Oxygen Poisoning in Man
Authors: L. Hill
Journal: BMJ (1947)

may have serious or even fatal results in severe cases of the disease.Higgins et al. mention that the blood culture remains positive " from four to seven days," which we regard as far too long.We have not ourselves tested many cases for repeated positive blood cultures, because of the rapid improvement in their clinical condition, but in those cases which we have tested the second culture has been sterile except in one case which had a penicillin-resistant infection for which we had at the time insufficient penicillin.We advocate an arbitrary daily dose of 400,000 units (equal to the whole course advocated by Higgins et al. for many of their cases), falling to a minimum of 200,000 units daily given by intramuscular drip, for patients of all ages.If infants are unsuitable for drip administra- tion we should give this dose by two-hourly injections during the acute stage in order to be certain of a constant bacteriostatic level of penicillin in the blood.Buchanan, in a paper on dosage of penicillin in infants, for infec- tions generally advocates a routine dosage of four times that used by Higgins et al., given three-and not four-hourly (4,000 units per lb.per 24 hours by three-hourly injections).She found that 1,000 units per lb.per 24 hours was often insufficient for obtaining inhibition with serum dilution 1/1; that 2,000 units per lb.was sufficient, but that 4,000 units per lb.gave better-maintained results.We read in the paper by Higgins et al. that one child with a streptococcal infec- tion of 12 times the normal resistance to penicillin made " a com- plete recovery on the standard dosage of penicillin," and that makes us wonder how much has penicillin really affected this series.But on referring to the table we see that " complete recovery " includes " erosion of the head of the humerus, now delay in epiphysial development."And it may be that some of the local recoveries do not differ as they should from those which would have been seen in pre-penicillin days.Ini,nobilization.-We read in the paper that " immobilization was not prolonged much beyond the period of penicillin treatment, and movement was encouraged as soon as it was painless even in cases with marked radiological changes." (The italics are ours.)We should have been afraid that such a policy might have produced sooner or later a pathological fracture, a fact which is substantiated by these authors' experience, for in the table-again without com- ment in the text-we find " fracture " in a case of osteomyelitis of the tibia.Before allowing movement and weight-bearing we do care- fully consider both the clinical and laboratory findings for evidence of residual inflammation on the one hand and the radiograph for soundness of the bone on the other, and we tend to conservatism if there is any doubt.Only such careful consideration can prevent unnecessary complications such as pathological fracture.We are very sorry to be forced to stress our points of dis- agreement with the views of Higgins et al., especially as they offer us one of the largest series of acute osteomyelitis in infants treated with penicillin which has so far been published, and the authors' conclusion on cases in this group can be discussed by few with comparable experience.-Weare, etc., J. TRUETA.