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"PSYCHOTHERAPEUTIC"
between the two thumb nails until they burst and a slight show of blood appears. This treatment is best performed, with or without help from an assistant, in the bath. Itching ceases for good, and rare recurrences can be retreated. I have never found topical applications effective for more than an hour or two, but after half an hour’s work on an anguished patient with fifty or sixty bites, he can be confident of cure. M.R.C.
Group for Research in Bilharzia, St. Albans, Herts.
J. NEWSOME.
BEDSORES OF THE GUT
SiR,—Ihave read with great interest in your issue of June 25 the excellent leading article, which ends by asking two questions: "
Should we mouth from ill,
consider whether the withholding of food by shocked, semicomatose, and comatose patients does not needlessly expose their gut mucosa to severe chemical irritation ? Intravenous therapy can provide water, salt, and calories; but it cannot neutralise or dilute gastrointestinal enzymes, nor stimulate peristalsis. Was there some sense after all in that much-maligned cup of hot sweet tea ? not
much more than a misnomer, for this usage carries an implication of the chemical causalitv of psvchic processes. The Middlesex Hospital, London, W.1.
ALEXANDER DUDDINGTON.
BLOOD-TRANSFUSIONS FOR DENTAL EXTRACTIONS IN HÆMOPHILIA SIR,-Following publicationof the method used for dental extractions in haemophilia and Christmas disease, I received inquiries regarding the amount of blood given to each patient. May I be allowed to supply this information ? A total of 458 fresh-blood transfusions were used for the successful performance of 92 operations. With the exception of TRANSFUSIONS USED FOR TEETH EXTRACTIONS IN HEMOPHILIA AND CHRISTMAS DISEASE
"
Dalgaard,l whom you quote, considers that the close association between certain types of cerebral lesions and acute peptic ulceration as a mere chance coincidence can be excluded. He quotes Balo who made the significant observation that within a very short time a few ulcers appeared to be already in process of healing and that it is reasonable to assume that the acute ulcers might have healed if the patients had survived the primary cerebral lesion. I believe that it is now generally admitted that the acute lesion is, invariably and characteristically, symptom-free in contradistinction to the painful chronic lesions and that the former, which cannot be diagnosed clinically except when it is complicated by hxmorrhage or perforation, originates in the subniucosa, while the latter originates in the mucosa. Indeed, the acute and chronic lesions are two unrelated disease entities. Since in the shocked patient the gastric secretions are considerably reduced and since, in any case, the acid element does not participate in the causation or maintenance of the acute ulcer, there is no reason further to reduce gastric acidity. I have stated on many occasions that the acute lesion is a secondary manifestation of a remotely situated pathological locus, it represents the " alarm reaction" of Selye, who advocates the administration of glucose as the appropriate treatment.
These considerations suggest the answer to both questions. The answer to the first must be in the negative and to the second in the affirmative. More detailed information
monograph Gastro-Duodenal
on this Ulcer.
subject
may be found in my
J.-JACQUES SPIRA.
* Each transfusion consisted of 540 ml. ACD blood
or
plasma therefrom.
2 patients who received 11 and 15 fresh-blood transfusions for the extraction of 16 and 6 teeth respectively, no more than 10 fresh blood-transfusions were required for achieving the necessary hxmostasis. Details of the remaining 90 occasions are given in the accompanying table. Only after 14 operations did I supplement the fresh blood with packed red cells (5 transfusions) or stored blood (32 transfusions), in order to correct reduction in hxmoglobin levels. Although the condition of 1 of these patients, who had 6 teeth removed, necessitated the use of 10 stored-blood transfusions, the postoperative loss of blood in the remaining 13 operations was adequately replaced by the administration of 1-3 transfusions in each case. Blood Transfusion Centre, Brentwood, Essex.
F. NOUR-ELDIN.
THE MEDICAL DIRECTORY
"PSYCHOTHERAPEUTIC" SIR,-Recent years have seen the introduction of a number of effective drugs which by their influence on various central neurophysiological mechanisms are of value in the treatment of certain mental and nervous disorders. The makers of a new such product, which is claimed to be specific for the relief of anxiety and tension, introduce it as a " psychotherapeutic ". This misnomer calls for correction before it becomes established-leaving aside the question of whether this (or an analogous drug) is effective or not. Psychotherapy (and its adjective, psychotherapeutic) have long been established as referring specifically to non-physical methods of effecting change in a patient, and to describe a chemical agent as psychotherapeutic is therefore a mistake. But it is a matter of
The Editor of The Medical "
Dalgaard, J. B.
A.M.A. Arch. Path. 1960,
28, 359.
The annual schedule, upon the
return
of which the
accur-
acy of The Medical
Directory mainly depends, has recently been posted to all traceable members of the medical profession, and its speedy return would be appreciated. A number of schedules, sent to a doctor’s last known address, have been returned through the post office marked ’gone away’. Although in such cases every effort is made to find a new address, I should like to remind practitioners that if these successful before the book goes to press, the be omitted from the next edition. " Any doctor who has not received the annual schedule, or who has mislaid it and would like a duplicate, is requested to communicate as soon as possible with the Editor, The Medical Directory, 104, Gloucester Place, London, W.1. The full name and year of qualification of the doctor should be sent for efforts
are not
names
in
question will
identification." 1.
1.
Directory writes :
MacIntyre, H., Nour-Eldin, F., Israels, M. C. G., Wilkinson, J. F. Lancet, 1959, ii, 642.
Group for Research in Bilharzia, St. Albans, Herts.
J. NEWSOME.
BEDSORES OF THE GUT
SiR,—Ihave read with great interest in your issue of June 25 the excellent leading article, which ends by asking two questions: "
Should we mouth from ill,
consider whether the withholding of food by shocked, semicomatose, and comatose patients does not needlessly expose their gut mucosa to severe chemical irritation ? Intravenous therapy can provide water, salt, and calories; but it cannot neutralise or dilute gastrointestinal enzymes, nor stimulate peristalsis. Was there some sense after all in that much-maligned cup of hot sweet tea ? not
much more than a misnomer, for this usage carries an implication of the chemical causalitv of psvchic processes. The Middlesex Hospital, London, W.1.
ALEXANDER DUDDINGTON.
BLOOD-TRANSFUSIONS FOR DENTAL EXTRACTIONS IN HÆMOPHILIA SIR,-Following publicationof the method used for dental extractions in haemophilia and Christmas disease, I received inquiries regarding the amount of blood given to each patient. May I be allowed to supply this information ? A total of 458 fresh-blood transfusions were used for the successful performance of 92 operations. With the exception of TRANSFUSIONS USED FOR TEETH EXTRACTIONS IN HEMOPHILIA AND CHRISTMAS DISEASE
"
Dalgaard,l whom you quote, considers that the close association between certain types of cerebral lesions and acute peptic ulceration as a mere chance coincidence can be excluded. He quotes Balo who made the significant observation that within a very short time a few ulcers appeared to be already in process of healing and that it is reasonable to assume that the acute ulcers might have healed if the patients had survived the primary cerebral lesion. I believe that it is now generally admitted that the acute lesion is, invariably and characteristically, symptom-free in contradistinction to the painful chronic lesions and that the former, which cannot be diagnosed clinically except when it is complicated by hxmorrhage or perforation, originates in the subniucosa, while the latter originates in the mucosa. Indeed, the acute and chronic lesions are two unrelated disease entities. Since in the shocked patient the gastric secretions are considerably reduced and since, in any case, the acid element does not participate in the causation or maintenance of the acute ulcer, there is no reason further to reduce gastric acidity. I have stated on many occasions that the acute lesion is a secondary manifestation of a remotely situated pathological locus, it represents the " alarm reaction" of Selye, who advocates the administration of glucose as the appropriate treatment.
These considerations suggest the answer to both questions. The answer to the first must be in the negative and to the second in the affirmative. More detailed information
monograph Gastro-Duodenal
on this Ulcer.
subject
may be found in my
J.-JACQUES SPIRA.
* Each transfusion consisted of 540 ml. ACD blood
or
plasma therefrom.
2 patients who received 11 and 15 fresh-blood transfusions for the extraction of 16 and 6 teeth respectively, no more than 10 fresh blood-transfusions were required for achieving the necessary hxmostasis. Details of the remaining 90 occasions are given in the accompanying table. Only after 14 operations did I supplement the fresh blood with packed red cells (5 transfusions) or stored blood (32 transfusions), in order to correct reduction in hxmoglobin levels. Although the condition of 1 of these patients, who had 6 teeth removed, necessitated the use of 10 stored-blood transfusions, the postoperative loss of blood in the remaining 13 operations was adequately replaced by the administration of 1-3 transfusions in each case. Blood Transfusion Centre, Brentwood, Essex.
F. NOUR-ELDIN.
THE MEDICAL DIRECTORY
"PSYCHOTHERAPEUTIC" SIR,-Recent years have seen the introduction of a number of effective drugs which by their influence on various central neurophysiological mechanisms are of value in the treatment of certain mental and nervous disorders. The makers of a new such product, which is claimed to be specific for the relief of anxiety and tension, introduce it as a " psychotherapeutic ". This misnomer calls for correction before it becomes established-leaving aside the question of whether this (or an analogous drug) is effective or not. Psychotherapy (and its adjective, psychotherapeutic) have long been established as referring specifically to non-physical methods of effecting change in a patient, and to describe a chemical agent as psychotherapeutic is therefore a mistake. But it is a matter of
The Editor of The Medical "
Dalgaard, J. B.
A.M.A. Arch. Path. 1960,
28, 359.
The annual schedule, upon the
return
of which the
accur-
acy of The Medical
Directory mainly depends, has recently been posted to all traceable members of the medical profession, and its speedy return would be appreciated. A number of schedules, sent to a doctor’s last known address, have been returned through the post office marked ’gone away’. Although in such cases every effort is made to find a new address, I should like to remind practitioners that if these successful before the book goes to press, the be omitted from the next edition. " Any doctor who has not received the annual schedule, or who has mislaid it and would like a duplicate, is requested to communicate as soon as possible with the Editor, The Medical Directory, 104, Gloucester Place, London, W.1. The full name and year of qualification of the doctor should be sent for efforts
are not
names
in
question will
identification." 1.
1.
Directory writes :
MacIntyre, H., Nour-Eldin, F., Israels, M. C. G., Wilkinson, J. F. Lancet, 1959, ii, 642.