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PNEUMOCONIOSIS IN COALMINERS
1326 BRONCHOGENIC CARCINOMA TREATED WITH NITROGEN MUSTARD
SIR,—The experience of Dr. Frankel and Dr. Workman, described in your issue of June 2, coincides with my own experience of the treatment of neoplastic disease with mustard. So far I have treated six bronchial carcinomata with nitrogen mustard, if necessary with repeated courses of up to 90 mg., each dose not exceeding 5 mg. in 10 ml. of saline daily. The nausea which follows the injection of nitrogen mustard can be controlled with anti-histamine drugs and atropine. Two of our patients who came to us for " terminal care " were able to return home. Of four carcinomata of the breast only one grossly fungating carcinoma has responded well to nitrogen mustard. I was particularly impressed by the disappearance of the accompanying sepsis. I have not seen the development of anaemia and leucopenia ; most patients developed a certain measure of euphoria with temporary increase in appetite. As regards the survival-time after institution of treatment, I feel that it is too early to pass judgment. I regard nitrogen mustard therapy as a palliative measure, but whether it is as effective as X-ray therapy one cannot tell until a representative series (with controls) have been seen. H. DROLLER St. James’s Hospital, Leeds. Consultant Geriatric Physician.
nitrogen
PNEUMOCONIOSIS IN COALMINERS SIR,—I was glad to see last week the prompt and restrained reply of the Pneumoconiosis Research Unit to your attack on them and on all those who have long been convinced of the need for proper medical control of pneumoconiosis through the periodic X-ray examination of mine-workers. The further extension of our knowledge of this disease and the proper control of the mining engineers’ efforts to eliminate the dust hazard are to a large extent dependent on the institution of such a scheme as that for which Fletcher and his colleagues have been calling since 1948. There exists at present no other yardstick by which to assess dust-control than the effects to be observed in the miner’s lung. This must, in any case, remain the final arbiter no matter how adequate we imagine dust-control practice to be. As a chest physician I cannot agree that the radiograph is an unsuitable means for exercising the medical control necessary for assessing the success of dust-control It offers the only means of detecting and measures. stages, so long as the measuring the disease in its safeguards mentioned by Cochrane et al. are observed. It is difficult to understand how a radiograph taken on entry to the coal-mining industry can provide a " standard for future comparison " unless periodical X-ray examinations are contemplated. Or are these to be taken only when the miner develops symptoms of a severe degree ? 2 It is equally difficult to appreciate why a justifiable concern on the part ol the South Wales coalminers about the effect of their work on their capacity to maintain health and breath, and to reach a decent age, should be
early
represented
as
"
a mass
psychosomatic disorder affecting
the whole local community." The " apprehensive and querulous " attitude of the miners is surely not only understandable but-on the basis of their own biological experience-justifiable also. Finally, it is not true to state, as your leading article did, that authorities are divided (even " broadly speaking") into those who would control dust and those who favour periodic medical examination. All recognise that both have their place. By implying that the members of the Pneumoconiosis Research Unit belong to the latter school you
their views. The most recent statement of these appears in the article you criticiyewherein they sum up :
misrepresent "
The doctor’s r6le is to ensure that miners who are in danger of disablement by pneumoconiosis are protected, if necessary by advising them to leave the industry. It would be for the engineers to ensure that the dust-level.-, were such that very few men would have to be so advised. ’
I find this an admirable atlirmation of the proper standpoint of medical men, and it is in striking contrast to the shameful repudiation of medical responsibility and the denigration of medical science which unhappily characterised your leading article. T. FRANCIS JARMAN Medical Director, Mass Radiography, Llandaff, Cardiff.
Welsh
Region.
TRAUMATIC AMNESIA INHIBITING HYPNOTIC SUGGESTION SIR,—The following case is reported because it is rarely possible to demonstrate under controlled conditions that traumatic loss of consciousness inhibits a hypnotic
suggestion. girl, aged 15 years, had extensive warts on the dorsum of hand and several more on the fingersof both hands. After unsuccessful attempts at treatment over 3 years, hypnotic suggestion was decided on. Instead of hypnosis proper, the warts were with due ceremony painted a bright colour and covered with elastic adhesive bandage. The patient was told that this was a new and highly effective form of treatment, and it was suggested to her that it would produce tingling and some pain for 24 hours, followed by a feeling of numbness, and that the warts could be expected to disappear on the 7th day, when she was to report again. 18 hours afterwards she fell from a horse, and was unconscious for about 3 hours. On coming round one of her first observations was to ask why she had the bandage on her hands;. she did not remember having been to the hospital. She was fully orientated within 48 hours. When she was seen a week later the warts were found to have been unaffected by the suggestion. A
one
The experiment was then repeated in exactly the same way, and this time the warts had largely disappeared at the end of a week. Dermatological Department, St. Bartholomew’s Hospital, London, E.C.1.
IDA MACALPINE.
IMPROVISED VACCINE-LYMPH EJECTOR
Galpine in your improvised vaccinelymph ejector, I decided to endeavour to make a cheap ejector which did not require to be blown by mouth. As a result a suitable one, shown in the accompanying figure, was made from waste materials from the dental SIR,—After reading
issue of
surgery. Two
filling
the letter
April 21, describing
by
Dr.
an
,
obtained from empty bottles of dental materials, and the end of one of the glass tubes was
pipettes
were
A, rubber teat; B, glass tube ;C, vaccine-lymph tube. removed so that there remained a piece of tubing approximately 11/4 in. long and of equal size throughout. Over this the rubber teat from the second pipette was placed, the rubber flange from the edge of this teat being first removed ; a small hole was pierced in the end. The removal of the flange indicated that this end of the ejector was the one in which the tube of lymph would be inserted. To use the ejector, first remove one end of the vaccinelymph capillary tube and insert the broken end of the tube into the rubber teat. The other end of the capillary tube may then be removed, and by gentle pressure of the thumb and finger on the teat at the reverse end of the ejector a small quantity of lymph may be extruded. ,
1. Brit. J. industr. Med.
1951,
8, 53.
SIR,—The experience of Dr. Frankel and Dr. Workman, described in your issue of June 2, coincides with my own experience of the treatment of neoplastic disease with mustard. So far I have treated six bronchial carcinomata with nitrogen mustard, if necessary with repeated courses of up to 90 mg., each dose not exceeding 5 mg. in 10 ml. of saline daily. The nausea which follows the injection of nitrogen mustard can be controlled with anti-histamine drugs and atropine. Two of our patients who came to us for " terminal care " were able to return home. Of four carcinomata of the breast only one grossly fungating carcinoma has responded well to nitrogen mustard. I was particularly impressed by the disappearance of the accompanying sepsis. I have not seen the development of anaemia and leucopenia ; most patients developed a certain measure of euphoria with temporary increase in appetite. As regards the survival-time after institution of treatment, I feel that it is too early to pass judgment. I regard nitrogen mustard therapy as a palliative measure, but whether it is as effective as X-ray therapy one cannot tell until a representative series (with controls) have been seen. H. DROLLER St. James’s Hospital, Leeds. Consultant Geriatric Physician.
nitrogen
PNEUMOCONIOSIS IN COALMINERS SIR,—I was glad to see last week the prompt and restrained reply of the Pneumoconiosis Research Unit to your attack on them and on all those who have long been convinced of the need for proper medical control of pneumoconiosis through the periodic X-ray examination of mine-workers. The further extension of our knowledge of this disease and the proper control of the mining engineers’ efforts to eliminate the dust hazard are to a large extent dependent on the institution of such a scheme as that for which Fletcher and his colleagues have been calling since 1948. There exists at present no other yardstick by which to assess dust-control than the effects to be observed in the miner’s lung. This must, in any case, remain the final arbiter no matter how adequate we imagine dust-control practice to be. As a chest physician I cannot agree that the radiograph is an unsuitable means for exercising the medical control necessary for assessing the success of dust-control It offers the only means of detecting and measures. stages, so long as the measuring the disease in its safeguards mentioned by Cochrane et al. are observed. It is difficult to understand how a radiograph taken on entry to the coal-mining industry can provide a " standard for future comparison " unless periodical X-ray examinations are contemplated. Or are these to be taken only when the miner develops symptoms of a severe degree ? 2 It is equally difficult to appreciate why a justifiable concern on the part ol the South Wales coalminers about the effect of their work on their capacity to maintain health and breath, and to reach a decent age, should be
early
represented
as
"
a mass
psychosomatic disorder affecting
the whole local community." The " apprehensive and querulous " attitude of the miners is surely not only understandable but-on the basis of their own biological experience-justifiable also. Finally, it is not true to state, as your leading article did, that authorities are divided (even " broadly speaking") into those who would control dust and those who favour periodic medical examination. All recognise that both have their place. By implying that the members of the Pneumoconiosis Research Unit belong to the latter school you
their views. The most recent statement of these appears in the article you criticiyewherein they sum up :
misrepresent "
The doctor’s r6le is to ensure that miners who are in danger of disablement by pneumoconiosis are protected, if necessary by advising them to leave the industry. It would be for the engineers to ensure that the dust-level.-, were such that very few men would have to be so advised. ’
I find this an admirable atlirmation of the proper standpoint of medical men, and it is in striking contrast to the shameful repudiation of medical responsibility and the denigration of medical science which unhappily characterised your leading article. T. FRANCIS JARMAN Medical Director, Mass Radiography, Llandaff, Cardiff.
Welsh
Region.
TRAUMATIC AMNESIA INHIBITING HYPNOTIC SUGGESTION SIR,—The following case is reported because it is rarely possible to demonstrate under controlled conditions that traumatic loss of consciousness inhibits a hypnotic
suggestion. girl, aged 15 years, had extensive warts on the dorsum of hand and several more on the fingersof both hands. After unsuccessful attempts at treatment over 3 years, hypnotic suggestion was decided on. Instead of hypnosis proper, the warts were with due ceremony painted a bright colour and covered with elastic adhesive bandage. The patient was told that this was a new and highly effective form of treatment, and it was suggested to her that it would produce tingling and some pain for 24 hours, followed by a feeling of numbness, and that the warts could be expected to disappear on the 7th day, when she was to report again. 18 hours afterwards she fell from a horse, and was unconscious for about 3 hours. On coming round one of her first observations was to ask why she had the bandage on her hands;. she did not remember having been to the hospital. She was fully orientated within 48 hours. When she was seen a week later the warts were found to have been unaffected by the suggestion. A
one
The experiment was then repeated in exactly the same way, and this time the warts had largely disappeared at the end of a week. Dermatological Department, St. Bartholomew’s Hospital, London, E.C.1.
IDA MACALPINE.
IMPROVISED VACCINE-LYMPH EJECTOR
Galpine in your improvised vaccinelymph ejector, I decided to endeavour to make a cheap ejector which did not require to be blown by mouth. As a result a suitable one, shown in the accompanying figure, was made from waste materials from the dental SIR,—After reading
issue of
surgery. Two
filling
the letter
April 21, describing
by
Dr.
an
,
obtained from empty bottles of dental materials, and the end of one of the glass tubes was
pipettes
were
A, rubber teat; B, glass tube ;C, vaccine-lymph tube. removed so that there remained a piece of tubing approximately 11/4 in. long and of equal size throughout. Over this the rubber teat from the second pipette was placed, the rubber flange from the edge of this teat being first removed ; a small hole was pierced in the end. The removal of the flange indicated that this end of the ejector was the one in which the tube of lymph would be inserted. To use the ejector, first remove one end of the vaccinelymph capillary tube and insert the broken end of the tube into the rubber teat. The other end of the capillary tube may then be removed, and by gentle pressure of the thumb and finger on the teat at the reverse end of the ejector a small quantity of lymph may be extruded. ,
1. Brit. J. industr. Med.
1951,
8, 53.