- Email: [email protected]
DO REDHEADS BLEED EASILY ?
1186 than for a member to seek advice and legal representation, only to find that, through failure to pay his subscription, he is not entitled to any assistance.
On
further matter which has, perhaps, a similar the attention of the council has been drawn to numerous members whose names have been deleted from the Medical Register owing to their failure to reply to communications addressed to them by the Registrar of the General Medical Council. It is of paramount importance that practitioners should give an address at or through which they can always be reached by telephone or letter. a
cause :
Medical Defence Union, Tavistock House South, Tavistock Square, London, W.C.1. W.C.I.
Union, ROBERT
FORBES
Secretary.
DO REDHEADS BLEED EASILY ? was interested and instructed by the report in your issue of May 22 (p. 1061) of Mr. Walker Ashcroft’s paper to the Royal Society of Medicine. I should like to ask what is the evidence that red-haired females tend to bleed easily. It is a claim often made but I have been unable to find factual corroboration in the literature. Redheads are also alleged to be more susceptible to rheumatic fever. A shock of red hair is remarkable and easily remembered, and I suspect it is this selective memory that has biased clinical observations. In a series of 98 normal individuals,l 14 of whom had red hair, I estimated the bleeding-time by the Ivy technique (3 incisions on two different days). In with other workers,2 I found that females on average had longer bleeding-times than males, but there was no statistical difference between the groups arranged by hair colour. The striking feature of this normal series, with a technique as carefully standardised as possible, was the extreme variations both between individuals and even in one individual. But the bleeding-time does not necessarily measure a "tendency to bleed." J. R. O’BRIEN. Portsmouth.
SIR,-I
EGGS AND RHEUMATIC FEVER SIR,-We would like to comment on several statements in your annotation of April 17. It is true that streptolysin S has not been shown capable of producing lesions of rheumatic type ; but in the reference you cited in support of this point none of the animals survived more than 48 hours, Which is scarcely long enough. The statement that choline deficiency may be associated with a rise in plasma-phospholipid is contrary both to current concepts and to the intent of the sources cited. As a determining factor in rheumaticfever susceptibility we do not envision a choline deficiency severe enough to cause fat accumulation in the liver but merely one which is capable of producing a relative lack in certain individuals who may have an unusually high choline requirement. We regard the relation of choline intake to the synthesis of plasma-phospholipid as enabling or permissive rather than stimulating. Evaluation of methionine as a substitute for choline is complicated by species differences and by the influence of other dietary factors such as protein and vitamin BI2. In any event, it seems significant that the greatest incidence of subjects with a below-average plasma-phospholipid or childhood egg intake was found in patients with the more severe grades of heart-disease or multiple episodes of acute rheumatic fever. ALLAN D. WALLIS Episcopal Hospital, ELLENMAE VIERGIVER. Philadelphia, Pennsylvania.
conformity
SEX AND SOCIETY
SIR,-Dr. Sherriff’s letter last week some
perhaps
deserves
analysis :
"
Those of us who hoped for a lead from the Practitioner in its symposium on Sex and its Problems must have been
sadly disappointed."
,
By what right does Dr. Sherriff speak for this putative group and why expect a lead from a symposium, which is a collection of views on one topic " "
"
SAFER HYPOTENSION
SIR,-There are several ways in which chlorpromazine could contribute to safer hypotension for cerebral surgery without resorting to the active cooling described by Dr. Dundee and his colleagues in their letter of April 24. The narcobiotic property of chlorpromazine described by Decourt 3 causes a reversible depression of activity of all cellular life. It could, therefore, conceivably reduce the activity of the cells of the. brain, rendering them more resistant to aggressions, including anoxia. Admittedly, a similar effect can be produced by cooling, but the necessity for duplication of the process is open to question. The specific action of chlorpromazine in abolishing central autonomic activity45 might be of assistance in preventing the cardiovascular emergencies that arise during neurosurgery, following transmission of retractor pressure to the mid-brain, or active surgical intervention at the base of the brain. Finally, chlorpromazine itself possesses peripheral ganglion-blocking properties and it is not surprising therefore that smaller doses of ‘ Arfonad ’ are required to produce hypotension. These remarks are not made in criticism of the method described. They are made because hypothermia is given the credit which is probably due to chlorpromazine. Equally good results might well be obtained without the additional complication of hypothermia. Lambeth Hospital, London, S.E.11.
D. A. B. HOPKIN.
1. O’Brien, J. R. J. clin. Path. 1951, 4, 272. 2. Pauwen, L. J., Roskam, J., Derouaux, G., Puissant, A. Arch. int. Pharmacodyn. 1942, 67, 390. 3. Decourt, P. C.R. Acad. Sci., Paris, 1953, 236, 1195. 4. Pocidalo, J. J., Cathala, H. P., Humbert, J., Tardieu, Mme. C.R. Soc. Biol. Paris, 1953, 146, 368. 5. Cathala, H. P., Pocidalo, J. J. Ibid, p. 1709.
Nowhere is a radically new approach to sex suggested." Dr. Sherriff’s new approach is a policy of licence which is older than some hills. If our criminal law on male homosexuality were to be "
civilised
as
in France,
Scandinavia, Switzerland,
and most
socially advanced European countries, many of these problems would simply fade away." " Civilised begs the whole question. The implication of " most socially advanced " is that the countries named and unnamed are more socially advanced than we are. But are they’? "... many of the problems would simply fade away " : of course they would, but they would be "
replaced by
many
more.
"
Fifty years ago the most frantic rubbish was uttered about deadly evils of masturbation." It still is, and among the rubbish is the statement that
the
masturbation is of "
we
no
importance.
In another fifty years posterity will likewise marvel that could make such a mountain out of the molehill of
homosexuality." This is the kernel of the letter. Dr. Sherriff thinks that a mere molehill. I do not’; it often ruins lives and is contagious.
homosexuality is "
Let us hope that a kindly and earthy sexual common will then prevail, which would minimise homosexuality and other sexual disabilities more than anything else."
sense
But why " let us hope " when in the preceding sentence he has said it will? I deny that such a view could be " kindly," but am inclined to agree with " earthy." The last part of the sentence is obscure: " Let us hope that a sexual common sense will then prevail, which would minimise homosexuality... more than anything else." Minimise the quantity of or the importance of it ? ...
it
On
further matter which has, perhaps, a similar the attention of the council has been drawn to numerous members whose names have been deleted from the Medical Register owing to their failure to reply to communications addressed to them by the Registrar of the General Medical Council. It is of paramount importance that practitioners should give an address at or through which they can always be reached by telephone or letter. a
cause :
Medical Defence Union, Tavistock House South, Tavistock Square, London, W.C.1. W.C.I.
Union, ROBERT
FORBES
Secretary.
DO REDHEADS BLEED EASILY ? was interested and instructed by the report in your issue of May 22 (p. 1061) of Mr. Walker Ashcroft’s paper to the Royal Society of Medicine. I should like to ask what is the evidence that red-haired females tend to bleed easily. It is a claim often made but I have been unable to find factual corroboration in the literature. Redheads are also alleged to be more susceptible to rheumatic fever. A shock of red hair is remarkable and easily remembered, and I suspect it is this selective memory that has biased clinical observations. In a series of 98 normal individuals,l 14 of whom had red hair, I estimated the bleeding-time by the Ivy technique (3 incisions on two different days). In with other workers,2 I found that females on average had longer bleeding-times than males, but there was no statistical difference between the groups arranged by hair colour. The striking feature of this normal series, with a technique as carefully standardised as possible, was the extreme variations both between individuals and even in one individual. But the bleeding-time does not necessarily measure a "tendency to bleed." J. R. O’BRIEN. Portsmouth.
SIR,-I
EGGS AND RHEUMATIC FEVER SIR,-We would like to comment on several statements in your annotation of April 17. It is true that streptolysin S has not been shown capable of producing lesions of rheumatic type ; but in the reference you cited in support of this point none of the animals survived more than 48 hours, Which is scarcely long enough. The statement that choline deficiency may be associated with a rise in plasma-phospholipid is contrary both to current concepts and to the intent of the sources cited. As a determining factor in rheumaticfever susceptibility we do not envision a choline deficiency severe enough to cause fat accumulation in the liver but merely one which is capable of producing a relative lack in certain individuals who may have an unusually high choline requirement. We regard the relation of choline intake to the synthesis of plasma-phospholipid as enabling or permissive rather than stimulating. Evaluation of methionine as a substitute for choline is complicated by species differences and by the influence of other dietary factors such as protein and vitamin BI2. In any event, it seems significant that the greatest incidence of subjects with a below-average plasma-phospholipid or childhood egg intake was found in patients with the more severe grades of heart-disease or multiple episodes of acute rheumatic fever. ALLAN D. WALLIS Episcopal Hospital, ELLENMAE VIERGIVER. Philadelphia, Pennsylvania.
conformity
SEX AND SOCIETY
SIR,-Dr. Sherriff’s letter last week some
perhaps
deserves
analysis :
"
Those of us who hoped for a lead from the Practitioner in its symposium on Sex and its Problems must have been
sadly disappointed."
,
By what right does Dr. Sherriff speak for this putative group and why expect a lead from a symposium, which is a collection of views on one topic " "
"
SAFER HYPOTENSION
SIR,-There are several ways in which chlorpromazine could contribute to safer hypotension for cerebral surgery without resorting to the active cooling described by Dr. Dundee and his colleagues in their letter of April 24. The narcobiotic property of chlorpromazine described by Decourt 3 causes a reversible depression of activity of all cellular life. It could, therefore, conceivably reduce the activity of the cells of the. brain, rendering them more resistant to aggressions, including anoxia. Admittedly, a similar effect can be produced by cooling, but the necessity for duplication of the process is open to question. The specific action of chlorpromazine in abolishing central autonomic activity45 might be of assistance in preventing the cardiovascular emergencies that arise during neurosurgery, following transmission of retractor pressure to the mid-brain, or active surgical intervention at the base of the brain. Finally, chlorpromazine itself possesses peripheral ganglion-blocking properties and it is not surprising therefore that smaller doses of ‘ Arfonad ’ are required to produce hypotension. These remarks are not made in criticism of the method described. They are made because hypothermia is given the credit which is probably due to chlorpromazine. Equally good results might well be obtained without the additional complication of hypothermia. Lambeth Hospital, London, S.E.11.
D. A. B. HOPKIN.
1. O’Brien, J. R. J. clin. Path. 1951, 4, 272. 2. Pauwen, L. J., Roskam, J., Derouaux, G., Puissant, A. Arch. int. Pharmacodyn. 1942, 67, 390. 3. Decourt, P. C.R. Acad. Sci., Paris, 1953, 236, 1195. 4. Pocidalo, J. J., Cathala, H. P., Humbert, J., Tardieu, Mme. C.R. Soc. Biol. Paris, 1953, 146, 368. 5. Cathala, H. P., Pocidalo, J. J. Ibid, p. 1709.
Nowhere is a radically new approach to sex suggested." Dr. Sherriff’s new approach is a policy of licence which is older than some hills. If our criminal law on male homosexuality were to be "
civilised
as
in France,
Scandinavia, Switzerland,
and most
socially advanced European countries, many of these problems would simply fade away." " Civilised begs the whole question. The implication of " most socially advanced " is that the countries named and unnamed are more socially advanced than we are. But are they’? "... many of the problems would simply fade away " : of course they would, but they would be "
replaced by
many
more.
"
Fifty years ago the most frantic rubbish was uttered about deadly evils of masturbation." It still is, and among the rubbish is the statement that
the
masturbation is of "
we
no
importance.
In another fifty years posterity will likewise marvel that could make such a mountain out of the molehill of
homosexuality." This is the kernel of the letter. Dr. Sherriff thinks that a mere molehill. I do not’; it often ruins lives and is contagious.
homosexuality is "
Let us hope that a kindly and earthy sexual common will then prevail, which would minimise homosexuality and other sexual disabilities more than anything else."
sense
But why " let us hope " when in the preceding sentence he has said it will? I deny that such a view could be " kindly," but am inclined to agree with " earthy." The last part of the sentence is obscure: " Let us hope that a sexual common sense will then prevail, which would minimise homosexuality... more than anything else." Minimise the quantity of or the importance of it ? ...
it