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BLUE PENCILS FOR AUTHORS
1059 In fcetuses subjected to surgical interference-e.g., foetal thyroidectomy, adrenalectomy, limb amputation, or eye removal-and then allowed to continue development to term within the uterine cavity, severe compression is occasionally observed and even a " snake like appearance. This deformity occurs particularly after too much amniotic fluid has escaped during the operation, and when the incision in the uterine wall "
has failed to heal and allowed amniotic fluid to leak. These fretuses survived surgical interference and continued to develop within the uterine cavity, but obvious signs of deformity were noted when they were removed just before term. Department of Anatomy, The Middlesex Hospital Medical School, J. G. BEARN. London, W.1.
BLUE PENCILS FOR AUTHORS SIR,-Letters in last week’s Lancet on the spate of communications recalled I had once to assess a paper for publication in a society’s Transactions. I reported that if the 128 pages of typescript were reduced to 25, it was acceptable. The young author was incensed, but after I spent an hour pointing out tautologies, irrelevancies,
and frills, he rewrote it. It was printed, and eventually accepted for a PH.D., which certainly would not have been probable in its original state. I read many journals, and rarely see a paper which could not be cut without loss. Although journal editors can and do sometimes shorten manuscripts, they seldom rewrite papers. One must be sympathetic to the Editor’s difficulties, for to criticise a man’s literary style is the surest way of rousing enmity. But it would seem practical to return accepted manuscripts to authors with a blue pencil and an invitation to use it. This would not solve the ever-growing problem but it would help. WALTER P. KENNEDY. London, S.W.3. P.S.-This is 57 words shorter than the first draft.
is called for as well as less superficial inquiry into family incidence in the genetic forms and more thoroughgoing elucidation of possible hepatotoxic agents in the past histories of patients with the acquired type. An added complication is that each of the clinical manifestations, some of which enter into the framing of specifications of the subgroups, commonly occur in patients where the diagnosis of porphyria is not at issue. Moreover, whilst much useful diagnostic information can be gained by quite simple screening tests in the laboratory, the more elaborate procedures require a degree of proficiency only obtained by practice, and some of the techniques need
methodological re-appraisal. Careful and critical evaluation of all these features should be the basis of further study of porphyria, the first concept of which originated a little less than 100 years ago, but these disorders now clearly deserve more serious attention than they currently receive. South African Institute for Medical
Johannesburg.
SIR,-The subclassification and nomenclature of the disorders resulting from disturbances of porphyrin biosynthesis are in a most confused state at the moment, and your editorial of April 29 is welcomed as an endeavour to review some of the salient points. The more minutely past publications are studied the more discouraging the situation
seems--to
become.
There is a considerable body of evidence to support a division of these disorders into distinctive groups but others prefer a " unitary hypothesis ", regarding the differences as being of no fundamental significance. The most extreme instance of the latter is the claim by Bariety et a1.l that the findings in one of their patients virtually demolish the validity of all classifications proposed during the past 50 years. In his Chester M. Jones lecture2 Professor Watson describes cases of hepatic porphyria from eight kindreds which present difficulties in subclassification. It is suggested that the former have ignored several unusual features in their patient which offer an alternative _explanation for some of their findings. In several of the cases discussed by the latter the data are incomplete, especially with respect to faecal porphyrin excretion, and some of the difficulties might have been resolved had this evidence been available. It is also pertinent in this connection to inquire how much support is provided for distinctive subgrouping of hepatic porphyrias by others of Professor Watson’s large collection of some 270 cases. The further studies you suggest are warmly supported, in particular an unbiased investigation of groups of patients in countries where porphyria has been shown to be reasonably prevalent-France, Italy, Argentine, &c. It is felt that patient correlation of clinical manifestations and biochemical findings 1. Pr. Méd. 1960, 68, 643. 2. New Engl. J. Med. 1960,
263, 1205.
H. D. BARNES.
NEW PENICILLINS SIR,-Now that the nucleus of penicillin has been isolated, reports of new synthetic " penicillins ", each one masquerading under a variety of different names, will
form a steady stream in our medical journals, not to mention the flow through our letterboxes in the form of advertisements. In time the wheat will sort itself from the chaff, but in the intervening period confusion is inevitable. That confusion may not be worse confounded it is vital that extravagant claims for any newcomer are not allowed to pass unchallenged. It is for this reason that we wish to join Dr. Rolinson (April 29) in criticising the last sentence of your leading article of April 22 which states that " Like methicillin, PA-248 (tx-phenoxypropylpenicillin) remains active in the presence of staphylococcal penicillinase;...". This is a
misleading PORPHYRIA
Research,
statement.
In experiments by one of usit has been shown that a-phenoxypropylpenicillin is hydrolysed by staphylococcal penicillinase at one-fifth to one-half the rate of benzylpenicillin (penicillin G) depending on the concentration of antibiotic
used. Under similar conditions methicillin retains almost full activity. It is thus quite untrue to suggest that rx-phenoxypropylpenicillin resembles methicillin in its stability to staphylococcal penicillinase. In fact it is only slightly more stable than phenethicillin. In terms of in-vitro sensitivity tests these findings mean that with penicillinase-producing staphylococci the results are just as much dependent on inoculum size as is the case with benzylpenicillin. We have confirmed the finding of Dr. Rolinson that, although a small inoculum of a penicillinaseproducing staphylococcus is somewhat more sensitive to a-phenoxypropylpenicillin than to benzylpenicillin or phenethicillin, yet if the inoculum be large the organisms will grow in a concentration far higher than that obtainable in the tissues of a patient. For those concerned with the treatment of patients the conclusion is obvious. Methicillin has proved to be life-saving in the treatment of staphylococcal septicaernias due to penicillinase-producing organisms and is now the drug of choice for all severe penicillin-resistant staphylococcal infections. For such cases rx-phenoxypropylpenicillin is not a serious rival. Postgraduate Medical School of London, BARBER. BARBER W.12. MARY MARY BARBER. London, W.12. National Institute for Medical Research, RICHARD NOVICK. NOVIGK. London, N.W.7. * * Some readers may suppose from our correspon-
dents’ concluding remarks (and the earlier comments of Dr. Rolinson) that our ill-judged phrase was part of an 1.
Novick, R. P. Unpublished data.
has failed to heal and allowed amniotic fluid to leak. These fretuses survived surgical interference and continued to develop within the uterine cavity, but obvious signs of deformity were noted when they were removed just before term. Department of Anatomy, The Middlesex Hospital Medical School, J. G. BEARN. London, W.1.
BLUE PENCILS FOR AUTHORS SIR,-Letters in last week’s Lancet on the spate of communications recalled I had once to assess a paper for publication in a society’s Transactions. I reported that if the 128 pages of typescript were reduced to 25, it was acceptable. The young author was incensed, but after I spent an hour pointing out tautologies, irrelevancies,
and frills, he rewrote it. It was printed, and eventually accepted for a PH.D., which certainly would not have been probable in its original state. I read many journals, and rarely see a paper which could not be cut without loss. Although journal editors can and do sometimes shorten manuscripts, they seldom rewrite papers. One must be sympathetic to the Editor’s difficulties, for to criticise a man’s literary style is the surest way of rousing enmity. But it would seem practical to return accepted manuscripts to authors with a blue pencil and an invitation to use it. This would not solve the ever-growing problem but it would help. WALTER P. KENNEDY. London, S.W.3. P.S.-This is 57 words shorter than the first draft.
is called for as well as less superficial inquiry into family incidence in the genetic forms and more thoroughgoing elucidation of possible hepatotoxic agents in the past histories of patients with the acquired type. An added complication is that each of the clinical manifestations, some of which enter into the framing of specifications of the subgroups, commonly occur in patients where the diagnosis of porphyria is not at issue. Moreover, whilst much useful diagnostic information can be gained by quite simple screening tests in the laboratory, the more elaborate procedures require a degree of proficiency only obtained by practice, and some of the techniques need
methodological re-appraisal. Careful and critical evaluation of all these features should be the basis of further study of porphyria, the first concept of which originated a little less than 100 years ago, but these disorders now clearly deserve more serious attention than they currently receive. South African Institute for Medical
Johannesburg.
SIR,-The subclassification and nomenclature of the disorders resulting from disturbances of porphyrin biosynthesis are in a most confused state at the moment, and your editorial of April 29 is welcomed as an endeavour to review some of the salient points. The more minutely past publications are studied the more discouraging the situation
seems--to
become.
There is a considerable body of evidence to support a division of these disorders into distinctive groups but others prefer a " unitary hypothesis ", regarding the differences as being of no fundamental significance. The most extreme instance of the latter is the claim by Bariety et a1.l that the findings in one of their patients virtually demolish the validity of all classifications proposed during the past 50 years. In his Chester M. Jones lecture2 Professor Watson describes cases of hepatic porphyria from eight kindreds which present difficulties in subclassification. It is suggested that the former have ignored several unusual features in their patient which offer an alternative _explanation for some of their findings. In several of the cases discussed by the latter the data are incomplete, especially with respect to faecal porphyrin excretion, and some of the difficulties might have been resolved had this evidence been available. It is also pertinent in this connection to inquire how much support is provided for distinctive subgrouping of hepatic porphyrias by others of Professor Watson’s large collection of some 270 cases. The further studies you suggest are warmly supported, in particular an unbiased investigation of groups of patients in countries where porphyria has been shown to be reasonably prevalent-France, Italy, Argentine, &c. It is felt that patient correlation of clinical manifestations and biochemical findings 1. Pr. Méd. 1960, 68, 643. 2. New Engl. J. Med. 1960,
263, 1205.
H. D. BARNES.
NEW PENICILLINS SIR,-Now that the nucleus of penicillin has been isolated, reports of new synthetic " penicillins ", each one masquerading under a variety of different names, will
form a steady stream in our medical journals, not to mention the flow through our letterboxes in the form of advertisements. In time the wheat will sort itself from the chaff, but in the intervening period confusion is inevitable. That confusion may not be worse confounded it is vital that extravagant claims for any newcomer are not allowed to pass unchallenged. It is for this reason that we wish to join Dr. Rolinson (April 29) in criticising the last sentence of your leading article of April 22 which states that " Like methicillin, PA-248 (tx-phenoxypropylpenicillin) remains active in the presence of staphylococcal penicillinase;...". This is a
misleading PORPHYRIA
Research,
statement.
In experiments by one of usit has been shown that a-phenoxypropylpenicillin is hydrolysed by staphylococcal penicillinase at one-fifth to one-half the rate of benzylpenicillin (penicillin G) depending on the concentration of antibiotic
used. Under similar conditions methicillin retains almost full activity. It is thus quite untrue to suggest that rx-phenoxypropylpenicillin resembles methicillin in its stability to staphylococcal penicillinase. In fact it is only slightly more stable than phenethicillin. In terms of in-vitro sensitivity tests these findings mean that with penicillinase-producing staphylococci the results are just as much dependent on inoculum size as is the case with benzylpenicillin. We have confirmed the finding of Dr. Rolinson that, although a small inoculum of a penicillinaseproducing staphylococcus is somewhat more sensitive to a-phenoxypropylpenicillin than to benzylpenicillin or phenethicillin, yet if the inoculum be large the organisms will grow in a concentration far higher than that obtainable in the tissues of a patient. For those concerned with the treatment of patients the conclusion is obvious. Methicillin has proved to be life-saving in the treatment of staphylococcal septicaernias due to penicillinase-producing organisms and is now the drug of choice for all severe penicillin-resistant staphylococcal infections. For such cases rx-phenoxypropylpenicillin is not a serious rival. Postgraduate Medical School of London, BARBER. BARBER W.12. MARY MARY BARBER. London, W.12. National Institute for Medical Research, RICHARD NOVICK. NOVIGK. London, N.W.7. * * Some readers may suppose from our correspon-
dents’ concluding remarks (and the earlier comments of Dr. Rolinson) that our ill-judged phrase was part of an 1.
Novick, R. P. Unpublished data.