- Email: [email protected]
AMINE IN SEARCH OF A FUNCTION
495 The Government of India realises this fact fully, and the Indian Planning Commission clearly states in the second fiveyear plan that " The problem of regulating India’s population from the dual standpoint of size and quality is of the utmost importance to national welfare and national planning ". The Government, therefore, is actively supporting a family planning programme and is giving it high priority. A provision of nearly Rs. 50 million has been made for this in the second plan, and 300 urban and 2000 rural clinics are being set up (by the end of 1959 there were 1147 clinics of which 712 were in the rural areas). The Census Commissioner to the Government of India, in his report on the 1951 census, laid down a national policy by which India could attain a stationary population. This should be done by avoiding " improvident maternity "-defined as childbirth in a mother who has already given birth to three or In order to more children, of whom one at least is alive. achieve this, the people, 83% of whom live in more than 500,000 villages in India, with no privacy or toilet facilities of any kind, and who are mostly illiterate and ignorant, should have suitable and cheap means of contraception at their disposal. That is the biggest hurdle yet to be crossed in the way of family planning, and it needs serious thought and investigation by the demographers, medical men, and scientists. In my opinion, coitus interruptus appears for the present to offer itself as the most practicable method for mass adoption. Oral contraceptives which would be acceptable may take a few decades of experimentation before they can be recommended for mass adoption.
All this, Sir, may seem far removed from the subject of your leading article, but it is only fair to pay due consideration to the background against which the medical needs of India must be assessed. We, in this country, are trying to achieve results which " Western " countries have only enjoyed after perhaps a hundred and fifty years of intensive efforts. We cannot hope, nor do we want, to imitate all aspects of Western medicine, for our way of life is, and must remain, different. We do, indeed, welcome people who are prepared to come and work with us provided that they will stay sufficiently long to learn and understand the customs and habits of the country. May I make one further comment, on your criticisms of the administrative framework. While it is true that this medical college is unique in India in that it is directly under the University, which is an autonomous body, all senior academic posts in medical colleges are, so far as I am aware, filled, like my own, after open advertisement and interview by a University Selection Board or the State Public Service Commission on which there are independent assessors or experts. Department of Social and Preventive Medicine, King George’s Medical College, Lucknow University, Lucknow, India.
B. G. PRASAD.
AMINE IN SEARCH OF A FUNCTION SIR,-Your annotation of Dec. 12 with this title seems to imply that this agent is also in search of a name. It is
variously known as 5-hydroxytryptamine, 5-OH-T, 5-HT (the jazzy variant, 5-HOT has been wisely overlooked), serotonin and, in an early guise, enteramine. The chemical names are specific to a degree but, since they begin with the strident word " five ", cacaphonous. Trivial names may properly describe functions; among these, our " term serotonin alludes both to one of the source materials to this amine’s major effect on smooth muscle, while and Erspamer’s " enteramine" characterises a single, possibly physiological function. However, few are so humble as to wish to rest even their primitive central nervous activities on so gutty a base as enteramine. (The pun is intentional.) Hence, "
the term " serotoninseems both defensible and useful. Lastly, it is a pity to burden medical letters, bemuse indexers, and confuse students with increasing numbers of names for the same thing, or further to separate the English and American elevator " and now divided on such terms as languages, " and braces ", lift ", suspenders by adding this "
"
"
"
particular. There may be another solution. C. of E., Paleyian theology directs us to the view that anything as widely distributed in Nature and active in so many ways must have major significance in the Order of the Universe. Since we cannot yet define this in any unitary way, perhaps an alternative to " serotonin "" viz., confusotonin ", once proposed in jest-deserves more serious consideration by some appropriate reference committee. Department of Clinical Investigation, St. Vincent Charity Hospital, A. C. CORCORAN. Cleveland, Ohio. TREATMENT OF ADVANCED CARCINOMA OF THE BREAST
SIR,-In their valuable contribution of Jan. 16 Dr.
Brinkley and Dr. Pillers make the dogmatic statement that " operation is necessary because X-ray castration does not completely stop ovarian function ". I am sure that many would be grateful to know the evidence for this statement.
In the breast clinic in this hospital the oestrogen content of smears has been seen to fall dramatically following radiation castration, and in other cases no appreciable alteration in cestrogen content has occurred following surgical castration. In these latter cases other sources of cestrogenic function are evidently still active and one would not conclude that the ovarian function had not been completely stopped by the operation. There is also abundant clinical evidence of regression of breast carcinoma following radiotherapeutic castration. In many instances operation is undoubtedly to be preferred. When a rapid response is required in a patient with fulminating and rapidly progressing disease, the effect of surgical castration is more dramatic and more rapid than if ovarian function is affected by external radiation. On the other hand, it is our experience that the menopausal symptoms are less severe if X-ray castration is employed. It would, therefore, be unfortunate if the impression were gained that oophorectomy is always to be preferred to radiation castration.
vaginal
Department of Radiation Therapy, The Johns Hopkins Hospital,
R. J. DICKSON.
Baltimore.
IMMUNE TOLERANCE IN MOTHER AND FŒTUS
SIR,-It is difficult to understand why the foetus, which achieves antigenic competence in utero, is not rejected by the mother by immune phenomena much in the manner that a primary skin homograft would be. Many explanations have been proposed for this surprising manifestation of immune tolerance but none has yet received general acceptance. Dr. Gordon’s1 intriguing hypothesis (Jan. 9), with which I cannot agree, prompts me to put forward my own theory which at the present time is based on ample contributory evidence and is strongly supported by preliminary experimental observations. Although Woodruff2 has postulated that the placenta may protect the fcetus by acting as a millipore filter, no account has been taken of the antigenic action of the placenta itself, which is, after all, of foetal genetic origin. The syncytiotrophoblast may well play an important role in this respect, for this unique tissue is not only the first part of the embryo to come into contact with maternal tissue at implantation but also remains the sole fcetal tissue that 1. 2.
ever
associates with maternal
Gordon, I. Nature, Lond. 1960, 185, 118; Lancet, 1949, i, 807. Woodruff, M. F. A. Proc. roy. Soc. B, 1958, 148, 68.
All this, Sir, may seem far removed from the subject of your leading article, but it is only fair to pay due consideration to the background against which the medical needs of India must be assessed. We, in this country, are trying to achieve results which " Western " countries have only enjoyed after perhaps a hundred and fifty years of intensive efforts. We cannot hope, nor do we want, to imitate all aspects of Western medicine, for our way of life is, and must remain, different. We do, indeed, welcome people who are prepared to come and work with us provided that they will stay sufficiently long to learn and understand the customs and habits of the country. May I make one further comment, on your criticisms of the administrative framework. While it is true that this medical college is unique in India in that it is directly under the University, which is an autonomous body, all senior academic posts in medical colleges are, so far as I am aware, filled, like my own, after open advertisement and interview by a University Selection Board or the State Public Service Commission on which there are independent assessors or experts. Department of Social and Preventive Medicine, King George’s Medical College, Lucknow University, Lucknow, India.
B. G. PRASAD.
AMINE IN SEARCH OF A FUNCTION SIR,-Your annotation of Dec. 12 with this title seems to imply that this agent is also in search of a name. It is
variously known as 5-hydroxytryptamine, 5-OH-T, 5-HT (the jazzy variant, 5-HOT has been wisely overlooked), serotonin and, in an early guise, enteramine. The chemical names are specific to a degree but, since they begin with the strident word " five ", cacaphonous. Trivial names may properly describe functions; among these, our " term serotonin alludes both to one of the source materials to this amine’s major effect on smooth muscle, while and Erspamer’s " enteramine" characterises a single, possibly physiological function. However, few are so humble as to wish to rest even their primitive central nervous activities on so gutty a base as enteramine. (The pun is intentional.) Hence, "
the term " serotoninseems both defensible and useful. Lastly, it is a pity to burden medical letters, bemuse indexers, and confuse students with increasing numbers of names for the same thing, or further to separate the English and American elevator " and now divided on such terms as languages, " and braces ", lift ", suspenders by adding this "
"
"
"
particular. There may be another solution. C. of E., Paleyian theology directs us to the view that anything as widely distributed in Nature and active in so many ways must have major significance in the Order of the Universe. Since we cannot yet define this in any unitary way, perhaps an alternative to " serotonin "" viz., confusotonin ", once proposed in jest-deserves more serious consideration by some appropriate reference committee. Department of Clinical Investigation, St. Vincent Charity Hospital, A. C. CORCORAN. Cleveland, Ohio. TREATMENT OF ADVANCED CARCINOMA OF THE BREAST
SIR,-In their valuable contribution of Jan. 16 Dr.
Brinkley and Dr. Pillers make the dogmatic statement that " operation is necessary because X-ray castration does not completely stop ovarian function ". I am sure that many would be grateful to know the evidence for this statement.
In the breast clinic in this hospital the oestrogen content of smears has been seen to fall dramatically following radiation castration, and in other cases no appreciable alteration in cestrogen content has occurred following surgical castration. In these latter cases other sources of cestrogenic function are evidently still active and one would not conclude that the ovarian function had not been completely stopped by the operation. There is also abundant clinical evidence of regression of breast carcinoma following radiotherapeutic castration. In many instances operation is undoubtedly to be preferred. When a rapid response is required in a patient with fulminating and rapidly progressing disease, the effect of surgical castration is more dramatic and more rapid than if ovarian function is affected by external radiation. On the other hand, it is our experience that the menopausal symptoms are less severe if X-ray castration is employed. It would, therefore, be unfortunate if the impression were gained that oophorectomy is always to be preferred to radiation castration.
vaginal
Department of Radiation Therapy, The Johns Hopkins Hospital,
R. J. DICKSON.
Baltimore.
IMMUNE TOLERANCE IN MOTHER AND FŒTUS
SIR,-It is difficult to understand why the foetus, which achieves antigenic competence in utero, is not rejected by the mother by immune phenomena much in the manner that a primary skin homograft would be. Many explanations have been proposed for this surprising manifestation of immune tolerance but none has yet received general acceptance. Dr. Gordon’s1 intriguing hypothesis (Jan. 9), with which I cannot agree, prompts me to put forward my own theory which at the present time is based on ample contributory evidence and is strongly supported by preliminary experimental observations. Although Woodruff2 has postulated that the placenta may protect the fcetus by acting as a millipore filter, no account has been taken of the antigenic action of the placenta itself, which is, after all, of foetal genetic origin. The syncytiotrophoblast may well play an important role in this respect, for this unique tissue is not only the first part of the embryo to come into contact with maternal tissue at implantation but also remains the sole fcetal tissue that 1. 2.
ever
associates with maternal
Gordon, I. Nature, Lond. 1960, 185, 118; Lancet, 1949, i, 807. Woodruff, M. F. A. Proc. roy. Soc. B, 1958, 148, 68.