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DUPUYTREN'S CONTRACTURE
280 been
During my ten years of venereological practice, I never found any association of Dupuytren’s contracture with Peyronie’s
We put forward no claim to cure addiction but we do claim to have disorganised the pedlars’ market and to have improved the lives of many addicts who are still under
disease. Much commoner, of course, was the " lordosis " of the member accompanying neisserian infection.
them
at
intervals from
new
patients
to
whom
they have
selling drugs.
Kelvedon Common, near
London, W.l.
1. M. FRANKAU I. PATRICIA M. STANWELL.
TOLBUTAMIDE IN MULTIPLE SCLEROSIS SIR,-A recent claim1 that the administration of tolbutamide had been followed by striking and rapid improvement in a group of patients with multiple sclerosis raised widespread if somewhat sceptical hopes, and led us to institute a controlled trial of the drug, with statistical collaboration as previously described.2 This trial will not be completed until the end of March, 1961 ; but in order that indiscriminate prescription of this drug should not be encouraged in this disease we can report now that re-examination of 20 patients treated with 0.5 g. tolbutamide thrice daily for one month revealed no benefit as compared with a similar group of patients who received dummy tablets. J. B. FOSTER The Royal Victoria Infirmary HENRY MILLER and the Medical School, D. J. NEWELL. Newcastle upon Tyne. DUPUYTREN’S CONTRACTURE
SIR,-I read with interest your annotation of Jan. 14 this disability, from which I and my Reverend father suffered. Recurrence of contractures developed in his case in both hands, after surgical intervention. The more successful conservative treatment adopted by myself may be worthy of mention, but first let me refer to contributory
on
causes.
ROBERT FORGAN.
POMP AND CIRCUMSTANCE not sure whether you are right in commendam Sir ing to all teaching hospitals the suggestion of the Oxford Medical School Gazette1 that all "bedside"teaching should take place in a room adjacent to the ward with chairs, blackboard, and X-ray screen. Such an arrangement is likely to degenerate into yet another didactic lecture, with little reference to physical signs and clinical emphasis today is more and more on problems. The " basic doctor " who will be able to take a a producing proper history, recognise the signs that may lead to a correct diagnosis, and manage the treatment on sound lines. While he should undoubtedly do as much as he can, he should also know and accept the limits to which he can
proceed single-handed. In a teaching hospital in India as many as forty new cases may be admitted as inpatients on a single day. These will present the most varied clinical features, and problems in diagnosis and management. The only method of drawing the attention of the ward-clerks to the numerous physical findings, many of which may have disappeared by the time the patient’s turn arrives to be taken into the adjacent "static round" room, is to lead them from bed to bed and make them verify the signs. I wish to register this protest against your advice, since our urge to emulate the British is perhaps even greater now than in the days of the British rule.
K. S.
Madras.
Born at St. Andrews, as it were with a golf club in his hand, it is possible that repeated minor trauma may have been a factor. A scratch player of the old he insisted on the major part which the left hand had in making the stroke. My own higher golf handicap may have been due to my using the left hand less: and this too might explain why my lesion is only
school,
right-handed. Far
Brentwood, Essex.
treatment.
SANJIVI.
CORTICOSTEROIDS FOR INFECTIONS SIR,-I read with great interest your leading article of Oct. 22 concerning corticosteroids for infections. I should like to support what you said with a short description of a case.
A 6-year-old girl was admitted to our hospital with scarlet important, to my mind, than speculations on SEtiology are my experiences of treatment. Beginning when I fever. She had a very conspicuous rash and was in poor coilwas nearing 60 years of age, I used to be wakened from sleep dition because of hyperpyrexia, tachycardia, and dehydration. by painful spasmodic flexion of the right middle finger, which She was given penicillin, and fluid and electrolyte balance were I forcibly corrected with my left hand. I had a plastic palmar maintained by intravenous drip infusion. Next day a soft splint made, which was sewn to a glove and worn at night for apical systolic bruit was noted. The erythrocyte-sedimentation a couple of years. Thereafter the splint was found to be rate was 100 mm. per hour. The antistreptolysin titre was high. unnecessary, as the condition had apparently entered a chronic At the same time T, and T waves on the electrocardiogram semi-quiescent stage. The only trouble for the last eight years became inverted and ST segments were characteristic of hypoxia, has been an occasional very powerful, but not so very painful, She had become subfebrile, but her pulse-rate remained high contraction, induced once or twice on attempting to resume at 170 per min. The clinical picture and the laboratory findings golf, but relatively frequently when using secateurs in the indicated acute rheumatic carditis, probably due to heavy garden. The sudden meeting of the blades through a rather streptococcal infection. tough stem suffices to bring on the contraction, which can be Despite the fact that she was in the very acute period of undone usually in a few seconds. streptococcal infection, we decided to give a steroid. We I have the uneasy feeling that many Dupuytren sufferers increased the penicillin to 4,000,000 units daily and gave her need never have developed their contractures if they had made dexamethasone (’ Oradexon ’) 3 mg. daily. The tachycardia use of a splint in the acute stage and had known that, when decreased in five days and the sedimentation-rate reached nor. sufficient force is used, the bent finger can be straightened. mal in a fortnight, but the electrocardiogram still showed Considerable pressure is needed and some degree of pain is pathological changes. Atrial and ventricular extrasystoles inevitable, but for me this " operation " is required only at the developed and were recorded during the next four weeks, weekends. I claim to have a useful hand, although there is Steroid therapy was continued and stopped step by step after palpable evidence of sclerosed tissue. There might have been thirty days. The patient was discharged without symptoms of a less happy outcome had I yielded to the blandishments of acute carditis. kindly surgical colleagues who offered, inter alia, to excise the We cannot foresee the residual changes, but I wanted little finger to facilitate dealing with the fibrous tissue andto describe this case because I thought that carditis more recentlv-to iniect corticosteroid. developing in the first days of scarlet fever should be 1. 2.
more
Sawyer, G. T. J. Amer. med. Ass. 1960, 174, 470. Miller, H., Newell, D. J., Ridley, A. Lancet, Jan. 21, 1961, p. 127.
1. See Lancet,
1960, ii,
1071.
During my ten years of venereological practice, I never found any association of Dupuytren’s contracture with Peyronie’s
We put forward no claim to cure addiction but we do claim to have disorganised the pedlars’ market and to have improved the lives of many addicts who are still under
disease. Much commoner, of course, was the " lordosis " of the member accompanying neisserian infection.
them
at
intervals from
new
patients
to
whom
they have
selling drugs.
Kelvedon Common, near
London, W.l.
1. M. FRANKAU I. PATRICIA M. STANWELL.
TOLBUTAMIDE IN MULTIPLE SCLEROSIS SIR,-A recent claim1 that the administration of tolbutamide had been followed by striking and rapid improvement in a group of patients with multiple sclerosis raised widespread if somewhat sceptical hopes, and led us to institute a controlled trial of the drug, with statistical collaboration as previously described.2 This trial will not be completed until the end of March, 1961 ; but in order that indiscriminate prescription of this drug should not be encouraged in this disease we can report now that re-examination of 20 patients treated with 0.5 g. tolbutamide thrice daily for one month revealed no benefit as compared with a similar group of patients who received dummy tablets. J. B. FOSTER The Royal Victoria Infirmary HENRY MILLER and the Medical School, D. J. NEWELL. Newcastle upon Tyne. DUPUYTREN’S CONTRACTURE
SIR,-I read with interest your annotation of Jan. 14 this disability, from which I and my Reverend father suffered. Recurrence of contractures developed in his case in both hands, after surgical intervention. The more successful conservative treatment adopted by myself may be worthy of mention, but first let me refer to contributory
on
causes.
ROBERT FORGAN.
POMP AND CIRCUMSTANCE not sure whether you are right in commendam Sir ing to all teaching hospitals the suggestion of the Oxford Medical School Gazette1 that all "bedside"teaching should take place in a room adjacent to the ward with chairs, blackboard, and X-ray screen. Such an arrangement is likely to degenerate into yet another didactic lecture, with little reference to physical signs and clinical emphasis today is more and more on problems. The " basic doctor " who will be able to take a a producing proper history, recognise the signs that may lead to a correct diagnosis, and manage the treatment on sound lines. While he should undoubtedly do as much as he can, he should also know and accept the limits to which he can
proceed single-handed. In a teaching hospital in India as many as forty new cases may be admitted as inpatients on a single day. These will present the most varied clinical features, and problems in diagnosis and management. The only method of drawing the attention of the ward-clerks to the numerous physical findings, many of which may have disappeared by the time the patient’s turn arrives to be taken into the adjacent "static round" room, is to lead them from bed to bed and make them verify the signs. I wish to register this protest against your advice, since our urge to emulate the British is perhaps even greater now than in the days of the British rule.
K. S.
Madras.
Born at St. Andrews, as it were with a golf club in his hand, it is possible that repeated minor trauma may have been a factor. A scratch player of the old he insisted on the major part which the left hand had in making the stroke. My own higher golf handicap may have been due to my using the left hand less: and this too might explain why my lesion is only
school,
right-handed. Far
Brentwood, Essex.
treatment.
SANJIVI.
CORTICOSTEROIDS FOR INFECTIONS SIR,-I read with great interest your leading article of Oct. 22 concerning corticosteroids for infections. I should like to support what you said with a short description of a case.
A 6-year-old girl was admitted to our hospital with scarlet important, to my mind, than speculations on SEtiology are my experiences of treatment. Beginning when I fever. She had a very conspicuous rash and was in poor coilwas nearing 60 years of age, I used to be wakened from sleep dition because of hyperpyrexia, tachycardia, and dehydration. by painful spasmodic flexion of the right middle finger, which She was given penicillin, and fluid and electrolyte balance were I forcibly corrected with my left hand. I had a plastic palmar maintained by intravenous drip infusion. Next day a soft splint made, which was sewn to a glove and worn at night for apical systolic bruit was noted. The erythrocyte-sedimentation a couple of years. Thereafter the splint was found to be rate was 100 mm. per hour. The antistreptolysin titre was high. unnecessary, as the condition had apparently entered a chronic At the same time T, and T waves on the electrocardiogram semi-quiescent stage. The only trouble for the last eight years became inverted and ST segments were characteristic of hypoxia, has been an occasional very powerful, but not so very painful, She had become subfebrile, but her pulse-rate remained high contraction, induced once or twice on attempting to resume at 170 per min. The clinical picture and the laboratory findings golf, but relatively frequently when using secateurs in the indicated acute rheumatic carditis, probably due to heavy garden. The sudden meeting of the blades through a rather streptococcal infection. tough stem suffices to bring on the contraction, which can be Despite the fact that she was in the very acute period of undone usually in a few seconds. streptococcal infection, we decided to give a steroid. We I have the uneasy feeling that many Dupuytren sufferers increased the penicillin to 4,000,000 units daily and gave her need never have developed their contractures if they had made dexamethasone (’ Oradexon ’) 3 mg. daily. The tachycardia use of a splint in the acute stage and had known that, when decreased in five days and the sedimentation-rate reached nor. sufficient force is used, the bent finger can be straightened. mal in a fortnight, but the electrocardiogram still showed Considerable pressure is needed and some degree of pain is pathological changes. Atrial and ventricular extrasystoles inevitable, but for me this " operation " is required only at the developed and were recorded during the next four weeks, weekends. I claim to have a useful hand, although there is Steroid therapy was continued and stopped step by step after palpable evidence of sclerosed tissue. There might have been thirty days. The patient was discharged without symptoms of a less happy outcome had I yielded to the blandishments of acute carditis. kindly surgical colleagues who offered, inter alia, to excise the We cannot foresee the residual changes, but I wanted little finger to facilitate dealing with the fibrous tissue andto describe this case because I thought that carditis more recentlv-to iniect corticosteroid. developing in the first days of scarlet fever should be 1. 2.
more
Sawyer, G. T. J. Amer. med. Ass. 1960, 174, 470. Miller, H., Newell, D. J., Ridley, A. Lancet, Jan. 21, 1961, p. 127.
1. See Lancet,
1960, ii,
1071.