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ACUTE THYROIDITIS AND GLUTAMIC ACID
217 One could aay cardiovascular and renal diseases ? that there is a prima-facie case for study but nothing more. No syllogism can be derived from it. I have endeavoured to show as simply aa possible that the available information does not allow us to state that the relief of obesity prolongs life and vice versa. My interest lies not in obesity but in the scientific approach to medicine, and it is in this light that I criticise the thesis. The investigation of the problem must begin with the establishment of weight-ranges which are optimal for all the somatotypes, assuming that there are optima. It would be a tragedy indeed if physicians were to reduce constitutionally large men to invalidism by zealous underfeeding and so enter into sharp competition with the phlebotomists of the dark ages. ,
Roffey Park Rehabilitation Centre, Sussex. Horsham, Sussex.
R. H. BOARDMAN. BOARDMAN. R.H.
MASS RADIOGRAPHY AND PULMONARY TUBERCULOSIS SIR,—It is gratifying indeed to see within one week two articleswhich show so convincingly the supreme value of mass radiography for the detection of pulmonary tuberculosis and other serious chest diseases by placing this method freely at the disposal of general practitioners. Dr. Sutherland in his admirable paper quite rightly puts the burden of early diagnosis on the G.P.s, and he suggests as an important step towards this aim that the British Medical Association should arrange for suitable postgraduate lectures to G.P.s on the Early Diagnosis of Tuberculosis. He may like to know that, with the local branch of the B.M.A., I started such lectures last year. May I, however, differ from Dr. Sutherland in his appreciation of the value of sputum examinations arranged by the G.P. ? As I have pointed out before,2 a negative sputum return, particularly in the case of one single direct smear, has no significance. It excludes neither active tuberculosis nor cancer nor anv other serious chest disease. Moreover, I doubt whether the patient-or even the doctor—knows exactly what sort of sputum is required and that non-purulent sputum is not likely to show tubercle bacilli. Practitioners should, in my opinion, rather be discouraged from wasting time by waiting for the sputum result and from creating possibly undue optimism as a result of a negative return. If the sputum is positive the patient has to be radiographed as soon as possible in any case. If the result is negative, no information whatever has been gained : the patient ought still to be radiographed. The statement that sputum examination in the hands of the G.r. is a double-edged sword, which can easily "’ do more harm than good if any reliance were to be placed on negative returns," bears repetition. On the page following Dr. Sutherland’s article we are informed of a new venture by the North-West Metropolitan Regional Hospital Board—a survey designed for " examining radiographically the wtcole adult population of Islington." One wonders by what gentle means of persuasion, propaganda, promises, or incentives the authorities will secure the wholehearted cooperation of "the whole adult population." It will be most interesting to see from the ensuing report on this survey not only the number of people examined and of cases discovered but also the number of people who failed to attend. Earlier figuressuggest that the success of any mass survey depends entirely on a very high rate of attendance. Holywood Hall Sanatorium, E. G. W. HOFFSTAEDT. Wolsingham,
co.
1. Sutherland, H.
Durham.
Lancet, Jan. 19, 1952, p. 152. Trenchard, H. J.
Grenville-Mathers, R.
Tubercle, 1952, 33, 20. 2. Hoffstaedt, E. G. W. Lancet, 1947, ii, 955. 3. Bradbury, F. C. S. Ibid, 1948, ii, 293. Hoffstaedt, E. G. W. Ibid, 1950, ii, 756.
ACUTE THYROIDITIS AND GLUTAMIC ACID
SIR,—In view of the rarity of acute thyroiditis and the use of glutamic acid in the treatment of the following case intellectual defect, epilepsy, &c., be of interest. to special appears
increasing
A male imbecile patient, aged 22 years, who had noabnormal and was in good physical health, was given 4 g. of glutamic acid daily from Aug. 24, 1950. On Oct. 2 lie developed influenza, which was characterised by cough, backache, and a temperature of 1O0.6OF. Influenza was prevalent in the hospital at that time ; a number of patients in his ward had the disease, and this patient’s condition was clinically similar to theirs. After forty-eight hours both lie and the other patients in that ward were afebrile.
signs
Four days later this patient developed a prominent swelling of the thyroid gland, and the administration of glutamic acid was discontinued. At first the swelling was greatest around the isthmus, but by the following day the whole gland was At the onset of the swelling the very tense and tender. rose to 104°F, and the patient was very ill ; neck movements, particularly extension, caused severe pain from pressure on the inflamed gland. During the next five days a brassy cough developed, and also slight dyspnoea ; and .his temperature fluctuated between 102’80 and 99ùF. He was treated with penicillin and sulphadimidine, and after sixteen days he had recovered except for some fullness in the region of the thyroid and a husky voice. At no time did the thyroid have the " woody " feel ascribed to Riedel’s
temperature
thyroiditis. It is not
therapy acute
possible
did in fact
thyroiditis,
to state whether the glutamic acid predispose to the development of but this possibility cannot ’ be
discounted. Hensol Hensol Castle, Pontyclun, Glam.
T. S. DAVIES.
COLLEGES AND FACULTIES SIR,—Your memory is generally long, but in your leading article last week you overlooked, if you did not reject, the logical conclusion of your argument-namely, fusion of the three Royal Colleges into one Academy. Such a body could well embrace the " senior discipline," general practice, and speak with one voice for Medicine
whole. Other advantages of such federation were cogently argued by the late Lord Dawson of Penn. It is not too late to reconsider the situation ; indeed the needs of general practitioners provide the opportunity. E. ROCK CARLING. London, W.1. as a
Medicine and the Law Accident with an Electric Blanket A FIRE caused by an electric blanket was described at an inquest in Cheshire.’ A retired doctor, aged 87, who suffered from arthritis was extensively burned when the blanket on which he was lying caught fire, and he died a week later. An Inspector of Factories said in evidence that one of the thermostats in the blanket had been damaged by the doctor lying on or near it : the blanket, it seems, should not have been slept upon, but put over the patient. A representative of the manufacturers, on the other hand, thought that dampness had produced a short-circuit and caused the fire ; but there was no evidence to suggest that the blanket was damp. The manufacturers specified in their instructions that a waterproof sheet should cover the blanket. This particular type of blanket was intended for use in hospitals and was not suitable for the home. A verdict of " death by misadventure was recorded. "
1. Liverpool Echo, Jan. 4, 1952.
Roffey Park Rehabilitation Centre, Sussex. Horsham, Sussex.
R. H. BOARDMAN. BOARDMAN. R.H.
MASS RADIOGRAPHY AND PULMONARY TUBERCULOSIS SIR,—It is gratifying indeed to see within one week two articleswhich show so convincingly the supreme value of mass radiography for the detection of pulmonary tuberculosis and other serious chest diseases by placing this method freely at the disposal of general practitioners. Dr. Sutherland in his admirable paper quite rightly puts the burden of early diagnosis on the G.P.s, and he suggests as an important step towards this aim that the British Medical Association should arrange for suitable postgraduate lectures to G.P.s on the Early Diagnosis of Tuberculosis. He may like to know that, with the local branch of the B.M.A., I started such lectures last year. May I, however, differ from Dr. Sutherland in his appreciation of the value of sputum examinations arranged by the G.P. ? As I have pointed out before,2 a negative sputum return, particularly in the case of one single direct smear, has no significance. It excludes neither active tuberculosis nor cancer nor anv other serious chest disease. Moreover, I doubt whether the patient-or even the doctor—knows exactly what sort of sputum is required and that non-purulent sputum is not likely to show tubercle bacilli. Practitioners should, in my opinion, rather be discouraged from wasting time by waiting for the sputum result and from creating possibly undue optimism as a result of a negative return. If the sputum is positive the patient has to be radiographed as soon as possible in any case. If the result is negative, no information whatever has been gained : the patient ought still to be radiographed. The statement that sputum examination in the hands of the G.r. is a double-edged sword, which can easily "’ do more harm than good if any reliance were to be placed on negative returns," bears repetition. On the page following Dr. Sutherland’s article we are informed of a new venture by the North-West Metropolitan Regional Hospital Board—a survey designed for " examining radiographically the wtcole adult population of Islington." One wonders by what gentle means of persuasion, propaganda, promises, or incentives the authorities will secure the wholehearted cooperation of "the whole adult population." It will be most interesting to see from the ensuing report on this survey not only the number of people examined and of cases discovered but also the number of people who failed to attend. Earlier figuressuggest that the success of any mass survey depends entirely on a very high rate of attendance. Holywood Hall Sanatorium, E. G. W. HOFFSTAEDT. Wolsingham,
co.
1. Sutherland, H.
Durham.
Lancet, Jan. 19, 1952, p. 152. Trenchard, H. J.
Grenville-Mathers, R.
Tubercle, 1952, 33, 20. 2. Hoffstaedt, E. G. W. Lancet, 1947, ii, 955. 3. Bradbury, F. C. S. Ibid, 1948, ii, 293. Hoffstaedt, E. G. W. Ibid, 1950, ii, 756.
ACUTE THYROIDITIS AND GLUTAMIC ACID
SIR,—In view of the rarity of acute thyroiditis and the use of glutamic acid in the treatment of the following case intellectual defect, epilepsy, &c., be of interest. to special appears
increasing
A male imbecile patient, aged 22 years, who had noabnormal and was in good physical health, was given 4 g. of glutamic acid daily from Aug. 24, 1950. On Oct. 2 lie developed influenza, which was characterised by cough, backache, and a temperature of 1O0.6OF. Influenza was prevalent in the hospital at that time ; a number of patients in his ward had the disease, and this patient’s condition was clinically similar to theirs. After forty-eight hours both lie and the other patients in that ward were afebrile.
signs
Four days later this patient developed a prominent swelling of the thyroid gland, and the administration of glutamic acid was discontinued. At first the swelling was greatest around the isthmus, but by the following day the whole gland was At the onset of the swelling the very tense and tender. rose to 104°F, and the patient was very ill ; neck movements, particularly extension, caused severe pain from pressure on the inflamed gland. During the next five days a brassy cough developed, and also slight dyspnoea ; and .his temperature fluctuated between 102’80 and 99ùF. He was treated with penicillin and sulphadimidine, and after sixteen days he had recovered except for some fullness in the region of the thyroid and a husky voice. At no time did the thyroid have the " woody " feel ascribed to Riedel’s
temperature
thyroiditis. It is not
therapy acute
possible
did in fact
thyroiditis,
to state whether the glutamic acid predispose to the development of but this possibility cannot ’ be
discounted. Hensol Hensol Castle, Pontyclun, Glam.
T. S. DAVIES.
COLLEGES AND FACULTIES SIR,—Your memory is generally long, but in your leading article last week you overlooked, if you did not reject, the logical conclusion of your argument-namely, fusion of the three Royal Colleges into one Academy. Such a body could well embrace the " senior discipline," general practice, and speak with one voice for Medicine
whole. Other advantages of such federation were cogently argued by the late Lord Dawson of Penn. It is not too late to reconsider the situation ; indeed the needs of general practitioners provide the opportunity. E. ROCK CARLING. London, W.1. as a
Medicine and the Law Accident with an Electric Blanket A FIRE caused by an electric blanket was described at an inquest in Cheshire.’ A retired doctor, aged 87, who suffered from arthritis was extensively burned when the blanket on which he was lying caught fire, and he died a week later. An Inspector of Factories said in evidence that one of the thermostats in the blanket had been damaged by the doctor lying on or near it : the blanket, it seems, should not have been slept upon, but put over the patient. A representative of the manufacturers, on the other hand, thought that dampness had produced a short-circuit and caused the fire ; but there was no evidence to suggest that the blanket was damp. The manufacturers specified in their instructions that a waterproof sheet should cover the blanket. This particular type of blanket was intended for use in hospitals and was not suitable for the home. A verdict of " death by misadventure was recorded. "
1. Liverpool Echo, Jan. 4, 1952.