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FOLLOW-UP AFTER STERILISATION
1369
In A
England Now
Running Commentary by Peripatetic Correspondents
IN recent years my scientific communications have tended to get briefer and I have just submitted a short note on a lesion so rarely seen that no previous records of anything like it can be found. The pictures bring out the features of this remarkable oddity, the text is reduced to two-and-a-half pages of double-spaced typescript. It was readily accepted by the journal of my choice but returned with a request that it should be " rewritten with an eye to improving its general literary quality." Now I am no Montaigne or Thurber, and anything I write can be improved. But as the text consists mostly of nouns and descriptive adjectives I am rather stuck. Perusal of last year’s issues of the journal in question has not helped; the style of the articles seems to be flatly monotonous, just like my own. I have to alter my paper somehow, as the editor wants the original typescript returned with the improved article. I find it difficult to become lyrical about lethal lesions. My somewhat Gibbonian opening of the autopsy findings has already been censored. Norman Mailer ? Ernest Hemingway ? Somehow I can’t see the style of either being acceptable. There is no pornographic interest in the lesion. It was found in an octogenarian and not a beauteous damsel, so the Dashiel Hammett or Raymond Chandler style seems inappropriate. To follow the Russian schools would add much to the horrors of the clinical description and perhaps the now tersely expressed autopsy findings, but at great expense of space. Well, I have altered a few adjectives and the paper is flatter and more monotonous than it was. Let’s hope its " literary quality " is thereby improved. *
*
*
We often talk shop over lunch, but not until last week did the staff dining-room turn quite spontaneously into a laboratory. I was not eating anything special-just a wholesome salad in the British tradition, an undressed and unintegrated assembly of colourful ingredients, including lettuce, tomato, a hardboiled egg, diced beetroot, and red cabbage. But the egg had turned red, white, and blue, and this unexpected patriotism fascinated the whole table. " Is this what happens when a hen decides to back Britain ? " somebody asked. Research undertaken before the next course showed that hard-boiled eggwhite acts as a reagent for detecting beetroot and red cabbage. After a minute or two, in ordinary undressed salad conditions, it is stained red by beetroot and blue by red cabbage. Perhaps a peripatetic biochemist will tell us whether salad pH is critical, and whether red cabbage grows up with the blue dye or has it added post mortem. *
* *
My chatty but dyspnoeic patient was discharged from the to await the results of her avian precipitins. These came back positive for budgerigars, as rather expected, and I informed her family doctor. When I saw her again a few weeks later I started, "I hope you are glad that we seem to have found the cause of your trouble". " Oh yes! I’m much better thank you, doctor," she replied, but I must tell you. When I was pretty bad at home my Padre prayed for me in church one Sunday morning and do you know, doctor, that very afternoon my budgie died." God may move in a mysterious way, but He certainly gets ward
there. *
*
*
I had borrowed the veterinary journal to read a research article, but I read on enthralled. The role of the thyroid in the adaptation of young pigs to high temperatures, the knowledge of how goats clot, and the discovery that sheep suffer from nutritional toxaemia of pregnancy, were random pickings. The really imaginative article, however, gave details on how to catch narcotised zebras by noosing at speeds of 20-25 m.p.h., in order to carry out pelvic examinations. Those long, hot afternoons in the thick of the local antenatal clinic will never seem quite- the same again.
Letters
to
the Editor
FOLLOW-UP AFTER STERILISATION
SiR,—Iwrite in praise of Mr. Laughame’s excellent letter (June 15, p. 1315). He shows the need for detailed study of the family in at least some cases before sterilisation. I recently saw, with her family, a mother who had been sterilised after the birth of her twelfth child. Soon after the sterilisation her husband deserted them. The mother felt that she had lost her purpose in life since the operation. Sir Dugald Baird (June 8, p. 1248) writes: Tubal ligation is a simple local procedure... ". This it maybe to the surgeons, but for some women it feels more radical. I do not know which women and their families should be psychologically studied before sterilisation. Perhaps most. Sir Dugald with his experience should know. However, I would warn against the idea that sterilisation should be carried out in women who lack the intelligence and motivation to use other means to control the size of their families. Few wives, if carefully taught, have insufficient intelligence to master contraceptive techniques. Many may lack the motivation. Consciously they ask to be helped to have no more children. Unconscious doubts tend to make them make mistakes. That some may have good reason to doubt is well shown in Mr. Laugharne’s letter. Department of Psychiatry, West London Hospital, EMANUEL LEWIS. London W.6. "
METHYSERGIDE IN THE TREATMENT OF MANIA SiR,—Interest has been aroused by the beneficial effect of methysergide in mania mentioned in your leader of June 8. Details of trials will shortly be published in Nature, but meanwhile it seems important that those contemplating the use of methysergide, particularly long-term administration, should be aware of the factors involved. Cases of retroperitoneal fibrosis have been reported in patients that have been on methysergide for a long time (several months.)122 Fortunately this condition appears to remit when the methysergide is stopped but as the onset is insidious it has been recommended that administration of the drug should not exceed 6 months without a drug-free interval of at least one month. Occasional patients have also shown various forms of vasospasm, and contraindications include known or suspected vascular disease. For these reasons in the trial in this country3 methysergide administration was limited to one month maximum and the initial dosage was 1 mg. t.d.s., during which stage the patient was carefully observed for side-effects. A maximum dosage of 6 mg. daily was never exceeded (the standard dose used in a large-scale trial of methysergide in migraine 4). A dosage of 1-2 mg. per day or less may be perfectly adequate in mania. In an independently conducted trial by Haskovec and Soucek,5 in Prague, initial administration was by intramuscular injection of 1-3 mg. per day followed by a maintenance dose orally of approximately 6 mg. for periods of up to 14 days. The preliminary experience of these two studies indicate that effects are evident within 24 hours and certainly by the end of 48 hours. In the absence of any response within 48 hours prolongation of treatment or an increase of dosage is unlikely to bring benefit and the possible side-effects must be borne in mind. Such factors must be weighed against the knowledge that continuing mania itself imposes severe and often dangerous physical burdens on the body, and current treatment with phenothiazines, or lithium, may also produce serious sideeffects. As long-term prophylactic administration in migraine has hitherto been the main indication for methysergide, it is 1. Freestone, D. S. Br. med. J. 1965, i, 1434. 2. Lancet, 1965, i, 1262. 3. Dewhurst, W. G. Nature, Lond. (in the press). 4. Lance, J. W., Fine, R. D., Curran, D. A. Med. J. Aust. 1963, i, 5. Haskoveč, L., Souček, K. Nature, Lond. (in the press).
814.
In A
England Now
Running Commentary by Peripatetic Correspondents
IN recent years my scientific communications have tended to get briefer and I have just submitted a short note on a lesion so rarely seen that no previous records of anything like it can be found. The pictures bring out the features of this remarkable oddity, the text is reduced to two-and-a-half pages of double-spaced typescript. It was readily accepted by the journal of my choice but returned with a request that it should be " rewritten with an eye to improving its general literary quality." Now I am no Montaigne or Thurber, and anything I write can be improved. But as the text consists mostly of nouns and descriptive adjectives I am rather stuck. Perusal of last year’s issues of the journal in question has not helped; the style of the articles seems to be flatly monotonous, just like my own. I have to alter my paper somehow, as the editor wants the original typescript returned with the improved article. I find it difficult to become lyrical about lethal lesions. My somewhat Gibbonian opening of the autopsy findings has already been censored. Norman Mailer ? Ernest Hemingway ? Somehow I can’t see the style of either being acceptable. There is no pornographic interest in the lesion. It was found in an octogenarian and not a beauteous damsel, so the Dashiel Hammett or Raymond Chandler style seems inappropriate. To follow the Russian schools would add much to the horrors of the clinical description and perhaps the now tersely expressed autopsy findings, but at great expense of space. Well, I have altered a few adjectives and the paper is flatter and more monotonous than it was. Let’s hope its " literary quality " is thereby improved. *
*
*
We often talk shop over lunch, but not until last week did the staff dining-room turn quite spontaneously into a laboratory. I was not eating anything special-just a wholesome salad in the British tradition, an undressed and unintegrated assembly of colourful ingredients, including lettuce, tomato, a hardboiled egg, diced beetroot, and red cabbage. But the egg had turned red, white, and blue, and this unexpected patriotism fascinated the whole table. " Is this what happens when a hen decides to back Britain ? " somebody asked. Research undertaken before the next course showed that hard-boiled eggwhite acts as a reagent for detecting beetroot and red cabbage. After a minute or two, in ordinary undressed salad conditions, it is stained red by beetroot and blue by red cabbage. Perhaps a peripatetic biochemist will tell us whether salad pH is critical, and whether red cabbage grows up with the blue dye or has it added post mortem. *
* *
My chatty but dyspnoeic patient was discharged from the to await the results of her avian precipitins. These came back positive for budgerigars, as rather expected, and I informed her family doctor. When I saw her again a few weeks later I started, "I hope you are glad that we seem to have found the cause of your trouble". " Oh yes! I’m much better thank you, doctor," she replied, but I must tell you. When I was pretty bad at home my Padre prayed for me in church one Sunday morning and do you know, doctor, that very afternoon my budgie died." God may move in a mysterious way, but He certainly gets ward
there. *
*
*
I had borrowed the veterinary journal to read a research article, but I read on enthralled. The role of the thyroid in the adaptation of young pigs to high temperatures, the knowledge of how goats clot, and the discovery that sheep suffer from nutritional toxaemia of pregnancy, were random pickings. The really imaginative article, however, gave details on how to catch narcotised zebras by noosing at speeds of 20-25 m.p.h., in order to carry out pelvic examinations. Those long, hot afternoons in the thick of the local antenatal clinic will never seem quite- the same again.
Letters
to
the Editor
FOLLOW-UP AFTER STERILISATION
SiR,—Iwrite in praise of Mr. Laughame’s excellent letter (June 15, p. 1315). He shows the need for detailed study of the family in at least some cases before sterilisation. I recently saw, with her family, a mother who had been sterilised after the birth of her twelfth child. Soon after the sterilisation her husband deserted them. The mother felt that she had lost her purpose in life since the operation. Sir Dugald Baird (June 8, p. 1248) writes: Tubal ligation is a simple local procedure... ". This it maybe to the surgeons, but for some women it feels more radical. I do not know which women and their families should be psychologically studied before sterilisation. Perhaps most. Sir Dugald with his experience should know. However, I would warn against the idea that sterilisation should be carried out in women who lack the intelligence and motivation to use other means to control the size of their families. Few wives, if carefully taught, have insufficient intelligence to master contraceptive techniques. Many may lack the motivation. Consciously they ask to be helped to have no more children. Unconscious doubts tend to make them make mistakes. That some may have good reason to doubt is well shown in Mr. Laugharne’s letter. Department of Psychiatry, West London Hospital, EMANUEL LEWIS. London W.6. "
METHYSERGIDE IN THE TREATMENT OF MANIA SiR,—Interest has been aroused by the beneficial effect of methysergide in mania mentioned in your leader of June 8. Details of trials will shortly be published in Nature, but meanwhile it seems important that those contemplating the use of methysergide, particularly long-term administration, should be aware of the factors involved. Cases of retroperitoneal fibrosis have been reported in patients that have been on methysergide for a long time (several months.)122 Fortunately this condition appears to remit when the methysergide is stopped but as the onset is insidious it has been recommended that administration of the drug should not exceed 6 months without a drug-free interval of at least one month. Occasional patients have also shown various forms of vasospasm, and contraindications include known or suspected vascular disease. For these reasons in the trial in this country3 methysergide administration was limited to one month maximum and the initial dosage was 1 mg. t.d.s., during which stage the patient was carefully observed for side-effects. A maximum dosage of 6 mg. daily was never exceeded (the standard dose used in a large-scale trial of methysergide in migraine 4). A dosage of 1-2 mg. per day or less may be perfectly adequate in mania. In an independently conducted trial by Haskovec and Soucek,5 in Prague, initial administration was by intramuscular injection of 1-3 mg. per day followed by a maintenance dose orally of approximately 6 mg. for periods of up to 14 days. The preliminary experience of these two studies indicate that effects are evident within 24 hours and certainly by the end of 48 hours. In the absence of any response within 48 hours prolongation of treatment or an increase of dosage is unlikely to bring benefit and the possible side-effects must be borne in mind. Such factors must be weighed against the knowledge that continuing mania itself imposes severe and often dangerous physical burdens on the body, and current treatment with phenothiazines, or lithium, may also produce serious sideeffects. As long-term prophylactic administration in migraine has hitherto been the main indication for methysergide, it is 1. Freestone, D. S. Br. med. J. 1965, i, 1434. 2. Lancet, 1965, i, 1262. 3. Dewhurst, W. G. Nature, Lond. (in the press). 4. Lance, J. W., Fine, R. D., Curran, D. A. Med. J. Aust. 1963, i, 5. Haskoveč, L., Souček, K. Nature, Lond. (in the press).
814.