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FALLACIES IN MEDICAL EDUCATION
779 TABLE II-MEAN ACIDITY OF ORGANIC ACIDS AND MEAN BASAL
AND
STIMULATED
GASTRIC
JUICE,
IN ALL
A
ACIDITY OF
PATIENTS
AND
CONTROLS
Similarity of the features of herpes simplex and peptic ulcer, susceptible age-groups, in periodicity, in recurrence under some stress (physical or other), and in tendency to recur in the
in
same area, seems to suggest such a link. In view of what nasal and oral or vaginal secretions do to visible herpes clusters in the way of maceration, ulceration and confluence, it is not difficult to imagine how the gastric juice would affect a herpetic eruption and initiate ulceration, particularly if higher gastric acidity should interfere with healing. Complement-fixation studies may or may not confirm that there is such a herpes-simplex/peptic-ulcer link. Elmont, H. H. NEUMANN. New York 11003.
ions, but since it is
not known whether " buffers " of gastric secreted as salts, complexes, or free acids, or whether juice this secretion is related to the secretion of hydrochloric acid, measurement of hydrochloric acid is still best approximated by titration to pH 3-5. Only detailed investigations, like those of Piper et aI.,6 of all acids and " buffers " (and food remnants) of basal and stimulated gastric juice in patients with different gastric diseases can throw light on the origin of the hydrogen ions, measured from pH 3-5 to pH 7-0, and thereby improve our concents of gastric aciditv and achlorhvdria. Surgical Department A, Bispebjerg Hospital, POUL M. CHRISTIANSEN. Copenhagen NV. are
PENTAGASTRIN TEST OF GASTRIC SECRETION SIR,-In the paper by Mr. Johnston and Dr. Jepson (Sept. 16, p. 585) the word gastrin is repeatedly used as an abbreviation for pentagastrin. Since gastrin is a fully defined chemical substance different from pentagastrin, and since these two substances do not have identical biological actions, different words should be used to desilnate them. Veterans Administration Center, Los Angeles, California 90073, U.S.A.
MORTON I. GROSSMAN.
*** This letter has been shown
to Mr. Johnston and Dr. who write as follows: " Dr. Grossman is quite right. In extenuation of the terminology we used, may we point to the precise wording of the title and the careful definition of terms in the introduction, where we drew the distinction between pure gastrin and its synthetic derivatives such as pentagastrin. We also introducedthe gastrin test ’ between quotation marks, using ’gastrin’ as a generic term to contrast with histamine, which has been the traditional gastric stimulant in clinical practice in this country. Nevertheless, we must agree with all that Dr. Grossman says, and should probably have talked of ’the pentagastrin test ’ ".-ED. L.
Jepson,
HERPES SIMPLEX IN PEPTIC ULCERATION ? SIR,-A patient under my observation has recurring herpessimplex eruptions of the labia. Starting a day or two before this eruption, she also has consistently severe epigastric pains which last for about 3-5 days, with discomfort similar in character to peptic-ulcer pains, eased by the ingestion of some foods, made worse by others, and accompanied by tenderness on pressure in the episgastrium. The clinical sequence and course raise the question whether these symptoms are due to a gastric or duodenal herpes-simplex cluster. Since the gastric and duodenal mucosa seems to be susceptible to herpes simplex, this pathogenesis may explain cases of recurring epigastric pain, lasting about 3-5 days, and occurring in any age-group, particularly in younger and middle-aged patients. Notionally one may consider a herpes-simplex cluster as an xtiological factor in patients with gastric or duodenal ulcers.
SIMIAN LINE AND PSORIASIS SIR,-A modified, distal, transverse, flexion crease coursing continuously from radial to ulnar margins of the palm (i.e., simian line) occurs occasionally in normal persons.! Davies and Smallpeice2 found a single transverse crease on one or both hands in 1-7% of 811 primary-school children. Alter3 mentioned that Bettmann4 observed simian lines in 28% of psoriatics. However, in a study of British patients with psoriasis, I have found simian lines in only 2 patients in the first 104 (47 males, 57 females) observed (i.e., 1-9%)-in each case unilateral. Thus, I suggest that the incidence of simian lines in patients with psoriasis does not differ from that in the. normal population, and a single transverse crease should not be considered a feature of psoriasis. Department of Dermatology, Guy’s Hospital, London S.E.1. JULIAN L. VERBOV.
FALLACIES IN MEDICAL EDUCATION
SIR,-Professor Dornhorst and Dr. Hunter (Sept. 23, p. 666) criticise the critics of today’s medical education. They describe a " scientistic fallacy " born apparently of the " ludicrous intellectual parochialism " that " flourishes in universities ", and a pastoral fallacy espoused it seems by those no longer able to keep abreast " with " the technical complexities of modern medicine ". People tend to denigration when their argument is wearing thin. Perhaps that is the case "
"
"
here. There are a good many of us who are happy to be associated with views that can be described as both " scientistic " and "
"
pastoral (they
are
by
no
means
incompatible). We
believe that these contain many of the most creative of thought in modern medical education. Massachusetts Institute of Technology, Education Research Center, Cambridge, Massachusetts 02139.
currents
NICOLAS MALLESON.
PARTICULAR CARRIAGE OF RADIORESISTANCE SIR,-Selective protection of the bone-marrow, intestines, or other organs in total-body irradiation demands maximum concentration of the protective substance in these organs. But the protective substance should not be allowed to concentrate in tumours which are being irradiated. We have therefore suggested and used the method of selective accumulation in the bone-marrow, spleen, and liver of protective substances combined with corpuscular or macromolecular carriers.5 Substances
containing SH groups-for example, cystamine-
Cummins, H., Midlo, C. Finger Prints, Palms and Soles. An Introduction to Dermatoglyphics; p. 279. New York, 1961. 2. Davies, P. A., Smallpeice, V. Devl. Med. Child Neurol. 1963, 5, 491. 3. Alter, M. Medicine, Baltimore, 1967, 46, 50. 4. Bettmann, S. Z. Anat. EntwGesch. 1932, 98, 487. 5. Svet-Moldavsky, G. J., Pavlotsky, A. I., Ravkina, L. I. Vestnik USSR A.M.S. 1967, 5, 42. Svet-Moldavsky, G. J., Pavlotsky, A. I. Rep. USSR A.S. (in the press). 1.
AND
STIMULATED
GASTRIC
JUICE,
IN ALL
A
ACIDITY OF
PATIENTS
AND
CONTROLS
Similarity of the features of herpes simplex and peptic ulcer, susceptible age-groups, in periodicity, in recurrence under some stress (physical or other), and in tendency to recur in the
in
same area, seems to suggest such a link. In view of what nasal and oral or vaginal secretions do to visible herpes clusters in the way of maceration, ulceration and confluence, it is not difficult to imagine how the gastric juice would affect a herpetic eruption and initiate ulceration, particularly if higher gastric acidity should interfere with healing. Complement-fixation studies may or may not confirm that there is such a herpes-simplex/peptic-ulcer link. Elmont, H. H. NEUMANN. New York 11003.
ions, but since it is
not known whether " buffers " of gastric secreted as salts, complexes, or free acids, or whether juice this secretion is related to the secretion of hydrochloric acid, measurement of hydrochloric acid is still best approximated by titration to pH 3-5. Only detailed investigations, like those of Piper et aI.,6 of all acids and " buffers " (and food remnants) of basal and stimulated gastric juice in patients with different gastric diseases can throw light on the origin of the hydrogen ions, measured from pH 3-5 to pH 7-0, and thereby improve our concents of gastric aciditv and achlorhvdria. Surgical Department A, Bispebjerg Hospital, POUL M. CHRISTIANSEN. Copenhagen NV. are
PENTAGASTRIN TEST OF GASTRIC SECRETION SIR,-In the paper by Mr. Johnston and Dr. Jepson (Sept. 16, p. 585) the word gastrin is repeatedly used as an abbreviation for pentagastrin. Since gastrin is a fully defined chemical substance different from pentagastrin, and since these two substances do not have identical biological actions, different words should be used to desilnate them. Veterans Administration Center, Los Angeles, California 90073, U.S.A.
MORTON I. GROSSMAN.
*** This letter has been shown
to Mr. Johnston and Dr. who write as follows: " Dr. Grossman is quite right. In extenuation of the terminology we used, may we point to the precise wording of the title and the careful definition of terms in the introduction, where we drew the distinction between pure gastrin and its synthetic derivatives such as pentagastrin. We also introducedthe gastrin test ’ between quotation marks, using ’gastrin’ as a generic term to contrast with histamine, which has been the traditional gastric stimulant in clinical practice in this country. Nevertheless, we must agree with all that Dr. Grossman says, and should probably have talked of ’the pentagastrin test ’ ".-ED. L.
Jepson,
HERPES SIMPLEX IN PEPTIC ULCERATION ? SIR,-A patient under my observation has recurring herpessimplex eruptions of the labia. Starting a day or two before this eruption, she also has consistently severe epigastric pains which last for about 3-5 days, with discomfort similar in character to peptic-ulcer pains, eased by the ingestion of some foods, made worse by others, and accompanied by tenderness on pressure in the episgastrium. The clinical sequence and course raise the question whether these symptoms are due to a gastric or duodenal herpes-simplex cluster. Since the gastric and duodenal mucosa seems to be susceptible to herpes simplex, this pathogenesis may explain cases of recurring epigastric pain, lasting about 3-5 days, and occurring in any age-group, particularly in younger and middle-aged patients. Notionally one may consider a herpes-simplex cluster as an xtiological factor in patients with gastric or duodenal ulcers.
SIMIAN LINE AND PSORIASIS SIR,-A modified, distal, transverse, flexion crease coursing continuously from radial to ulnar margins of the palm (i.e., simian line) occurs occasionally in normal persons.! Davies and Smallpeice2 found a single transverse crease on one or both hands in 1-7% of 811 primary-school children. Alter3 mentioned that Bettmann4 observed simian lines in 28% of psoriatics. However, in a study of British patients with psoriasis, I have found simian lines in only 2 patients in the first 104 (47 males, 57 females) observed (i.e., 1-9%)-in each case unilateral. Thus, I suggest that the incidence of simian lines in patients with psoriasis does not differ from that in the. normal population, and a single transverse crease should not be considered a feature of psoriasis. Department of Dermatology, Guy’s Hospital, London S.E.1. JULIAN L. VERBOV.
FALLACIES IN MEDICAL EDUCATION
SIR,-Professor Dornhorst and Dr. Hunter (Sept. 23, p. 666) criticise the critics of today’s medical education. They describe a " scientistic fallacy " born apparently of the " ludicrous intellectual parochialism " that " flourishes in universities ", and a pastoral fallacy espoused it seems by those no longer able to keep abreast " with " the technical complexities of modern medicine ". People tend to denigration when their argument is wearing thin. Perhaps that is the case "
"
"
here. There are a good many of us who are happy to be associated with views that can be described as both " scientistic " and "
"
pastoral (they
are
by
no
means
incompatible). We
believe that these contain many of the most creative of thought in modern medical education. Massachusetts Institute of Technology, Education Research Center, Cambridge, Massachusetts 02139.
currents
NICOLAS MALLESON.
PARTICULAR CARRIAGE OF RADIORESISTANCE SIR,-Selective protection of the bone-marrow, intestines, or other organs in total-body irradiation demands maximum concentration of the protective substance in these organs. But the protective substance should not be allowed to concentrate in tumours which are being irradiated. We have therefore suggested and used the method of selective accumulation in the bone-marrow, spleen, and liver of protective substances combined with corpuscular or macromolecular carriers.5 Substances
containing SH groups-for example, cystamine-
Cummins, H., Midlo, C. Finger Prints, Palms and Soles. An Introduction to Dermatoglyphics; p. 279. New York, 1961. 2. Davies, P. A., Smallpeice, V. Devl. Med. Child Neurol. 1963, 5, 491. 3. Alter, M. Medicine, Baltimore, 1967, 46, 50. 4. Bettmann, S. Z. Anat. EntwGesch. 1932, 98, 487. 5. Svet-Moldavsky, G. J., Pavlotsky, A. I., Ravkina, L. I. Vestnik USSR A.M.S. 1967, 5, 42. Svet-Moldavsky, G. J., Pavlotsky, A. I. Rep. USSR A.S. (in the press). 1.