Hg. By 21.00 hours the patient felt well and the supine blood-pressure was 120/70 mm. Hg. Overnight the pressure rose to 160/100 (erect and supine). Tilt response was normal. 48 hours after the first dose of prazosin hydrochloride a 5 mg. dose produced no abnorevents
mality.
,
Postural hypotension is a common side-effect with many hypotensive drugs, but loss of consciousness is not. A Money, D. F. L. N.Z. med. J. 1970, 71, 32. Rhead, W. J., Cary, E. E., Allaway, W. M., Saltzstein, S. L., Schrauzer, G. N. Bioinorg. Chem. 1972, 1, 289. 9. Rhead, W. J., Schrauzer, G. N., Saltzstein, S. L., Cary, E. E., Allaway, W. M. J. Pediat. 1972, 81, 415. 10. Saltzstein, S. L., Schrauzer, G. N., Rhead, W. J. J. Am. med. Ass. 1973, 226, 466. 11. Rhead, W. J., Schrauzer, G. N., Saltzstein, S. L. Br. med. J. 1973, iv, 548. 12. Schrauzer, G. N., Rhead, W. J., Saltzstein, S. L. Annls clin. Lab. Sci. 1975, 5, 31. 7. 8.
Private Beds in N.H.S.
Hospitals
debate in the Commons last Monday, the Secretary of State for Social Services, Mrs BARBARA CASTLE, announced the Government’s intentions concerning pay-beds and the N.H.S. The policy, she said, was designed to end the unfairness of queue-jumping within the N.H.S. and to release more facilities and services for the benefit of N.H.S. patients. The phasingout of pay-beds would be effected by legislation as soon as parliamentary time was available; and Mrs Castle was entering into immediate consultations about thel details with all concerned. Meanwhile, she would approach the medical profession again to urge them to introduce common waiting-list procedures. The Government had decided to consider the extension of existing powers of licensing private nursing-homes. Present powers were limited and " their adequacy must be reviewed, given the role which’ the wholly private sector might take on once the phasing-out DURING
a
programme
was
completed".
QUESTION TIME Employment of Women Doctors Replying to a question in the House of Commons on April 29, Mrs BARBARA CASTLE, Secretary of State for Social Services, said that she was anxious to extend the employment of women doctors in the National Health Service. A number of steps had already been taken to this end, including the extension of the women doctors’ retainer scheme which was announced on April 1, but the whole question needed to be reviewed to see what more could be done. Representatives of the medical bodies concerned and individual practising women doctors would be invited to a special conference with the Department of Health in July to discuss the contribution of married women doctors to the N.H.S.; to consider the problems faced by married women doctors on re-entry to active medical practice and in combining family with professional responsibilities; and to make recommendations. The Department attached enormous importance to the increase in the intake of British medical schools. There was a planned programme of expansion aimed at doubling the figures by 1980, one of the purposes of which was to enable Britain to be less dependent on foreign doctors. Mrs Castle agreed that the women doctors in question were mainly British-born, and it was therefore her earnest desire to remove any remaining obstacles to the continuing employment of married women doctors and to their re-entry into the profession when they had had to leave it. Many of them wanted to work part-time, and this sometimes created difficulties, either for the practices or for the health authorities involved, but steps were being taken to overcome these difficulties. The conference in July would, it was hoped, help to overcome the remaining obstacles in the attitudes of mind of the employers concerned.
Center, San Francisco, California 94115, U.S.A.
bizarre response after the first dose of a hypotensive drug, in the therapeutic range, is unique to prazosin hydrochloride and is perhaps unrelated to the prolongation of action of cyclic A.M.r. We suggest that the manufacturers produce a 0-25 mg. tablet which should be given to every patient ’before therapeutic doses are started. Such a small dose might produce a less drastic effect than the 2 mg. tablet in patients at risk of hypotension and unconsciousness. ROGER GABRIEL DAVID MEEK B. C. GHOSH. Royal Infirmary, Hull.
LUKE P. WAGNER W. J. FESSEL.
Parliament VITAMIN-E DEFICIENCY IN COT DEATHS SiR,—Iread with interest the letter by Dr Tapp and Mrs Anfield (Feb. 22, p. 467) on vitamin-E and selenium deficiency as a possible cause of the sudden-infant-death syndrome (cot deaths). We also became interested in this possibility because of the report of Money.7 In briefest summary, our studies of 18 instances of this syndrome showed that the vitamin-E and selenium levels were lower than those in adults, but no different from those in 35 other infants of the same ages. 8-12 University Hospital, 225 West Dickinson Street, San Diego, California 92103, U.S.A.
SIDNEY L. SALTZSTEIN.
COLLAPSE AFTER PRAZOSIN HYDROCHLORIDE
SIR,-Prazosin hydrochloride (’Hypovase’) is a hypotensive drug producing peripheral arterial dilatation: it delays the breakdown of cyclic A.M.P. by inhibiting the enzyme phosphodiesterase, and the presence of cyclic A.M.P. allows arterial smooth muscle to relax. Although both the manufacturers and the Committee on Safety of Medicines have warned that the first dose of prazosin may cause an apparent profound fall in blood-pressure, the condition does not seem to have been formally reported. We describe the first case we have seen. kg. 62-year-old housewife consulted her practitioner because of epistaxis. The blood-pressure was raised, and prazosin hydrochloride 2 mg. twice daily was prescribed. The first dose was taken at 15.45 hours with afternoon tea while the patient was watching television. At 17.45 hours, whilst washing up, the patient felt faint and fell to the floor. She had no recall of An 80
for about an hour. She vomited twice and was admitted to Hull Royal Infirmary. At 18.20 hours she was weak and sweating and the supine blood-pressure was 130/90 mm. Hg. By 21.00 hours the patient felt well and the supine blood-pressure was 120/70 mm. Hg. Overnight the pressure rose to 160/100 (erect and supine). Tilt response was normal. 48 hours after the first dose of prazosin hydrochloride a 5 mg. dose produced no abnorevents
mality.
,
Postural hypotension is a common side-effect with many hypotensive drugs, but loss of consciousness is not. A Money, D. F. L. N.Z. med. J. 1970, 71, 32. Rhead, W. J., Cary, E. E., Allaway, W. M., Saltzstein, S. L., Schrauzer, G. N. Bioinorg. Chem. 1972, 1, 289. 9. Rhead, W. J., Schrauzer, G. N., Saltzstein, S. L., Cary, E. E., Allaway, W. M. J. Pediat. 1972, 81, 415. 10. Saltzstein, S. L., Schrauzer, G. N., Rhead, W. J. J. Am. med. Ass. 1973, 226, 466. 11. Rhead, W. J., Schrauzer, G. N., Saltzstein, S. L. Br. med. J. 1973, iv, 548. 12. Schrauzer, G. N., Rhead, W. J., Saltzstein, S. L. Annls clin. Lab. Sci. 1975, 5, 31. 7. 8.
Private Beds in N.H.S.
Hospitals
debate in the Commons last Monday, the Secretary of State for Social Services, Mrs BARBARA CASTLE, announced the Government’s intentions concerning pay-beds and the N.H.S. The policy, she said, was designed to end the unfairness of queue-jumping within the N.H.S. and to release more facilities and services for the benefit of N.H.S. patients. The phasingout of pay-beds would be effected by legislation as soon as parliamentary time was available; and Mrs Castle was entering into immediate consultations about thel details with all concerned. Meanwhile, she would approach the medical profession again to urge them to introduce common waiting-list procedures. The Government had decided to consider the extension of existing powers of licensing private nursing-homes. Present powers were limited and " their adequacy must be reviewed, given the role which’ the wholly private sector might take on once the phasing-out DURING
a
programme
was
completed".
QUESTION TIME Employment of Women Doctors Replying to a question in the House of Commons on April 29, Mrs BARBARA CASTLE, Secretary of State for Social Services, said that she was anxious to extend the employment of women doctors in the National Health Service. A number of steps had already been taken to this end, including the extension of the women doctors’ retainer scheme which was announced on April 1, but the whole question needed to be reviewed to see what more could be done. Representatives of the medical bodies concerned and individual practising women doctors would be invited to a special conference with the Department of Health in July to discuss the contribution of married women doctors to the N.H.S.; to consider the problems faced by married women doctors on re-entry to active medical practice and in combining family with professional responsibilities; and to make recommendations. The Department attached enormous importance to the increase in the intake of British medical schools. There was a planned programme of expansion aimed at doubling the figures by 1980, one of the purposes of which was to enable Britain to be less dependent on foreign doctors. Mrs Castle agreed that the women doctors in question were mainly British-born, and it was therefore her earnest desire to remove any remaining obstacles to the continuing employment of married women doctors and to their re-entry into the profession when they had had to leave it. Many of them wanted to work part-time, and this sometimes created difficulties, either for the practices or for the health authorities involved, but steps were being taken to overcome these difficulties. The conference in July would, it was hoped, help to overcome the remaining obstacles in the attitudes of mind of the employers concerned.
