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EPILEPSY AND ORGANIC DISEASE
94 from D2 to D5 as in cardiac denervation—can be with ease and safety.
performed
I feel that surgeons who employ this method will be gratified by the increased ease and success of their upper-limb sympathectomies. I hope to publish a more
detailed account in the Dublin.
near
future. PATRICK FITZGERALD.
SIR,—Following the publication of my letter of 17, I have been informed that this approach was originally suggested by Mr. W. G. Schulze, of Cape Town, a young surgeon now working in this country. Mr. Schulze did all the preliminary investigation on the cadaver, and eventually introduced the operation to the surgical unit at Cape Town. He informs me that an article will shortly be published, in conjunction Dec.
with Professor Goetz, which will include a full account of the procedure. H. J. B. ATKINS Director, Department of Surgery.
Guy’s Hospital.
EPILEPSY AND ORGANIC DISEASE
SIR,—Professor Nattrass, in his address to the Manchester Medical Society (Lancet, 1949, ii, 994), very rightly emphasised the importance of remembering the existence of organic disease as a possible cause of epilepsy. He quoted the results of post-mortem examinations on 25 cases of patients who had their first fit after the age of 40. In no less than 10 of these the cause of the fits was found to be intracranial tumour. It should be impressed on all patients who have their first fit after reaching adult life that they should see a neurologist frequently. Epilepsy is a symptom and not a disease sui generis. It is high time now to stop confusing ourselves by describing a symptom as an " idiopathic " disease. The word " idiopathic " is defined in the Shorter Oxford English Dictionary as " Of the nature of a primary morbid state ; not consequent What word could be more upon another disease." defeatist in diagnosis or research ? If the cause in any particular case has not been discovered, let it be called " epilepsy of unknown origin." H. W. DALTON. Dublin. HEINZ-BODY ANEMIA AFTER SULPHETRONE
SIR,—Dr. Morlock and Dr. Livingstone, in their article of Dec. 24, mention the known tendency to " hypochromic hæmolytic anaemia, which develops and continues throughout the administration of sulphetrone." Perhaps it is not generally known that this haemolytic anaemia is related to the formation of Heinz-Ehrlich bodies in the red corpuscles (" tagged" cells). Recently a 7-year-old child was given 1 g. of ’Sulphetrone ’ daily for three and a half days. Two days later (Dec. 19) polychromatic macrocytes and Howell Jolly bodies were present in the blood-film. Further blood-counts thrice
showed :
_
Dec. 22 Hb, g. per 100 ml. 13-5 Red cells, millions per
Dec. 23 11-1
4-2 1-08 77-2 7-4
3-52
-
c.mm.......
Colour-index.... Tagged " red cells, %..
1-07 67-8
Dec. 28 Jan. 3 9-62 9-99 2-64 1-2 5-4 23-2
2-86 1-19 0 9-6
14-3 Reticulocytes, % This haemolytic anaemia, despite the high reticulocytosis, due to the rapid elimination of the " tagged " cells by the reticulo-endothelial system, was associated with only a slight rise in the blood-bilirubin (0-9 mg. per 100 ml.), and was not accompanied by methaemoglobinaemia. The leaden blue discoloration of the skin was very pronounced. It is unlikely that the administration of iron could counteract the development of this anaemia, which, however, will gradually disappear when the sulphetrone and its split products have been ..
eliminated from the tissues.
By a coincidence your previous issue-that of Dec. 17an article, by Dr. Bourne, on the antipyretic It is worth mentioning that action of ’Cryogenine.’ similar haemolytic anaemias occur after cryogenine, as I observed in tuberculous patients some years ago. The cryogenine anaemia is due to the formation of phenyl-
contained
phenylsemicarbazide.l
from the administered Severe anaemia from these products, both of which are being used in the treatment of the same condition - tuberculosis-though with different purposes, may be averted by withholding the drugs on the of a high percentage of tagged " cells. S. VARADI City General Hospital,
hydrazine
appearance
"
Hæmatologist.
Sheffield, 5.
DEOXYCORTONE ACETATE AND ASCORBIC ACID IN RHEUMATOID ARTHRITIS
SIR,—Like other rheumatologists we were anxious to confirm the good results recorded by Lewin and W’assen2 in treating rheumatoid arthritis with deoxycortone acetate and ascorbic acid. Our results agree with those of Kellgren.3 Nine patients have been treated. All were undoubtedly suffering from rheumatoid arthritis and all showed signs of activity. The treatment was carried out exactly as described. All were carefully examined before and after the treatment ; accurate measurements were recorded of the maximum circumference of swollen joints (where feasible) and of the range of active movement. The erythrocyte-sedimentation rate (E.s.R.) was recorded before and after. No changes in signs were observed in any of these cases, and the E.s.R. remained unchanged. One patient said he felt better after the injections and another that he felt dopey ; the others felt no change. The one who felt better had a second treatment without anv benefit. ERNEST FLETCHER
Physician-in-Charge.
BRANDON LUSH Physician-in-Training.
J. F. BUCHAN Unit of Rheumatology, The Royal Free Hospital, North Western Branch, London, N.W.3.
Medical Registrar.
S. WOLFF House
Physician.
INTRAVENOUS INFUSIONS
SIR,—During the past few weeks, some most interesting helpful notes have been published in your journal concerning- the technique of administering intravenous fluids and also the sterilisation ofPolythene ’ tubing. For the past eighteen months, I have been using polythene tubing (sterilised by boiling) for intravenous therapy, and have found it particularly useful for babies, rendering cumbersome splints and difficult immobilisation of the foot unnecessary, and making nursing much In adults, I introduce it into a forearm vein easier. through a needle, or by cutting down’ on a vein and tying it off in the usual way. So far, I believe, my results are better than those obtained by the older methods. The method allows the patient freedom of movement, and I can usually keep the same vein in use for five or six days. The end-result, however, is alwayss the same ; thrombophlebitis develops, necessitating the removal of the tubing. I have been trying to perfect this technique for the continuous administration of penicillin in cases of subacute bacterial endocarditis. In ’my last patient, I introduced the tubing through a needle into a forearm and
-
’
vein with strict aseptic technique. The
natient was
1. Ungricht, M. Folia hœmat., Lpz. 1938, 60. 145. 2. Lewin, E., Wassén, E. Lancet, 1949, ii, 993. 3. Kellgren, J. H. Ibid, p. 1108.
performed
I feel that surgeons who employ this method will be gratified by the increased ease and success of their upper-limb sympathectomies. I hope to publish a more
detailed account in the Dublin.
near
future. PATRICK FITZGERALD.
SIR,—Following the publication of my letter of 17, I have been informed that this approach was originally suggested by Mr. W. G. Schulze, of Cape Town, a young surgeon now working in this country. Mr. Schulze did all the preliminary investigation on the cadaver, and eventually introduced the operation to the surgical unit at Cape Town. He informs me that an article will shortly be published, in conjunction Dec.
with Professor Goetz, which will include a full account of the procedure. H. J. B. ATKINS Director, Department of Surgery.
Guy’s Hospital.
EPILEPSY AND ORGANIC DISEASE
SIR,—Professor Nattrass, in his address to the Manchester Medical Society (Lancet, 1949, ii, 994), very rightly emphasised the importance of remembering the existence of organic disease as a possible cause of epilepsy. He quoted the results of post-mortem examinations on 25 cases of patients who had their first fit after the age of 40. In no less than 10 of these the cause of the fits was found to be intracranial tumour. It should be impressed on all patients who have their first fit after reaching adult life that they should see a neurologist frequently. Epilepsy is a symptom and not a disease sui generis. It is high time now to stop confusing ourselves by describing a symptom as an " idiopathic " disease. The word " idiopathic " is defined in the Shorter Oxford English Dictionary as " Of the nature of a primary morbid state ; not consequent What word could be more upon another disease." defeatist in diagnosis or research ? If the cause in any particular case has not been discovered, let it be called " epilepsy of unknown origin." H. W. DALTON. Dublin. HEINZ-BODY ANEMIA AFTER SULPHETRONE
SIR,—Dr. Morlock and Dr. Livingstone, in their article of Dec. 24, mention the known tendency to " hypochromic hæmolytic anaemia, which develops and continues throughout the administration of sulphetrone." Perhaps it is not generally known that this haemolytic anaemia is related to the formation of Heinz-Ehrlich bodies in the red corpuscles (" tagged" cells). Recently a 7-year-old child was given 1 g. of ’Sulphetrone ’ daily for three and a half days. Two days later (Dec. 19) polychromatic macrocytes and Howell Jolly bodies were present in the blood-film. Further blood-counts thrice
showed :
_
Dec. 22 Hb, g. per 100 ml. 13-5 Red cells, millions per
Dec. 23 11-1
4-2 1-08 77-2 7-4
3-52
-
c.mm.......
Colour-index.... Tagged " red cells, %..
1-07 67-8
Dec. 28 Jan. 3 9-62 9-99 2-64 1-2 5-4 23-2
2-86 1-19 0 9-6
14-3 Reticulocytes, % This haemolytic anaemia, despite the high reticulocytosis, due to the rapid elimination of the " tagged " cells by the reticulo-endothelial system, was associated with only a slight rise in the blood-bilirubin (0-9 mg. per 100 ml.), and was not accompanied by methaemoglobinaemia. The leaden blue discoloration of the skin was very pronounced. It is unlikely that the administration of iron could counteract the development of this anaemia, which, however, will gradually disappear when the sulphetrone and its split products have been ..
eliminated from the tissues.
By a coincidence your previous issue-that of Dec. 17an article, by Dr. Bourne, on the antipyretic It is worth mentioning that action of ’Cryogenine.’ similar haemolytic anaemias occur after cryogenine, as I observed in tuberculous patients some years ago. The cryogenine anaemia is due to the formation of phenyl-
contained
phenylsemicarbazide.l
from the administered Severe anaemia from these products, both of which are being used in the treatment of the same condition - tuberculosis-though with different purposes, may be averted by withholding the drugs on the of a high percentage of tagged " cells. S. VARADI City General Hospital,
hydrazine
appearance
"
Hæmatologist.
Sheffield, 5.
DEOXYCORTONE ACETATE AND ASCORBIC ACID IN RHEUMATOID ARTHRITIS
SIR,—Like other rheumatologists we were anxious to confirm the good results recorded by Lewin and W’assen2 in treating rheumatoid arthritis with deoxycortone acetate and ascorbic acid. Our results agree with those of Kellgren.3 Nine patients have been treated. All were undoubtedly suffering from rheumatoid arthritis and all showed signs of activity. The treatment was carried out exactly as described. All were carefully examined before and after the treatment ; accurate measurements were recorded of the maximum circumference of swollen joints (where feasible) and of the range of active movement. The erythrocyte-sedimentation rate (E.s.R.) was recorded before and after. No changes in signs were observed in any of these cases, and the E.s.R. remained unchanged. One patient said he felt better after the injections and another that he felt dopey ; the others felt no change. The one who felt better had a second treatment without anv benefit. ERNEST FLETCHER
Physician-in-Charge.
BRANDON LUSH Physician-in-Training.
J. F. BUCHAN Unit of Rheumatology, The Royal Free Hospital, North Western Branch, London, N.W.3.
Medical Registrar.
S. WOLFF House
Physician.
INTRAVENOUS INFUSIONS
SIR,—During the past few weeks, some most interesting helpful notes have been published in your journal concerning- the technique of administering intravenous fluids and also the sterilisation ofPolythene ’ tubing. For the past eighteen months, I have been using polythene tubing (sterilised by boiling) for intravenous therapy, and have found it particularly useful for babies, rendering cumbersome splints and difficult immobilisation of the foot unnecessary, and making nursing much In adults, I introduce it into a forearm vein easier. through a needle, or by cutting down’ on a vein and tying it off in the usual way. So far, I believe, my results are better than those obtained by the older methods. The method allows the patient freedom of movement, and I can usually keep the same vein in use for five or six days. The end-result, however, is alwayss the same ; thrombophlebitis develops, necessitating the removal of the tubing. I have been trying to perfect this technique for the continuous administration of penicillin in cases of subacute bacterial endocarditis. In ’my last patient, I introduced the tubing through a needle into a forearm and
-
’
vein with strict aseptic technique. The
natient was
1. Ungricht, M. Folia hœmat., Lpz. 1938, 60. 145. 2. Lewin, E., Wassén, E. Lancet, 1949, ii, 993. 3. Kellgren, J. H. Ibid, p. 1108.