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MANIPULATIVE TREATMENT IN GENERAL PRACTICE
1243 ENTROPY " SIR,-Clausius said: Die Energie der Welt ist konstant; die Entropie der Welt strebt ein Maximum zu ": and a later
entropy statistically, showing that it was a measure of the randomness or disorganisation of a system. Since life is maintained by taking in food, and since the living organism is more organised, or less random, than its food, it has been pointed out that for some purposes one may regard living things as machines for producing localised reductions in entropy. As a chemist with physical leanings, I claim equal right with the engineers to use the term entropy in its statistical as well as its thermodynamic form; and I hesitate to deny its use to a biologist, though I would prefer him to use the word " randomness ", or, for an increase in entropy " increase in disorganisation " or " decrease in organisation ". Surely there is little likelihood of confusion between these different uses; though I confess to a twinge of disquiet when I hear echoes from the historians of the future who will refer to the Nordic Volkerwanderung as the " post-Roman entropy increase ".
physicist interpreted
Central Middlesex Hospital,
GEORGE DISCOMBE.
London, N.W.10.
ANTIVACCINIAL GAMMA-GLOBULIN IN THE CONTROL OF SMALLPOX
SiR,—In answer to a question in the House of Commons May 7, Miss Edith Pitt, Parliamentary Secretary to the Ministry of Health, stated that, of the 24 deaths in the recent smallpox incidents, 8 were in people who had been on
vaccinated or revaccinated after contact. One may that not undertaken when the vaccination was presume of the were actual signs disease present, and that, accordingly, these persons were incubating the disease when traced. In such a situation it appears that antivaccinial gamma-globulin is the correct prophylactic, either to supplement vaccination early in the incubation period or to replace it late in the incubation period. The efficacy of this agent has been described in many papers, and it would be interesting to learn whether it was used in any of the 8 cases who died. As the number of doctors, even those working in public health, who have had practical experience of smallpox is very small, can we be assured that the Ministry of Health will do everything possible to indicate the value of antivaccinial gammaglobulin to those doctors who may be concerned with smallpox in this countrv ? T. L. HOBDAY. Liverpool.
*** Our issue of April 28 (p. 907) contained by Dr. Hobday on this subject.-ED. L.
an
article
TESTICULAR CHANGES IN INFANT OF DIABETIC MOTHER
SiR,—The microscopic changes in the ovaries of infants born to diabetic or prediabetic " mothers are well known. 12 It seems reasonable to suppose that analogous "
changes might
be
expected
similar circumstances, but not
disclose any
a
in the testis in of the literature did
to occur
study
comments on
this
point.
In a recent perinatal death, the mother was a known diabetic, at about 37 weeks’ gestation. Delivery was normal, but the child died at 18 hours. Necropsy revealed, in addition to a striking islet hyperplasia in the pancreas, a considerable hyperplasia of the interstitial-cell components of the testis. A 1. 2.
Hamilton, G. Drury, M. I.
M. J. Obstet. Gynœc. Brit. Emp. 1953, Irish J. med. Sci. 1961, ii, 426.
60, 533.
reasonable amount of control material was available from infants of comparable maturity who had died in the perinatal period. Dr. Edith Potter (personal communication) has noted similar changes in a case she studied this year. Perhaps other observers have noted these changes but have not reported their findings. National
Maternity Hospital, Dublin.
F. GEOGHEGAN M. I. DRURY.
MANIPULATIVE TREATMENT IN GENERAL PRACTICE SIR,-Some time or other the medical profession, anc
particularly the orthopaedic specialty, will have to com( to grips with Dr. Cyriax and his disciples. First, can w( really nail them down to what they are discussing ? The3 talk in one breath of lumbar disc lesions and in the of manipulation in general.
nexi
In 215 cases of low back pain studied over a period of si) months in the orthopxdic department of the Leicester Roya Infirmary, the diagnosis was: osteoarthritis 53, lumbosacra strain 48, sacro-iliac strain 25, intervertebral disc lesions 64 " sundries " 25. My paper stated: " When it is realised tha1 a good many of the sundries ’ and practically all the lumbosacral or sacro-iliac strains can be relieved, temporarily, b3 manipulation, and when it is realised that the teaching at St Thomas’s is that osteo-arthritis does not cause low back-ache it will be seen that the vast majority of these cases can gel relief from manipulation. It is our belief that in cases oi demonstrable disc lesion relief by manipulation is rarel3 obtained and if obtained, rarely permanent." In my opinion the reputation of the Cyriax school for successful manipulation of intervertebral disc lesions is basec upon their simplification of the whole problem by lumpin " together all sorts of conditions and calling them slippec discs ", so that they obtain a high proportion of successfu: manipulations simply because most of their cases are n01 cases of intervertebral disc lesions at all. I note that neither Dr. Cyriax, nor Dr. Barbor nor Dr, Wilson, has taken note of the relief to be obtained by the coldspray method advocated by Ellis of Leeds, which cannot by any stretch of imagination affect the state of the disc, bu1 which demonstrably does away with muscle spasm before your very eyes. In my view, when manipulation of this heterogeneous and ill-assorted group of conditions known a low back pain is performed, relief of muscle spasm is the deciding factor. Out of 64 cases in the above series shown to have an intervertebral disc lesion, with evidence of nerve compression, 53 were put into plaster jackets. 7 obtained immediate relief, 1C within a week, 19 within two weeks, 5 in the third week, and all within a month. No failures were reported. Further, it is significant that as a result of follow-up of these cases, only 3 so far have had a relapse, in contradistinction to the experience of manipulators, who state plainly that their followers must be prepared to be manipulated time and time again. Great Glen, Leicestershire.
G. A. STANTON.
SIR,-Dr. Stoddard’sappeal for the employment of osteopaths in the N.H.S. overlooks the claim of physiotherapists. Withoutwishing to sound melodramatic, we have laboured long and hard, giving complete loyalty to the medical profession, often to our own disadvantage. We too want " a reasonable status ". Given greater freedom and responsibility we are the profession to apply this form of therapy in the N.H.S., as many of us do at present. In private practice we are already at a great disadvantage compared to the osteopath because of this loyalty. Surely we are entitled to some priority in the Hospital Service ? DAVID WHITE. Sudbury, Suffolk.
entropy statistically, showing that it was a measure of the randomness or disorganisation of a system. Since life is maintained by taking in food, and since the living organism is more organised, or less random, than its food, it has been pointed out that for some purposes one may regard living things as machines for producing localised reductions in entropy. As a chemist with physical leanings, I claim equal right with the engineers to use the term entropy in its statistical as well as its thermodynamic form; and I hesitate to deny its use to a biologist, though I would prefer him to use the word " randomness ", or, for an increase in entropy " increase in disorganisation " or " decrease in organisation ". Surely there is little likelihood of confusion between these different uses; though I confess to a twinge of disquiet when I hear echoes from the historians of the future who will refer to the Nordic Volkerwanderung as the " post-Roman entropy increase ".
physicist interpreted
Central Middlesex Hospital,
GEORGE DISCOMBE.
London, N.W.10.
ANTIVACCINIAL GAMMA-GLOBULIN IN THE CONTROL OF SMALLPOX
SiR,—In answer to a question in the House of Commons May 7, Miss Edith Pitt, Parliamentary Secretary to the Ministry of Health, stated that, of the 24 deaths in the recent smallpox incidents, 8 were in people who had been on
vaccinated or revaccinated after contact. One may that not undertaken when the vaccination was presume of the were actual signs disease present, and that, accordingly, these persons were incubating the disease when traced. In such a situation it appears that antivaccinial gamma-globulin is the correct prophylactic, either to supplement vaccination early in the incubation period or to replace it late in the incubation period. The efficacy of this agent has been described in many papers, and it would be interesting to learn whether it was used in any of the 8 cases who died. As the number of doctors, even those working in public health, who have had practical experience of smallpox is very small, can we be assured that the Ministry of Health will do everything possible to indicate the value of antivaccinial gammaglobulin to those doctors who may be concerned with smallpox in this countrv ? T. L. HOBDAY. Liverpool.
*** Our issue of April 28 (p. 907) contained by Dr. Hobday on this subject.-ED. L.
an
article
TESTICULAR CHANGES IN INFANT OF DIABETIC MOTHER
SiR,—The microscopic changes in the ovaries of infants born to diabetic or prediabetic " mothers are well known. 12 It seems reasonable to suppose that analogous "
changes might
be
expected
similar circumstances, but not
disclose any
a
in the testis in of the literature did
to occur
study
comments on
this
point.
In a recent perinatal death, the mother was a known diabetic, at about 37 weeks’ gestation. Delivery was normal, but the child died at 18 hours. Necropsy revealed, in addition to a striking islet hyperplasia in the pancreas, a considerable hyperplasia of the interstitial-cell components of the testis. A 1. 2.
Hamilton, G. Drury, M. I.
M. J. Obstet. Gynœc. Brit. Emp. 1953, Irish J. med. Sci. 1961, ii, 426.
60, 533.
reasonable amount of control material was available from infants of comparable maturity who had died in the perinatal period. Dr. Edith Potter (personal communication) has noted similar changes in a case she studied this year. Perhaps other observers have noted these changes but have not reported their findings. National
Maternity Hospital, Dublin.
F. GEOGHEGAN M. I. DRURY.
MANIPULATIVE TREATMENT IN GENERAL PRACTICE SIR,-Some time or other the medical profession, anc
particularly the orthopaedic specialty, will have to com( to grips with Dr. Cyriax and his disciples. First, can w( really nail them down to what they are discussing ? The3 talk in one breath of lumbar disc lesions and in the of manipulation in general.
nexi
In 215 cases of low back pain studied over a period of si) months in the orthopxdic department of the Leicester Roya Infirmary, the diagnosis was: osteoarthritis 53, lumbosacra strain 48, sacro-iliac strain 25, intervertebral disc lesions 64 " sundries " 25. My paper stated: " When it is realised tha1 a good many of the sundries ’ and practically all the lumbosacral or sacro-iliac strains can be relieved, temporarily, b3 manipulation, and when it is realised that the teaching at St Thomas’s is that osteo-arthritis does not cause low back-ache it will be seen that the vast majority of these cases can gel relief from manipulation. It is our belief that in cases oi demonstrable disc lesion relief by manipulation is rarel3 obtained and if obtained, rarely permanent." In my opinion the reputation of the Cyriax school for successful manipulation of intervertebral disc lesions is basec upon their simplification of the whole problem by lumpin " together all sorts of conditions and calling them slippec discs ", so that they obtain a high proportion of successfu: manipulations simply because most of their cases are n01 cases of intervertebral disc lesions at all. I note that neither Dr. Cyriax, nor Dr. Barbor nor Dr, Wilson, has taken note of the relief to be obtained by the coldspray method advocated by Ellis of Leeds, which cannot by any stretch of imagination affect the state of the disc, bu1 which demonstrably does away with muscle spasm before your very eyes. In my view, when manipulation of this heterogeneous and ill-assorted group of conditions known a low back pain is performed, relief of muscle spasm is the deciding factor. Out of 64 cases in the above series shown to have an intervertebral disc lesion, with evidence of nerve compression, 53 were put into plaster jackets. 7 obtained immediate relief, 1C within a week, 19 within two weeks, 5 in the third week, and all within a month. No failures were reported. Further, it is significant that as a result of follow-up of these cases, only 3 so far have had a relapse, in contradistinction to the experience of manipulators, who state plainly that their followers must be prepared to be manipulated time and time again. Great Glen, Leicestershire.
G. A. STANTON.
SIR,-Dr. Stoddard’sappeal for the employment of osteopaths in the N.H.S. overlooks the claim of physiotherapists. Withoutwishing to sound melodramatic, we have laboured long and hard, giving complete loyalty to the medical profession, often to our own disadvantage. We too want " a reasonable status ". Given greater freedom and responsibility we are the profession to apply this form of therapy in the N.H.S., as many of us do at present. In private practice we are already at a great disadvantage compared to the osteopath because of this loyalty. Surely we are entitled to some priority in the Hospital Service ? DAVID WHITE. Sudbury, Suffolk.