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THE MEDICAL CIVIL SERVICE
950 of human endometrium.l One can exactly determine the amount of male hormone needed to neutralise the stimulating action of the female hormone ; 25 mg. of testosterone propionate neutralises 0-5 mg. of stilboestrol in the vaginal epithelium (ratio 50 : 1), and 600 mg. testosterone propionate neutralises 16 mg. of stilboestrol in the endometrium (ratio 30 : 1 )-which proves that male hormone in the female body has an action against cell growth. That is an undeniable fact. No-one would claim that testosterone is a cure for mammary cancer (I recommended male-hormone therapy as a prophylactic method against secondaries after a total mastectomy). No-one would say that stilboestrol is a cure for prostatic cancer, although it brings about very beneficial effects, just as testosterone does very often in mammary carcinoma. Therapy with endocrines-and here again I agree with Dodds-is not an ideal one, but the results so far obtained confirm my assumption which Dodds considers surely " unwarrantable " ; and the therapy should be still further tried until biochemists can give us the necessary anticarcinogenic tool. A. A. LOESER. London, W.l.
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which the spasm started is not known as it was only accidentally detected when the towels. were removed from the chest. It would be interesting to know whether any of your readers have seen any similar cases which might throw light on the nature of the condition. J. D. LAYCOCK. St. Thomas’s Hospital, London, S.E.1 THE MEDICAL CIVIL SERVICE are, of course, correct in pointing out that only a small proportion of the weekly National Insurance payment is devoted to the National Health Service. That, however, does not really affect the point which I wished to make-namely, that the average individual finds that he is paying some 210 a year in National Insurance, on which he may not live long enough to enjoy a distant return in the form of a pension, while his funeral, though paid for by the State, does not seem to promise much enjoyment, the only obvious immediate benefit which he sees being his ability to call on the doctor without further payment. There is thus an inherent tendency in the system to call on medical services for trifling ailments for which previously the help of the chemist, or not even his,
SiR,-You
would have been enlisted. CHANGING ENDS OF SOCIAL MEDICINE While sharing Mr. Patey’s general dislike of anonymity, article me last week reminded of SIR,-Your leading I would emphasise your editorial reference to the debt something I said in 1941 in my presidential address to the of English literature to that well-known author, " Anon," Welsh branch of the Society of Medical Officers of Health. and to his close relative, the writerHaving described what had been done in the past and e.g., Junius and Currer Bell; pseudonymous in this particular but, what it was still hoped to do in the development of our ’ case, for reasons already stated, beg again to subscribe health and social services, I said : myself "But when we have finished it there will remain the CHIRURGICUS. greatest problem of all-the problem of man himself, who has it in his own power at any time to ruin his health and DENGUE IN EARLY PREGNANCY happiness however much may have been done for him by SiB,—I have recently seen a case where a. European way of organising all kinds of social-welfare services for his lady had dengue (a virus infection) during what proved benefit. Even for this problem there are optimists in our to be the first month of pregnancy. The baby has midst-the psychiatrists, the child-guidance experts, and now been born, and as far as can be told is completely the like-and we have a new kind of clergyman who is normal and certainly is not deaf. part psychologist and part minister. In days gone by we R. B. WADDY had debates on church versus science. In the new era, Medical Officer of Health, church and science must march together, labouring in Northern Territories. Tamale, Gold Coast. harmony for the moral and spiritual as well as the material betterment of mankind.... Shall we this time have INDEPENDENCE IN RESEARCH learnt the lesson that a vigorous social purpose shall inspire " SIR,-Ishould like to comment upon some of the a community no less than the will to win survival ? points raised by Sir Ernest Graham-Little in his letter J. GREENWOOD WILSON. Cardiff. of Nov. 20. In the first part he is obviously advocating the RESPIRATORY OBSTRUCTION DURING " laissez faire " system in medical research. I am not ANÆSTHESIA a research-worker, but I should have thought that most would prefer to work as members of SIR,-Respiratory obstruction in general anaesthesia research-workers a nation-wide, coordinated team, rather than in isolation, .is common enough, but the following case seems to very often unnecessarily duplicating each other’s work. present some unusual features. It seems to me that Graham-Little, and others who think of a was The patient, about to undergo an 13, boy like him, are under the impression that freedom, including exploratory thoracotomy for congenital heart disease. Anoes- freedom in medical research, means the "absence of thesia was induced with nitrous oxide, oxygen, and cyclorestraint." This is a fundamental mistake. Freedom propane, using a Waters to-and-fro absorption technique. comes through cooperation, together with restraint on Induction was smooth as far as the second stage, when ether individuals which cooperation necessarily entails. This Mild laryngeal spasm resulted, but was added gradually. is true despite the obvious contradiction. respiration was otherwise regular and the jaw muscles were However, whilst I disagree with him on the organisawell relaxed. At this point it was observed that the whole tion of medical research, I do agree with him that the of the right side of the chest was immobile, whilst air was reference to research in the National Health Service Prior to there had left side. the freely entering operation Act is meagre. What is more to the point is the actual No pharyngeal been no abnormal physical signs in the lungs. on medical research compared Government airway had been used, nor had there been any noticeable with other expenditure Government expenditure-for example, secretion of mucus. During inspiration the intercostal spaces the expenditure of 1,173,000 on medical research comon the right side were seen to be drawn in. No mechanical with the expenditure of ;/367,185,000 on militaryexplanation could be advanced for the complete failure of pared science research over the same period, and compared no enter the was to as there gases right lung, especially with a total expenditure of ;/3154,500,000 on Greece. obstruction whatever on the left side. The head, which up Graham-Little concludes with an attack on the Russian to now had been turned over to the right, was then straightened biologist, Lysenko, and makes the sweeping and inaccuand a Macintosh laryngoscope easily introduced. During rate that Lysenko’s theories are universally assertion this manoeuvre the right side of the chest suddenly began rejected by authorities outside Russia. The Russian to inflate as fully as the left. An endotracheal tube was controversy in biology came to a head only a few months passed and no further abnormality in respiration occurred ago, and there has not been sufficient time for Lysenko’s Convalescence the was uneventful. throughout operation. views to have had any effect, good or bad, on the economy In the absence of any obvious cause of mechanical of the One of the basic principles of scientific obstruction, such as a plug of mucus, it must be con- work iscountry. the unity of theory and practice, and one of cluded that a reflex bronchial spasm was the explanation Lysenko’s main criticisms of his biological opponents of the condition described. The precise moment at was that nothing practical had come out of their idealist 1. Loeser, A. A. Lancet, 1938, i, 373. theories, that their theories had not helped the’Russian -
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which the spasm started is not known as it was only accidentally detected when the towels. were removed from the chest. It would be interesting to know whether any of your readers have seen any similar cases which might throw light on the nature of the condition. J. D. LAYCOCK. St. Thomas’s Hospital, London, S.E.1 THE MEDICAL CIVIL SERVICE are, of course, correct in pointing out that only a small proportion of the weekly National Insurance payment is devoted to the National Health Service. That, however, does not really affect the point which I wished to make-namely, that the average individual finds that he is paying some 210 a year in National Insurance, on which he may not live long enough to enjoy a distant return in the form of a pension, while his funeral, though paid for by the State, does not seem to promise much enjoyment, the only obvious immediate benefit which he sees being his ability to call on the doctor without further payment. There is thus an inherent tendency in the system to call on medical services for trifling ailments for which previously the help of the chemist, or not even his,
SiR,-You
would have been enlisted. CHANGING ENDS OF SOCIAL MEDICINE While sharing Mr. Patey’s general dislike of anonymity, article me last week reminded of SIR,-Your leading I would emphasise your editorial reference to the debt something I said in 1941 in my presidential address to the of English literature to that well-known author, " Anon," Welsh branch of the Society of Medical Officers of Health. and to his close relative, the writerHaving described what had been done in the past and e.g., Junius and Currer Bell; pseudonymous in this particular but, what it was still hoped to do in the development of our ’ case, for reasons already stated, beg again to subscribe health and social services, I said : myself "But when we have finished it there will remain the CHIRURGICUS. greatest problem of all-the problem of man himself, who has it in his own power at any time to ruin his health and DENGUE IN EARLY PREGNANCY happiness however much may have been done for him by SiB,—I have recently seen a case where a. European way of organising all kinds of social-welfare services for his lady had dengue (a virus infection) during what proved benefit. Even for this problem there are optimists in our to be the first month of pregnancy. The baby has midst-the psychiatrists, the child-guidance experts, and now been born, and as far as can be told is completely the like-and we have a new kind of clergyman who is normal and certainly is not deaf. part psychologist and part minister. In days gone by we R. B. WADDY had debates on church versus science. In the new era, Medical Officer of Health, church and science must march together, labouring in Northern Territories. Tamale, Gold Coast. harmony for the moral and spiritual as well as the material betterment of mankind.... Shall we this time have INDEPENDENCE IN RESEARCH learnt the lesson that a vigorous social purpose shall inspire " SIR,-Ishould like to comment upon some of the a community no less than the will to win survival ? points raised by Sir Ernest Graham-Little in his letter J. GREENWOOD WILSON. Cardiff. of Nov. 20. In the first part he is obviously advocating the RESPIRATORY OBSTRUCTION DURING " laissez faire " system in medical research. I am not ANÆSTHESIA a research-worker, but I should have thought that most would prefer to work as members of SIR,-Respiratory obstruction in general anaesthesia research-workers a nation-wide, coordinated team, rather than in isolation, .is common enough, but the following case seems to very often unnecessarily duplicating each other’s work. present some unusual features. It seems to me that Graham-Little, and others who think of a was The patient, about to undergo an 13, boy like him, are under the impression that freedom, including exploratory thoracotomy for congenital heart disease. Anoes- freedom in medical research, means the "absence of thesia was induced with nitrous oxide, oxygen, and cyclorestraint." This is a fundamental mistake. Freedom propane, using a Waters to-and-fro absorption technique. comes through cooperation, together with restraint on Induction was smooth as far as the second stage, when ether individuals which cooperation necessarily entails. This Mild laryngeal spasm resulted, but was added gradually. is true despite the obvious contradiction. respiration was otherwise regular and the jaw muscles were However, whilst I disagree with him on the organisawell relaxed. At this point it was observed that the whole tion of medical research, I do agree with him that the of the right side of the chest was immobile, whilst air was reference to research in the National Health Service Prior to there had left side. the freely entering operation Act is meagre. What is more to the point is the actual No pharyngeal been no abnormal physical signs in the lungs. on medical research compared Government airway had been used, nor had there been any noticeable with other expenditure Government expenditure-for example, secretion of mucus. During inspiration the intercostal spaces the expenditure of 1,173,000 on medical research comon the right side were seen to be drawn in. No mechanical with the expenditure of ;/367,185,000 on militaryexplanation could be advanced for the complete failure of pared science research over the same period, and compared no enter the was to as there gases right lung, especially with a total expenditure of ;/3154,500,000 on Greece. obstruction whatever on the left side. The head, which up Graham-Little concludes with an attack on the Russian to now had been turned over to the right, was then straightened biologist, Lysenko, and makes the sweeping and inaccuand a Macintosh laryngoscope easily introduced. During rate that Lysenko’s theories are universally assertion this manoeuvre the right side of the chest suddenly began rejected by authorities outside Russia. The Russian to inflate as fully as the left. An endotracheal tube was controversy in biology came to a head only a few months passed and no further abnormality in respiration occurred ago, and there has not been sufficient time for Lysenko’s Convalescence the was uneventful. throughout operation. views to have had any effect, good or bad, on the economy In the absence of any obvious cause of mechanical of the One of the basic principles of scientific obstruction, such as a plug of mucus, it must be con- work iscountry. the unity of theory and practice, and one of cluded that a reflex bronchial spasm was the explanation Lysenko’s main criticisms of his biological opponents of the condition described. The precise moment at was that nothing practical had come out of their idealist 1. Loeser, A. A. Lancet, 1938, i, 373. theories, that their theories had not helped the’Russian -