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WHO WILL CURE MY ULCERS ?
1398
The have been discovered in a larger experiment. sequential designs chosen by them are unlikely to permit prolonged experimentation. This means that the designs are not particularly sensitive to the detection of small differences. Dr. Grenville-Mathers and Dr. Trenchard are generally careful not to claim that the drugs are ineffective in prolonging survival, with the exception of the trial of thiotepa, where " only 12 cases were needed to show that this treatment did not prolong life". Incidentally, statisticians are by no means immune to this particular
temptation. London School of Hygiene and
Tropical Medicine, London, W.C.1.
P. ARMITAGE.
FIBRINOLYSIS IN OBESITY
SIR,-Dr. Ogston and Dr. McAndrew (Dec. 5) have finding by Goldrickand by Shaw and 2 MacNaughton of a relation in males between low fibrinolytic activity and obesity, and, incidentally, a similar finding by ourselves in a study of fibrinolysis in 100 diabetic patients and 100 age-matched controls.3 In our study, the correlation between low fibrinolytic activity and obesity was significant in diabetic males and females, highly significant in healthy males, and non-existent in
WHO WILL CURE MY ULCERS ? SIR,-As a conclusion to your annotation may I suggest the postscript " Is your journey (to the surgeon) really
necessary ?
It is not difficult to see why the normal approach to the ulcer problem is still in such a vague and confused state. The reasons are misunderstanding of the physiological control of the function of the alimentary sphincters, misinterpretation of the relation between the acute and chronic ulcer, and complete ignorance of the pathogenesis of the lesions. Hence the irrational basis of treatment. Surgery is indicated only in very special cases; basically the treatment must be medical. The Sippy treatment is obsolete, and the time has now come for a reappraisal of the whole problem. I am gratified to
observe that my views, based
be associated with reduced fibrinolysis, this may have a on the relative immunity of women to occlusive vascular disease.
not
bearing
We would be interested to know whether the data of Dr. Ogston and Dr. McAndrew, when expressed in relation to sex, agree with our findings. R. CHAKRABARTI The Gloucestershire Royal Hospital, G. R. FEARNLEY. Gloucester. TERMINATION OF PREGNANCY ON PSYCHIATRIC GROUNDS your leading article (Dec. 12) you state that of studies this problem similar to those carried out in Sweden are badly needed in Britain. For over twelve years such a study has been in progress in this department. Well over 200 cases have been investigated and interim reports have been published.4 It is expected to complete and in due course to publish the results of a much larger series within the next twelve months or so. Dr. Uhrus (Dec. 12) writes: The problems at issue are very delicate, evoking conflicts in members of the medical profession and laymen, in irreligious and religious persons. Their solution has always presented great difficulties; it still is very difficult, and probably it will always be so. Few problems evoke so many feelings, and so much personal aggression, even among members of the medical profession, as does induction of abortion."
Few of us who have been at all deeply concerned with this problem could fail to agree. I have reiterated essentially similar statements in almost every contribution I have made on the subject. It is unfortunate that many of those most vocal on the problem of abortion seem to have no understanding of the complexities involved. Department of Psychiatry,
E. W. ANDERSON. University of Manchester. 1. Goldrick, R. B. Aust. Ann. Med. 1961, 10, 20. 2. Shaw, D. A., MacNaughton, D. Lancet, 1963, i, 352. 3. Fearnley, G. R., Chakrabarti, R., Avis, P. R. D. Brit. med. J. 1963, i, 921. 4. Proc. R. Soc. Med. 1957, 50, 321. Proceedings of the Third World Congress of Psychiatry, November, 1961; (forensic) 1169.
the coordination of the
Better late than never!
J.-JACQUES J.-jACQUBS SPIRA.
London, W.1.
OPERATING ON CHILDREN AS DAY-CASES
SIR,-Most paediatricians would strongly approve Mr. Lawrie’s plea (Dec. 12) for short-stay admission for minor operations " in infants and toddlers. I am surprised to see so few cases of pyloromyotomy in his list, but there may be a good reason for this. His point isand I wholeheartedly agree-that there is no need to keep most of these babies in hospital for more than 24 hours. I am amazed to find that the old tedious postoperative feeding schedule is still in use at some of our leading children’s hospitals. Babies, whether breast-fed or bottle-fed, can (and should) be put on a full feeding regimen. I am a little disturbed to see so many operations being performed for umbilical hernia and circumcision. Unlike the inguinal hernia there is a negligible risk of obstruction in true umbilical hernia and most disappear in time. If any surgeon "
doubts this, let him watch the umbilical hernia of a cretin being " dispersed with medicine ". Why has the number of circumcisions lessened since the introduction of the N.H.S. ? Department of Child Health, Welsh National School of Medicine, Cardiff.
SIR,-In
"
on
physiology, pathology, and pathogenesis, are being accepted at last-slowly (perhaps even a little reluctantly)-and applied in practice without reference to their originator.
confirmed the
healthy females. There were 50 people in each of these groups. Dr. Ogston and Dr. McAndrew do not give figures for the males and females separately, except in two ancillary studies. If, as our findings suggest, obesity in the healthy female may
"
A. G. WATKINS.
Parliament Service
Disability
Pensions
ON Dec. 16, under the ten minutes’ rule, Mr. LESLIE HALE was given leave to introduce a Bill to make further provision for the rehearing of applications for Service disability pensions, and to amend the law in connection with the onus of proof and limitation of time in relation to these pensions. QUESTION TIME Imported Scientific and Medical Research Apparatus Lord AMULREE asked H.M. Government whether imported apparatus and equipment intended for use in scientific or medical research in this country was, or would be, subject to the 15% import levy.-Lord RHODES, parliamentary secretary to the Board of Trade, replied: Schedule 2 to the Finance Bill provides that articles intended for use non-commercially, in scientific research or for a purpose connected with the advancement of any branch of learning, shall qualify for relief from the temporary import charge. Lord AMULREE: What is the procedure whereby people engaged on work of this sort and who import goods which are for scientific purposes can obtain relief from import duty ? Lord RHODES: The procedure for getting this relief will be the same as that which already applies for a similar relief from duty under the Import Duties Act, 1958. This is set out in Notice 342 issued by the Commissioners of Customs and Excise. Relief from the temporary import charge will be given automatically to successful applicants under that procedure.
The have been discovered in a larger experiment. sequential designs chosen by them are unlikely to permit prolonged experimentation. This means that the designs are not particularly sensitive to the detection of small differences. Dr. Grenville-Mathers and Dr. Trenchard are generally careful not to claim that the drugs are ineffective in prolonging survival, with the exception of the trial of thiotepa, where " only 12 cases were needed to show that this treatment did not prolong life". Incidentally, statisticians are by no means immune to this particular
temptation. London School of Hygiene and
Tropical Medicine, London, W.C.1.
P. ARMITAGE.
FIBRINOLYSIS IN OBESITY
SIR,-Dr. Ogston and Dr. McAndrew (Dec. 5) have finding by Goldrickand by Shaw and 2 MacNaughton of a relation in males between low fibrinolytic activity and obesity, and, incidentally, a similar finding by ourselves in a study of fibrinolysis in 100 diabetic patients and 100 age-matched controls.3 In our study, the correlation between low fibrinolytic activity and obesity was significant in diabetic males and females, highly significant in healthy males, and non-existent in
WHO WILL CURE MY ULCERS ? SIR,-As a conclusion to your annotation may I suggest the postscript " Is your journey (to the surgeon) really
necessary ?
It is not difficult to see why the normal approach to the ulcer problem is still in such a vague and confused state. The reasons are misunderstanding of the physiological control of the function of the alimentary sphincters, misinterpretation of the relation between the acute and chronic ulcer, and complete ignorance of the pathogenesis of the lesions. Hence the irrational basis of treatment. Surgery is indicated only in very special cases; basically the treatment must be medical. The Sippy treatment is obsolete, and the time has now come for a reappraisal of the whole problem. I am gratified to
observe that my views, based
be associated with reduced fibrinolysis, this may have a on the relative immunity of women to occlusive vascular disease.
not
bearing
We would be interested to know whether the data of Dr. Ogston and Dr. McAndrew, when expressed in relation to sex, agree with our findings. R. CHAKRABARTI The Gloucestershire Royal Hospital, G. R. FEARNLEY. Gloucester. TERMINATION OF PREGNANCY ON PSYCHIATRIC GROUNDS your leading article (Dec. 12) you state that of studies this problem similar to those carried out in Sweden are badly needed in Britain. For over twelve years such a study has been in progress in this department. Well over 200 cases have been investigated and interim reports have been published.4 It is expected to complete and in due course to publish the results of a much larger series within the next twelve months or so. Dr. Uhrus (Dec. 12) writes: The problems at issue are very delicate, evoking conflicts in members of the medical profession and laymen, in irreligious and religious persons. Their solution has always presented great difficulties; it still is very difficult, and probably it will always be so. Few problems evoke so many feelings, and so much personal aggression, even among members of the medical profession, as does induction of abortion."
Few of us who have been at all deeply concerned with this problem could fail to agree. I have reiterated essentially similar statements in almost every contribution I have made on the subject. It is unfortunate that many of those most vocal on the problem of abortion seem to have no understanding of the complexities involved. Department of Psychiatry,
E. W. ANDERSON. University of Manchester. 1. Goldrick, R. B. Aust. Ann. Med. 1961, 10, 20. 2. Shaw, D. A., MacNaughton, D. Lancet, 1963, i, 352. 3. Fearnley, G. R., Chakrabarti, R., Avis, P. R. D. Brit. med. J. 1963, i, 921. 4. Proc. R. Soc. Med. 1957, 50, 321. Proceedings of the Third World Congress of Psychiatry, November, 1961; (forensic) 1169.
the coordination of the
Better late than never!
J.-JACQUES J.-jACQUBS SPIRA.
London, W.1.
OPERATING ON CHILDREN AS DAY-CASES
SIR,-Most paediatricians would strongly approve Mr. Lawrie’s plea (Dec. 12) for short-stay admission for minor operations " in infants and toddlers. I am surprised to see so few cases of pyloromyotomy in his list, but there may be a good reason for this. His point isand I wholeheartedly agree-that there is no need to keep most of these babies in hospital for more than 24 hours. I am amazed to find that the old tedious postoperative feeding schedule is still in use at some of our leading children’s hospitals. Babies, whether breast-fed or bottle-fed, can (and should) be put on a full feeding regimen. I am a little disturbed to see so many operations being performed for umbilical hernia and circumcision. Unlike the inguinal hernia there is a negligible risk of obstruction in true umbilical hernia and most disappear in time. If any surgeon "
doubts this, let him watch the umbilical hernia of a cretin being " dispersed with medicine ". Why has the number of circumcisions lessened since the introduction of the N.H.S. ? Department of Child Health, Welsh National School of Medicine, Cardiff.
SIR,-In
"
on
physiology, pathology, and pathogenesis, are being accepted at last-slowly (perhaps even a little reluctantly)-and applied in practice without reference to their originator.
confirmed the
healthy females. There were 50 people in each of these groups. Dr. Ogston and Dr. McAndrew do not give figures for the males and females separately, except in two ancillary studies. If, as our findings suggest, obesity in the healthy female may
"
A. G. WATKINS.
Parliament Service
Disability
Pensions
ON Dec. 16, under the ten minutes’ rule, Mr. LESLIE HALE was given leave to introduce a Bill to make further provision for the rehearing of applications for Service disability pensions, and to amend the law in connection with the onus of proof and limitation of time in relation to these pensions. QUESTION TIME Imported Scientific and Medical Research Apparatus Lord AMULREE asked H.M. Government whether imported apparatus and equipment intended for use in scientific or medical research in this country was, or would be, subject to the 15% import levy.-Lord RHODES, parliamentary secretary to the Board of Trade, replied: Schedule 2 to the Finance Bill provides that articles intended for use non-commercially, in scientific research or for a purpose connected with the advancement of any branch of learning, shall qualify for relief from the temporary import charge. Lord AMULREE: What is the procedure whereby people engaged on work of this sort and who import goods which are for scientific purposes can obtain relief from import duty ? Lord RHODES: The procedure for getting this relief will be the same as that which already applies for a similar relief from duty under the Import Duties Act, 1958. This is set out in Notice 342 issued by the Commissioners of Customs and Excise. Relief from the temporary import charge will be given automatically to successful applicants under that procedure.