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EXERCISE TESTS DURING TREATMENT OF HYPERTENSION
1350 became dilated and only the abdominal reflexes
were
pressure reacted differently in hypertensive and normotensive persons : in the normotensive it almost invariably decreased in the minutes immediately after exercise (out of a total of 41 observations, only 4 showed an increase) ; in essential
absent.
His
blood-pressure was 136/80 mm. Hg and did not rise above 150/60 subsequently. He received 150 mg. of the drug in the next 41/2 hours, after which he awoke and seemed to recognise his relatives. Dosage was continued with 330 mg. over another 41/2 hours, at the end of which he was fully awake and able to eat without assistance. The total dose of methylamphetamine was 560 mg. over 151/2 hours. For the next 24 hours he had decreasing visual hullucinations and was excitable though cooperative. Additional treatment during included oxygen by nasal 1 million units of penicillin.
coma
it usually rose (a decrease was noted in only 5 out of 36 observations). The difference between the " reaction of the two groups was significant by the t " test. the diastolic Exercise after T.J
hypertension
catheter, rectal saline, and
This patient was never on the verge of convulsions with methylamphetamine, as he was with picrotoxin ; his blood-pressure remained normal. It seems safe to
These findings are opposed to the conclusion of Stevenson et al.1 that the blood-pressure of patients with essential hypertension reacts differently from that of normotensive people because of psychic factors and not as a result of exercise. The cardiac output per minute in both hypertensive and normotensive patients is known to increase as a result of exercise, so the different behaviour of diastolic pressure in the two groups can only be attributed to the fact that exercise produces a greater fall in the peripheral resistance of normal individuals. Although exercise affected the diastolic pressure less after the administration of a ganglion-blocking agent, in 2 cases exercise was followed by a substantial drop in blood-pressure and a state of semi-collapse, which confirms Dr. Jessen’s observations. G. CZONICZER T. ZSÓTÉR University of Szeged, ZS. SEBÖK. Hungary.
give large doses of methvlamphetamine over a comparatively short time to patients in deep coma. Poe and Karp2 describe a case in which a total of 520 mg. was oivan- but
no
timf.s a.re stated.
Poole Hospital,
Nunthorpe, Middlesbrough.
’
-
C. F. HINGSTON.
DEMONSTRATIONS OF HYPNOTISM SiR,—The Hypnotism Act of 1952 was initiated and passed to curb the dangerous and degrading spectacle of stage hypnosis and to stop the abuse of a recognised medical technique as entertainment for the public. Are 1 Today we we any further now that the Act is a fact read3 of a television demonstration of by a dentist, using hypnosis. Yesterday we read4 of a layman who publicly demonstrated hypnosis on members of his audience and who was prosecuted under the Act and acquitted because he gavea "lecture" and no collection was made. We repeatedly read in the lay press articles by or about certain doctors and others practising hypnotism. This conduct should not be permitted and can only be controlled by a stronger Act
tooth-pulling
THE AFRICAN MIND
SIR,- our annotation of Jan. 30, under the title
Comparative Psychiatry, discusses the psychiatric section of Dr. Carothers’s monograph on The African -Nlind in Health and Disease. His observations are based on an earlier study,2 which was devoted to a careful analysis of the cases admitted over a period of 5 years to the African mental hospital in Kenya, and which raises, as you suggest, many interesting points of comparison between types of mental disease found in European and African communities. This section involves, however, only one chapter in Dr. Carothers’s monograph-a chapter which will probably only attract the interest of specialists in this field. A chapter which will, I imagine, arrest the attention of a wider group of readers is that on psychology, in which the author develops his views on the African mind in health. These are also based upon a previously
adequate action bya disciplinary body. If hypnotherapy is to achieve its correct status and position in medicine, it must not be abused. ’Ye are not or
asked to witness the extraction of teeth under thioor nitrous oxide on television, for it would not be tolerated by medical authority. Could we not expect the same consideration for a valuable therapy even now in the experimental stage ? GORDON AMBROSE. London, W.I. -
pentone
-
EXERCISE TESTS DURING TREATMENT OF HYPERTENSION
SIR,-In your issue of Oct. 3, Dr. Vagn Rønnov-Jessen reported 2 cases of hypertension in which, after the administration of hexamethonium, a fall in blood-
but one which unfortunately falls far short of the earlier one in standard of scientific inquiry. The evidence, in fact, which Dr. Carothers presents in support of his view that African behaviour resembles that of a leucotomised European psychopath consists of 33 personal and subjective anecdotes purporting to depict unreliable behaviour in Africans." For example, one of these (and not the most surprising) reads as follows :
published study,3
pressure set in after physical exertion. He postulated that the change of blood-pressure following exertion was a guide to the level to which blood-pressure should be reduced by treatment. We should like to report the results of similar tests on the effect of exercise on systolic and diastolic bloodpressure in normal and hypertensive individuals before and after the administration of tetraethyl ammonium bromide (T.E.A.B.). Our results partly confirm those of Dr. Jessen.
"
88 tests were performed on 73 people ; 35 had a normal blood-pressure, 28 had essential hypertension, and 10+ had renal hypertension. Blood-pressure and pulse-rate were taken in the lying position until the resting level was reached. The patient then performed 20 deep knee-bends in one minute ; immediately afterwards, the blood-pressure and pulse-rate were again recorded every minute for a period of at least 10 minutes. After a prolonged rest, 0-3 g. of T.E.A.B. was injected intravenously, and the above exercise test was then repeated. We found that the systolic pressure of hypertensive and’
,
normotensive individuals
rose
after exercise. But the diastolic
2. Poe, M. F., Karp, M. Curr. Res. Anesth. 3. News Chronicle, May 25, 1954. 4. Brit. med. J. May 8, 1954, p. 1103.
1948, 27, 176.
my shoes to be mended in my shopping basket the before so that I shall remember to take them to the cobbler the next day ; the house-boy takes them out, cleans them, and puts them elsewhere, though he might assume that they had been put in the basket for some purpose." I
put
night
Readers-and particularly those with some experience of East African mores-will be able to think of many explanations for this alleged shortcoming, but the point I wish to stress is that this is not the kind of evidence upon which serious conclusions can be based. In short, the contrast between the methods by which Dr. Carothers has arrived at his psychiatric and at his 1. Stevenson, I. P., Duncan, C. H., Flynn, J. T., Wolf, S. J. med. Sci. 1952, 224, 286. 2. Carothers, J. C. J. ment. Sci. 1948, 93, 548. 3. Carothers, J. C. Ibid, 1951, 97, 12.
Amer.
were
pressure reacted differently in hypertensive and normotensive persons : in the normotensive it almost invariably decreased in the minutes immediately after exercise (out of a total of 41 observations, only 4 showed an increase) ; in essential
absent.
His
blood-pressure was 136/80 mm. Hg and did not rise above 150/60 subsequently. He received 150 mg. of the drug in the next 41/2 hours, after which he awoke and seemed to recognise his relatives. Dosage was continued with 330 mg. over another 41/2 hours, at the end of which he was fully awake and able to eat without assistance. The total dose of methylamphetamine was 560 mg. over 151/2 hours. For the next 24 hours he had decreasing visual hullucinations and was excitable though cooperative. Additional treatment during included oxygen by nasal 1 million units of penicillin.
coma
it usually rose (a decrease was noted in only 5 out of 36 observations). The difference between the " reaction of the two groups was significant by the t " test. the diastolic Exercise after T.J
hypertension
catheter, rectal saline, and
This patient was never on the verge of convulsions with methylamphetamine, as he was with picrotoxin ; his blood-pressure remained normal. It seems safe to
These findings are opposed to the conclusion of Stevenson et al.1 that the blood-pressure of patients with essential hypertension reacts differently from that of normotensive people because of psychic factors and not as a result of exercise. The cardiac output per minute in both hypertensive and normotensive patients is known to increase as a result of exercise, so the different behaviour of diastolic pressure in the two groups can only be attributed to the fact that exercise produces a greater fall in the peripheral resistance of normal individuals. Although exercise affected the diastolic pressure less after the administration of a ganglion-blocking agent, in 2 cases exercise was followed by a substantial drop in blood-pressure and a state of semi-collapse, which confirms Dr. Jessen’s observations. G. CZONICZER T. ZSÓTÉR University of Szeged, ZS. SEBÖK. Hungary.
give large doses of methvlamphetamine over a comparatively short time to patients in deep coma. Poe and Karp2 describe a case in which a total of 520 mg. was oivan- but
no
timf.s a.re stated.
Poole Hospital,
Nunthorpe, Middlesbrough.
’
-
C. F. HINGSTON.
DEMONSTRATIONS OF HYPNOTISM SiR,—The Hypnotism Act of 1952 was initiated and passed to curb the dangerous and degrading spectacle of stage hypnosis and to stop the abuse of a recognised medical technique as entertainment for the public. Are 1 Today we we any further now that the Act is a fact read3 of a television demonstration of by a dentist, using hypnosis. Yesterday we read4 of a layman who publicly demonstrated hypnosis on members of his audience and who was prosecuted under the Act and acquitted because he gavea "lecture" and no collection was made. We repeatedly read in the lay press articles by or about certain doctors and others practising hypnotism. This conduct should not be permitted and can only be controlled by a stronger Act
tooth-pulling
THE AFRICAN MIND
SIR,- our annotation of Jan. 30, under the title
Comparative Psychiatry, discusses the psychiatric section of Dr. Carothers’s monograph on The African -Nlind in Health and Disease. His observations are based on an earlier study,2 which was devoted to a careful analysis of the cases admitted over a period of 5 years to the African mental hospital in Kenya, and which raises, as you suggest, many interesting points of comparison between types of mental disease found in European and African communities. This section involves, however, only one chapter in Dr. Carothers’s monograph-a chapter which will probably only attract the interest of specialists in this field. A chapter which will, I imagine, arrest the attention of a wider group of readers is that on psychology, in which the author develops his views on the African mind in health. These are also based upon a previously
adequate action bya disciplinary body. If hypnotherapy is to achieve its correct status and position in medicine, it must not be abused. ’Ye are not or
asked to witness the extraction of teeth under thioor nitrous oxide on television, for it would not be tolerated by medical authority. Could we not expect the same consideration for a valuable therapy even now in the experimental stage ? GORDON AMBROSE. London, W.I. -
pentone
-
EXERCISE TESTS DURING TREATMENT OF HYPERTENSION
SIR,-In your issue of Oct. 3, Dr. Vagn Rønnov-Jessen reported 2 cases of hypertension in which, after the administration of hexamethonium, a fall in blood-
but one which unfortunately falls far short of the earlier one in standard of scientific inquiry. The evidence, in fact, which Dr. Carothers presents in support of his view that African behaviour resembles that of a leucotomised European psychopath consists of 33 personal and subjective anecdotes purporting to depict unreliable behaviour in Africans." For example, one of these (and not the most surprising) reads as follows :
published study,3
pressure set in after physical exertion. He postulated that the change of blood-pressure following exertion was a guide to the level to which blood-pressure should be reduced by treatment. We should like to report the results of similar tests on the effect of exercise on systolic and diastolic bloodpressure in normal and hypertensive individuals before and after the administration of tetraethyl ammonium bromide (T.E.A.B.). Our results partly confirm those of Dr. Jessen.
"
88 tests were performed on 73 people ; 35 had a normal blood-pressure, 28 had essential hypertension, and 10+ had renal hypertension. Blood-pressure and pulse-rate were taken in the lying position until the resting level was reached. The patient then performed 20 deep knee-bends in one minute ; immediately afterwards, the blood-pressure and pulse-rate were again recorded every minute for a period of at least 10 minutes. After a prolonged rest, 0-3 g. of T.E.A.B. was injected intravenously, and the above exercise test was then repeated. We found that the systolic pressure of hypertensive and’
,
normotensive individuals
rose
after exercise. But the diastolic
2. Poe, M. F., Karp, M. Curr. Res. Anesth. 3. News Chronicle, May 25, 1954. 4. Brit. med. J. May 8, 1954, p. 1103.
1948, 27, 176.
my shoes to be mended in my shopping basket the before so that I shall remember to take them to the cobbler the next day ; the house-boy takes them out, cleans them, and puts them elsewhere, though he might assume that they had been put in the basket for some purpose." I
put
night
Readers-and particularly those with some experience of East African mores-will be able to think of many explanations for this alleged shortcoming, but the point I wish to stress is that this is not the kind of evidence upon which serious conclusions can be based. In short, the contrast between the methods by which Dr. Carothers has arrived at his psychiatric and at his 1. Stevenson, I. P., Duncan, C. H., Flynn, J. T., Wolf, S. J. med. Sci. 1952, 224, 286. 2. Carothers, J. C. J. ment. Sci. 1948, 93, 548. 3. Carothers, J. C. Ibid, 1951, 97, 12.
Amer.