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DIET AND WEIGHT
1063 Kenneth Walker’s " Enlarged Prostate and Prostatic Obstruction " ; and Clephan and Hills " Elementary Handbook on Radium."-(153) THE PRACTITIONER (6-8, Bouverie-street, E.C.) had on view several of their valuable special numbers, including the October issue on Modern Treatment, and a symposium on Birth Control.-(98) JOHN WRIGHT AND SONS, LTD. (Bristol), displayed the Medical Annual ; the Index Series, of which Hutchison’s Index of Treat-
an example, and their Synopsis series, which includes medicine, surgery, midwifery, and
ment is now
physiology.
-
In the account of the exhibition in our issue of Oct. 21st mention was made of Vagotonine (Anglo-French Drug Co.). This is not, as stated, an extract of regulating hormones, but is said to be a natural pancreatic hormone having a regulatory action on the organo-vegetative system.
CORRESPONDENCE DIET AND WEIGHT
To the Editor
THE LANCET SIR,-In your leading article of Oct. 14th occurs the following statement: "We raise these questions not to impugn in any degree Prof. Dodds’s main contention, but only to enter a caveat against an impression which his remarks may have left that any form of obesity can be reduced by suitable application of the principles he outlines. This is quite true of the exogenous obesity commonly met with in middleaged persons, but it is certainly not true of the endogenous cases-(our italics)." We feel that this statement might be construed to confirm that prevailing attitude of despair towards these unfortunates which Prof. Dodds has been at some pains to dispel. The daily output of energy cannot fall below a certain minimal level, and if the energy furnished by the diet does not exceed this level the subject must either lose flesh, sleep all day, cheat his physician, or violate the law of the conservation of energy. The basal heat output has been found by competent observers to fall within normal limits in most " exogenous " and many " endogenous " In a few of the latter rather low cases of obesity. been have found, but even such exceptions readings respond to diets calculated in accordance with basal needs.i It is, of course, quite possible that a patient afflicted with " endogenous " obesity may respond more slowly to dietetic restriction than an exogenous case, for the additional energy dependent on diurnal activity may be different in the two cases. A reducing diet may also be more irksome to a patient whose obesity is the result of pathological hunger than to an habitual over-eater. Some of the prevailing confusion arises from the erroneous assumption that loss of flesh and loss of weight are synonymous terms. Restriction of diet is not always followed immediately by loss of weight and L. H. Newburgh2 has shown that in such cases the loss of fat is masked by retention of water. This retention of water is only a temporary phenomenon, but it emphasises the need for perseverance. In the same connection, it is possible that the apparent virtue of the Turkish bath in obesity may lie in temporary dehydration from sweating. Admitting that the ultimate nature of obesity is in many cases obscure, the fact remains that its successful reduction by dietetic restriction is conditioned simply by the fortitude of the patient. We are, Sir, yours faithfully, F. B. BYROM. London Hospital, Whitechapel, DONALD HUNTER. E., Oct. 30th, 1933.
of
NASAL INFECTION IN THE PSYCHOSES To the Editor of THE LANCET
SIR,—As
years has the of focal role investigating in the production of the psychoses I wish to a
practitioner who
had opportunities of
sepsis
for
twenty
1 Wilder, R. M., Smith, F. M., and Sandiford, I. : Ann. Internal Med. 1932, vi., 724. 2 Jour. Amer. Med. Assoc., 1931, xcvii., 1659.
add my contribution to this correspondence. So long ago as 1914 Sir W. Arbuthnot Lane removed at my request portions of intestine in cases of certifiable insanity. These patients are still alive and well, and have since operation remained in full mental health. The late Dr. Henry Cotton paid more than one visit to London to study the methods of laboratory overhaul adopted by some of us, and I had the pleasure of collaborating with Dr. Graves in introducing laboratory methods of investigation in his hospitals. In my own practice I have seen excellent results in many psychoses, some less, some more advanced, follow a systematic examination of the patient in the laboratory ; teeth, tonsils, sinuses, intestinal and uterine mucosal surfaces have all contributed to these happy results. Since 1919 I have in a very large number of cases been able to confirm the late Ford Robertson’s estimate of the definite neurotoxic power of certain members of the diphtheroid group. These are a common find in many psychoses, and. have treated these cases with satisfactory results by autogenous detoxicated vaccines of the diphtheroid isolated. I am, Sir, yours faithfully, A. WHITE ROBERTSON. Welbeck-street, W., Oct. 28th, 1933.
PROBLEMS OF ASTHMA
THE LANCET SIR,-In your report of the discussion on asthma at a recent meeting of the Paddington Medical Society, Dr. Swietochowski " observed that many male patients seemed to inherit asthma from their mothers, while females inherited it from their fathers." Investigating this statement in the light of my own figures, I find that in one consecutive series of 700 cases of asthma my figures are as follows. I will not be so bold as to say that a child inherits asthma from anybody, but of the males (352) in this series a history of asthma or hay-fever was present in 87 cases in the father and his immediate relatives and in exactly the same number (87) in the mother and her immediate blood relations. Of the females (348) an asthmatical history or one of hay-fever was present in 73 of the fathers’ side and in 77 of the mothers’ side. In another series of 400 cases of hay-fever a direct history of hay-fever in the actual parents was present in 16 fathers and 18 mothers of 211 males. In 189 females, 13 fathers and 14 mothers were In neither case affected themselves by hay-fever. do the figures lend support to Dr. Swietochowski’s To the Editor
statement. At the
of
discussion Prof. Millais Culpin is saying, "Feather-sensitiveness might in some cases be due to the juvenile association of the smell of feathers with the witnessing of sexual intercourse between the parents." Now if 20 or more unknown proteins be applied by the scratch method or intradermally to the skin of these feather-sensitive people, reactions will be obtained to feathers without the patient in any way knowing the nature of the proteins which are being applied. Are we really
reported
same
as
asked to believe that the shock of the
scenes
described
an example, and their Synopsis series, which includes medicine, surgery, midwifery, and
ment is now
physiology.
-
In the account of the exhibition in our issue of Oct. 21st mention was made of Vagotonine (Anglo-French Drug Co.). This is not, as stated, an extract of regulating hormones, but is said to be a natural pancreatic hormone having a regulatory action on the organo-vegetative system.
CORRESPONDENCE DIET AND WEIGHT
To the Editor
THE LANCET SIR,-In your leading article of Oct. 14th occurs the following statement: "We raise these questions not to impugn in any degree Prof. Dodds’s main contention, but only to enter a caveat against an impression which his remarks may have left that any form of obesity can be reduced by suitable application of the principles he outlines. This is quite true of the exogenous obesity commonly met with in middleaged persons, but it is certainly not true of the endogenous cases-(our italics)." We feel that this statement might be construed to confirm that prevailing attitude of despair towards these unfortunates which Prof. Dodds has been at some pains to dispel. The daily output of energy cannot fall below a certain minimal level, and if the energy furnished by the diet does not exceed this level the subject must either lose flesh, sleep all day, cheat his physician, or violate the law of the conservation of energy. The basal heat output has been found by competent observers to fall within normal limits in most " exogenous " and many " endogenous " In a few of the latter rather low cases of obesity. been have found, but even such exceptions readings respond to diets calculated in accordance with basal needs.i It is, of course, quite possible that a patient afflicted with " endogenous " obesity may respond more slowly to dietetic restriction than an exogenous case, for the additional energy dependent on diurnal activity may be different in the two cases. A reducing diet may also be more irksome to a patient whose obesity is the result of pathological hunger than to an habitual over-eater. Some of the prevailing confusion arises from the erroneous assumption that loss of flesh and loss of weight are synonymous terms. Restriction of diet is not always followed immediately by loss of weight and L. H. Newburgh2 has shown that in such cases the loss of fat is masked by retention of water. This retention of water is only a temporary phenomenon, but it emphasises the need for perseverance. In the same connection, it is possible that the apparent virtue of the Turkish bath in obesity may lie in temporary dehydration from sweating. Admitting that the ultimate nature of obesity is in many cases obscure, the fact remains that its successful reduction by dietetic restriction is conditioned simply by the fortitude of the patient. We are, Sir, yours faithfully, F. B. BYROM. London Hospital, Whitechapel, DONALD HUNTER. E., Oct. 30th, 1933.
of
NASAL INFECTION IN THE PSYCHOSES To the Editor of THE LANCET
SIR,—As
years has the of focal role investigating in the production of the psychoses I wish to a
practitioner who
had opportunities of
sepsis
for
twenty
1 Wilder, R. M., Smith, F. M., and Sandiford, I. : Ann. Internal Med. 1932, vi., 724. 2 Jour. Amer. Med. Assoc., 1931, xcvii., 1659.
add my contribution to this correspondence. So long ago as 1914 Sir W. Arbuthnot Lane removed at my request portions of intestine in cases of certifiable insanity. These patients are still alive and well, and have since operation remained in full mental health. The late Dr. Henry Cotton paid more than one visit to London to study the methods of laboratory overhaul adopted by some of us, and I had the pleasure of collaborating with Dr. Graves in introducing laboratory methods of investigation in his hospitals. In my own practice I have seen excellent results in many psychoses, some less, some more advanced, follow a systematic examination of the patient in the laboratory ; teeth, tonsils, sinuses, intestinal and uterine mucosal surfaces have all contributed to these happy results. Since 1919 I have in a very large number of cases been able to confirm the late Ford Robertson’s estimate of the definite neurotoxic power of certain members of the diphtheroid group. These are a common find in many psychoses, and. have treated these cases with satisfactory results by autogenous detoxicated vaccines of the diphtheroid isolated. I am, Sir, yours faithfully, A. WHITE ROBERTSON. Welbeck-street, W., Oct. 28th, 1933.
PROBLEMS OF ASTHMA
THE LANCET SIR,-In your report of the discussion on asthma at a recent meeting of the Paddington Medical Society, Dr. Swietochowski " observed that many male patients seemed to inherit asthma from their mothers, while females inherited it from their fathers." Investigating this statement in the light of my own figures, I find that in one consecutive series of 700 cases of asthma my figures are as follows. I will not be so bold as to say that a child inherits asthma from anybody, but of the males (352) in this series a history of asthma or hay-fever was present in 87 cases in the father and his immediate relatives and in exactly the same number (87) in the mother and her immediate blood relations. Of the females (348) an asthmatical history or one of hay-fever was present in 73 of the fathers’ side and in 77 of the mothers’ side. In another series of 400 cases of hay-fever a direct history of hay-fever in the actual parents was present in 16 fathers and 18 mothers of 211 males. In 189 females, 13 fathers and 14 mothers were In neither case affected themselves by hay-fever. do the figures lend support to Dr. Swietochowski’s To the Editor
statement. At the
of
discussion Prof. Millais Culpin is saying, "Feather-sensitiveness might in some cases be due to the juvenile association of the smell of feathers with the witnessing of sexual intercourse between the parents." Now if 20 or more unknown proteins be applied by the scratch method or intradermally to the skin of these feather-sensitive people, reactions will be obtained to feathers without the patient in any way knowing the nature of the proteins which are being applied. Are we really
reported
same
as
asked to believe that the shock of the
scenes
described