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NOMENCLATURE OF ABNORMAL UTERINE HÆMORRHAGE.
575 of their schooling—and laboratory workers all know the baneful results of boric acid and other similar preservatives on foodstuffs, whether for the child or the adult.
impedimenta
THE CARDIAC CIRCULATION AND DISEASE. To the Editor of THE LANCET. valuable paper in your last issue his Sm,-In Dr. Geoffrey Bourne states that an agency that could reduce the frequency of the heart-beat like digitalis would be of great therapeutic value. May I remind your readers that, as has been long ago and repeatedly
pointed
out
by good observers,
we
have such
agency in coldIn acute disease the heart is
T
an
responsive to local applications of cold, and the vicious circle of threatening heart failure may often In chronic conditions of rapid be broken thereby.’. heart from myocardial weakness, cooling (but not " hot ") baths of various kinds may similarly be relied upon to increase the force and diminish the frequency of the pulse. The relation between the diastole and the nutrition of the heart is an interesting one, and Dr. Bourne’s view agrees with the observation that many persons with feeble but slow hearts are long lived. It may be noted that cold applied to the precordium during hot baths and applications often prevents acceleration This method, known at Pistyan as of the heart. " heart-cooling," enables thermal " treatment "to be used in many cases of debility, rheumatic and I am, Sir, yours faithfully, ether. j R. FORTESCUE Fox.
To the Editor of THE LANCET. SIR,—It is a wholesome sign of the times when someone like Mr. McLachlan does not fear to take his stand against the sophistication or doctoring of natural food. Many years ago I had a hard fight in an English residential town-Cheltenham-to kill the trade of selling sterilised milk ; now, I have not the least doubt but that 90 per cent. of a section of the population of that town alone would have been rickety had this section’s mothers not had the good sense to be impressed by my simple reasoning : " What nourishment is the little one having ? "the little one being the picture of pre-rachitic hemic impoverishment. " Cow’s milk," was the reply, " Cow’s milk, boiled or sterilised." "Why?" " I thought it killed the "germs." " Is a mother’s milk boiled or sterilised ? That settled the doom of the laboratory worker’s advice. The true test of a food was, and is, the effect on the nutrition and development and strength of the consumer; and the wise man was the one who foresaw what would happen to the consumer in 10 or 12 years. My experience is that the laboratory worker has never done this. Pasteurised milk has, and will have, the same deplorable results as boiled or sterilised milk, because, and this is the all-important point, it is cooked. Anyone can perform the following experiment: Place an egg in water for 30 minutes at the temperature of 145° F. and the result is a cooked eyg ; and do not pasteurisers frequently proudly say that they hold the milk at 150 °, or thereabouts, for half an hour ? The nutritional, developmental, and sthenic value of milk is destroyed by pasteurising; and it does not need much prevision to know that rickets and its congeners are in the future to wreck or to ruin the health of the young. No one is much to blame, and least of all the parents, but an3one who has studiously observed, over a series of years, the lamentable effect of feeding anyone on sophisticated or doctored milk can only be doing a public duty by persisting in pointing out the destructive effects on the growing body organism - deformity and maldevelopment, asthenia, predisposition to disease, and inability to withstand any morbid process. In effect, the same condition results to a food from pasteurising as from the use of a preservative such as boric acid; there is devitalising of organismal life-i.e., of bacterial lifenot destruction, and there is devitalising of the cellular life of the food itself. Now, surely, mothers, educated doctors-i.e., those who have jettisoned much of the
Sir I am,Sir,yours faithful y,
yours
faithfully
R. CUNNINGHAM AFFLECK.
singularly
PASTEURISATION OF MILK.
H.m
NOMENCLATURE OF ABNORMAL UTERINE HÆMORRHAGE. To the Editor of THE LANCET. interested in Prof. Blair Bell’s criticisms SIR,—I in your last issue of the nomenclature suggested and approved at the Nottingham meeting of the B.M.A. for the varieties of abnormal uterine hæmorrhage, and I welcome this opportunity of clearing up any doubts that may still exist in his mind and in those ofothers. I am indeed sorry that illness prevented him from being present at the discussion in question which, if it has done nothing else, has served to focus attention once more upon the urgent necessity for standardising a nomenclature in connexion with this subject. I do not claim on this occasion to have put forward anything new in the matter of terminology. What I did attempt to " propound," if this word must be used, was a pathological basis to substantiate terms which are already in use. Mere names to cover symptoms do not appear to have much value unless they are backed up by pathological facts. The nomenclature I used in my paper at Nottingham is practically the same as that employed by me in my article on Uterine Haemorrhage in the " Practitioner’s Encyclopaedia of Obstetrics and Gynaecology " (Fairbairn), published in 1921. Here Prof. Bell will find that full credit is accorded to him as regards " " Menostaxis " was a the word epimenorrhoea." term introduced by me in 1921 to designate a proam
longed " period " and which has, as a pathological basis, a patchy necrosis of the endometrium. It is, in other words, an incomplete menstrual abortion, and is a distinct entity. Menorrhagia," in the "
in which I
employ and teach the term, is a short, sharp haemorrhage due to atonicity of the uterus, probably with a neuro-muscular basis. It is to post-partum hæmorrhage. Both " menoranalogous " " rhagia and metrostaxis " are terms that havelong been in use, and neither Prof. Bell nor I lay claim to any originality in the matter. Prof. Bell complains that in the classification accepted at Nottingham no reference is made to his term " epimenorrhagia." I did not include it because candidly I could not see the necessity for it. As I understand the word it means too frequent and too excessive periods. It has no definite pathological basis apart from what is included under the other names, and to my mind is mere hair-splitting. One of the great difficulties in investigating uterine haemorrhage from a clinical standpoint is that not only two but sometimes three of the standardised varieties may and do occur together. If each one of these numerous possible combinations is to be honoured with the dignity of a " name such as epimenorrhagia," an algebraical and pathological problem is set which I am only too pleased to leave to Prof. Bell to elucidate. The Nottingham classification of uterine hæmorrhage is at least based upon pathology in addition to symptomatology, and it has the merit of fact in addition to theory. From a practical standpoint, to this—the old therefore, "the matter amounts " terms of and " metrostaxis are menorrhagia retained with the limitations noted in my opening new terms " epimenorpaper; the comparatively rhoea " and " menostaxis " are introduced to designate specific pathological types of bleeding, and the name " epimenorrhagia " is dropped as being " ledundant. In this " new terminology what is good of the old has been retained and, of the new, I think the honours stand even. sense
"
T
am
Sir
yours
faithfully.
BECKWITH WHITEHOUSE.
impedimenta
THE CARDIAC CIRCULATION AND DISEASE. To the Editor of THE LANCET. valuable paper in your last issue his Sm,-In Dr. Geoffrey Bourne states that an agency that could reduce the frequency of the heart-beat like digitalis would be of great therapeutic value. May I remind your readers that, as has been long ago and repeatedly
pointed
out
by good observers,
we
have such
agency in coldIn acute disease the heart is
T
an
responsive to local applications of cold, and the vicious circle of threatening heart failure may often In chronic conditions of rapid be broken thereby.’. heart from myocardial weakness, cooling (but not " hot ") baths of various kinds may similarly be relied upon to increase the force and diminish the frequency of the pulse. The relation between the diastole and the nutrition of the heart is an interesting one, and Dr. Bourne’s view agrees with the observation that many persons with feeble but slow hearts are long lived. It may be noted that cold applied to the precordium during hot baths and applications often prevents acceleration This method, known at Pistyan as of the heart. " heart-cooling," enables thermal " treatment "to be used in many cases of debility, rheumatic and I am, Sir, yours faithfully, ether. j R. FORTESCUE Fox.
To the Editor of THE LANCET. SIR,—It is a wholesome sign of the times when someone like Mr. McLachlan does not fear to take his stand against the sophistication or doctoring of natural food. Many years ago I had a hard fight in an English residential town-Cheltenham-to kill the trade of selling sterilised milk ; now, I have not the least doubt but that 90 per cent. of a section of the population of that town alone would have been rickety had this section’s mothers not had the good sense to be impressed by my simple reasoning : " What nourishment is the little one having ? "the little one being the picture of pre-rachitic hemic impoverishment. " Cow’s milk," was the reply, " Cow’s milk, boiled or sterilised." "Why?" " I thought it killed the "germs." " Is a mother’s milk boiled or sterilised ? That settled the doom of the laboratory worker’s advice. The true test of a food was, and is, the effect on the nutrition and development and strength of the consumer; and the wise man was the one who foresaw what would happen to the consumer in 10 or 12 years. My experience is that the laboratory worker has never done this. Pasteurised milk has, and will have, the same deplorable results as boiled or sterilised milk, because, and this is the all-important point, it is cooked. Anyone can perform the following experiment: Place an egg in water for 30 minutes at the temperature of 145° F. and the result is a cooked eyg ; and do not pasteurisers frequently proudly say that they hold the milk at 150 °, or thereabouts, for half an hour ? The nutritional, developmental, and sthenic value of milk is destroyed by pasteurising; and it does not need much prevision to know that rickets and its congeners are in the future to wreck or to ruin the health of the young. No one is much to blame, and least of all the parents, but an3one who has studiously observed, over a series of years, the lamentable effect of feeding anyone on sophisticated or doctored milk can only be doing a public duty by persisting in pointing out the destructive effects on the growing body organism - deformity and maldevelopment, asthenia, predisposition to disease, and inability to withstand any morbid process. In effect, the same condition results to a food from pasteurising as from the use of a preservative such as boric acid; there is devitalising of organismal life-i.e., of bacterial lifenot destruction, and there is devitalising of the cellular life of the food itself. Now, surely, mothers, educated doctors-i.e., those who have jettisoned much of the
Sir I am,Sir,yours faithful y,
yours
faithfully
R. CUNNINGHAM AFFLECK.
singularly
PASTEURISATION OF MILK.
H.m
NOMENCLATURE OF ABNORMAL UTERINE HÆMORRHAGE. To the Editor of THE LANCET. interested in Prof. Blair Bell’s criticisms SIR,—I in your last issue of the nomenclature suggested and approved at the Nottingham meeting of the B.M.A. for the varieties of abnormal uterine hæmorrhage, and I welcome this opportunity of clearing up any doubts that may still exist in his mind and in those ofothers. I am indeed sorry that illness prevented him from being present at the discussion in question which, if it has done nothing else, has served to focus attention once more upon the urgent necessity for standardising a nomenclature in connexion with this subject. I do not claim on this occasion to have put forward anything new in the matter of terminology. What I did attempt to " propound," if this word must be used, was a pathological basis to substantiate terms which are already in use. Mere names to cover symptoms do not appear to have much value unless they are backed up by pathological facts. The nomenclature I used in my paper at Nottingham is practically the same as that employed by me in my article on Uterine Haemorrhage in the " Practitioner’s Encyclopaedia of Obstetrics and Gynaecology " (Fairbairn), published in 1921. Here Prof. Bell will find that full credit is accorded to him as regards " " Menostaxis " was a the word epimenorrhoea." term introduced by me in 1921 to designate a proam
longed " period " and which has, as a pathological basis, a patchy necrosis of the endometrium. It is, in other words, an incomplete menstrual abortion, and is a distinct entity. Menorrhagia," in the "
in which I
employ and teach the term, is a short, sharp haemorrhage due to atonicity of the uterus, probably with a neuro-muscular basis. It is to post-partum hæmorrhage. Both " menoranalogous " " rhagia and metrostaxis " are terms that havelong been in use, and neither Prof. Bell nor I lay claim to any originality in the matter. Prof. Bell complains that in the classification accepted at Nottingham no reference is made to his term " epimenorrhagia." I did not include it because candidly I could not see the necessity for it. As I understand the word it means too frequent and too excessive periods. It has no definite pathological basis apart from what is included under the other names, and to my mind is mere hair-splitting. One of the great difficulties in investigating uterine haemorrhage from a clinical standpoint is that not only two but sometimes three of the standardised varieties may and do occur together. If each one of these numerous possible combinations is to be honoured with the dignity of a " name such as epimenorrhagia," an algebraical and pathological problem is set which I am only too pleased to leave to Prof. Bell to elucidate. The Nottingham classification of uterine hæmorrhage is at least based upon pathology in addition to symptomatology, and it has the merit of fact in addition to theory. From a practical standpoint, to this—the old therefore, "the matter amounts " terms of and " metrostaxis are menorrhagia retained with the limitations noted in my opening new terms " epimenorpaper; the comparatively rhoea " and " menostaxis " are introduced to designate specific pathological types of bleeding, and the name " epimenorrhagia " is dropped as being " ledundant. In this " new terminology what is good of the old has been retained and, of the new, I think the honours stand even. sense
"
T
am
Sir
yours
faithfully.
BECKWITH WHITEHOUSE.