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VITAMIN-B DEFICIENCY AND NERVOUS DISEASE
580
imperative as d-tubocurarine chloride, a pure crystalline substance having a potency of 6-6 units per
more
more generally available. Dr. West has also expressed concern over the occurrence of bronchospasm in connexion with curarisation. We have not observed bronchospasm in dogs. In this country the possibility of laryngospasm and bronchospasm have not been considered as deterrents to the use of the drug. In fact, several investigators believe that the incidence of,laryngospasm in anaesthesia is smaller when intocostrin is used in conjunction with an anaesthetic agent. However, endoscopists have encountered convulsions and laryngospasm repeatedly when using the drug in combination with cocaine. Bronchospasm has been reported subsequent to lightening the plane of ansesthesia. Dr. Duncan Holaday suggests (unpublished report) that it is possible that the generalised paresis which results from curarisation of unansesthetised subjects constitutes an extremely strong psychic stimulus, and that involuntary reflexes originating during an acute anxiety state so produced are of sufficient strength to break through pre-apnoeic degrees of curarisation, and to interfere with respiration by producing salivation and laryngospasm. E. R. Squibb & Sons, H. SIDNEY NEWCOMER.
mg., becomes
New York.
THIOURACIL IN GOITRE
SiB,—Dr. Cookson (Oct. 20) says that thiouracil is able to neutralise the toxic effects of thyroxine in the human subject. It may not have been his intention to give such an impression, but it is right to point out that the consensus of opinion is that thiouracil acts by preventing the synthesis of thyroxine in the thyroid gland. There is always a delay in the clinical response to thiouracil, because the drug has no power to antagonise or neutralise thyroxine already formed in the body ; and again a patient fully under the effect of thiouracil will still respond to the action of thyroxine given orally. Cookson"s statement that iodine previously administered had no close relation to the time-lag in response to thiouracil is also at variance with other experience. His own case of a pregnant woman who took iodine for 13 months before she failed with thiouracil is a striking example of how the former may influence the action of the latter. A. M. NUSSEY. Selly Oak Hospital, Birmingham. * ** We have referred this letter to Dr. CooKsoN, who writes : " Thiouracil does not neutralise thyroxine in the chemical sense of acting directly upon it, but does neutralise or counteract effects due to the excessive secretion of thyroxine in toxic goitre. There is strong evidence that the drug acts, as Dr. Nussey says, by lessening the amount of thyroxine formed in the gland. The failure of thiouracil in a woman in late pregnancy could not certainly be attributed to iodine, since my results as a whole showed that the response of patients who had been taking iodine was little different from those who had not."-ED. L. .
VITAMIN-B DEFICIENCY AND NERVOUS DISEASE Dr. E. JENNER WRIG]EIT, in the course of a letter from Sierra Leone, refers to a statement in our leading article of Sept. 8, that the " syndrome, which when full blown is characterised by a rapidly developing amblyopia (usually with central scotomas), cheilitis, glossitis, scrotal eczema, reflex changes, and involvement of cranial nerves, was first described by FITZGERALD MooRE in 1930 in Nigerian school-children." Dr. Wright has already pointed out (Brit. med. J. 1944, ii, 352) that he described this syndrome and its treatment with vitamins (West Afr. med. J. 1928,2, 127) two years before Moore’s paper appeared (Ibid, 1930, 3, 46). He adds : The syndrome I described in 1928 consisted of various
degrees of glazing, soreness, and smarting of the tongue ; altered condition of the angles of the mouth ; changes in the external eye, varnished appearance of canthi and conjunctivitis ; thrush-like condition of the vulva or eczema of the scrotum ; tremulousness of the tongue ; altered, often asymmetrical knee-jerks ; paraesthesias in the extremities ; various degrees of failure of vision ; difficulty of locomotion up to complete incapacitation. Defective vision was particularly stressed and attention drawn to its importance and
in school-children if treated early by dietetic oil and yeast. The syndrome Fitzgerald Moore described two years later was a condition of loss of central acuity of vision in young adolescents thought to be due to toxic amblyopia or retrobulbar neuritis with, as an setiological factor, a dietetic" deficiency, because there had been antecedent " sore tongue and " sore mouth." He also mentions white patches at the edges of the lips. No other signs or symptoms of the syndrome are mentioned in this work which deals mainly with an ocular study of the syndrome already described by me. Later, in Leitch’s Dietetics in Warm Climates (London
amenability
means-i.e., cod-liver
1930) Dr. Jenner Wright defined the syndrome he described as " a disease distinct from pellagra and beriberi, characterised by lesions of the mucous membranes and skin especially evident at the mucocutaneous junctions, associated with or followed by disorders of the nervous system curable by the addition of cod-liver oil and yeast to the diet."
On Active Service CASUALTIES PREVIOUSLY REPORTED MISSING, NOW PRESUMED KILLED Captain PEROY Louis, Macs, RAMO .
Captain JOHN DIVER, MB
DIED OAMB., RAMC
AWARDS OBE
Lieut.-Colonel F. S. FIDDES, MB EDIN., RAMC Lieut.-Colo-nel J. A. D. JOHNSTON, MO, MB GLASG., Lieut.-Colonel F. M. Lirscon2s, FROP, RAMO
RAMC
DSC
Surgeon Commander A. C. K. YATES, MB
SYDNEY, FROSE,
BNVB.
retd
On Oct. 20 we announced the award of the DSO to Lieut.-Colonel M. W. Gonin. The citation announcing the
appointment
states :
In the present campaign in North-West Europe Lieut.-Colonel Gonin has shown throughout great courage and powers of leadership of a very high order. As oHicer-in-comma,nd of the light field ambulance attached to the 6th Guards Armoured Brigade, he has been responsible for the evacuation of all the casualties of that formation from the foremost areas. For the assault crossing of the Rhine, his unit formed part of the bank-control group on the right flank and he was entirely responsible for the organisation of the medical arrangements on the banks. By constant supervision of all his many posts often under heavy shell and mortar fire he set an inspiring example to all his men which was largely responsible for the smooth evacuation of casualties from the far bank. More recently Lieut.-Colonel Gonin with his unit has been responsible for the actual evacuation of all the most serious cases from the worst " horror " camp at Belsen. He has thrown himself into the part of organising this with tireless energy and despite the serious dangers of disease involved he has personally supervised all the arrangements throughout, and must have been responsible for the saving of thousands of lives. A measure of the danger is evident from the fact that almost 20 of the personnel working in camp 1 have already contracted typhus. ’
MEMOIR
Captain PETER BARKEY, the elder son of Mr. James Barkey of Newlands, Glasgow, was killed in Burma on Feb. 24. In 1941 he- joined the RAMC and was posted overseas to Burma as RMO to the 1st battalion of the Queen’s Own Cameron Highlanders, and served in the bitter fighting at Imphal and Kohima. Later during the reconquest of Burma he took part in the long march to the Irrawaddy, at the crossing of which he was killed. Born 30 years ago, Barkey was educated at St. Aloysius’ College, Glasgow, and the University of Glasgow, where he graduated MB in 1939. He spent a year and a half at Kilmarnock Infirmary as housesurgeon, later joining a general practice in Alloa. Both in civilian practice and in the Army, Peter Barkey quickly gained the esteem of his patients and men. Although he was rather shy, his kindly consideration and human interest won a permanent place for him in the hearts of those who came under his care. A man with many interests, he played tennis and chess, and was a member of the Glasgow Golf Club. But above -all he was a reader, and already had built up a fine library which reflected his interest in arts and politics as well as in biology and medicine.
imperative as d-tubocurarine chloride, a pure crystalline substance having a potency of 6-6 units per
more
more generally available. Dr. West has also expressed concern over the occurrence of bronchospasm in connexion with curarisation. We have not observed bronchospasm in dogs. In this country the possibility of laryngospasm and bronchospasm have not been considered as deterrents to the use of the drug. In fact, several investigators believe that the incidence of,laryngospasm in anaesthesia is smaller when intocostrin is used in conjunction with an anaesthetic agent. However, endoscopists have encountered convulsions and laryngospasm repeatedly when using the drug in combination with cocaine. Bronchospasm has been reported subsequent to lightening the plane of ansesthesia. Dr. Duncan Holaday suggests (unpublished report) that it is possible that the generalised paresis which results from curarisation of unansesthetised subjects constitutes an extremely strong psychic stimulus, and that involuntary reflexes originating during an acute anxiety state so produced are of sufficient strength to break through pre-apnoeic degrees of curarisation, and to interfere with respiration by producing salivation and laryngospasm. E. R. Squibb & Sons, H. SIDNEY NEWCOMER.
mg., becomes
New York.
THIOURACIL IN GOITRE
SiB,—Dr. Cookson (Oct. 20) says that thiouracil is able to neutralise the toxic effects of thyroxine in the human subject. It may not have been his intention to give such an impression, but it is right to point out that the consensus of opinion is that thiouracil acts by preventing the synthesis of thyroxine in the thyroid gland. There is always a delay in the clinical response to thiouracil, because the drug has no power to antagonise or neutralise thyroxine already formed in the body ; and again a patient fully under the effect of thiouracil will still respond to the action of thyroxine given orally. Cookson"s statement that iodine previously administered had no close relation to the time-lag in response to thiouracil is also at variance with other experience. His own case of a pregnant woman who took iodine for 13 months before she failed with thiouracil is a striking example of how the former may influence the action of the latter. A. M. NUSSEY. Selly Oak Hospital, Birmingham. * ** We have referred this letter to Dr. CooKsoN, who writes : " Thiouracil does not neutralise thyroxine in the chemical sense of acting directly upon it, but does neutralise or counteract effects due to the excessive secretion of thyroxine in toxic goitre. There is strong evidence that the drug acts, as Dr. Nussey says, by lessening the amount of thyroxine formed in the gland. The failure of thiouracil in a woman in late pregnancy could not certainly be attributed to iodine, since my results as a whole showed that the response of patients who had been taking iodine was little different from those who had not."-ED. L. .
VITAMIN-B DEFICIENCY AND NERVOUS DISEASE Dr. E. JENNER WRIG]EIT, in the course of a letter from Sierra Leone, refers to a statement in our leading article of Sept. 8, that the " syndrome, which when full blown is characterised by a rapidly developing amblyopia (usually with central scotomas), cheilitis, glossitis, scrotal eczema, reflex changes, and involvement of cranial nerves, was first described by FITZGERALD MooRE in 1930 in Nigerian school-children." Dr. Wright has already pointed out (Brit. med. J. 1944, ii, 352) that he described this syndrome and its treatment with vitamins (West Afr. med. J. 1928,2, 127) two years before Moore’s paper appeared (Ibid, 1930, 3, 46). He adds : The syndrome I described in 1928 consisted of various
degrees of glazing, soreness, and smarting of the tongue ; altered condition of the angles of the mouth ; changes in the external eye, varnished appearance of canthi and conjunctivitis ; thrush-like condition of the vulva or eczema of the scrotum ; tremulousness of the tongue ; altered, often asymmetrical knee-jerks ; paraesthesias in the extremities ; various degrees of failure of vision ; difficulty of locomotion up to complete incapacitation. Defective vision was particularly stressed and attention drawn to its importance and
in school-children if treated early by dietetic oil and yeast. The syndrome Fitzgerald Moore described two years later was a condition of loss of central acuity of vision in young adolescents thought to be due to toxic amblyopia or retrobulbar neuritis with, as an setiological factor, a dietetic" deficiency, because there had been antecedent " sore tongue and " sore mouth." He also mentions white patches at the edges of the lips. No other signs or symptoms of the syndrome are mentioned in this work which deals mainly with an ocular study of the syndrome already described by me. Later, in Leitch’s Dietetics in Warm Climates (London
amenability
means-i.e., cod-liver
1930) Dr. Jenner Wright defined the syndrome he described as " a disease distinct from pellagra and beriberi, characterised by lesions of the mucous membranes and skin especially evident at the mucocutaneous junctions, associated with or followed by disorders of the nervous system curable by the addition of cod-liver oil and yeast to the diet."
On Active Service CASUALTIES PREVIOUSLY REPORTED MISSING, NOW PRESUMED KILLED Captain PEROY Louis, Macs, RAMO .
Captain JOHN DIVER, MB
DIED OAMB., RAMC
AWARDS OBE
Lieut.-Colonel F. S. FIDDES, MB EDIN., RAMC Lieut.-Colo-nel J. A. D. JOHNSTON, MO, MB GLASG., Lieut.-Colonel F. M. Lirscon2s, FROP, RAMO
RAMC
DSC
Surgeon Commander A. C. K. YATES, MB
SYDNEY, FROSE,
BNVB.
retd
On Oct. 20 we announced the award of the DSO to Lieut.-Colonel M. W. Gonin. The citation announcing the
appointment
states :
In the present campaign in North-West Europe Lieut.-Colonel Gonin has shown throughout great courage and powers of leadership of a very high order. As oHicer-in-comma,nd of the light field ambulance attached to the 6th Guards Armoured Brigade, he has been responsible for the evacuation of all the casualties of that formation from the foremost areas. For the assault crossing of the Rhine, his unit formed part of the bank-control group on the right flank and he was entirely responsible for the organisation of the medical arrangements on the banks. By constant supervision of all his many posts often under heavy shell and mortar fire he set an inspiring example to all his men which was largely responsible for the smooth evacuation of casualties from the far bank. More recently Lieut.-Colonel Gonin with his unit has been responsible for the actual evacuation of all the most serious cases from the worst " horror " camp at Belsen. He has thrown himself into the part of organising this with tireless energy and despite the serious dangers of disease involved he has personally supervised all the arrangements throughout, and must have been responsible for the saving of thousands of lives. A measure of the danger is evident from the fact that almost 20 of the personnel working in camp 1 have already contracted typhus. ’
MEMOIR
Captain PETER BARKEY, the elder son of Mr. James Barkey of Newlands, Glasgow, was killed in Burma on Feb. 24. In 1941 he- joined the RAMC and was posted overseas to Burma as RMO to the 1st battalion of the Queen’s Own Cameron Highlanders, and served in the bitter fighting at Imphal and Kohima. Later during the reconquest of Burma he took part in the long march to the Irrawaddy, at the crossing of which he was killed. Born 30 years ago, Barkey was educated at St. Aloysius’ College, Glasgow, and the University of Glasgow, where he graduated MB in 1939. He spent a year and a half at Kilmarnock Infirmary as housesurgeon, later joining a general practice in Alloa. Both in civilian practice and in the Army, Peter Barkey quickly gained the esteem of his patients and men. Although he was rather shy, his kindly consideration and human interest won a permanent place for him in the hearts of those who came under his care. A man with many interests, he played tennis and chess, and was a member of the Glasgow Golf Club. But above -all he was a reader, and already had built up a fine library which reflected his interest in arts and politics as well as in biology and medicine.