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CLINICAL TEST OF 6-AZAURIDINE
371 is the lost fluid replaced, but in addition valuable potassium, sodium, and other ions are given which help to prevent postoperative ileus. Giving a high-protein diet is important in the postoperative period when protein loss is great. It is true, as Professor Wells and his associates state, that diarrhoea may be caused in a few cases fed by intra-alimentary drip; but this clears up as soon as the drip is stopped.
I believe that administration of fluids into the bowel after abdominal operation is the safest and most physiological method. The double tube I have devised2 makes it easy to apply; and at the same time it allows the stomach to be kept empty in the postoperative period when it is static and empties slowly. Furthermore, the intratube alimentary passing through the anastomosis after a partial gastrectomy, whether it be of the Billroth I type (stomach anastomosed to duodenum) or the Hofmeister-
Finsterer
operation (stomach remnant to jejunum) safeguards the anastomosis until healing is well under way. This applies particularly to the Billroth I operation, in which the stoma often becomes oedematous and temporarily obstructed. MAURICE LEE. London, W.I. CLINICAL TEST OF 6-AZAURIDINE
SIR,-We
are
writing
to
ask for assistance in a clinical (AzUR) is effective
test to determine whether 6-azauridine treatment for trophoblast tumours.
We have recently reportedthat AzUR given orally is an effective ovicide in the mouse, terminating early pregnancy at dosage levels which produce no detectable toxic effect in the mother. We have found that the first effect of the drug on the foetus is to reduce its rate of growth, and to produce a relatively structureless mole. Later, there is autolysis, beginning at the centre of the mole, rapidly progressing to the periphery, and eventually including the placenta. Within a few days of the onset of lysis, the products of conception are entirely resorbed and normal oestrous periodicity is resumed. Though we do not yet know the effect of AzUR on the human ovum, we do know that it is non-toxic in man in doses which, by analogy, might be expected to be ovicidal. Thus, it has been given in doses of 300 mg. per kg. body-weight daily for several weeks in leukaemia, without any of the adverse effects commonly produced by cytotoxic and cytostatic agents such as mercaptopurine and folic-acid antagonists. Supplies of AzUR are limited by the difficulty of preparation. Moreover, we have found that different batches vary somewhat in activity, and their ovicidal activity and their toxicity are not necessarily related. However, the Distillers Company (Biochemicals), Ltd., have undertaken to supply AzUR in amounts which, though small, will be sufficient to determine its activity against trophoblast tumours. Each batch will be prepared in aqueous solution for intravenous use, and will then be tested in mice both for ovicidal activity and
toxicity. It is proposed that suitable batches of AzUR shall be available at the Highlands Hospital for patients under the care of Mr. David Savage. It is hoped that physicians and surgeons will refer cases of trophoblast tumours, especially chorion carcinoma, so that they may be considered for inclusion in the trial. The numbers will be determined by the amount of AzUR available; it is hoped that this will become sufficient for the inclusion, later, of some cases of hydatiform mole. Inquiries concerning admission should be addressed Savage, F.R.C.S., Highlands Hospital, London, Department of Nutrition, Queen Elizabeth College, Gollege, London. London, W.8.
to
Mr. David
N.21.
MARGARET A. SANDERS B. P. WIESNER JOHN YUDKIN.
2. Lee, M. Post Grad. med. J. 1957, 33, 78. 3. Nature, Lond. 1961, 189, 1015
LANGUAGE: THE LOST TOOL OF LEARNING
biR,—ror
a
long
time it has
been necessary tor a
spokesman of Sir George Pickering’s eminence to criticise in forthright fashion the deplorable situation into which the professional (and other) language of doctors has fallen. We are greatly in his debt. Other voices have been raised from time to time but have been ignored, or made inaudible by the grinding of jargon’s juggernaut. The situation is serious and not just the preoccupation of pedants and pitiable colleagues on the lunatic fringe. For, as we think and speak so do we act if we are in good faith; if our thought and speech are confused and obscured so will be our acts-and, among other things, this means our research and approach to patients. To look back, for example, at medical papers and books towards the end of the last century is to find writing which, though perhaps wordy by present-day standards, is clear and No doubt, no wondering what on earth the man means. It is a prodigious irony, in the Age of Science when Man supposes he is clarifying all branches of knowledge, that doctors (we must speak only of ourselves, for it is the disorder in our own house that is nearest to us), when professionally engaged, talk and write chaotically. Surely it is disconcerting to read medical articles full of the machinery of precision -statistics-only to be confounded by the text. Unnecessary neologisms, one suspects, feed on and bolster personal pride and are not easily set aside; and, of course, they are used by everybody else. But pride apart, is it not easier,
precise.
readily understandable, more euphonious, companionable and only five letters more to write high blood-potassium ", than it is to write " hyperkalaemia " ? Errors of logic arise from ignorance of its rudiments and, while Sir George is disposed to blame the medieval Schoolmen for being " the greatest of all obstacles to the growth of new knowledge won by the scientific method ", there is little doubt that recollection by present-day medical doctors of Thomist-fostered principles of logic and disputation would make their own talk and writings considerably clearer-to say the least. When sitting down to write case-sheet or dissertation it is well worth remembering the simple rules which appear on the first page of chapter I in Fowler’s The King’s English:: " Prefer the familiar word to the far-fetched. Prefer the concrete word to the abstract. Prefer the simple word to the circumlocution. Prefer the short word to the long. Prefer the Saxon word to the Romance
The poet can ignore these rules, for his craft involves the love of words and their precision; the doctor writing Medicine ignores them at his and other men’s peril.
It is really rather sad we have to be reminded that Medicine is a fusion of " two cultures ". That this is no longer generally felt is due to a widespread misapprehension that Science is replacing the Art of Medicine instead of being, as it is, its tool-no matter how important a tool, still a tool. It is even sadder that these things need to be said at all. W. RAYMOND PARKES. Cardiff. agree with Sir George Pickering (July 15) that unnecessary new words should be introduced, but I
SiR,—I no
think he is overemphasising the facts. It is difficult to understand how you can work without tools; if the tools have been lost, as Sir George says, how can it be explained that knowledge-the natural result of learning (and to learn you need the Lost Tools)-is today wider than ever before ? What is wrong with medical jargon? Every branch of knowledge has it; or does he want new, popular names to all the rare and little-known names used in legal, military, mechanical, and
I believe that administration of fluids into the bowel after abdominal operation is the safest and most physiological method. The double tube I have devised2 makes it easy to apply; and at the same time it allows the stomach to be kept empty in the postoperative period when it is static and empties slowly. Furthermore, the intratube alimentary passing through the anastomosis after a partial gastrectomy, whether it be of the Billroth I type (stomach anastomosed to duodenum) or the Hofmeister-
Finsterer
operation (stomach remnant to jejunum) safeguards the anastomosis until healing is well under way. This applies particularly to the Billroth I operation, in which the stoma often becomes oedematous and temporarily obstructed. MAURICE LEE. London, W.I. CLINICAL TEST OF 6-AZAURIDINE
SIR,-We
are
writing
to
ask for assistance in a clinical (AzUR) is effective
test to determine whether 6-azauridine treatment for trophoblast tumours.
We have recently reportedthat AzUR given orally is an effective ovicide in the mouse, terminating early pregnancy at dosage levels which produce no detectable toxic effect in the mother. We have found that the first effect of the drug on the foetus is to reduce its rate of growth, and to produce a relatively structureless mole. Later, there is autolysis, beginning at the centre of the mole, rapidly progressing to the periphery, and eventually including the placenta. Within a few days of the onset of lysis, the products of conception are entirely resorbed and normal oestrous periodicity is resumed. Though we do not yet know the effect of AzUR on the human ovum, we do know that it is non-toxic in man in doses which, by analogy, might be expected to be ovicidal. Thus, it has been given in doses of 300 mg. per kg. body-weight daily for several weeks in leukaemia, without any of the adverse effects commonly produced by cytotoxic and cytostatic agents such as mercaptopurine and folic-acid antagonists. Supplies of AzUR are limited by the difficulty of preparation. Moreover, we have found that different batches vary somewhat in activity, and their ovicidal activity and their toxicity are not necessarily related. However, the Distillers Company (Biochemicals), Ltd., have undertaken to supply AzUR in amounts which, though small, will be sufficient to determine its activity against trophoblast tumours. Each batch will be prepared in aqueous solution for intravenous use, and will then be tested in mice both for ovicidal activity and
toxicity. It is proposed that suitable batches of AzUR shall be available at the Highlands Hospital for patients under the care of Mr. David Savage. It is hoped that physicians and surgeons will refer cases of trophoblast tumours, especially chorion carcinoma, so that they may be considered for inclusion in the trial. The numbers will be determined by the amount of AzUR available; it is hoped that this will become sufficient for the inclusion, later, of some cases of hydatiform mole. Inquiries concerning admission should be addressed Savage, F.R.C.S., Highlands Hospital, London, Department of Nutrition, Queen Elizabeth College, Gollege, London. London, W.8.
to
Mr. David
N.21.
MARGARET A. SANDERS B. P. WIESNER JOHN YUDKIN.
2. Lee, M. Post Grad. med. J. 1957, 33, 78. 3. Nature, Lond. 1961, 189, 1015
LANGUAGE: THE LOST TOOL OF LEARNING
biR,—ror
a
long
time it has
been necessary tor a
spokesman of Sir George Pickering’s eminence to criticise in forthright fashion the deplorable situation into which the professional (and other) language of doctors has fallen. We are greatly in his debt. Other voices have been raised from time to time but have been ignored, or made inaudible by the grinding of jargon’s juggernaut. The situation is serious and not just the preoccupation of pedants and pitiable colleagues on the lunatic fringe. For, as we think and speak so do we act if we are in good faith; if our thought and speech are confused and obscured so will be our acts-and, among other things, this means our research and approach to patients. To look back, for example, at medical papers and books towards the end of the last century is to find writing which, though perhaps wordy by present-day standards, is clear and No doubt, no wondering what on earth the man means. It is a prodigious irony, in the Age of Science when Man supposes he is clarifying all branches of knowledge, that doctors (we must speak only of ourselves, for it is the disorder in our own house that is nearest to us), when professionally engaged, talk and write chaotically. Surely it is disconcerting to read medical articles full of the machinery of precision -statistics-only to be confounded by the text. Unnecessary neologisms, one suspects, feed on and bolster personal pride and are not easily set aside; and, of course, they are used by everybody else. But pride apart, is it not easier,
precise.
readily understandable, more euphonious, companionable and only five letters more to write high blood-potassium ", than it is to write " hyperkalaemia " ? Errors of logic arise from ignorance of its rudiments and, while Sir George is disposed to blame the medieval Schoolmen for being " the greatest of all obstacles to the growth of new knowledge won by the scientific method ", there is little doubt that recollection by present-day medical doctors of Thomist-fostered principles of logic and disputation would make their own talk and writings considerably clearer-to say the least. When sitting down to write case-sheet or dissertation it is well worth remembering the simple rules which appear on the first page of chapter I in Fowler’s The King’s English:: " Prefer the familiar word to the far-fetched. Prefer the concrete word to the abstract. Prefer the simple word to the circumlocution. Prefer the short word to the long. Prefer the Saxon word to the Romance
The poet can ignore these rules, for his craft involves the love of words and their precision; the doctor writing Medicine ignores them at his and other men’s peril.
It is really rather sad we have to be reminded that Medicine is a fusion of " two cultures ". That this is no longer generally felt is due to a widespread misapprehension that Science is replacing the Art of Medicine instead of being, as it is, its tool-no matter how important a tool, still a tool. It is even sadder that these things need to be said at all. W. RAYMOND PARKES. Cardiff. agree with Sir George Pickering (July 15) that unnecessary new words should be introduced, but I
SiR,—I no
think he is overemphasising the facts. It is difficult to understand how you can work without tools; if the tools have been lost, as Sir George says, how can it be explained that knowledge-the natural result of learning (and to learn you need the Lost Tools)-is today wider than ever before ? What is wrong with medical jargon? Every branch of knowledge has it; or does he want new, popular names to all the rare and little-known names used in legal, military, mechanical, and