- Email: [email protected]
CARCINOMA OF THE BLADDER
905 REMEDY FOR ANÆMIA
SiR,-Dr. Mennie (April 18) seems to think that most of the anaemic people in Britain today are getting He also seems too little food or the wrong sort of food. to believe that nutritional megaloblastic anaexmias are common. Both these beliefs are erroneous. In Britain today iron-deficiency anaemia is usually caused
by pregnancy
or
by pathological bleeding,
not
by
malnutrition. Most iron-deficient patients who fail to respond to iron salts by mouth respond quite well to
hydroxide intravenouslythey do not respond to liver or to folic acid. Slight differences in the speed of response to treatment are of little practical importance, because oral therapy with iron should be continued for some weeks even after apparent cure, and the dosage of intravenous iron is determined by the initial haemoglobin level and the body-weight. Nutritional megaloblastic ansemias are very rare. I bave never seen that of pellagra nor that of infancy, and but 5 cases of megaloblastic anaemia of pregnancy among In Britain our common over 13,000pregnant women. megaloblastic anaemia is pernicious anaemia, which is saccharated iron
nutritional anaemia.
Pernicious anemia is better It is well known that folic acid may precipitate subacute combined degeneration of the cord in a previously untreated patient suffering from pernicious anaemia. Suboptimal treatment of pernicious anaemia produces peculiar nonspecific blood and bone-marrow changes which make diagnosis difficult or impossible. Can Dr. Mennie wonder if I maintain that the remedy under discussion is unnecessary and probably dangerous, and that its introduction was against the best interests both of the patient and of the country ? not
a
controlled by vitamin B12 than by liver.!
Central Middlesex Hospital, London, N.W.10.
GEORGE DISCOMBE.
CARCINOMA OF THE BLADDER
SiR,-The article by Mr. Winsbury-White (April 18; calls for some comment from radiotherapists. I feel sure that nearly-all radiotherapists have obtained good results from radon-seed implants, mostly, I admit, in non-infiltrating growths, but with a reasonable percentage of success in the infiltrating type confined to the bladder. Permanent disappearance of bladder cancer can be obtained also by well-planned X-ray therapy, including rotation methods. To attempt a bladder implantation without a good reserve supply of radon 8eeds is, of course, tragic ; but this should never happen with adequate preliminary cystoscopy. I would cite the five-year survival-rates in 95 patients published by the Holt Radium Institute, Manchester, in 1945 : Method and intravesical radon..
Cystotomy X-ray therapy
Early 59%
60%
Late
7% 17%
ANTHONY GREEN London, W.I.
Radiotherapist, Royal Northern Hospital.
SiR,-Mr. Winsbury-White’s remarks about vesical papillomata interested and consoled me. I have been treating a woman, now aged71, for this condition since 1931. Diathermy keeps her symptom-free. A short trial of podophyllin, applied locally, gave little relief to either party. An unusual complication afflicted another patient. -
She first
under my care in 1933 when she was a mental hospital. Her age was 63 and she had undergone an open operation for vesical papilloma in 1928. Cystoseopy showed numerous papillomata covering the base of the bladder. These responded well to diathermy ; her mental condition improved, and she was able to leave
patient in
came
a
hospital. 1.
Brewerton, D. A., Asher, R.
A. J.
Lancet, 1952, ii, 265.
She remained under regular observation and treatment until March, 1949. During this period she was known to have a lump, about the size of a walnut, in the suprapubic scar. She said there was occasional discharge from it but preferred not to have it examined. In January, 1944, she was admitted to a nursing-home bleeding freely from the tumour, which had increased in size. After a blood-transfusion had been given I excised the tumour, which was made up of two superimposed cysts with ossification in the walls. The pathologist’s report was : Implantation of papilloma into scar with calcification and ossification." "
This
patient made a good immediate recovery, but few months later her mental disorder recurred, and she died with ursemic symptoms. C. C. HOLMAN. a
POLIOMYELITIS VACCINES
SiR,-Recent articles and reviews dealing with research
poliomyelitis virus and with poliomyelitis vaccines do not mention the work of G. Blanc and L. A. Martin at the Pasteur Institute of Morocco. These workers claim to have adapted the poliomyelitis virus (both th Brunhilde and the Lansing types) to the rabbit.! In this animal the virus causes a sharp febrile illness without paralysis, and the virus-recovered from the spleencan be transmitted from rabbit to rabbit almost on
indefinitely. The laboratory diagnosis of human non-paralytic poliomyelitis has been achieved by inoculation of the_ rabbit with specimens of faeces from the patients.2 -
These workers have also shown that this rabbit-fixed virus can be inoculated into hundreds of men, women and children without any harm ; and that when given in large quantities orally, it multiplies in the alimentary tract and behaves like an authentic poliomyelitis virus. Admittedly their findings have not yet been confirmed, and they have yet to show that the rabbit-fixed virus can induce an active immunity against the human fieldvirus of poliomyelitis, but their work is full of so many far-reaching possibilities that it deserves at least a passing reference. Park Hospital, Hither Green, L. J. MAURICE LAURENT. London, S.E.13. PROFESSIONALISM IN THE HEALTH SERVICE
SiR,-On Mr. Farrer-Brown’s strictures (April 11) upon
professional standards and behaviour I would not dare to comment ; but anyone, I think, is entitled to discuss whether the N.H.S. is an industry or not. Mr. Farrer-Brown says it is an industry " with the noblest of purposes." Wisely enough he leaves this purpose undefined ; but, be it what it may, is not production, rather than purpose, the essential feature of an industry Must it not have a product-coal, cocoa, or what you will ? What is the product of the N.H.S. ? The only likely " health " or " healthy citizens." But if this answer is be so, why does it patch and keep alive so many cripples and " crocks," and why are not the homes, food, schools, occupations, and recreations of the citizens, on which their health chiefly depends, its foremost concern"I I am sure the answer is that it is not an industry. Its supposed product, health, is only a by-product. If it is an industry, so are the educational services and the Royal Navy. It is a service, and not a health service but a medical service (or perhaps a medical and dental our
service). It exists to give medical aid, comfort, and advice ta The medical those citizens who need or ask for it. G., Martin, L. A. Arch. Inst. Pasteur Maroc, 1950, 4, 19. 2. Martin, L. A., Delon, J., Grevin, J., Catala, L., Félix, J. Pr. méd. 1952, 60, 1179. 3. Blanc, G., Martin, L. A. Bull. Acad. nat. Méd. 1952, 136, 655. 1. Blanc,
SiR,-Dr. Mennie (April 18) seems to think that most of the anaemic people in Britain today are getting He also seems too little food or the wrong sort of food. to believe that nutritional megaloblastic anaexmias are common. Both these beliefs are erroneous. In Britain today iron-deficiency anaemia is usually caused
by pregnancy
or
by pathological bleeding,
not
by
malnutrition. Most iron-deficient patients who fail to respond to iron salts by mouth respond quite well to
hydroxide intravenouslythey do not respond to liver or to folic acid. Slight differences in the speed of response to treatment are of little practical importance, because oral therapy with iron should be continued for some weeks even after apparent cure, and the dosage of intravenous iron is determined by the initial haemoglobin level and the body-weight. Nutritional megaloblastic ansemias are very rare. I bave never seen that of pellagra nor that of infancy, and but 5 cases of megaloblastic anaemia of pregnancy among In Britain our common over 13,000pregnant women. megaloblastic anaemia is pernicious anaemia, which is saccharated iron
nutritional anaemia.
Pernicious anemia is better It is well known that folic acid may precipitate subacute combined degeneration of the cord in a previously untreated patient suffering from pernicious anaemia. Suboptimal treatment of pernicious anaemia produces peculiar nonspecific blood and bone-marrow changes which make diagnosis difficult or impossible. Can Dr. Mennie wonder if I maintain that the remedy under discussion is unnecessary and probably dangerous, and that its introduction was against the best interests both of the patient and of the country ? not
a
controlled by vitamin B12 than by liver.!
Central Middlesex Hospital, London, N.W.10.
GEORGE DISCOMBE.
CARCINOMA OF THE BLADDER
SiR,-The article by Mr. Winsbury-White (April 18; calls for some comment from radiotherapists. I feel sure that nearly-all radiotherapists have obtained good results from radon-seed implants, mostly, I admit, in non-infiltrating growths, but with a reasonable percentage of success in the infiltrating type confined to the bladder. Permanent disappearance of bladder cancer can be obtained also by well-planned X-ray therapy, including rotation methods. To attempt a bladder implantation without a good reserve supply of radon 8eeds is, of course, tragic ; but this should never happen with adequate preliminary cystoscopy. I would cite the five-year survival-rates in 95 patients published by the Holt Radium Institute, Manchester, in 1945 : Method and intravesical radon..
Cystotomy X-ray therapy
Early 59%
60%
Late
7% 17%
ANTHONY GREEN London, W.I.
Radiotherapist, Royal Northern Hospital.
SiR,-Mr. Winsbury-White’s remarks about vesical papillomata interested and consoled me. I have been treating a woman, now aged71, for this condition since 1931. Diathermy keeps her symptom-free. A short trial of podophyllin, applied locally, gave little relief to either party. An unusual complication afflicted another patient. -
She first
under my care in 1933 when she was a mental hospital. Her age was 63 and she had undergone an open operation for vesical papilloma in 1928. Cystoseopy showed numerous papillomata covering the base of the bladder. These responded well to diathermy ; her mental condition improved, and she was able to leave
patient in
came
a
hospital. 1.
Brewerton, D. A., Asher, R.
A. J.
Lancet, 1952, ii, 265.
She remained under regular observation and treatment until March, 1949. During this period she was known to have a lump, about the size of a walnut, in the suprapubic scar. She said there was occasional discharge from it but preferred not to have it examined. In January, 1944, she was admitted to a nursing-home bleeding freely from the tumour, which had increased in size. After a blood-transfusion had been given I excised the tumour, which was made up of two superimposed cysts with ossification in the walls. The pathologist’s report was : Implantation of papilloma into scar with calcification and ossification." "
This
patient made a good immediate recovery, but few months later her mental disorder recurred, and she died with ursemic symptoms. C. C. HOLMAN. a
POLIOMYELITIS VACCINES
SiR,-Recent articles and reviews dealing with research
poliomyelitis virus and with poliomyelitis vaccines do not mention the work of G. Blanc and L. A. Martin at the Pasteur Institute of Morocco. These workers claim to have adapted the poliomyelitis virus (both th Brunhilde and the Lansing types) to the rabbit.! In this animal the virus causes a sharp febrile illness without paralysis, and the virus-recovered from the spleencan be transmitted from rabbit to rabbit almost on
indefinitely. The laboratory diagnosis of human non-paralytic poliomyelitis has been achieved by inoculation of the_ rabbit with specimens of faeces from the patients.2 -
These workers have also shown that this rabbit-fixed virus can be inoculated into hundreds of men, women and children without any harm ; and that when given in large quantities orally, it multiplies in the alimentary tract and behaves like an authentic poliomyelitis virus. Admittedly their findings have not yet been confirmed, and they have yet to show that the rabbit-fixed virus can induce an active immunity against the human fieldvirus of poliomyelitis, but their work is full of so many far-reaching possibilities that it deserves at least a passing reference. Park Hospital, Hither Green, L. J. MAURICE LAURENT. London, S.E.13. PROFESSIONALISM IN THE HEALTH SERVICE
SiR,-On Mr. Farrer-Brown’s strictures (April 11) upon
professional standards and behaviour I would not dare to comment ; but anyone, I think, is entitled to discuss whether the N.H.S. is an industry or not. Mr. Farrer-Brown says it is an industry " with the noblest of purposes." Wisely enough he leaves this purpose undefined ; but, be it what it may, is not production, rather than purpose, the essential feature of an industry Must it not have a product-coal, cocoa, or what you will ? What is the product of the N.H.S. ? The only likely " health " or " healthy citizens." But if this answer is be so, why does it patch and keep alive so many cripples and " crocks," and why are not the homes, food, schools, occupations, and recreations of the citizens, on which their health chiefly depends, its foremost concern"I I am sure the answer is that it is not an industry. Its supposed product, health, is only a by-product. If it is an industry, so are the educational services and the Royal Navy. It is a service, and not a health service but a medical service (or perhaps a medical and dental our
service). It exists to give medical aid, comfort, and advice ta The medical those citizens who need or ask for it. G., Martin, L. A. Arch. Inst. Pasteur Maroc, 1950, 4, 19. 2. Martin, L. A., Delon, J., Grevin, J., Catala, L., Félix, J. Pr. méd. 1952, 60, 1179. 3. Blanc, G., Martin, L. A. Bull. Acad. nat. Méd. 1952, 136, 655. 1. Blanc,