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" CHEMOTHERAPEUTIC AGENT " AND " ANTIBIOTIC "
400 ENDOCRINE
FACTORS IN DISORDERS
AFFECTIVE
SiR,-I read Dr. Joan Malleson’s timely article (July 25) I am sure many of us have felt that endocrine upset in at least some of our women patients with altered affective states, but that the precise nature has been obscure. Doubtless most of us have used either natural or synthetic oestrone to relieve the " hot flushes" of the menopause, and usually with -a fair measure of success.
with
great
interest.
there has been
some
’
Some six years ago I became very interested- in depression and melancholia arising in the puerperium, and at one time I was treating 3 patients with moderately severe symptoms at the same time. Their ages varied from the late twenties to the early thirties. The chief symptoms that come to mind were a lack of interest in the baby, and in one case a terrifying desire to throw the baby out of the window ; an inability to enjoy anything (one patient,became fearful of going to the cinema, for she was convinced she would create a scene by standing and a no enthusiasm for housework ; up and shouting) ; feeling of general depression. I started treatment by giving them injections of deoxycortone acetate and combined this with explanation and The improvement, was slow but steady in 2 reassurance. cases, and a complete cure resulted in some two to three months. The 3rd patient showed some slight improvement, followed by a relapse with very definite suicidal tendencies (her mother had committed suicide some three years previously), and she had to have electroconvulsive therapy. This caused a temporary alleviation of her symptoms, but her fears soon returned and further hormone treatment was given, with only very slight success. A further relapse ensued. This story bears out Dr. Malleson’s contention that some of these cases may well get beyond the state where
.endocrine
therapy
London, W.l.
is effective. R. JOHN GOURLAY.
SiR,—For many years I have observed endocrine minor imbalance to be frequently present in affective disorders. I strongly support Dr. Malleson in the view that the endocrine approach to psychological illness is worthy of much more attention. For over five years I have frequently prescribed stilboestrol for "affective" symptoms at the menopause or even later if menopausal symptoms persist. A dose of 0.5 mg. daily is adequate and will, where there is endocrine lack, vary the menses by 2-3 days ; thence the dose is dropped to 0-5 mg. every other day. The therapeutic effect can be checked by the timing of the period, the extent of blood loss, and the diminution of flushes, numbness of the head, &c. Withdrawal of such doses does not cause postmenopausal bleeding in the majority of patients-and surely these days an obstetric surgeon should make suitable inquiries as to past and recent treatments. I should also like to add both from experience and perusal of many published reports that stilboestrol does not enhance the risk of cancer. KENNETH HAZELL. London, W.l.
recent anaesthetic periodical published in Australia, com. menting on this advertisement, pointed out that although a wide variety of anaesthetic apparatus and surgical instruments were drawn, there was no sign of oxygen, airway, laryngoscope, endotracheal tube, or suction pump, while the patient’s arm was splinted in abduction and supination. The second example was posted to me this week, and is an expensively printed brochure in colour also showing the technique for intravenous narcosis. A saline drip is inserted
into the antecubital fossa, and about
two feet from the needle
syringe containing the drug is shown piercing the drip tubing at right angles. The patient’s arm is abducted at more than a right-angle and the wrist is firmly strapped in full supination to an unpadded wooden splint. a
So far as I can see, the only uses to which such pictures be put is to make them a basis for a competition amongst anaesthetic clerks to find out the maximum number of errors. They might well prove disastrous to anyone who attempted to copy the techniques shown, and it would be interesting to know what liability, if any, the advertisers would have if the doctor was sued for damages for (say) brachial plexus palsy. can
Department of Anæsthesia, St. Bartholomew’s Hospital, London, E.C.1. "
C. LANGTON HEWER.
CHEMOTHERAPEUTIC AGENT " ANTIBIOTIC
"
AND
"
SIR,-The letter by Dr. K. H. Nickol in your issue of 25 is a perfect illustration of the misuse and abuse of two popular terms in medical science. Beginning with the statement " the affinity of the medical profession for misleading terminology," and emphasising that it may already be too late to hope that the collective appellation of drugs directed against micro-organisms may be revised," the writer tries to correct the usage of the terms " chemotherapeutic and antibiotic." He ends his letter by confusing the terms, the usage of which he attempts to correct. How can one interpret the following statements : " The present use of the term chemotherapy ’ is too restricted for accuracy" and the term ’antibiotic ’ may appropriately be applied to any drug which has an inimical effect on microorganisms " ? The whole question is really quite simple. Proper definitions are available, without sacrificing historical perspective, scientific accuracy, or current usage, and this should not be left to the whim of individuals who decide to redefine important terms according to their own points of view. The term " chemotherapy means exactly what it says-the use of chemical agents in the treatment of infectious diseases. These agents-whether they are produced synthetically in the laboratory, such as salvarsan and the sulpha drugs ; or by plants in the field, such as quinine and essential oils ; or by animals, such as lysozyme ; or by microbes, as in the case of antibiotics, such as penicillin-may all be designated as
July
"
"
"
"
" chemotherapeutic agents " (or " chemotherapeutics," rather awkward term). Since 1942, the term " antibiotic " has been defined a chemical substance produced by micro-organisms as which has the capacity, in dilute solution, to inhibit the growth of or even to destroy other micro-organisms." Whether the term " antibiotic therapy " is to be preferred to chemotherapy," when an antibiotic is used is a matter for the individual worker to decide. Personally, I prefer the latter. Let us hope that neither the scientific worker nor the medical practitioner will permit this type of confusion to arise between the broad terms " chemotherapeutic agent " and " chemotherapy," on the one hand, and the narrower and more specific terms "antibiotic’’ and "antibiotic therapy," on the other. a
MISLEADING PICTURES SiR,—Medical advertisers have apparently discovered that the mostlaudatory descriptions of their products sometimes fail to stimulate sales, and are relying on diagrams and pictures to an ever-increasing extent. This would seem to be an admirable policy provided that this is not accuracy is observed, but the case. always Two recent examples of misleading advertisements might be cited.
unfortunately
One, which appeared in the British medical press, was headed "’ A Wider Margin of Safety in Intravenous Ansesthesia." The title subtly implied that the advertiser’s product conferred the additional safety-a; very questionable assumption. The accompanying drawing depicted a bird’s-eye view of an operation in progress under intravenous anaesthesia. A
"
"
"
New Brunswick, New Jersey, U.S.A.
,
,,
.
SELMAN A. WAKSMAX. WAKSMAN.
FACTORS IN DISORDERS
AFFECTIVE
SiR,-I read Dr. Joan Malleson’s timely article (July 25) I am sure many of us have felt that endocrine upset in at least some of our women patients with altered affective states, but that the precise nature has been obscure. Doubtless most of us have used either natural or synthetic oestrone to relieve the " hot flushes" of the menopause, and usually with -a fair measure of success.
with
great
interest.
there has been
some
’
Some six years ago I became very interested- in depression and melancholia arising in the puerperium, and at one time I was treating 3 patients with moderately severe symptoms at the same time. Their ages varied from the late twenties to the early thirties. The chief symptoms that come to mind were a lack of interest in the baby, and in one case a terrifying desire to throw the baby out of the window ; an inability to enjoy anything (one patient,became fearful of going to the cinema, for she was convinced she would create a scene by standing and a no enthusiasm for housework ; up and shouting) ; feeling of general depression. I started treatment by giving them injections of deoxycortone acetate and combined this with explanation and The improvement, was slow but steady in 2 reassurance. cases, and a complete cure resulted in some two to three months. The 3rd patient showed some slight improvement, followed by a relapse with very definite suicidal tendencies (her mother had committed suicide some three years previously), and she had to have electroconvulsive therapy. This caused a temporary alleviation of her symptoms, but her fears soon returned and further hormone treatment was given, with only very slight success. A further relapse ensued. This story bears out Dr. Malleson’s contention that some of these cases may well get beyond the state where
.endocrine
therapy
London, W.l.
is effective. R. JOHN GOURLAY.
SiR,—For many years I have observed endocrine minor imbalance to be frequently present in affective disorders. I strongly support Dr. Malleson in the view that the endocrine approach to psychological illness is worthy of much more attention. For over five years I have frequently prescribed stilboestrol for "affective" symptoms at the menopause or even later if menopausal symptoms persist. A dose of 0.5 mg. daily is adequate and will, where there is endocrine lack, vary the menses by 2-3 days ; thence the dose is dropped to 0-5 mg. every other day. The therapeutic effect can be checked by the timing of the period, the extent of blood loss, and the diminution of flushes, numbness of the head, &c. Withdrawal of such doses does not cause postmenopausal bleeding in the majority of patients-and surely these days an obstetric surgeon should make suitable inquiries as to past and recent treatments. I should also like to add both from experience and perusal of many published reports that stilboestrol does not enhance the risk of cancer. KENNETH HAZELL. London, W.l.
recent anaesthetic periodical published in Australia, com. menting on this advertisement, pointed out that although a wide variety of anaesthetic apparatus and surgical instruments were drawn, there was no sign of oxygen, airway, laryngoscope, endotracheal tube, or suction pump, while the patient’s arm was splinted in abduction and supination. The second example was posted to me this week, and is an expensively printed brochure in colour also showing the technique for intravenous narcosis. A saline drip is inserted
into the antecubital fossa, and about
two feet from the needle
syringe containing the drug is shown piercing the drip tubing at right angles. The patient’s arm is abducted at more than a right-angle and the wrist is firmly strapped in full supination to an unpadded wooden splint. a
So far as I can see, the only uses to which such pictures be put is to make them a basis for a competition amongst anaesthetic clerks to find out the maximum number of errors. They might well prove disastrous to anyone who attempted to copy the techniques shown, and it would be interesting to know what liability, if any, the advertisers would have if the doctor was sued for damages for (say) brachial plexus palsy. can
Department of Anæsthesia, St. Bartholomew’s Hospital, London, E.C.1. "
C. LANGTON HEWER.
CHEMOTHERAPEUTIC AGENT " ANTIBIOTIC
"
AND
"
SIR,-The letter by Dr. K. H. Nickol in your issue of 25 is a perfect illustration of the misuse and abuse of two popular terms in medical science. Beginning with the statement " the affinity of the medical profession for misleading terminology," and emphasising that it may already be too late to hope that the collective appellation of drugs directed against micro-organisms may be revised," the writer tries to correct the usage of the terms " chemotherapeutic and antibiotic." He ends his letter by confusing the terms, the usage of which he attempts to correct. How can one interpret the following statements : " The present use of the term chemotherapy ’ is too restricted for accuracy" and the term ’antibiotic ’ may appropriately be applied to any drug which has an inimical effect on microorganisms " ? The whole question is really quite simple. Proper definitions are available, without sacrificing historical perspective, scientific accuracy, or current usage, and this should not be left to the whim of individuals who decide to redefine important terms according to their own points of view. The term " chemotherapy means exactly what it says-the use of chemical agents in the treatment of infectious diseases. These agents-whether they are produced synthetically in the laboratory, such as salvarsan and the sulpha drugs ; or by plants in the field, such as quinine and essential oils ; or by animals, such as lysozyme ; or by microbes, as in the case of antibiotics, such as penicillin-may all be designated as
July
"
"
"
"
" chemotherapeutic agents " (or " chemotherapeutics," rather awkward term). Since 1942, the term " antibiotic " has been defined a chemical substance produced by micro-organisms as which has the capacity, in dilute solution, to inhibit the growth of or even to destroy other micro-organisms." Whether the term " antibiotic therapy " is to be preferred to chemotherapy," when an antibiotic is used is a matter for the individual worker to decide. Personally, I prefer the latter. Let us hope that neither the scientific worker nor the medical practitioner will permit this type of confusion to arise between the broad terms " chemotherapeutic agent " and " chemotherapy," on the one hand, and the narrower and more specific terms "antibiotic’’ and "antibiotic therapy," on the other. a
MISLEADING PICTURES SiR,—Medical advertisers have apparently discovered that the mostlaudatory descriptions of their products sometimes fail to stimulate sales, and are relying on diagrams and pictures to an ever-increasing extent. This would seem to be an admirable policy provided that this is not accuracy is observed, but the case. always Two recent examples of misleading advertisements might be cited.
unfortunately
One, which appeared in the British medical press, was headed "’ A Wider Margin of Safety in Intravenous Ansesthesia." The title subtly implied that the advertiser’s product conferred the additional safety-a; very questionable assumption. The accompanying drawing depicted a bird’s-eye view of an operation in progress under intravenous anaesthesia. A
"
"
"
New Brunswick, New Jersey, U.S.A.
,
,,
.
SELMAN A. WAKSMAX. WAKSMAN.