HYPNOSIS

520

fully investigate all and every type of disease of the rectum and colon at St. Mark’s. A word on the confusion that appears to exist about what is really meant by the terms " ileocolitis " and proctosigmoiditis." Mr. Brooke, in his original article,

we

While agreeing that further evidence is required, I feel that this modified Arnulf operation offers better prospect, than any other treatment for severe angina pectoris and that it merits a careful trial.

"

Crumpsall Hospital,

HERBERT HAXTON.

Manchester. impression that these conditions were entirely separate diseases, something quite on their own and BLOOD DYSCRASIAS ASSOCIATED WITH not to be regarded as part of a colitis ; they were static CHLORAMPHENICOL and did not spread. This idea is very misleading, for I SIR,—Few would venture to disagree with the con. have clear proof of antiperistaltic spread towards the of Dr. Hodgkinson in his timely review (Fel,, ti! clusions It may take six months or perhaps years, but csecum. of this subject’; though his recommendations incline to in some cases it does spread, and in a few it may end in caution, they are not generally difficult to comply with ulceration. The few static cases continue as ordinary in this country. However, in overseas countries where examples of simple colitis, perhaps quiescent for a time, fever is common it is a different matter; for in typhoid then recurring or clearing up under treatment. I can this disease it is at present considered necessary to see no reason for regarding these cases of ileocolitis and the antibiotic in relatively heavy total dosage proctosigmoiditis as separate pathological conditions. administer and over a period in order to reduce the They are simply examples of localised or " regional " incidence of fairly long which exceeds 20% in main relapses, colitis which may remain localised or spread throughout recorded series treated with chloramphenicol. the bowel as part of a generalised colitis ; and I shall Attempts to reduce the relapse-rate have usually I)Peli continue to recognise and describe those cases as along three lines: regional colitis."

gave the

"

(1) Prolonged administration of the antibiotic: course days or longer, have been advocated and found

NORMAN P. HENDERSON.

of 12-18

SURGICAL TREATMENT OF ANGINA PECTORIS

SIR,—Your annotation of Jan. 30 ends

on a

gloomy

by suggesting that surgical

endeavour has achieved little and that the well-tried cervicothoracic ganglionec. tomy is the best it can offer in the way of treatment. In this you do less than justice to the work of Professor Arnulf1 who has carried out his operation in at least twenty-five cases, with no immediate mortality and 80% relief of symptoms.2 Some of his patients are back at heavy work. Arnulf has a fine colour film of his operation and the anatomical and experimental work behind it, which I was fortunate enough to see in Parma in June, 1953. Two of my patients illustrate the value of his operation. note

A man of 70 was operated on under local analgesia three months ago and was up and walking about the ward on the same day. He can now do much more than before the operation, but gets some pain in the right side of the chest only. This pain disappears in 3 or 4 minutes with rest, whereas before operation it took 20 minutes to go. The second patient, a man of 50, had been in bed at home or in hospital continuously for 10 months because of the angina which he had when he walked a few paces across a room. He had several severe attacks at rest. The electrocardiograms showed a constant right-branch bundle block. 3 weeks ago an extended Arnulf operation was done, the space between the aorta and pulmonary, artery being thoroughly dissected back to the bifurcation of the trachea in order to divide the deep as well as the superficial cardiac plexus. For this a Coldlite ’ retractor with a special handle containing a suctioncooled motor-car headlamp bulb was found very helpful. The result has been dramatic, with complete freedom from anginal pain; indeed the patient can walk up six flights of stairs with no pain whatsoever. He feels that his prospects have been transformed from permanent rest in bed to useful activity, and there is no doubt that this could not have been achieved by any medical measures. ’

reasonably

effective

by

Smadel et al.1 and many

workers.

subsequent

’

short courses have been used by some John and Vinayagam,2 unsuccessfully by Parkerand Marmion.4 (3) A fairly short course, immediately followed by admimtration of antityphoid vaccine, has given promising results in small trials.25

(2) Repeated successfully by

.

third method permits a total dosage anda well within Dr. Hodgkinson’s maxima of 26 g. and 10 days respectively, but unfortunatelyit does not appear to have been tried on a sufficiently extensive scale for us to be able to assess its efficaey. My object in writing this letter is to encourage doctor who treat many cases of typhoid fever to give the s accine method a controlled trial, and to ask those who may already have done so to record their results and conclusions.

Only the length of

course

Cambridge Military Hospital, Aldershot.

D. E. MARMION.

HYPNOSIS to note the comments in your annotation of Jan. 23 about Dr. Kitching’s paper at the .

SIR,—It is interesting

annual meeting of the British Dental Association. May I correct two errors which, as they stand, alter the emphasis on certain points. Dr. Esdaile is quotedas performing his amazing series of major operations befor,i!’ he left for India, whereas these were carried out India itself. There are grounds for thinking that,iu general, the Asiatic temperament is much more sus ceptible to hypnosis than the more sophisticated European, and the series would have been even more remark able if carried out in England. Unfortunately Esdaile died soon after his return, and a comparison ot results proved impossible. Dr. Bramwell was also quoted as sending his patients This operation would appear to do all that cord to his junior partner at Leeds. Mr. McAlpine. who sympathectomy can do and has the advantage of requiring carried out the extractions, was a junior partner to two only one incision and one stage. To be anatomically dental surgeons of Leeds and a very young man at the oomplete, sympathectomy would have to include the first time. This is a significant point because he lacked the 4 or 5 thoracic ganglia on both sides, and this means two prestige value which is so important in hypnosis The Moreover, there is some physio- results were, therefore, entirely due to the posthynotic fairly big operations. logical evidence 3 that vagal cardiac fibres maintain a suggestions of Dr. Bramwell. tonic vasoconstriction, and their severance may well A study of the literature associated with hypnosis is improve the coronary circulation. The fact that my first very instructive. I feel sure that my medical colleagues patient’s pain now disappears more quickly with rest than who have done this would agree with me that the before the operation suggests that improved myocardial 1. Smadel, E., Bailey, C. A., Lewthwaite, R. Ann. intern M function has been achieved. 1950, 33, 1. 1. Arnulf, G. J. Chir., Paris, 1950, 66, 97. 2. Arnulf, G. Personal communication. 1953. 3. Anrep, G. V., Segall, H. N. Heart, 1926, 13, 239.

2. 3. 4. 5.

John, A. T., Vinayagam, V. S. Lancet, 1952, ii. 757. Parker, M. T. Unpublished work. See Lancet, 1950, i, 72 Marmion, D. E. Trans. R. Soc. trop. Med. Hyg. 1952. 46, Nina, C. Gaz. med. portug. 1950, 3, 247.

521

remaining 4 cases, however, did not respond to ample work done by cautious and honest tically. Theturmeric therapy : the diarrhoea persisted in 2 a from Braid onwards to continued justify full-scale investigators who finally died, and convalescence was prolonged patients, am the medical of I today. profession investigation by in the other 2, who ultimately recovered. convinced that in the limited fields of obstetrics, denrelaxation for remedial It seems that the juice of Coleus aromaticus is better exercises, hypnosis tistry, and ought to be more widely used. - In the broader aspects than turmeric for the control of diarrhoea in cholera. of medicine, especially psychiatry, its investigation Besides, Coleus aromaticus was tried at the peak of the becomes an extremely complex matter, but it should not epidemic and the proportion of cures was much higher than with turmeric. On the other hand, Coleus aromaticus be shirked. did not free the stools of vibrios, and rough colonies In dentistry the problem is a comparatively simple were seen even as late as the seventeenth day of obserone. The dental surgeon has to abolish fear and to increase vation. The turmeric patients gave negative stool the proportion of patients who can be brought to the stage of anaesthesia. This needs constant practice of cultures by the eighth or ninth day in the 22 cases of clinical cure. But the results are not exactly comparable induction technique and, equally important to my mind, education of patients-an aspect which has been greatly because coleus therapy was tested during the peak of hampered by the false impressions created by stage the epidemic while turmeric was tried only at the end. In vitro, we found that coleus juice had no hypnosis. The dental profession have formed a group to study bacteriolytic properties and was only mildly bacteriohypnosis and are endeavouring to found this on as static. Turmeric was both bacteriolytic and bacteriobroad a. basis as possible, with the help, which we static to a mild degree; but these properties were gratefully acknowledge, of medical colleagues experienced insufficient, we thought, to account for its observed benefeial effects in such a severe condition as cholera. in this field. Welook forward confidently to a wider medical investigation, and shall always welcome to our Chittaranjan Hospital, HEMENDRA NATH CHATTERJEE. Calcutta. are interested in medical who meetings any practitioners the subject, and particularly our anaesthetist colleagues. VITREOUS OPACITIES has been

E. E. WOOKEY Chairman, British Society of Dental

Hypnotists.

THERAPY OF DIARRHŒA IN CHOLERA

SIR,—During the cholera epidemic of 1952, in Calcutta, impressed by the therapeutic efficiency of the raw of juice Coleus aromaticus.1 But the huge quantities that would be needed if the juice was to be widely used in the next epidemic were not available, so a garden was lasted. The products of this garden may not be available in all districts during an epidemic season, and it would therefore be an advantage to have an alternative preparation. During the latter part of the 1953 epidemic, I tried a fay readily obtainable vegetable product-the yellow 2-4

SIR,—One reads accounts of researches into nearly all the ills to which the flesh is heir ; but so far no-one seems to have been able to produce any relief for sufferers from vitreous opacities, or " Boaters" as the oculists call them.

I was

I have been myopic for as long as I can remember, and for many years now have been troubled by vitreous opacities. I have consulted several oculists with the same result: in plain English " grin and bear them." One friend told me that he had had them for twenty years ; he regarded them as physiological, and was able to ignore them. In the same breath he stated that he always looked for septic foci, especially carious teeth, and on the strength of that I had some very useful old teeth removed, with no result beyond a fresh crop of " floaters," and a great deal of discomfort from a lower denture.

common Indian rhizome, turmeric longa (Sanskrit, haridra ;; Hindi, haldi; Bengalee, haletd). This powder has been used as a condiment and as a toilet agent throughout India from prehistoric times. Its various medicinal properties are said to include the promotion of healing by early production 5

I am quite sure that there must be a great many people besides myself who would welcome some means of improving this " physiological " but very tiresome condition, and I commend the problem to the inquiring minds of the day.

powder from the Curcuma

or

of granulation tissue.

can be ground into a bright goldenmildly bitter taste and a peculiar smell. In the treatment of cholera, gr. 2 of the dry fine powder was given in gelatin capsules. The initial dose was 2 capsules followed by 1 capsule every four hours. The vomiting, if

The dried rhizome

yellow powder, with

present,

was

treatment

a

checked withAvomine.’6 The trials of this in early July, 1953, and continued until

began

September. of 1953 was a peculiar one and was and prolonged than that of 1952 ; and although the peak was over by the end of July, cases continued to come in until mid-October. The effects of turmeric were studied in 39 patients with cimical cholera, 30 of whom showed cholera vibrios on culture of stools by the three-plate method.l Only these 30 vibriopositive cases are considered here. In 22 of these cases the diarrhœa was checked within seventy-two hours. In the other patients the diarrhoea continued : 4 of them were switched tr, Coleus aromaticus juice and the diarrhoea stopped drama-

The cholera

very much

epidemic

more severe

1. Chatterjee, H. N. Lancet, 1953, ii, 1045. 2. Dymock, W. Pharmacographia Indica. Calcutta, 1893 ;

3.

III, p. 407. Kirtikar, K. R., Basu, B. D. 1918; vol. II, p. 1250.

4.

Mukerji, B. Indian Pharmaceutical Codex. vol. I, p. 87.

Indian Medicinal Plants. New

vol.

Calcutta,

Delhi, 1953;

5. Gujral, M. L., Chowdhury, N. K., Saxena, P. N. J. Ind. med. Ass. 1953, 22, 273. 6. Chatterjee, H. N. Lancet, 1953, ii, 1063.

Pietermaritzburg, Natal, South Africa.

GEOFFREY DUNDERDALE.

POLYMYXIN B

SIR,-Dr. McGill and Dr. Mendel quote (Dec. 19) my work in what I believe to be a misleading fashion. Describing the use of polymyxin B in bacterial meningitis, they say that " its injection intrathecally has been very recently said to be harmless (Jawetz 1952, British Medical Journal 1953)." I believe that such a statement is not meaningful unless the dose recommended by a previous worker is stated. We have never employed a dose in excess of 10 mg. of polymyxin B daily intrathecally. The official recommendation of the American Medical Association’s Council on Pharmacy and Chemistry, as well as that of Burroughs Wellcome & Co., reads as follows: " Children over two years and adults, 5 mg. daily for 3 or 4 days, then 5 mg. every other day." Had the authors used this schedule it seems very improbable that they would have encountered a significant meningeal reaction. However, they injected 30 mg. of the drug in the first twenty-four hours of treatment, which is far in excess of the recommended dose. When used in unduly high dose, or concentration, many drugs are, of course, known to produce meningeal irritation and perhaps arachnoiditis. ,

School of Medicine, University of California.

ERNEST JAWETZ.