COUGH MIXTURES

COUGH MIXTURES

44 fewer patients needing -repeated admissions to result. hospital Chemotherapy is e-xtremely valuable, but its place is still limited ; when and if a...

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44 fewer patients needing -repeated admissions to result. hospital Chemotherapy is e-xtremely valuable, but its place is still limited ; when and if a -sufficiently potent antibiotic becomes available to arrest tuberculosis medically, thoracic surgeons will be pleased to be able to rest a little! There is no panacea; and if surgery is needed, neither resection nor thoracoplasty is universally applicable. I am sure that Dr. Brailsford would agree with me that the object of treatment is to restore the patient as nearly as possible to a state of good health by the safest and quickest means. Ryan and his colleagues, and those with -whom I have the pleasure of being associated in Liverpool, believe that it is an advance to resect the lesion which is unlikely to heal while it is still possible to do so, although we here have no great faith in the technique of multiple wedge resections. I hope that Dr. Brailsford will believe me when I say that surgery (including lung resection) is often beneficial in pulmonary tuberculosis, that it has a logical basis, and that it often produces a dramatic improvement in the general health ; and I can assure him that surgery is not undertaken unless it appears necessary for the The healed lesion is of no concern reasons I have given. to the surgeon, but the failure to treat adequately the unhealed localised lesion is of the utmost concern to the patient because of the tragic consequences of the development, sooner or later, of chronic cavitation which may be difficult or impossible to cure. B. J. BICKFORD. Liverpool. there

are

as a

The problems raised by this hypostatisation of diseases not purely abstract theoretical or linguistic ; for example, he is a singularly fortunate or forgetful doctor who cannot recall that any of his patients have suffered as a result of his preoccupation with diagnostic labels and his misconception of theirsignificance-or lack of significance. To some extent, too, the failure to appreate that disease names do not represent real things causes disease -statistics to be less accurate than they might be ; though probably the search for names as such has a more serious effect in this way, as Dr. Todd seems to It is difficult to see what cure there can be for this state of affairs unless it be in an increasing awareness of the extent and danger of this fundamental misconception

are

imply.

RONALD G. HENDERSON.

Falkirk.

-

SPLENOMEGALY IN SCARLET FEVER

SiR,-Dr. O’Reilly asks (Dec. 20) whether others had

the

same

experience

as

he

in

have

finding splenic

enlargement in scarlet fever. While in charge of an isolation block in a military hospital in Egypt during the late war, I recorded the prevalence of splenic enlargement in various infectious diseases. The prevalence in three of these infections was as

follows :

Total cases 42.. 81 221 Diphtheria .

..

.

..

Splenomegaly lo

lVo.

3

7-1

5.. 14..

6-2 6-3

In all cases malaria was excluded by blood in all cases the spleen was no longer palpable on Department of Child Health, University of Shemeld.

films, and

discharge.

S ILLINGWORTH. R- RS.

PRECISION IN DIAGNOSIS

SIR,—I agree with Dr. Todd (Dec. 27) that it is often

quite impossible to attach a precise textbook diagnosis to a patient’s disability and at the same time maintain one’s professional intellectual integrity ; and I find myself in sympathy with his plea for a less rigid system of nomenclature in medical documents. I would suggest, however, that a cause of error, confusion, and misunderstanding more fundamental and more serious than the mere attaching of officially acceptable disease-labels to patients, lies in the assumption that behind these labels there are disease-entities each possessing a genuine, intrinsic, if vague, reality. The belief that diseases have independent existence is implanted in us by the teaching we receive as students and is encouraged by our textbooks, our journals, and all forms of professional communication so that the whole pattern of our thought and speech is influenced by it ; and that the belief is accepted without question is implicit in the way we talk about " discovering" or describing " diseases (diseases which, by the way, we have not defined) or in the way we pass over without comment such phrases as ’’ the biological propertiesI of this or that disease-phrases which imply that the diseases in question have existence in their own right. "

an annotation1 SIR,—I was reference to the use of inhalations of carbon dioxide (in a 5% mixture with oxygen), and to Banyai’s description of this inhalation as an " effective expectorant, which not only stimulates respiration and increases bronchial peristalsis but’liquefies mucopurulent " inflammatory exudates.’ Dr. Herxheimer and Dr. McAllen mentioned carbon dioxide favourably in their subsequent letter,2 in which they were good enough to refer to my work on expectoration. I would only add that in my view it is unlikely that bronchial peristalsis plays any part in expectoration. Anatomically it is improbable that a peristaltic mechanism exists in the alveolar musculature (the myoelastic tissue of Macklin). Many investigators have postulated a kind of reflex by which expectoration is - always associated with peristalsis ; but I have been unable to demonstrate any such mechanism radiologically. I found instead that the expulsive force came from reinforcement of the normal respiratory effort, rather than from added peristalsis. It follows that carbon dioxide increases

a

expectoration Rimnlv hv stimulating respiration

Scarlet fever Tonsillitis

-

COUGH MIXTURES interested to see in

University of Berne,

T. GORDONOFF.

Switzerland.

RESEARCH INTO INTESTINAL POLYPOSIS more than twenty-five years the research of St. Mark’s Hospital, assisted by an annual department the from British Empire Cancer Campaign, has grant been collecting information about the inheritance, pathology, and treatment of familial intestinal polyposis

SIR,—For

(polyposis intestini). More than fifty families have been investigated, and in each case a complete family pedigree has been constructed. A special follow-up department has been organised to keep in touch’with all these polyposis cases .and their relatives, of whom

more than one thousand are included in the hospital records. It would be of great assistance to the further development of this work if doctors who know of other cases of generalised intestinal polyposis would be good enough to send me the names and clinical details of such patients, having obtained their permission to do so. This would enable me to trace linkages between new cases and families already investigated. If any such linkage could be discovered, either now or at a later date, I should inform the doctor at once but should not of course communicate with the patient unless the doctor wished me to do so. I am signing this letter because I am responsible for organising this research, but I should like it to be understood that all the surgical staff of St. Mark’s Hospital are actively cooperating in this investigation. now



Research Department, St. Mark’s Hospital, City Road, London, E.C.1.

CUTHBERT DUKES.

1. Lancet, 1952, i, 959. 2. Ibid, p. 1213.