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CHRONIC INFECTION AND BLOOD-PRESSURE
491
EJACULATION IN MALE RHESUS MONKEYS SIR,—Dr. Wiener’s interesting suggestion (Aug. 13), that the transmission of sexual information from the female monkey to the male may be by olfactory cues, is supported by work currently in progress and briefly reported elsewhere.’ Observamade on the sexual behaviour of ovariectomised rhesus monkeys after the local application of very small quantities of cestrogen (5 ug. per day) to their genitalia. Application restricted to the hormone-sensitive area of specialised skin " surrounding the external genitalia (the sexual skin ") restored the vivid red colour of the intact animal, but induced slight changes in the low sexual activity of the male. Vaginal smears taken during this procedure showed the vaginal epithelium to be unaffected. But when oestrogen in the same dose was introduced into the vaginal lumen, there was considerable stimulation of the male’s sexual activity, and mounting and ejaculation occurred frequently. The vaginal smears in this experiment resembled those from animals given large doses of oestrogen systemically. Alteration in some hormone-dependent quality within the vagina, and not changes in the female’s behaviour2 " or in the appearance of the sexual skin ", seems therefore to transmit information on the female monkey’s sexual attractiveness to the male. Experiments are in progress with anosmic males to test whether (as seems most likely) an olfactory mechanism is involved. The widespread use of perfume as a sexual attractant in our own species suggests that similar mechanisms, modified by social conventions, may operate in
of coronary-artery disease and thromboembolism. Dr. Maddocks and Dr. Vines have some information
Perhaps these
on
matters.
Holy Name of Jesus Hospital, Gadsden, Alabama.
J. H. ROGERS.
nons were
man.
Two further factors must be considered before these results on rhesus monkeys are applied more generally. Firstly, the extremely dominant position occupied by the male rhesus monkey over the female is greater than in some other species of monkeys, such as the langur3 or howler,4 and in these the females’ behaviour may have greater influence. Secondly, the smdies upon monkeys cited by Dr. Wiener were carried out upon temporarily isolated pairs of individuals, and social factors were therefore excluded: these themselves substantially modify basic neuroendocrine mechanisms. Department of Anatomy, University Medical School, Birmingham 15.
J. HERBERT.
A NEW REMEDY FOR MIGRAINE treatment of migraine with described in his letter last week, acidophilus, makes me wonder whether this organism replaces intestinal putrefactive anaerobes to such an extent as to influence alimentary tyramine tolerance,5 and whether a change in pH has this effect. J. P. CRAWFORD.
SIR,—Professor Ask-Upmark’s
Lactobacillus
CHRONIC INFECTION AND BLOOD-PRESSURE SIR,-The excellent article by Dr. Maddocks and Dr. Vines (July 30) raises the subject of the effect of chronic infection on degenerative vascular disease in general. I have maintamed that chronic or repeated infection has a beneficial effect on the incidence of coronary-artery disease, and thromboembolism generally, by virtue of changes in plasma-proteins :consisting of increase in globulins (including fibrinogen) and decrease in albumin.These changes, I believe, result in a relative in-vivo hypocoagulable state of the blood ". Pernaps a better term would be a relative hypothromboic state. Throughout the world, populations such as the one studied by Dr. Maddocks and Dr. Vines have shown low incidences ’‘
1. Herbert, J. Excerpta med. Int. Cong. Ser. 1966, 111, 212. 2. Herbert, J., Michael, R. P. Acta. endocr., Copenh. 1965, suppl. 100, p 173.
Jay, P. in Primate Behavior (edited by I. DeVore). New York, 1965. Carpenter, C. R. ibid. 5. Crawford, J. P. Medical News, July 31, 1964. 6. Rogers, J. H. Lancet, 1963, i, 175; ibid. 1964, i, 114. 3 4.
DIURETICS IN RESPIRATORY FAILURE SIR,-In their article (July 30) Dr. Noble and his co-workers state that in their cases 1 and 2 oedema followed the rise of P aC02, and that this observation was compatible with the suggestion of Campbell and Short1 " that the oedema of ’cor pulmonaleis secondary to the respiratory failure ". But slight ankle cedema had been noted earlier in case 2 when the PC02 was only 37-5 mm. Hg, and in both cases fluid retention before significant oedema appeared might have preceded the development of hypercapnia. In ambulant and non-cedematous patients with chronic bronchitis attending this clinic, tests of ventilatory capacity have suggested that hypercapnia may be related to superadded restriction of ventilation rather than to further airflow obstruction,23 and there was some evidence that such restriction might have been associated with fluid retention.3 Reduced compliance in chronic airways obstruction has been found not only with œdema,4 5 but also in chronic hypercapnia without cedema.6It seems possible that fluid retention in the chest (lungs, chest wall) might produce superadded restriction of ventilation, which initiates the hypercapnia before oedema occurs.
Finchley Chest Clinic, 980 High Road,
J. J. SEGALL.
London N.20.
TRAINING DISTRICT MEDICAL OFFICERS SIR,-My objective in using the term " rural medicine ″7 was not to introduce a new discipline but to focus attention on a little-known type of physician-the district medical officerand his needs in training. He is vitally important to the progress of health in the underprivileged countries, which contain three-fifths of the world’s population. In most of these countries the responsibility for organising and delivering health services to the majority of the people rests on but a few of their qualified physicians-namely, district medical officers. Not only are physicians in these countries scarce, but for the most part they are concentrated in the larger urban centres where the practice of medicine bears a striking similarity to that in any large provincial town in an industrialised country. District medical officers may be few but their importance in delivering health services to the rural majority cannot be overstated. The district medical officer is as much in need of special consideration in training programmes as the general practitioner or the specialist. He needs to be trained as the " super generalist," and to learn how to make the greatest impact with inadequate funds, personnel, and facilities in the face of an overwhelming demand. At present he learns his job, or never learns it, through experience. Neither under-
graduate
nor
postgraduate training adequately
prepares him
for the job. If through the use of the phrase " rural medicine " I have been able to focus some attention on him and his needs, then I am content. I agree with Dr. Robertson (Aug. 13) in his plea for the non-proliferation of a multiplicity of terms having similar meanings. I do not propose to enter a semasiological discussion as to which term is most appropriate. I have, however, two observations. Firstly, in postgraduate study, the field of study and the nomenclature of the award should bear a relation 1. 2. 3. 4. 5. 6.
Campbell, E. J. M., Short, D. S. Lancet, 1960, i, 1184. Segall, J. J. ibid. 1965, ii, 546. Segall, J. J., Butterworth, B. A. Scand. J. resp. Dis. (in the press). Cherniack, R. M. J. clin. Invest. 1956, 35, 394. Hammond, J. D. S. Clin. Sci. 1957, 16, 481. Kahana, L. M., Aronovitch, M., Place, R. Am. 87, 699.
7.
Fendall,
N. R. E.
Lancet, 1966, i, 1097.
Rev. resp. Dis.
1963,
EJACULATION IN MALE RHESUS MONKEYS SIR,—Dr. Wiener’s interesting suggestion (Aug. 13), that the transmission of sexual information from the female monkey to the male may be by olfactory cues, is supported by work currently in progress and briefly reported elsewhere.’ Observamade on the sexual behaviour of ovariectomised rhesus monkeys after the local application of very small quantities of cestrogen (5 ug. per day) to their genitalia. Application restricted to the hormone-sensitive area of specialised skin " surrounding the external genitalia (the sexual skin ") restored the vivid red colour of the intact animal, but induced slight changes in the low sexual activity of the male. Vaginal smears taken during this procedure showed the vaginal epithelium to be unaffected. But when oestrogen in the same dose was introduced into the vaginal lumen, there was considerable stimulation of the male’s sexual activity, and mounting and ejaculation occurred frequently. The vaginal smears in this experiment resembled those from animals given large doses of oestrogen systemically. Alteration in some hormone-dependent quality within the vagina, and not changes in the female’s behaviour2 " or in the appearance of the sexual skin ", seems therefore to transmit information on the female monkey’s sexual attractiveness to the male. Experiments are in progress with anosmic males to test whether (as seems most likely) an olfactory mechanism is involved. The widespread use of perfume as a sexual attractant in our own species suggests that similar mechanisms, modified by social conventions, may operate in
of coronary-artery disease and thromboembolism. Dr. Maddocks and Dr. Vines have some information
Perhaps these
on
matters.
Holy Name of Jesus Hospital, Gadsden, Alabama.
J. H. ROGERS.
nons were
man.
Two further factors must be considered before these results on rhesus monkeys are applied more generally. Firstly, the extremely dominant position occupied by the male rhesus monkey over the female is greater than in some other species of monkeys, such as the langur3 or howler,4 and in these the females’ behaviour may have greater influence. Secondly, the smdies upon monkeys cited by Dr. Wiener were carried out upon temporarily isolated pairs of individuals, and social factors were therefore excluded: these themselves substantially modify basic neuroendocrine mechanisms. Department of Anatomy, University Medical School, Birmingham 15.
J. HERBERT.
A NEW REMEDY FOR MIGRAINE treatment of migraine with described in his letter last week, acidophilus, makes me wonder whether this organism replaces intestinal putrefactive anaerobes to such an extent as to influence alimentary tyramine tolerance,5 and whether a change in pH has this effect. J. P. CRAWFORD.
SIR,—Professor Ask-Upmark’s
Lactobacillus
CHRONIC INFECTION AND BLOOD-PRESSURE SIR,-The excellent article by Dr. Maddocks and Dr. Vines (July 30) raises the subject of the effect of chronic infection on degenerative vascular disease in general. I have maintamed that chronic or repeated infection has a beneficial effect on the incidence of coronary-artery disease, and thromboembolism generally, by virtue of changes in plasma-proteins :consisting of increase in globulins (including fibrinogen) and decrease in albumin.These changes, I believe, result in a relative in-vivo hypocoagulable state of the blood ". Pernaps a better term would be a relative hypothromboic state. Throughout the world, populations such as the one studied by Dr. Maddocks and Dr. Vines have shown low incidences ’‘
1. Herbert, J. Excerpta med. Int. Cong. Ser. 1966, 111, 212. 2. Herbert, J., Michael, R. P. Acta. endocr., Copenh. 1965, suppl. 100, p 173.
Jay, P. in Primate Behavior (edited by I. DeVore). New York, 1965. Carpenter, C. R. ibid. 5. Crawford, J. P. Medical News, July 31, 1964. 6. Rogers, J. H. Lancet, 1963, i, 175; ibid. 1964, i, 114. 3 4.
DIURETICS IN RESPIRATORY FAILURE SIR,-In their article (July 30) Dr. Noble and his co-workers state that in their cases 1 and 2 oedema followed the rise of P aC02, and that this observation was compatible with the suggestion of Campbell and Short1 " that the oedema of ’cor pulmonaleis secondary to the respiratory failure ". But slight ankle cedema had been noted earlier in case 2 when the PC02 was only 37-5 mm. Hg, and in both cases fluid retention before significant oedema appeared might have preceded the development of hypercapnia. In ambulant and non-cedematous patients with chronic bronchitis attending this clinic, tests of ventilatory capacity have suggested that hypercapnia may be related to superadded restriction of ventilation rather than to further airflow obstruction,23 and there was some evidence that such restriction might have been associated with fluid retention.3 Reduced compliance in chronic airways obstruction has been found not only with œdema,4 5 but also in chronic hypercapnia without cedema.6It seems possible that fluid retention in the chest (lungs, chest wall) might produce superadded restriction of ventilation, which initiates the hypercapnia before oedema occurs.
Finchley Chest Clinic, 980 High Road,
J. J. SEGALL.
London N.20.
TRAINING DISTRICT MEDICAL OFFICERS SIR,-My objective in using the term " rural medicine ″7 was not to introduce a new discipline but to focus attention on a little-known type of physician-the district medical officerand his needs in training. He is vitally important to the progress of health in the underprivileged countries, which contain three-fifths of the world’s population. In most of these countries the responsibility for organising and delivering health services to the majority of the people rests on but a few of their qualified physicians-namely, district medical officers. Not only are physicians in these countries scarce, but for the most part they are concentrated in the larger urban centres where the practice of medicine bears a striking similarity to that in any large provincial town in an industrialised country. District medical officers may be few but their importance in delivering health services to the rural majority cannot be overstated. The district medical officer is as much in need of special consideration in training programmes as the general practitioner or the specialist. He needs to be trained as the " super generalist," and to learn how to make the greatest impact with inadequate funds, personnel, and facilities in the face of an overwhelming demand. At present he learns his job, or never learns it, through experience. Neither under-
graduate
nor
postgraduate training adequately
prepares him
for the job. If through the use of the phrase " rural medicine " I have been able to focus some attention on him and his needs, then I am content. I agree with Dr. Robertson (Aug. 13) in his plea for the non-proliferation of a multiplicity of terms having similar meanings. I do not propose to enter a semasiological discussion as to which term is most appropriate. I have, however, two observations. Firstly, in postgraduate study, the field of study and the nomenclature of the award should bear a relation 1. 2. 3. 4. 5. 6.
Campbell, E. J. M., Short, D. S. Lancet, 1960, i, 1184. Segall, J. J. ibid. 1965, ii, 546. Segall, J. J., Butterworth, B. A. Scand. J. resp. Dis. (in the press). Cherniack, R. M. J. clin. Invest. 1956, 35, 394. Hammond, J. D. S. Clin. Sci. 1957, 16, 481. Kahana, L. M., Aronovitch, M., Place, R. Am. 87, 699.
7.
Fendall,
N. R. E.
Lancet, 1966, i, 1097.
Rev. resp. Dis.
1963,