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DI-IODOTYROSINE IN TOXIC GOITRE
116 under the transverse metatarsal arch and the toes may, or may not, need a very thin wedge. Into the compartment opening along the inner edge, one, two or three leather wedges are inserted to obtain the greatest possible degree of comfort. I much prefer these separate leather wedges to one thick wedge of moulded rubber. As a precaution the supports were put in the shoes for both feet, and on leaving the shop the patient was able to walk in comfort for the first time in 18 months. All sciatic pains disappeared soon afterwards. The supports were used for eight years as there was a tendency to recurrence of sciatica when they were left out of the shoes while engaged in strenuous housework. They havenot been needed during the past year. CASE 2.-In 1937 a sister of this patient had an attack of subacute sciatica which did not yield to medicinal treatment as quickly as desired. She then obtained instep supports similar to her sister’s. The pain quickly subsided, and she left off using the supports after six weeks. There has been no return of pain. CASE 3.-A man of about 55 had to give up working as a village postman owing to very severe sciatica." After treatment in bed for some weeks, at home and in hospital, he He attended the outpatient department for about a year. was then told that nothing more could be done to relieve the pain. He was still in misery every time he put his foot to the ground. His son heard of the benefit derived by the first patient from instep-arch supports and got a similar pair. His father put them in his boots on a Saturday afternoon and promptly went to see a cricket match. He announced, on returning home, that he had had no pain ; nor did the sciatica return subsequently. ALLAN EDWARD MAHOOD. Haynford, nr. Norwich.
Pavilion has
than doubled since 1926. The imsuccess is the absence of dual authorities. In the presence of the latter the scheme will break down sooner or later. JOHN GRIEVE. Oxford. more
portant factor for continued
POSITIVE SYPHILITIC TESTS IN HEALTHY PEOPLE SiR,-The question whether positive syphilis tests may occur in non-syphilitic people, as discussed in your annotation of May 10 (p. 606), requires careful consideration. If care is taken to use suitable antigens and a technique adapted to them, false positive reactions will be very exceptional, even in blood from patients suffering from a variety of diseases other than syphilis or from pregnant women. Great progress has been made during the last decades, but the aim has often been t6 increase the sensitivity of tests, and the necessary specificity has sometimes been insufficiently considered. In cases giving false positive results it is general experience that only one or some tests give positive reactions while others do not. It is often advisable, therefore, not to rely on a single test. The more tests that are performed and the more they agree the more certainly is the result diagnostic of syphilis. This remains true in spite of improvements in technique and reliability of the tests. False positive results are due to an increased " lability’’ of the serum proteins, and are not true antigen-antibody reactions. This lability is nearly always sufficiently reduced by heating the serum to 55° C. or, in some flocculation (clarification) tests by using higher salt concentrations. Since non-specific reactivity is very exceptional even in pregnancy or diseases other than DI-IODOTYROSINE IN TOXIC GOITRE syphilis, false positive results in really healthy people SiR,-Mr. Wass underestimates the material which must be rare indeed. The fact that animal sera often react positively with antigens adapted for the examinaexists in this country for the study of thyrotoxicosis. If tion of human serum must not be taken to imply that he had referred to the synopsis of three lectures on Toxic the serum of healthy people sometimes gives positive Goitre which I delivered in May, 1939, at the British Postgraduate Medical School (Brit., med. J. 1939, 2, 436) reactions. The non-specific reactivity of the antigens he would have found that I had used di-iodotyrosine as depends on the colloidal structure of the serum, and this suggested by Harington in over 600 cases. This was structure differs in various animals from the structure in given in the form of tablets prepared by Messrs. British man. Thus antigens and methods suitable for the Drug Houses, the dose employed being usually 2 tablets serodiagnosis of human syphilis cannot be used successthrice daily-equivalent approximately to 40 minims of fully for the examination of syphilitic rabbits ; for that, Lugol’s solution in 24 hours. Sinee 1938 we have addedspecially prepared antigens are needed with a lower considerably to the series treated in this way in my clinic, content of cholesterol. It is a lucky chance that human though we do not now employ di-iodotyrosine as a serum has a relatively high degree of stability. Eagle’s :report (Amer. J. Syph. January, 1941, p. 7) on an routine for reasons which seem to us cogent-viz., it is relatively expensive and it is no more efficient than is attempt to distinguish " biologic false positive " reactions ; cases of latent syphilis is not available to me at Lugol’s solution, though its portability makes it a con- from venient method of administering iodine. But it is, I present, but I should like to mention a method elaborated think, misleading to suggest that di-iodotyrosine has thein my former department by Witebsky (Z. ImmunForsch. advantages over iodine which Harington believed on 1933, 80, 323) by which it is possible, when the theoretical grounds it might possess ; he has neverserum originates from a syphilitic patient, to recover the antibodies from the flocculates by elution at 55° C., claimed that it exhibits any of these virtues in practice. and thus to differentiate syphilitic reactions from false I think, therefore, that Mr. Wass is over-optimistic if ones. he hopes to influence favourably with di-iodotyrosine : positive According to Bier and Trapp (J. Immunol. cases which fail to respond to iodine or which have 1941, 40, 465) this method may be improved by using become recalcitrant to its action. 10% sodium chloride solution instead of 0-9% saline for dissociation. This procedure corresponds to that used CECIL A. JOLL. Harley Street, W.l. by Heidelberger (J. exp. Med. 1936, 64, 161) for the VILLAGE SETTLEMENTS IN WAR TIME dissociation of complexes of pneumococcal carbo11 and their antibodies. SiB,—Dr. McDougall is not strictly correct when he says hvdrates in his letter of July 19 that " the association of a general H. SACHS. Trinity College, Dublin. hospital cheek by jowl with a sanatorium is something SAMPLE OF PUBLIC OPINION new in medical organisation in this country." Although the name of Osler is not primarily associated with the SiB,—In the large number of bodies that are beginning war on tuberculosis, it was ever uppermost in his t, occupy themselves in medical planning, little opporto t has so far been given for the general public to thoughts. On many occasions he stressed the importance tunity of a sanatorium being run in conjunction with a general v voice its views. When the claims and counter claims f4 a state salaried service versus private practice are hospital. As a tribute to this ideal, the Osler Pavilion, for which is the sanatorium for Oxford and district and at b being put forward by the profession, these usually include the same time a unit of the Radcliffe Infirmary, was t: the profession’s own interpretation of what the public would like. It is to be hoped that medical planners opened in 1926 by Mr. Neville Chamberlain, then VI Minister of Health. This association has undoubted v will now pay attention to the results of the Gallup survey advantages-the patients are within easy reach of any you y published on July 12 (p. 59). Asked to choose b (a) all doctors and hospitals under state control, type of consultant, are near their relatives, and yet have between all the benefits of a sanatorium. No less is this so from (l extension of the panel system to include everybody, (b) and (c) having a private doctor, the answers from a a the teaching point of view-the students have ready c of the population were 55% for (a), 30% cross-section access, and pulmonary cases can be and are used for f( for final examinations. Gone are the days when it took (b), and 15% for (c). In other words, more than h half the population surveyed was in favour of state conmost of an afternoon to complete the journey to and and a minority for extension of the panel or for t trol from the sanatorium. That such a scheme can work is si simple private practice. When the group was broken shown by the fact that the number of beds at the Osler "
.
,
.
Pavilion has
than doubled since 1926. The imsuccess is the absence of dual authorities. In the presence of the latter the scheme will break down sooner or later. JOHN GRIEVE. Oxford. more
portant factor for continued
POSITIVE SYPHILITIC TESTS IN HEALTHY PEOPLE SiR,-The question whether positive syphilis tests may occur in non-syphilitic people, as discussed in your annotation of May 10 (p. 606), requires careful consideration. If care is taken to use suitable antigens and a technique adapted to them, false positive reactions will be very exceptional, even in blood from patients suffering from a variety of diseases other than syphilis or from pregnant women. Great progress has been made during the last decades, but the aim has often been t6 increase the sensitivity of tests, and the necessary specificity has sometimes been insufficiently considered. In cases giving false positive results it is general experience that only one or some tests give positive reactions while others do not. It is often advisable, therefore, not to rely on a single test. The more tests that are performed and the more they agree the more certainly is the result diagnostic of syphilis. This remains true in spite of improvements in technique and reliability of the tests. False positive results are due to an increased " lability’’ of the serum proteins, and are not true antigen-antibody reactions. This lability is nearly always sufficiently reduced by heating the serum to 55° C. or, in some flocculation (clarification) tests by using higher salt concentrations. Since non-specific reactivity is very exceptional even in pregnancy or diseases other than DI-IODOTYROSINE IN TOXIC GOITRE syphilis, false positive results in really healthy people SiR,-Mr. Wass underestimates the material which must be rare indeed. The fact that animal sera often react positively with antigens adapted for the examinaexists in this country for the study of thyrotoxicosis. If tion of human serum must not be taken to imply that he had referred to the synopsis of three lectures on Toxic the serum of healthy people sometimes gives positive Goitre which I delivered in May, 1939, at the British Postgraduate Medical School (Brit., med. J. 1939, 2, 436) reactions. The non-specific reactivity of the antigens he would have found that I had used di-iodotyrosine as depends on the colloidal structure of the serum, and this suggested by Harington in over 600 cases. This was structure differs in various animals from the structure in given in the form of tablets prepared by Messrs. British man. Thus antigens and methods suitable for the Drug Houses, the dose employed being usually 2 tablets serodiagnosis of human syphilis cannot be used successthrice daily-equivalent approximately to 40 minims of fully for the examination of syphilitic rabbits ; for that, Lugol’s solution in 24 hours. Sinee 1938 we have addedspecially prepared antigens are needed with a lower considerably to the series treated in this way in my clinic, content of cholesterol. It is a lucky chance that human though we do not now employ di-iodotyrosine as a serum has a relatively high degree of stability. Eagle’s :report (Amer. J. Syph. January, 1941, p. 7) on an routine for reasons which seem to us cogent-viz., it is relatively expensive and it is no more efficient than is attempt to distinguish " biologic false positive " reactions ; cases of latent syphilis is not available to me at Lugol’s solution, though its portability makes it a con- from venient method of administering iodine. But it is, I present, but I should like to mention a method elaborated think, misleading to suggest that di-iodotyrosine has thein my former department by Witebsky (Z. ImmunForsch. advantages over iodine which Harington believed on 1933, 80, 323) by which it is possible, when the theoretical grounds it might possess ; he has neverserum originates from a syphilitic patient, to recover the antibodies from the flocculates by elution at 55° C., claimed that it exhibits any of these virtues in practice. and thus to differentiate syphilitic reactions from false I think, therefore, that Mr. Wass is over-optimistic if ones. he hopes to influence favourably with di-iodotyrosine : positive According to Bier and Trapp (J. Immunol. cases which fail to respond to iodine or which have 1941, 40, 465) this method may be improved by using become recalcitrant to its action. 10% sodium chloride solution instead of 0-9% saline for dissociation. This procedure corresponds to that used CECIL A. JOLL. Harley Street, W.l. by Heidelberger (J. exp. Med. 1936, 64, 161) for the VILLAGE SETTLEMENTS IN WAR TIME dissociation of complexes of pneumococcal carbo11 and their antibodies. SiB,—Dr. McDougall is not strictly correct when he says hvdrates in his letter of July 19 that " the association of a general H. SACHS. Trinity College, Dublin. hospital cheek by jowl with a sanatorium is something SAMPLE OF PUBLIC OPINION new in medical organisation in this country." Although the name of Osler is not primarily associated with the SiB,—In the large number of bodies that are beginning war on tuberculosis, it was ever uppermost in his t, occupy themselves in medical planning, little opporto t has so far been given for the general public to thoughts. On many occasions he stressed the importance tunity of a sanatorium being run in conjunction with a general v voice its views. When the claims and counter claims f4 a state salaried service versus private practice are hospital. As a tribute to this ideal, the Osler Pavilion, for which is the sanatorium for Oxford and district and at b being put forward by the profession, these usually include the same time a unit of the Radcliffe Infirmary, was t: the profession’s own interpretation of what the public would like. It is to be hoped that medical planners opened in 1926 by Mr. Neville Chamberlain, then VI Minister of Health. This association has undoubted v will now pay attention to the results of the Gallup survey advantages-the patients are within easy reach of any you y published on July 12 (p. 59). Asked to choose b (a) all doctors and hospitals under state control, type of consultant, are near their relatives, and yet have between all the benefits of a sanatorium. No less is this so from (l extension of the panel system to include everybody, (b) and (c) having a private doctor, the answers from a a the teaching point of view-the students have ready c of the population were 55% for (a), 30% cross-section access, and pulmonary cases can be and are used for f( for final examinations. Gone are the days when it took (b), and 15% for (c). In other words, more than h half the population surveyed was in favour of state conmost of an afternoon to complete the journey to and and a minority for extension of the panel or for t trol from the sanatorium. That such a scheme can work is si simple private practice. When the group was broken shown by the fact that the number of beds at the Osler "
.
,
.