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Apple juice and the chemical-contact softening of gallstones
Down’s syndrome screening Sir—We appreciate Nicholas Wald’s (Oct 9, p 1264)1 demonstration of the inequity in health care in the UK in the area of prenatal diagnosis. We work for a health authority that had chosen not to implement any form of biochemical screening for Down’s syndrome. Several bids to introduce triple testing have been made to our health authority, the first in 1992. In principal, we are told, the triple test is a much more effective screening method than amniocentesis, which is offered to older mothers. However, we must await the report of the National Screening Committee who (we agree) will probably know best. This report has been long delayed, and meanwhile the inequity of services increases. Some health authorities, as Wald reports, offer two forms of screening (nuchal and biochemical) and others offer none. We are surrounded by health authorities who do offer biochemical screening and dating scans, and, being a tertiary referral centre we provide women from these districts with counselling and amniocentesis as appropriate. Meanwhile, local women pay for a variety of screening tests, often with no pretest counselling and no dating scan. We have waited too long for national guidelines. The decision of the National Screening Committee should be made known as a matter of urgency and the inequity that currently exists in screening for Down’s syndrome and other congenital anomalies removed. *P A Boyd, P Chamberlain Oxford Prenatal Diagnosis Service, Women’s Centre, Oxford Radcliffe Hospital, Headington, Oxford OX3 9DU, UK 1
Wald NJ, Huttly WJ, Hennessy CF. Down’s syndrome screening in the UK in 1998. Lancet 1999; 354: 1264.
Mycobacterium ulcerans Sir—As captain of the Buruli team at Makerere in Kampala, Uganda, about 30 years ago, I read with interest Tjip van der Werf and colleagues’ (Sept 18, p 1013)1 review on Mycobacterium ulcerans. There have been substantial advances in the understanding of the epidemiology and pathogenesis of the Buruli ulcer. It is surprising that there is no mention of the occurrence of any heavy rainful or flooding in west Africa as possible factors in the surge of occurrence of M ulcerans. Van der Werf and colleagues give a bland logical explanation of the discovery that M ulcerans grows only at 32–33ºC.
THE LANCET • Vol 354 • December 18/25, 1999
It would be regrettable if the story of one of the greatest tricks of fate were buried in time. P MacCallum was repeatedly unsuccessful in his attempts to grow this acid-fast bacillus; then one day he was successful—when the incubator was out of order. I have had confirmation of this anecdote from the distinguished Australian pathologist John Hayman who was pathology registrar with P MacCallum in 1963–66. He calls attention to the report of Buckle.2 William Parson Medical University of Washington, Seattle, WA 98115, USA 1
2
Van der Werf TS, Van der Graaf TA, Tappero JW, Asiedu K. Mycobacterium ulcerans infection. Lancet 1999; 354: 1013–18. Buckle G. Notes on M ulcerans. Aust NZ J Surg 1972; 41: 320–23.
Apple juice and the chemical-contact softening of gallstones Sir—As a chemical engineer I enjoyed Axel Helmstädter’s explanation (Oct 16, p 1376)1 of dissolution of gallstones by application of several organic solvents, anorganic acids, and mixtures of them. I was surprised that he did not mention the possible sideeffects. As a doctor I would expect erosion of the epithelial lining of the intestines and airways, chemical pneumonia, and acute intoxication. Perhaps some of the cured patients had an acid-proof and solvent-resistant condition. My wife has treated herself for gallstones. She took for 1 week 1 L apple juice daily and on the 7th day 1 cup of olive oil just before going to bed. She then lay on her left side during the night. Next morning the stones were collected in the stool. They were soft and brown. At the university hospital they were recognised as fatty stones. For easy collection of the stones the bowels can be cleaned by an oral dose of magnesium sulphate at noon and skipping of the evening meal on day 7. In comparison with the chemical prescription, apple-juice therapy is kinder to the human body and will have only some minor untasty side-effects. R Dekkers Regional Community Health Department of South-Kennemerland, Section of Infectious Diseases and Environmental Health, P OB o x 1622, 2003 BR Haarlem, Netherlands 1
Helmsträdter A. Ether and the chemicalcontact dissolution of gallstones. Lancet 1999; 354: 1376–77.
Web of life Sir—Penny Osmond and Martyn Osmond (Oct 23, p 1482),1 in their review of London Zoo’s exhibition Web of Life, show wisdom beyond their years. They explore with great insight some of the most important issues that should be faced by the worlds’ human population—ie, the interaction of organisms within a biodiverse environment. In 1999, the world’s population briefly reached 6 billion; seconds later it ploughed on upwards. “All species strive to proliferate, but predators, disease, and starvation limit populations that get out of hand, and disturb the balance of nature. Can humanity keep its own population in check before nature applies its own brutal methods?” writes Richard Buckley.2 The ideas of environmentalists have often been dismissed; their aspirations to save the world from the devastating onslaught of mankind are often sidelined in a world driven by capitalist values, economic development, and efforts to raise gross national product. A century is a very short time in the history of the world, and provides only a few generations of mankind. It is rare for economic development to be considered in timescales longer than a decade. The short-term philosophy encapsulated in today’s economic development is far from sustainable in the long-term. James Lovelock described the Gaia hypothesis, a theory in which the notion of unity of the environment with all living organisms is inherent. He wrote that, “the evolution of the species of living organisms is so closely coupled with the evolution of their physical and chemical environment that together they constitute a single and indivisible evolutionary process.”3 He continued, “the entire Gaia system has many features in common with the physiology of warm-blooded animals, the atmosphere acting as a global lungs, and the rivers and the oceans, acting like the blood in a circulatory system”. In short, the Gaia hypothesis describes the earth as a global organism. I agree with your criticism (Oct 23 editorial)4 of the narrowness of Nobel awards for physiology or medicine. The determinants of health are extremely broad. The understanding of the role of nitric oxide in the cardiovascular system will in time no doubt produce much benefit for man. The elimination of poverty will do much to benefit the health of society today. However, the broadest determinant of mankind’s health over centuries is our global
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Wald NJ, Huttly WJ, Hennessy CF. Down’s syndrome screening in the UK in 1998. Lancet 1999; 354: 1264.
Mycobacterium ulcerans Sir—As captain of the Buruli team at Makerere in Kampala, Uganda, about 30 years ago, I read with interest Tjip van der Werf and colleagues’ (Sept 18, p 1013)1 review on Mycobacterium ulcerans. There have been substantial advances in the understanding of the epidemiology and pathogenesis of the Buruli ulcer. It is surprising that there is no mention of the occurrence of any heavy rainful or flooding in west Africa as possible factors in the surge of occurrence of M ulcerans. Van der Werf and colleagues give a bland logical explanation of the discovery that M ulcerans grows only at 32–33ºC.
THE LANCET • Vol 354 • December 18/25, 1999
It would be regrettable if the story of one of the greatest tricks of fate were buried in time. P MacCallum was repeatedly unsuccessful in his attempts to grow this acid-fast bacillus; then one day he was successful—when the incubator was out of order. I have had confirmation of this anecdote from the distinguished Australian pathologist John Hayman who was pathology registrar with P MacCallum in 1963–66. He calls attention to the report of Buckle.2 William Parson Medical University of Washington, Seattle, WA 98115, USA 1
2
Van der Werf TS, Van der Graaf TA, Tappero JW, Asiedu K. Mycobacterium ulcerans infection. Lancet 1999; 354: 1013–18. Buckle G. Notes on M ulcerans. Aust NZ J Surg 1972; 41: 320–23.
Apple juice and the chemical-contact softening of gallstones Sir—As a chemical engineer I enjoyed Axel Helmstädter’s explanation (Oct 16, p 1376)1 of dissolution of gallstones by application of several organic solvents, anorganic acids, and mixtures of them. I was surprised that he did not mention the possible sideeffects. As a doctor I would expect erosion of the epithelial lining of the intestines and airways, chemical pneumonia, and acute intoxication. Perhaps some of the cured patients had an acid-proof and solvent-resistant condition. My wife has treated herself for gallstones. She took for 1 week 1 L apple juice daily and on the 7th day 1 cup of olive oil just before going to bed. She then lay on her left side during the night. Next morning the stones were collected in the stool. They were soft and brown. At the university hospital they were recognised as fatty stones. For easy collection of the stones the bowels can be cleaned by an oral dose of magnesium sulphate at noon and skipping of the evening meal on day 7. In comparison with the chemical prescription, apple-juice therapy is kinder to the human body and will have only some minor untasty side-effects. R Dekkers Regional Community Health Department of South-Kennemerland, Section of Infectious Diseases and Environmental Health, P OB o x 1622, 2003 BR Haarlem, Netherlands 1
Helmsträdter A. Ether and the chemicalcontact dissolution of gallstones. Lancet 1999; 354: 1376–77.
Web of life Sir—Penny Osmond and Martyn Osmond (Oct 23, p 1482),1 in their review of London Zoo’s exhibition Web of Life, show wisdom beyond their years. They explore with great insight some of the most important issues that should be faced by the worlds’ human population—ie, the interaction of organisms within a biodiverse environment. In 1999, the world’s population briefly reached 6 billion; seconds later it ploughed on upwards. “All species strive to proliferate, but predators, disease, and starvation limit populations that get out of hand, and disturb the balance of nature. Can humanity keep its own population in check before nature applies its own brutal methods?” writes Richard Buckley.2 The ideas of environmentalists have often been dismissed; their aspirations to save the world from the devastating onslaught of mankind are often sidelined in a world driven by capitalist values, economic development, and efforts to raise gross national product. A century is a very short time in the history of the world, and provides only a few generations of mankind. It is rare for economic development to be considered in timescales longer than a decade. The short-term philosophy encapsulated in today’s economic development is far from sustainable in the long-term. James Lovelock described the Gaia hypothesis, a theory in which the notion of unity of the environment with all living organisms is inherent. He wrote that, “the evolution of the species of living organisms is so closely coupled with the evolution of their physical and chemical environment that together they constitute a single and indivisible evolutionary process.”3 He continued, “the entire Gaia system has many features in common with the physiology of warm-blooded animals, the atmosphere acting as a global lungs, and the rivers and the oceans, acting like the blood in a circulatory system”. In short, the Gaia hypothesis describes the earth as a global organism. I agree with your criticism (Oct 23 editorial)4 of the narrowness of Nobel awards for physiology or medicine. The determinants of health are extremely broad. The understanding of the role of nitric oxide in the cardiovascular system will in time no doubt produce much benefit for man. The elimination of poverty will do much to benefit the health of society today. However, the broadest determinant of mankind’s health over centuries is our global
2171