PENTOTHAL ACID
1
1072 relief; and, as the report remarks, the issue of a al war might turn on its success. In the British Medical is Journal last week a surgeon wrote of the sense of ai futility and bitterness with which he viewed the task tl that seemed to lie before him a few weeks ago ; he w saw it as an unending effort-useless from a military ir standpoint-to repair damage wrought by bombs on b- civilians who should not have been in London at all. ir Only those civilians should remain in the front line, sl he said, whose presence is essential; and in present f circumstances all will agree with him. But according Sl to current plans at least half or two-thirds will v remain, including most of the wives of workers and n many of their young children. The question arises n whether much more elaborate provision for the safety w of all these people should not be made. A.R.P. ri policy hitherto has been directed chiefly against b the menace of gas, because protection against gas is d much simpler than protection against high-explosive I bombs. The main purpose, it is clear, has been to 2. take enough precautions to prevent panic ; for it is believed that guns, balloon barrages, and fighter aeroplanes would suffice to prevent any terrific destruction of life and that the real danger from air C9 raids is not so much material loss as a collapse of t civilian morale. Prof. J. B. S. Haldane, F.R.S., t argues against this policy on various grounds, the I chief of which is that protection against bigh explo- 1 sives has proved vitally necessary in Spanish cities, and is even more applicable to this country. His l book 2 puts forward a scheme by which brick-lined ( tunnels would be built at a safe depth (in London about 60 feet) below the towns in such a way that no dwelling would be more than 400 yards from an entrance and the entire population could take secure f shelter when a warning is given. The scheme may I sound fantastic ; but he estimates that, by engaging unemployed miners, tunnels holding tbree-quarters J of the population could be soon prepared at a cost : of something like JE400 million-" about one quarter of the sum which the Government proposes to spend on rearmament during the next few years." As compared with other means of defence, such as aeroplanes, the tunnels would have the advantage of being a permanent investment. They would threaten nobody and they would remove any hope of victory over this country by a knock-out blow. In the House of Commons six years ago Lord Baldwin, then Prime Minister, said: " I think it is well for the man in the street to realise that there is no power on earth that can protect him from being bombed. Whatever people may tell him, the bomber will always get through.... The only defence is in offence, which means you have to kill more women and children quickly if you want to save yourselves." Prof. Haldane’s book challenges these statements on the ground that the offensive defence is technically as well as morally wrong. Writing from experience of contemporary warfare in Spain, he pleads for the variety of defence which does not concentrate on destroying the enemy’s women and children, and which accordingly rates the subterranean tunnel higher than the bombing plane. In so doing he recognises a psychological difficulty. During countless genera- tions the soldier has been given a prestige and glory greater than the miner, though his work is seldom more dangerous and his courage in emergency no greater. Hence an expenditure of E400 million on army, navy, and air force does not seem excessive, whereas expenditure of the same sum on digging 2 A.R.P. By J. B. S. Haldane, F.R.S. London : Victor Gollancz. 1938. Pp. 296. 7s. 6d. appears rather absurd. A second difficulty, he believes, is that military men are taught how to win battles and campaigns but not how to win wars ; whereas the manoeuvring of troops and the use of offensive weapons are not necessarily any longer the most important part of war. A third obstacle encountered by supporters of passive defence is that many industrialists are interested in the production of guns, ships, and aeroplanes ; and even the concrete manu- facturers are beginning to see the possibility of superficial street shelters ; whereas no powerful or vocal interest would profit by setting unemployed miners to dig in the London clay-especially as most of the money would go direct to the miners in wages. Against this, if Prof. Haldane were proved right about the feasibility of building such tunnels, his proposals would have the goodwill of all who deplore the policy of ordeal and reprisal that Lord Baldwin unwillingly held to be inevitable. Sir John Anderson will have much to think about. PENTOTHAL ACID THE latest barbituric narcotic of which we have an account, Pentothal acid, ethyl (1-methyl butyl). thiobarbituric acid, appears to be a useful addition to the drugs that can safely be used to procure somno- lence before the administration of the main anms- thetic. In the October issue of the British Journal of Ancesthesia, Dr. J. S. Horsley describes the result of three years’ clinical and laboratory research with pentothal sodium which resulted in his trial of pentothal acid. The main chemical difference between the acid and the salt is in the much greater solubility of the latter so that the acid is relatively stable. It is supplied as a purified powder of a, lemon-yellow colour which must be kept in tightly stoppered bottles, or else as tablets each containing 4 grains. Small doses are sedative, medium doses hypnotic, and large doses anaesthetic. Respiration is lessened by full ansesthetic doses but almost unaffected by doses recommended for basal anoes- thesia. The drowsiness following anaesthesia from pentothal acid is less often associated with rest- lessness than is that after the other barbiturates. The chief practical advantage offered by this new basal narcotic appears to be its certainty of action when given by the mouth. Nembutal, for example, although valuable and much used orally, has the drawback that it cannot be relied on with the same certainty as when injected into a vein. Pentothal acid has been given by the mouth in a series of 500 patients. The dosage, however, needs careful arrangement, and after various amounts had been tried the conclusion was reached that the best results are achieved by giving 8 grains three hours before operation, repeating this dose at intervals of an hour, either once or twice according to the effect. Doses. of gr. 8 given three and two hours before opera- I tion gave consistently better results than a single dose of gr. 16 ; this, in may be, is another example of that cumulative action of drugs which led to the r conception of synergism. L Pentothal acid is one of the rapidly eliminated - barbiturates. It certainly appears that a good case r has been made out for its administration, without other drugs, as a basal narcotic. 1 ON Tuesday and Thursday, Nov. 8th and lOth, at , 5 P.M., Dr. Harold Scott will deliver the FitzPatrick lectures at the Royal College of Physicians of London. His subject will be the conquest of disease r in the tropics.
Transcript of PENTOTHAL ACID
1072
relief; and, as the report remarks, the issue of a alwar might turn on its success. In the British Medical isJournal last week a surgeon wrote of the sense of ai
futility and bitterness with which he viewed the task tlthat seemed to lie before him a few weeks ago ; he w
saw it as an unending effort-useless from a military ir
standpoint-to repair damage wrought by bombs on b-civilians who should not have been in London at all. ir
Only those civilians should remain in the front line, slhe said, whose presence is essential; and in present fcircumstances all will agree with him. But according Sl
to current plans at least half or two-thirds will v
remain, including most of the wives of workers and n
many of their young children. The question arises n
whether much more elaborate provision for the safety w
of all these people should not be made. A.R.P. ri
policy hitherto has been directed chiefly against bthe menace of gas, because protection against gas is dmuch simpler than protection against high-explosive Ibombs. The main purpose, it is clear, has been to 2.take enough precautions to prevent panic ; for it isbelieved that guns, balloon barrages, and fighteraeroplanes would suffice to prevent any terrificdestruction of life and that the real danger from air
C9raids is not so much material loss as a collapse of tcivilian morale. Prof. J. B. S. Haldane, F.R.S., targues against this policy on various grounds, the Ichief of which is that protection against bigh explo- 1sives has proved vitally necessary in Spanish cities,and is even more applicable to this country. His
l
book 2 puts forward a scheme by which brick-lined (
tunnels would be built at a safe depth (in Londonabout 60 feet) below the towns in such a way thatno dwelling would be more than 400 yards from anentrance and the entire population could take secure
f
shelter when a warning is given. The scheme may Isound fantastic ; but he estimates that, by engagingunemployed miners, tunnels holding tbree-quarters Jof the population could be soon prepared at a cost :
of something like JE400 million-" about one quarterof the sum which the Government proposes to
spend on rearmament during the next few years."As compared with other means of defence, such asaeroplanes, the tunnels would have the advantage ofbeing a permanent investment. They would threatennobody and they would remove any hope of victoryover this country by a knock-out blow.
In the House of Commons six years ago LordBaldwin, then Prime Minister, said:
" I think it is well for the man in the street torealise that there is no power on earth that canprotect him from being bombed. Whatever peoplemay tell him, the bomber will always get through....The only defence is in offence, which means you haveto kill more women and children quickly if you wantto save yourselves."Prof. Haldane’s book challenges these statements onthe ground that the offensive defence is technicallyas well as morally wrong. Writing from experienceof contemporary warfare in Spain, he pleads for thevariety of defence which does not concentrate on
destroying the enemy’s women and children, andwhich accordingly rates the subterranean tunnel higherthan the bombing plane. In so doing he recognises apsychological difficulty. During countless genera-tions the soldier has been given a prestige and glorygreater than the miner, though his work is seldommore dangerous and his courage in emergency no
greater. Hence an expenditure of E400 million onarmy, navy, and air force does not seem excessive,whereas expenditure of the same sum on digging
2 A.R.P. By J. B. S. Haldane, F.R.S. London : VictorGollancz. 1938. Pp. 296. 7s. 6d.
appears rather absurd. A second difficulty, he believes,is that military men are taught how to win battlesand campaigns but not how to win wars ; whereasthe manoeuvring of troops and the use of offensiveweapons are not necessarily any longer the mostimportant part of war. A third obstacle encounteredby supporters of passive defence is that manyindustrialists are interested in the production of guns,ships, and aeroplanes ; and even the concrete manu-facturers are beginning to see the possibility of
superficial street shelters ; whereas no powerful orvocal interest would profit by setting unemployedminers to dig in the London clay-especially as
most of the money would go direct to the miners inwages. Against this, if Prof. Haldane were provedright about the feasibility of building such tunnels,his proposals would have the goodwill of all whodeplore the policy of ordeal and reprisal that LordBaldwin unwillingly held to be inevitable. Sir JohnAnderson will have much to think about.
PENTOTHAL ACID
THE latest barbituric narcotic of which we havean account, Pentothal acid, ethyl (1-methyl butyl).thiobarbituric acid, appears to be a useful additionto the drugs that can safely be used to procure somno-lence before the administration of the main anms-thetic. In the October issue of the British Journalof Ancesthesia, Dr. J. S. Horsley describes the resultof three years’ clinical and laboratory research withpentothal sodium which resulted in his trial of
pentothal acid. The main chemical differencebetween the acid and the salt is in the much greatersolubility of the latter so that the acid is relativelystable. It is supplied as a purified powder of a,
lemon-yellow colour which must be kept in tightlystoppered bottles, or else as tablets each containing4 grains. Small doses are sedative, medium doseshypnotic, and large doses anaesthetic. Respirationis lessened by full ansesthetic doses but almostunaffected by doses recommended for basal anoes-
thesia. The drowsiness following anaesthesia frompentothal acid is less often associated with rest-lessness than is that after the other barbiturates.The chief practical advantage offered by this newbasal narcotic appears to be its certainty of actionwhen given by the mouth. Nembutal, for example,although valuable and much used orally, has thedrawback that it cannot be relied on with the samecertainty as when injected into a vein. Pentothalacid has been given by the mouth in a series of500 patients. The dosage, however, needs carefularrangement, and after various amounts had beentried the conclusion was reached that the best resultsare achieved by giving 8 grains three hours beforeoperation, repeating this dose at intervals of an hour,either once or twice according to the effect. Doses.of gr. 8 given three and two hours before opera-
I tion gave consistently better results than a singledose of gr. 16 ; this, in may be, is another exampleof that cumulative action of drugs which led to the
r conception of synergism.L
Pentothal acid is one of the rapidly eliminated
-
barbiturates. It certainly appears that a good caser
has been made out for its administration, withoutother drugs, as a basal narcotic.
1 ON Tuesday and Thursday, Nov. 8th and lOth, at, 5 P.M., Dr. Harold Scott will deliver the FitzPatrick lectures at the Royal College of Physicians of- London. His subject will be the conquest of diseaser in the tropics.
