- Email: [email protected]
A VISIT TO KOLTUSHI
1074 horizontal mattress sutures for the latter. During this period there has been only one " burst " but this I shall regard as fortuitous only, unless the passage of several years more confirms the reduced incidence. Mr. Walton’s other points agree with those stated or inferred in my paper. A. STANDEVEN. Hove. RADIOLOGY OF PLACENTA PRÆVIA note with interest the correspondence which our article of April 16. Our experience of placentography is limited to the past three years, but we have come to rely on the method to show which cases of antepartum haemorrhage are due to placenta praevia and must therefore remain under observation in hospital. In our article we described how radiology has helped in the
SIR,—We
has followed
management of cases of anterior placenta prævia delivered by caesarean section. An important point yet to be determined, we believe, is the extent to which placentography can replace the final vaginal assessment by the obstetrician in the theatre. Mr. Percival (April 23) has suggested that there should be no " percervical " examination when clinical and radiological evidence points to a major degree of placenta prævia. Weappreciate his reasons for wishing to proceed to cæsarean section without delay and would agree that there are certain cases where this action might appear justifiable. Nevertheless we consider that there is a need for caution in this matter. Despite the claims of Dr. Blair Hartley (April 30) and the great contribution he has made to the radiographic localisation of placenta prævia, we are impressed by the difficulty in establishing by postural and soft-tissue radiography the exact extent to which the placenta encroaches on the lower uterine segment. It is the difficulty of defining precisely the lower edge of the placenta in many cases of placenta prævia which makes us believe that there is still a place for careful vaginal assessment before the final decision as to vaginal or abdominal delivery is made. Without this vaginal assessment it may be difficult to agree upon what constitutes a " major" degree of placenta praevia. For the individual patient it is important to avoid an unnecessary cæsarean section, particularly as placenta pro3via is not a recurring condition and between 40% and 50% of cases can safely be delivered per vaginam. Even with radiographs of the superb quality produced Hospitals, Manchester, it is only in 30% of by St. Mary’s pregnant women after the thirty-second week that it has been possible to demonstrate placental calcification. Moreover, the demonstration of placental calcification does not necessarily enable the lower edge to be identified, especially in cases of placenta prævia. Until it is possible to do this precisely we believethat vaginal examination in the theatre is indicated. J. K. RUSSELL Royal Victoria Infirmary, C. K. WARRICK. Newcastle
** * In and Dr.
upon
an
Tyne.
article in this issue (p. 1045) Mr. Percival their experiences of soft-tissue
Murray record placentography.-ED. L.
A VISIT TO KOLTUSHI
SIR,—I note Dr. Foggitt’s criticism last week of my letter of May 7. He makes a serious charge that I show a doctrinaire disregard of facts." On the contrary, in the last paragraph of my letter, I stated a procedure enabling a person to demonstrate a fact disregarded by Pavlov and his followers. I refer to the fact that a person who employs a technique of conscious guidance and control of reaction enabling him to guide the manner of the working of the self as a whole by means of the primary control of the use of the self, head forward and np, thereby controls the self in such a way that it may be demonstrated to work as a unity. "
It works, therefore, in a manner preventing the person from interfering with the needs which are " vital"for providing the freedom enabling the human mechanism to work in the best possible way as a whole. As a consequence, "vital"processes such as digestion, respiration, and thought work in what may be shown to be the best way, and, therefore, in a way capable of preventing disturbances of gastric function, incidents such as bronchospasm and the kind of thought associated with what is recognised as schizophrenia. Freedom of thought and action are essential not only in the scientific world " but in the world at large ; and I described a practical procedure whereby a person might provide himself with these advantages. Dr. Foggitt can prove this for himself by employing the procedure I set down in my last letter. If he has not enjoyed the experience necessary to this end, both Mr. F. Matthias Alexander and I will be to demonstrate and discuss for his benefit the objective procedure involved. If he is prepared to accept this invitation, he will discover that he will be required to show an unremitting " meticulous objectivity" in giving his attention to the details of the procedure, if he wishes to employ it in a manner enabling him to provide for his use a self working at its best, therefore, in a way associated with kinsesthetic information about near and distant influences in the environment, both external and internal, working in a reliable way, and, therefore, in a way enabling him to prevent himself from being dominated by reflexes conditioned by his environment about whose influence over him he would otherwise be unaware. Unless he employs the procedure with a meticulous attention to detail. he may very well find himself enslaved by reflexes controlling his behaviour in a way that makes him in no sense free.
glad
MUNGO DOUGLAS.
Bolton. Lanes.
IRON-DEXTRAN COMPLEX IN MICE AND MEN
be unfortunate if Dr. Nissim’s interestarticle (April 2) were to pass without further comment ing than that so aptly made by Dr. Golberg and his 16. colleagues in their letter of The title of the paper, the dramatic photomicrographs, the tenor of the discussion, and the brief conclusions summate to produce in the mind of the casual reader the impression that the administration of intramuscular iron might be followed by the development of testicular atrophy in a male patient. We have found that, despite Dr. Nissim’s reservation at the of his discussion, this impression has already been gained by those who havenot calculated that the same relativedosage in man would involve the injection of between 30 and 200 times as much as would ever be given clinically, given moreover to patients with a deficiencv of iron. The inference, therefore, that " the iron apparently interferes with the normal metabolism of the endocrine cells... and upsets spermatogenesis " is unreal when applied to clinical medicine, and is an example of the way in which the academic pharmaeologist may become divorced from the realities of
SIR,—It would
April
beginning
compound
practical therapeutics.
Furthermore, Dr. Nissim states loosely that " the of iron in the testes after the administration of imferon reminds one of the deposition of iron in the testes [my italics] and testicular atrophy in hsemochromatosis." This statement could be taken to transfer his results in mice with gargantuan doses (doses, may it be noted, only possible because the preparation is of low toxicity) to those which might be expected in man. It is, moreover, a mis-statement of fact as iron deposition does not occur in the testes in hæmochromatosis, and as Sheldon1 pointed out, the only appreciable iron detectable in the testes is small quantities in the vessels. It is the experience of Dr. Mary K. Macdonald in the department of pathology, University of Edinburgh, and of myself that iron deposition never occurs in the tubules or interstitial cells of the testes in haemochromatosis, and, when the patient is hypogonadal, the testicular atrophy is probably secondary to pituitary infiltration
deposition
1. Sheldon, J. H. Hæmochromatosis.
London, 1935.
SIR,—We
has followed
management of cases of anterior placenta prævia delivered by caesarean section. An important point yet to be determined, we believe, is the extent to which placentography can replace the final vaginal assessment by the obstetrician in the theatre. Mr. Percival (April 23) has suggested that there should be no " percervical " examination when clinical and radiological evidence points to a major degree of placenta prævia. Weappreciate his reasons for wishing to proceed to cæsarean section without delay and would agree that there are certain cases where this action might appear justifiable. Nevertheless we consider that there is a need for caution in this matter. Despite the claims of Dr. Blair Hartley (April 30) and the great contribution he has made to the radiographic localisation of placenta prævia, we are impressed by the difficulty in establishing by postural and soft-tissue radiography the exact extent to which the placenta encroaches on the lower uterine segment. It is the difficulty of defining precisely the lower edge of the placenta in many cases of placenta prævia which makes us believe that there is still a place for careful vaginal assessment before the final decision as to vaginal or abdominal delivery is made. Without this vaginal assessment it may be difficult to agree upon what constitutes a " major" degree of placenta praevia. For the individual patient it is important to avoid an unnecessary cæsarean section, particularly as placenta pro3via is not a recurring condition and between 40% and 50% of cases can safely be delivered per vaginam. Even with radiographs of the superb quality produced Hospitals, Manchester, it is only in 30% of by St. Mary’s pregnant women after the thirty-second week that it has been possible to demonstrate placental calcification. Moreover, the demonstration of placental calcification does not necessarily enable the lower edge to be identified, especially in cases of placenta prævia. Until it is possible to do this precisely we believethat vaginal examination in the theatre is indicated. J. K. RUSSELL Royal Victoria Infirmary, C. K. WARRICK. Newcastle
** * In and Dr.
upon
an
Tyne.
article in this issue (p. 1045) Mr. Percival their experiences of soft-tissue
Murray record placentography.-ED. L.
A VISIT TO KOLTUSHI
SIR,—I note Dr. Foggitt’s criticism last week of my letter of May 7. He makes a serious charge that I show a doctrinaire disregard of facts." On the contrary, in the last paragraph of my letter, I stated a procedure enabling a person to demonstrate a fact disregarded by Pavlov and his followers. I refer to the fact that a person who employs a technique of conscious guidance and control of reaction enabling him to guide the manner of the working of the self as a whole by means of the primary control of the use of the self, head forward and np, thereby controls the self in such a way that it may be demonstrated to work as a unity. "
It works, therefore, in a manner preventing the person from interfering with the needs which are " vital"for providing the freedom enabling the human mechanism to work in the best possible way as a whole. As a consequence, "vital"processes such as digestion, respiration, and thought work in what may be shown to be the best way, and, therefore, in a way capable of preventing disturbances of gastric function, incidents such as bronchospasm and the kind of thought associated with what is recognised as schizophrenia. Freedom of thought and action are essential not only in the scientific world " but in the world at large ; and I described a practical procedure whereby a person might provide himself with these advantages. Dr. Foggitt can prove this for himself by employing the procedure I set down in my last letter. If he has not enjoyed the experience necessary to this end, both Mr. F. Matthias Alexander and I will be to demonstrate and discuss for his benefit the objective procedure involved. If he is prepared to accept this invitation, he will discover that he will be required to show an unremitting " meticulous objectivity" in giving his attention to the details of the procedure, if he wishes to employ it in a manner enabling him to provide for his use a self working at its best, therefore, in a way associated with kinsesthetic information about near and distant influences in the environment, both external and internal, working in a reliable way, and, therefore, in a way enabling him to prevent himself from being dominated by reflexes conditioned by his environment about whose influence over him he would otherwise be unaware. Unless he employs the procedure with a meticulous attention to detail. he may very well find himself enslaved by reflexes controlling his behaviour in a way that makes him in no sense free.
glad
MUNGO DOUGLAS.
Bolton. Lanes.
IRON-DEXTRAN COMPLEX IN MICE AND MEN
be unfortunate if Dr. Nissim’s interestarticle (April 2) were to pass without further comment ing than that so aptly made by Dr. Golberg and his 16. colleagues in their letter of The title of the paper, the dramatic photomicrographs, the tenor of the discussion, and the brief conclusions summate to produce in the mind of the casual reader the impression that the administration of intramuscular iron might be followed by the development of testicular atrophy in a male patient. We have found that, despite Dr. Nissim’s reservation at the of his discussion, this impression has already been gained by those who havenot calculated that the same relativedosage in man would involve the injection of between 30 and 200 times as much as would ever be given clinically, given moreover to patients with a deficiencv of iron. The inference, therefore, that " the iron apparently interferes with the normal metabolism of the endocrine cells... and upsets spermatogenesis " is unreal when applied to clinical medicine, and is an example of the way in which the academic pharmaeologist may become divorced from the realities of
SIR,—It would
April
beginning
compound
practical therapeutics.
Furthermore, Dr. Nissim states loosely that " the of iron in the testes after the administration of imferon reminds one of the deposition of iron in the testes [my italics] and testicular atrophy in hsemochromatosis." This statement could be taken to transfer his results in mice with gargantuan doses (doses, may it be noted, only possible because the preparation is of low toxicity) to those which might be expected in man. It is, moreover, a mis-statement of fact as iron deposition does not occur in the testes in hæmochromatosis, and as Sheldon1 pointed out, the only appreciable iron detectable in the testes is small quantities in the vessels. It is the experience of Dr. Mary K. Macdonald in the department of pathology, University of Edinburgh, and of myself that iron deposition never occurs in the tubules or interstitial cells of the testes in haemochromatosis, and, when the patient is hypogonadal, the testicular atrophy is probably secondary to pituitary infiltration
deposition
1. Sheldon, J. H. Hæmochromatosis.
London, 1935.