Since the preliminary report on the use of mepacrine in the treatment of rheumatoid arthritis (Freedman and Bach, 1952), there has been a gradual appreciation of the value of 4-amino quinolone compounds for this condition. Many papers have appeared (Forestier and Certonciny, 1954;Scherbel, Schuchter, and Harrison, 1957;Erlendsson, 1958;Fuld and Horwich, 1958), but controlled trials have been few. The first (Freedman, 1956) dealt with 66 patients each observed for a period of 16 weeks. The finding that the chloroquine-treated patients did better than the controls was confirmed by trials undertaken by Rinehart, Rosenbaum, and Hopkins (1957), Cohen andCalkins (1958), andKuipers (1959) Patients ill enough to be admitted to hospital were not accepted into the trial, and anyone within the trial was withdrawn if the condition so deteriorated as to warrant admission to hospital.Treatment.-During the trial period all patients received eight 5-gr. tablets of enteric-coated aspirin daily, and if they were anaemic oral iron was also prescribed. The patients also received either chloroquine or dummy tablets of identical appearance, the physician not knowing which kind the patient was having throughout the trial. These tablets were prescribed according to the serial number given to the patient as each was admitted into the trial. A list of these numbers divided randomly into two groups, P and Q, was held by the pharmacist, who dispensed either P or Q tablets according to the serial number. The dispenser did not know which was the active preparation. Those patients who were receiving the active preparation were in fact taking chloroquine sulphate 200 mg. twice daily. In a few cases in both groups side-effects occurred; these were considered to be toxic effects and a reduction of dosage to one and a half tablets daily was made. Appropriate splinting and physiotherapy were also prescribed.Assessment.-The patients were examined by one of us at a special clinic held for this purpose on a separate afternoon. At each visit they were asked specific questions concerning their symptoms and their need for analgesics other than those routinely prescribed, and about any change in their self-care and ability to work.Special note was made of their colour, and the presence of oedema, nodules, lymph-glands, and rashes.The temporo-mandibular, clavicular, and manubrial joints and the spine as well as the limb joints were separately examined.

SummaryA case of poisoning as a result of the ingestion of an alcoholic podophyllum extract is described.The resulting toxic effects comprised an initial severe disturbance of consciousness followed by a state of confusion, and a fairly severe type of peripheral neuropathy.A substantial amount of recovery of function had occurred at the end of six months after ingestion of the podophyllin, but a residual neurological deficit was still evident at the end of 16 months.The mode of action and probable effects of the podophyllum extract are discussed briefly. GroupThis paper describes six cases in which ankylosing spondylitis was associated with chronic non-specific inflammatory lesions of the intestines. Four of these cases had chronic ulcerative colitis, one had Crohn's disease, and one had ulcerative colitis and Crohn's disease. The aetiology of ulcerative colitis and Crohn's disease is uncertain. Although it seems unlikely that they represent different man-ifestations of the same diseases, nevertheless there appears to be enough similarity between them to make differentiation difficult at times (Butler, 1953 ; Crohn, Garlock, and Yarnis, 1947), and we may be justified in considering them together. The diagnosis of Crohn's disease was made at operation in both our cases, while radiology with a barium-filled colon was relied on for the diagnosis of ulcerative colitis.The English literature has few references to the association of ankylosing spondylitis and ulcerative colitis. West (1949) (Marche, 1950; Ford, 1953 and for several years he had little trouble. In 1954 he complained of pain in the right knee, followed by pain in the back. Examination showed rigidity of the thoracic and lumbar spines, and limitation of movement of the cervical spine. There was an effusion in the right knee. X-ray examination showed typical changes of ankylosing spondylitis, with obliteration of the sacro-iliac joints and calcification of the spinal ligaments. Erythrocyte sedimentation rate was 20 mm. in one hour. He was treated by physical methods, with improvement. One month before this was written he had a further relapse of diarrhoea, with blood, and a barium enema showed a loss of haustration involving the descending and pelvic colon. For some years this man had had diffuse psoriasis.Case 3.-A man aged 48 complained in 1937 of diarrhoea and bloody stools. He was admitted to hospital, and ulcerative colitis was diagnosed. In 1942, while in hospital with a further attack, he first noted stiffness of his spine. Since then he has had intermittent attacks of ulcerative colitis. He also found that his neck was bending forward, and that he was unable to look up. In 1949 a diagnosis of ankylosing spondylitis was made. He was treated with deep x-ray therapy. Following this he developed his first attack of iridocyclitis, affecting the left eye. In 1950 he experienced a severe attack, affecting the right eye. X-ray examination revealed obliteration of both sacro-iliac joints, typical of ankylosing spondylitis. 1158 Nov. 16, 1957 ANKYLOSING...

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