1280 LETTERS TO THE JOURNAL Canad. Med. Ass. J.

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for publication, they should be typewritten, double-spaced, should be of reasonable length,
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these letters is the responsibility of the correspondent.
Views expressed in Letters to the Journal are those of the writers concerned and are NOT
to be interpreted as the opinions of The Canadian Medical Association or of the editors.

PAINLESS INJECTIONS
To the Editor:
The main function of the anesthesiologist is to
prevent and alleviate pain. Progress in medicine seems
to coincide with the increasing use of injections in
everyday therapy. This is a feature of modern medi-
cine that most patients, especially the younger ones,
find objectionable. Two years ago we learned that
needles need no longer be associated with pain, thanks
to the Dermo-jet (manufacturer: F. H. Wright, In-
dustrial Estate, Kingsway West, Dundee; it is avail-
able through distributors in Canada).
Originally intended for dentistry, the Dermo-jet re-
places both syringe and needle for producing skin
wheals. It anesthetizes the skin by introducing, under
pressure, small amounts of local anesthetic. The only
sensation assodiated with the use of the Dermo-jet
is that of a slight pinching. Even a large-bore needle
can be inserted painlessly through the wheal.
The essential component of the Dermo-jet (Fig. 1-
showing the component parts) is a compression chamber.
The instrument is primed by a lever. The release of
the trigger butto. forces into the skin less than 1/10
c.c. of the anesthetic solution. The instrument is
equipped with a rubber cone to prevent damage to
the skin or mucosa. The cone also damps the sound of
the instrument and permits exact locating of the
wheal. The diameter of the wheal produced is about
5 mm.
The Dermo-jet must be primed three to four times
in a vertical position whenever the glass container
(3.1 c.c.) is refilled. A full reservoir permits the
giving of over 40 consecutive injections.
In order to maintain the instrument upright at all
times, we have devised a metal sheath which is
welded to the anesthetic table.
It is advisable to make the patient familiar with
the sound of the Dermo-jet by giving a demonstration
before use.
Sterilization presents no problem. The Dermo-jet is
dismantled and is sterilized by any method currently
in use.
Daily cleaning, as recommended by the manufac-
turer, does not seem to be necessary. However, the
local anesthetics contained in the reservoir chamber
have a tendency to precipitate after a period of time.
This precipitate looks like rust, but it is not rust. It
can be scoured with any detergent used for surgical
instruments.
The glass container, if broken, can be replaced by
the cylinder of a 5-c.c. B-D syringe, with both ends
sawed off.
The usefulness of the Dermo-jet is evident. Pain
is no more a problem in injections, and one can do
away both with syringe and needle for dermal wheals.
No loss of time is involved.
a-.I.ip
Fig. 1.-A Dermo-jet dismantled.
We now use the Dermo-jet routinely in the operating
room, for giving blood transfusions, and for any kind of
intravenous solution or injectiQn. It is also useful in
infiltration therapy and in the suturing of wounds.
Our local Red Cross Society clinic has been using the
Dermo-jet for blood donors for a number of months
and reports very satisfactory results.
MICHEL BoIsvERT, M.D. AND
HENRI DROLET, M.D.
Department of Anesthesia,
H6pital St-Ambroise de Loretteville,
Loretteville, Que.
CORTICOSTEROIDS IN ACUTE
LARYNCOTRACHEITIS
To the Editor:
I read with great interest the article by Drs. P. N.
Skowron, J. A. P. Turner and C. A. McNaughton on
the use of corticosteroids in the treatment of acute
laryngotracheitis (Canad. Med. Ass. 1., 94: 528, 1966).
I noted in particular their conclusion that "in view of
the risks inherent in steroid therapy" the results did
not "warrant routine use of this drug for patients with
acute laryngotracheitis".
Might I ask what exactly are these risks so con-
stantly paraded before us by those who write about
the steroids? Quite clearly they are not very imme-
diate, for in their series of 100 cases, no side effects
were recorded, and I feel sure that they would have
included them had they occurred.
For my part I have now given six-day courses of
steroids to more than 800 patients seriously ill with
one or other of the acute infectious diseases, and I
have yet to encounter any side effects, other than
beneficial ones, such as euphoria etc. (I say nothing
of long-term therapy, of which I have had no ex-
perience.)