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FATTY FOODS AND OBESITY
1352 "
SPIRITUAL HEALERS
"
IN HOSPITAL
SIR,-Mr. Harry Edwards (June 11) assumes that Dr. Cotton Cornwall has presented the strongest case against the new practice of allowing " spiritual healers " to attend the sick in hospitals. I would like to record an experience of mine in this connection. I was invited to attend a demonstration of spiritual healing given by Mr. Edwards in the St. Andrew’s Hall, Norwich, on Nov. 12, 1949. He began by saying that any healing that they might see would not take place through any physical skill of his or his helpers. A number of patients were brought on to the platform ; one of them being a little girl with poliomyelitis affecting one leg, who happened to be a patient of mine. She was lifted on to the platform and into a chair and was wearing a short iron, to support a flail foot, which had been ordered by me. The healer approached the child and ordered removal of the iron and then took the child by the hand and said " get up and walk ", which she did to the astonishment of everybody. Of course, they did not know that the child could walk like that beforehand, but I did. There were even cries of " it’s a miracle ". I saw the same child the next week at my clinic at the Children’s Hospital; there was no change whatever in her condition and fortunately the mother had replaced the short iron. There were other cases " healed " at the same time. I remember one of them quite well-a man with a stiff shoulder, which was quite vigorously manipulated in direct contrast to the opening words of the healer. The patients were subjected to suggestive treatment and were encouraged to do their best in front of a large audience, and there was also a certain amount of handling and manipulations-all well-recognised methods of treatment, but not spiritual healing. I would like to say that I am a firm believer in cooperation between medicine and the Church. But these experiences of mine put " spiritual healing " as demonstrated in Norwich in November, 1949, at quite a different level. If benighted patients want this form of treatment let them go and have it at the spiritual healer’s home or centre, but not in the recognised hospitals of this country. G. K. MCKEE. Norwich. FATTY FOODS AND OBESITY
SIR,-In their letter of May 28, Professor Kekwick and Mr. Pawan repeat their claim that a decrease in body constituents other than water (i.e., fat) is involved in the weight-loss produced over a short period by a fatty diet; in other words, that such a diet brings about an increased tissue catabolism. If Kekwick and Pawan were right in this contention, it should be easy to demonstrate, during the high-fat period, the increase in energy expenditure which must necessarily accompany the accelerated combustion of fat. However, present evidence, including our experiment, is against any significant increase in metabolic-rate on a high-fat regimen; if more fat is burnt on the unaltered oxygen consumption recorded by us, it has to be at the expense of other fuel, probably carbohydrate, and this would even indicate a reduced energy utilisation, considering that 1 litre of oxygen used for burning fat yields fewer calories than 1 litre used for combustion of carbohydrate (about 4-7 and 5-0 kCal., respectively). Kekwick and Pawan’s demonstration of a fat-mobilising factor released on a high-fat regimen is most interesting, but does not exempt us from observing the law of constant energy: the fact that more fat is mobilised might be expected to result in hyperlipxmia, but it does not per se indicate that more fat is burnt. The increase in insensible water loss which Kekwick and Pawan have found in patients on a fatty diet is no reliable indi-
cator
of
a
corresponding
increase of the
metabolic-rate;
thus
Passmore, Strong, and Ritchie1 found that evaporative waterloss varied considerably although calorie expenditure and diet remained unaltered. Nor should we be too much impressed by the fact, also referred to by Kekwick and Pawan, that high-fat feeding inhibits the in-vitro lipogenesis in adipose tissue from rats 2in view of the observation that rats do actually grow fat on high-fat diets.3 Until the disappearance of fat is properly accounted for, we feel justified in " falling back on to the old argument ": that a change in total body-water is the major reason for the changes occurring in body-weight when shifting between equicaloric diets rich in either fat or carbohydrate. In our support we may cite Benedict and Milner4 who demonstrated a large negative water balance on a high-fat diet and, conversely, a positive balance on a high-carbohydrate diet. Also Passmore et al., found a positive water balance in two persons receiving 1000 calories with 90% carbohydrate. E. S. OLESEN 7th Department of Medicine, Kommunehospitalet, Copenhagen.
F. QUAADE.
HEPATITIS AFTER INOCULATIONS
ago the late Sir Alexander Fleming demonstrate a method of sterilising a single syringe and needle for use during mass inoculations. Medicinal paraffin heated over a flame to about 150°C was sucked in and out of the syringe, with the needle in situ, between each injection. I have never used this simple method myself, but I am surprised that no-one from St. Mary’s has written to you about it. JOHN BRAY. London, N.W.I.
SiR,łTwenty years
used
to
LATEX AGGLUTINATION REACTION IN NON-RHEUMATIC DISEASES
SIR,-In your annotation of March 26 and in Dr. Morgan’s letter of April 9, the topic of latex agglutination reaction in non-rheumatic diseases was discussed. You correctly underscored Dresner’s findings5 as emphasising a basic difference between the factors responsible for agglutination of globulin-coated latex particles and the agglutination of erythrocytes sensitised with " amboceptor ". Recent studies of Epstein et al.Lospalluto and Ziff,’ and Franklinhave clearly demonstrated that there are at least two rheumatoid factors. One of these reacts with rabbit the other with human gamma-globulin. gamma-globulin, Those observations should be taken into consideration when interpreting discrepancies between latex fixation tests and " amboceptor "-sensitised erythrocyte procedures. The latex (polystryene) particles are coated with human gammaglobulin, whereas the red cells used for the Rose-Waaler D.A.T. were coated with rabbit antibody gamma-globulin
(amboceptor). In
9
we have found that alligator erythrocytes lend themselves to detection of rheumatoid factor(s) by direct or inhibition haemagglutination procedures. We have observed that 6 of 44 subjects with liver disease due to carcinomatosis or cirrhosis were positive by alligator hsemagglutination. By slide latex fixation, 7 were positive. Whereas our own
laboratory
1. Passmore, R., Strong, J. A., Ritchie, F. J. Brit. J. Nutr. 1959, 13, 17. 2. Masek, J., Fábry, P. Experientia, Basle, 1959, 15, 444. 3. Hausberger, F. X., Milstein, S. W. J. biol. Chem. 1955, 214, 483. 4. Benedict, F. G., Milner, R. D. Experiments on the metabolism of matter and energy in the human body, 1903-1904. Bull. 175. U.S. Department of Agriculture. Office of Experiment Stations, 1907. 5. Dresner, E., Trombly, P., O’Brien, G. F. New Engl. J. Med. 1959, 261, 981. 6. Epstein, W., Johnson, A. M., Rogan, C. Proc. Soc. exp. Biol. Med. 1956, 91, 235. 7. Lospalluto, J., Ziff, M. J. exp. Med. 1959, 110, 169. 8. Franklin, E. G. Arth. Rheum. 1960, 3, 16. 9. Cohen, E., Neter, E., Mink, I., Norcross, B. M. Arch. Inter-Am. Rheum. 1959, 2, 75.
SPIRITUAL HEALERS
"
IN HOSPITAL
SIR,-Mr. Harry Edwards (June 11) assumes that Dr. Cotton Cornwall has presented the strongest case against the new practice of allowing " spiritual healers " to attend the sick in hospitals. I would like to record an experience of mine in this connection. I was invited to attend a demonstration of spiritual healing given by Mr. Edwards in the St. Andrew’s Hall, Norwich, on Nov. 12, 1949. He began by saying that any healing that they might see would not take place through any physical skill of his or his helpers. A number of patients were brought on to the platform ; one of them being a little girl with poliomyelitis affecting one leg, who happened to be a patient of mine. She was lifted on to the platform and into a chair and was wearing a short iron, to support a flail foot, which had been ordered by me. The healer approached the child and ordered removal of the iron and then took the child by the hand and said " get up and walk ", which she did to the astonishment of everybody. Of course, they did not know that the child could walk like that beforehand, but I did. There were even cries of " it’s a miracle ". I saw the same child the next week at my clinic at the Children’s Hospital; there was no change whatever in her condition and fortunately the mother had replaced the short iron. There were other cases " healed " at the same time. I remember one of them quite well-a man with a stiff shoulder, which was quite vigorously manipulated in direct contrast to the opening words of the healer. The patients were subjected to suggestive treatment and were encouraged to do their best in front of a large audience, and there was also a certain amount of handling and manipulations-all well-recognised methods of treatment, but not spiritual healing. I would like to say that I am a firm believer in cooperation between medicine and the Church. But these experiences of mine put " spiritual healing " as demonstrated in Norwich in November, 1949, at quite a different level. If benighted patients want this form of treatment let them go and have it at the spiritual healer’s home or centre, but not in the recognised hospitals of this country. G. K. MCKEE. Norwich. FATTY FOODS AND OBESITY
SIR,-In their letter of May 28, Professor Kekwick and Mr. Pawan repeat their claim that a decrease in body constituents other than water (i.e., fat) is involved in the weight-loss produced over a short period by a fatty diet; in other words, that such a diet brings about an increased tissue catabolism. If Kekwick and Pawan were right in this contention, it should be easy to demonstrate, during the high-fat period, the increase in energy expenditure which must necessarily accompany the accelerated combustion of fat. However, present evidence, including our experiment, is against any significant increase in metabolic-rate on a high-fat regimen; if more fat is burnt on the unaltered oxygen consumption recorded by us, it has to be at the expense of other fuel, probably carbohydrate, and this would even indicate a reduced energy utilisation, considering that 1 litre of oxygen used for burning fat yields fewer calories than 1 litre used for combustion of carbohydrate (about 4-7 and 5-0 kCal., respectively). Kekwick and Pawan’s demonstration of a fat-mobilising factor released on a high-fat regimen is most interesting, but does not exempt us from observing the law of constant energy: the fact that more fat is mobilised might be expected to result in hyperlipxmia, but it does not per se indicate that more fat is burnt. The increase in insensible water loss which Kekwick and Pawan have found in patients on a fatty diet is no reliable indi-
cator
of
a
corresponding
increase of the
metabolic-rate;
thus
Passmore, Strong, and Ritchie1 found that evaporative waterloss varied considerably although calorie expenditure and diet remained unaltered. Nor should we be too much impressed by the fact, also referred to by Kekwick and Pawan, that high-fat feeding inhibits the in-vitro lipogenesis in adipose tissue from rats 2in view of the observation that rats do actually grow fat on high-fat diets.3 Until the disappearance of fat is properly accounted for, we feel justified in " falling back on to the old argument ": that a change in total body-water is the major reason for the changes occurring in body-weight when shifting between equicaloric diets rich in either fat or carbohydrate. In our support we may cite Benedict and Milner4 who demonstrated a large negative water balance on a high-fat diet and, conversely, a positive balance on a high-carbohydrate diet. Also Passmore et al., found a positive water balance in two persons receiving 1000 calories with 90% carbohydrate. E. S. OLESEN 7th Department of Medicine, Kommunehospitalet, Copenhagen.
F. QUAADE.
HEPATITIS AFTER INOCULATIONS
ago the late Sir Alexander Fleming demonstrate a method of sterilising a single syringe and needle for use during mass inoculations. Medicinal paraffin heated over a flame to about 150°C was sucked in and out of the syringe, with the needle in situ, between each injection. I have never used this simple method myself, but I am surprised that no-one from St. Mary’s has written to you about it. JOHN BRAY. London, N.W.I.
SiR,łTwenty years
used
to
LATEX AGGLUTINATION REACTION IN NON-RHEUMATIC DISEASES
SIR,-In your annotation of March 26 and in Dr. Morgan’s letter of April 9, the topic of latex agglutination reaction in non-rheumatic diseases was discussed. You correctly underscored Dresner’s findings5 as emphasising a basic difference between the factors responsible for agglutination of globulin-coated latex particles and the agglutination of erythrocytes sensitised with " amboceptor ". Recent studies of Epstein et al.Lospalluto and Ziff,’ and Franklinhave clearly demonstrated that there are at least two rheumatoid factors. One of these reacts with rabbit the other with human gamma-globulin. gamma-globulin, Those observations should be taken into consideration when interpreting discrepancies between latex fixation tests and " amboceptor "-sensitised erythrocyte procedures. The latex (polystryene) particles are coated with human gammaglobulin, whereas the red cells used for the Rose-Waaler D.A.T. were coated with rabbit antibody gamma-globulin
(amboceptor). In
9
we have found that alligator erythrocytes lend themselves to detection of rheumatoid factor(s) by direct or inhibition haemagglutination procedures. We have observed that 6 of 44 subjects with liver disease due to carcinomatosis or cirrhosis were positive by alligator hsemagglutination. By slide latex fixation, 7 were positive. Whereas our own
laboratory
1. Passmore, R., Strong, J. A., Ritchie, F. J. Brit. J. Nutr. 1959, 13, 17. 2. Masek, J., Fábry, P. Experientia, Basle, 1959, 15, 444. 3. Hausberger, F. X., Milstein, S. W. J. biol. Chem. 1955, 214, 483. 4. Benedict, F. G., Milner, R. D. Experiments on the metabolism of matter and energy in the human body, 1903-1904. Bull. 175. U.S. Department of Agriculture. Office of Experiment Stations, 1907. 5. Dresner, E., Trombly, P., O’Brien, G. F. New Engl. J. Med. 1959, 261, 981. 6. Epstein, W., Johnson, A. M., Rogan, C. Proc. Soc. exp. Biol. Med. 1956, 91, 235. 7. Lospalluto, J., Ziff, M. J. exp. Med. 1959, 110, 169. 8. Franklin, E. G. Arth. Rheum. 1960, 3, 16. 9. Cohen, E., Neter, E., Mink, I., Norcross, B. M. Arch. Inter-Am. Rheum. 1959, 2, 75.