- Email: [email protected]
CHEST X-RAYS AND RADIATION HAZARDS
1302 purpose for which it was not designed. I thought that, with the virtual cessation of pneumothorax treatment, it had gone into honourable retirement. We no longer possess one at this hospital. a
Brompton Hospital, Frimley Branch, Aldershot, Hants.
A. F. FOSTER-CARTER.
Mass
SIR,-You report (Nov. 19, p. 1149) that the Council advising the Home Secretary on judicial corporal punishconsidered that its reintroduction would be
M. E. MOORE. *** The second report of the Adrian Committee was published this week. Its recommendations appear on p. 1292, and the report is discussd in a leading article in this issue.-ED. L.
a
NATURAL HISTORY OF STAPHYLOCOCCAL SEPTICÆMIA
" retrograde step ". I have no doubt that this horrible phrase was in fact used as it is beloved by politicians and public figures generally, but in a scientific journal I think it should be printed only in italics or between inverted commas. Retrograde is derived from retro " (backward) and gradus (a step), and a retrograde step " is in my opinion on a par with our old friends the " gastric stomach ar)r<
t1-)f
"
rarrHar apart
"
JOHN M. ROBERTSON. CHEST X-RAYS AND RADIATION HAZARDS
SIR,-Although I agree with some of the points made by Dr. Beresford (Nov. 26), I should like to comment on his references to the use of mass miniature radiography. Such general pronouncements are not really helpful since the method of employing units needs to vary so much from area to area, and is indeed always under review by those in charge of units and by the regional hospital boards. In this area we continue to find a worthwhile pick-up rate; above the national average, from amongst the general public and industrial groups, and that is in spite of the very real cooperation we get from general practitioners. Our antenatal pick-up rate has also been persistently high, much higher than the figures held by the Adrian committee, in their interim report, to warrant continuation of the routine X-raying of antenatal patients. Court-Brown and others2 concluded that an increase of leukxmia among children due to radiographic examination of their mother’s abdomen during the relevant pregnancy was not established. With chest radiography, of course, the dosage received by the foetus is a fraction of that involved in X-ray pelvimetry. I hope, therefore, that obstetricians and general practitioners will not be discouraged, by Dr. Beresford’s letter, from getting their antenatal patients X-rayed where facilities are available, and especially where it is known that the pick-up rate is high. In 1959 mass radiography produced 37 % of the Southampton Chest Clinic notifications, and only 6 out of the 46 cases were general practitioners’ referrals. Many of these cases would not have been discovered if full use had not been made of the units available. Although we have not had a 35 mm. camera unit for many years and their replacements are with 70 or 100 mm. units, it is a pity to drum them out with malign implications; they have given great service and were a lot more trouble-free than some of the later units. In the interim Adrian report the radiation figures for the 35 mm. units were certainly as good as and in some cases better than for the 70 and 100 mm. units.
I agree that all reasonable steps should be taken to reduce radiation figures to the lowest level, and with the use of light-beam defining systems and faster X-ray film we have been able to get readings for the female ovary dose up to 30 times less than the average figures quoted in thi- interim Acir;nn 1. 2.
ri-nnrt
Radiological Hazards to Patients: Interim Report of the Committee. H.M. Stationery Office, 1959. Court-Brown, W. M., Doll, R., Bradford Hill, A. Brit. med. J. Nov. 26, 1960, p. 1539.
Radiography Centre, Southampton
"RETROGRADE STEP"
ment
This is a time when we need to discover every possible of pulmonary tuberculosis, and the method of using mass miniature radiography for that purpose must be decided locally. Finally, is the discovery of other abnormalities so unimportant ? case
SIR,-I stated in the first paragraph of my paper1 on this subject that some have suggested that this infection is increasing in frequency, but others have denied this. In the second statement I referred to Dr. Hassall and Dr. Rountree as denying this. This is an error because they were particularly impressed by the increase in cases of staphylococcal septicaemia from 1954 onwards. They were therefore in agreement with our findings in the paper. State
University of Iowa, Iowa
IAN MACLEAN SMITH.
City.
TREATMENT OF OBESITY BY THE HIGH-FAT DIET
SIR,-As Dr. Sasieni
says (Nov. 12), it is most importdiet for the obese should be acceptable both financially and socially, particularly since one’s aim is to make the diet a permanent eating habit. The lowcarbohydrate diet of which we wrote (Oct. 29) can fulfil these criteria as least as well as any other diet low in ant
that
a
calories. It is understandable that
a
diet in which the
stress
is laid
positively on unlimited amounts of eggs, meat, cheese, fish, green vegetables, butter, and cream should seem inordinately expensive. But in four ways this immediate reaction is misleading. Firstly, one often forgets that many people consume a great deal of carbohydrate in quite expensive foods, such as cakes, biscuits, sweets, and chocolates. For these people, a change to a low carbohydrate diet may represent a greatly reduced expenditure on food. Our patient no. 1 spent 12s. a such items. Secondly, it should be remembered that one essential feature of any long-term dietary regime is that it must be nutritionally adequate. It is possible that some patients consume diets with a preponderance of carbohydrate, and with inadequate or at least marginal amounts of some of the nutrients. Quite irrespective of dieting, therefore, a doctor who becomes aware that a patient is eating such a diet must advise him to take more of the foods that we have mentioned, since they are on the whole foods which supply a greater proportion of the essential nutrients. Thirdly, it should be remembered that the low-carbohydrate diet, whilst stressing " unlimited " amounts of carbohydratefree foods, is in fact self-limiting; as we pointed out, this is why it reduces weight. Finally, it is not necessary that meat should always be prime steak, or that cheese always be Camembert, or that fish always be salmon: there are equally nutritious but far cheaper alternatives. week
on
Socially, too, no calorically restricted diet can be more acceptable than a low-carbohydrate diet. This point has already been covered in some detail.2 Consider, for example, the food which would be eaten at a dinner party by the overweight woman of whom Dr. Sasieni writes. She would have the smoked salmon but take no brown bread. She would have the soup, but not nibble her bread roll. 1. 2.
Lancet, 1960, i, 1318. Yudkin, J. This Slimming Business. London, 1958.
Brompton Hospital, Frimley Branch, Aldershot, Hants.
A. F. FOSTER-CARTER.
Mass
SIR,-You report (Nov. 19, p. 1149) that the Council advising the Home Secretary on judicial corporal punishconsidered that its reintroduction would be
M. E. MOORE. *** The second report of the Adrian Committee was published this week. Its recommendations appear on p. 1292, and the report is discussd in a leading article in this issue.-ED. L.
a
NATURAL HISTORY OF STAPHYLOCOCCAL SEPTICÆMIA
" retrograde step ". I have no doubt that this horrible phrase was in fact used as it is beloved by politicians and public figures generally, but in a scientific journal I think it should be printed only in italics or between inverted commas. Retrograde is derived from retro " (backward) and gradus (a step), and a retrograde step " is in my opinion on a par with our old friends the " gastric stomach ar)r<
t1-)f
"
rarrHar apart
"
JOHN M. ROBERTSON. CHEST X-RAYS AND RADIATION HAZARDS
SIR,-Although I agree with some of the points made by Dr. Beresford (Nov. 26), I should like to comment on his references to the use of mass miniature radiography. Such general pronouncements are not really helpful since the method of employing units needs to vary so much from area to area, and is indeed always under review by those in charge of units and by the regional hospital boards. In this area we continue to find a worthwhile pick-up rate; above the national average, from amongst the general public and industrial groups, and that is in spite of the very real cooperation we get from general practitioners. Our antenatal pick-up rate has also been persistently high, much higher than the figures held by the Adrian committee, in their interim report, to warrant continuation of the routine X-raying of antenatal patients. Court-Brown and others2 concluded that an increase of leukxmia among children due to radiographic examination of their mother’s abdomen during the relevant pregnancy was not established. With chest radiography, of course, the dosage received by the foetus is a fraction of that involved in X-ray pelvimetry. I hope, therefore, that obstetricians and general practitioners will not be discouraged, by Dr. Beresford’s letter, from getting their antenatal patients X-rayed where facilities are available, and especially where it is known that the pick-up rate is high. In 1959 mass radiography produced 37 % of the Southampton Chest Clinic notifications, and only 6 out of the 46 cases were general practitioners’ referrals. Many of these cases would not have been discovered if full use had not been made of the units available. Although we have not had a 35 mm. camera unit for many years and their replacements are with 70 or 100 mm. units, it is a pity to drum them out with malign implications; they have given great service and were a lot more trouble-free than some of the later units. In the interim Adrian report the radiation figures for the 35 mm. units were certainly as good as and in some cases better than for the 70 and 100 mm. units.
I agree that all reasonable steps should be taken to reduce radiation figures to the lowest level, and with the use of light-beam defining systems and faster X-ray film we have been able to get readings for the female ovary dose up to 30 times less than the average figures quoted in thi- interim Acir;nn 1. 2.
ri-nnrt
Radiological Hazards to Patients: Interim Report of the Committee. H.M. Stationery Office, 1959. Court-Brown, W. M., Doll, R., Bradford Hill, A. Brit. med. J. Nov. 26, 1960, p. 1539.
Radiography Centre, Southampton
"RETROGRADE STEP"
ment
This is a time when we need to discover every possible of pulmonary tuberculosis, and the method of using mass miniature radiography for that purpose must be decided locally. Finally, is the discovery of other abnormalities so unimportant ? case
SIR,-I stated in the first paragraph of my paper1 on this subject that some have suggested that this infection is increasing in frequency, but others have denied this. In the second statement I referred to Dr. Hassall and Dr. Rountree as denying this. This is an error because they were particularly impressed by the increase in cases of staphylococcal septicaemia from 1954 onwards. They were therefore in agreement with our findings in the paper. State
University of Iowa, Iowa
IAN MACLEAN SMITH.
City.
TREATMENT OF OBESITY BY THE HIGH-FAT DIET
SIR,-As Dr. Sasieni
says (Nov. 12), it is most importdiet for the obese should be acceptable both financially and socially, particularly since one’s aim is to make the diet a permanent eating habit. The lowcarbohydrate diet of which we wrote (Oct. 29) can fulfil these criteria as least as well as any other diet low in ant
that
a
calories. It is understandable that
a
diet in which the
stress
is laid
positively on unlimited amounts of eggs, meat, cheese, fish, green vegetables, butter, and cream should seem inordinately expensive. But in four ways this immediate reaction is misleading. Firstly, one often forgets that many people consume a great deal of carbohydrate in quite expensive foods, such as cakes, biscuits, sweets, and chocolates. For these people, a change to a low carbohydrate diet may represent a greatly reduced expenditure on food. Our patient no. 1 spent 12s. a such items. Secondly, it should be remembered that one essential feature of any long-term dietary regime is that it must be nutritionally adequate. It is possible that some patients consume diets with a preponderance of carbohydrate, and with inadequate or at least marginal amounts of some of the nutrients. Quite irrespective of dieting, therefore, a doctor who becomes aware that a patient is eating such a diet must advise him to take more of the foods that we have mentioned, since they are on the whole foods which supply a greater proportion of the essential nutrients. Thirdly, it should be remembered that the low-carbohydrate diet, whilst stressing " unlimited " amounts of carbohydratefree foods, is in fact self-limiting; as we pointed out, this is why it reduces weight. Finally, it is not necessary that meat should always be prime steak, or that cheese always be Camembert, or that fish always be salmon: there are equally nutritious but far cheaper alternatives. week
on
Socially, too, no calorically restricted diet can be more acceptable than a low-carbohydrate diet. This point has already been covered in some detail.2 Consider, for example, the food which would be eaten at a dinner party by the overweight woman of whom Dr. Sasieni writes. She would have the smoked salmon but take no brown bread. She would have the soup, but not nibble her bread roll. 1. 2.
Lancet, 1960, i, 1318. Yudkin, J. This Slimming Business. London, 1958.