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REACTION TO VITAMIN B12
1129 one loses in pathological grade-3 cases one in gains grade-1 cases. My personal view is that staging should only be clinical but that in the presentation of results the histology should also be considered when this is known. Dr. Robert Morrison’s staging,3 employing as it does eleven groups, looks complex but is in fact an application of the TNM system, which will undoubtedly form the basis of any international staging, not only for I feel cancer of the breast but for other sites as well. confident myself that an acceptable staging will emerge in the not too distant future. HARMER. MICHAEL HARRIER. London, W.l.
stage what
REACTION TO VITAMIN
B12
SiR,-I read with interest the account by Dr. Gillhespy of a patient in whom an injection of vitamin B12 produced an anaphylactoid reaction with urticaria of the skin. In 1952 I reported4 that, whereas side-effects occasionally occurred following the administration of certain preparations of vitamin B12 derived from cultures of Streptomyces griseus, there were no adverse reactions to a preparation of vitamin B12 derived from liver. It would be of interest to know the nature of the vitamin-B12 preparation which produced the sensitivity reaction in Dr. Gillhespy’s patient. Cowley
Road
Hospital,
Oxford.
P. D. BEDFORD.
INFORMATION FROM HOSPITAL
SiR,—Working in the vicinity of several of the teaching hospitals, I am impressed by the frequent complaints from relatives of inpatients and from outpatients themselves that they find it almost impossible to obtain adequate information from the hospital about their progress and about the proposed investigations and treatment. Whilst I always find house-officers extremely coöperative when asked for information over the telephone, this is a time-consumin business both for them
and for me. Would it be worth appointing a general practitioner to each large hospital whose sole and very much fulltime function would be to act as a medical liaison and information officer, and who would always be available to those patients, relatives, and general practitioners in the district, needing immediate clinical details, rather than the usual nurse’s bulletin ? BENJAMIN LEE. London, S.W.7. DRUGS IN THE TREATMENT OF DEPRESSION SiR,-Your annotation of May 21 does not mention opium. I think this is still a valuable drug in the treatment of minor depressive syndromes, many of them with
anxiety, which are so commonly seen in psychiatric outpatient practice. It may be dispensed in the form of a mixture containing 10 minims of tincture of opium (B.P.) to the half-ounce of chloroform water (its constipating effect being offset by the addition of a few minims of liquid extract of cascara) taken thrice daily. Its soothing effect is as great as that of the barbiturates, though not produced so rapidly. I have been prescribing a mixture of this kind for many years. I have never seen a patient become addicted to it (it is extremely unpleasant to take) and only once to my knowledge has a patient attempted to use it for ostensible suicidal purposes. He swallowed an estimated quantity of six ounces of the mixture, slept for about fourteen hours, and woke up feeling better than he had done for months. Considering, too, the ease with which patients may hoard barbiturate tablets or capsules, and the frequency with which they are used in suicidal attempts, I think there is still much to be said for the old-fashioned opium 3. Ibid, May 7, 1955, p. 1153. 4. Bedford, P. D. Ibid, 1952, i, 690.
mixture. Dispensed in the strength I have mentioned, the mixture is not subject to the Dangerous Drugs Regulations. It can be used safely for many weeks at a time and it goes well with the amphetamine group of drugs. I have generally found that it is only when insomnia is severe that it is necessary to add a nocturnal barbiturate to this regime. Warneford Hospital, IAN SKOTTOWE. Oxford.
REGISTRARS AND REGISTRARS SIR,-If, for some, my letter of April 23 expressed malevolence I can only retort, as did the mediocre marksman at the firing-point, Well, Sarge, it left here A Letter to the Editor may appear in various alright ! " styles ; and if a correspondent thinks it more effective to make his point with very obvious exaggeration and a bit of fun-poking, surely it is in accordance with accepted practice-particularly if the subject is a political "
one.
May I take the opportunity of repeating the previous theme : that registrars at the periphery-registrars (p) if you like-deserve far more encouragement. REGISTRAR (W PLUS). METCHNIKOFF, LISTER, AND EHRLICH Dr. Leonard Crome, honorary secretary of the medical committee of the- Society for Cultural Relations with the TJ.S.S.R. (14, Kensington Square, London, W.8), writes : "
A request has come to the Society from the Metchnikoff Museum in the U.S.S.R. for information concerning the whereabouts of letters from Metchnikoff to Lord Lister and Paul Ehrlich. We should be most grateful if any of your readers could help us to trace these letters."
Medicine and the Law Damages for Rheumatoid Arthritis A Scottish school-teacher has been awarded E2000 damages against her employers, the for rheumatoid arthritis contracted
unhealthy
Glasgow Corporation, through working
in
conditions.1
The plaintiff, a woman aged 28, averred that as a result she had become unfit for her professional duties and claimed f 10,000 damages. She said that the classroom in which she taught was badly ventilated and inadequately heated. The corporation maintained that the room was not in an unhealthy or dangerous condition and called medical evidence to the effect that conditions of damp and cold had no relevance in considering the cause or aggravation of rheumatoid arthritis. The judge, in summing up, told the jury that there were three questions which they must decide. The first was whether they held it proved on the evidence that the plaintiff’s teaching place was cold, damp, and ill-ventilated throughout the whole period of two and a half years that she was there. If they were not satisfied that the room was unduly cold and damp during that period, then they must find for the defendants. If they were satisfied that the room was unduly cold and damp, then they must consider whether those conditions caused or aggravated the rheumatoid arthritis from which the plaintiff suffered. The third question was whether the development of rheumatoid arthritis in the plaintiff was something that the defendants should have anticipated from the exposure of the plaintiff to the conditions in the room. The law required that the plaintiff must prove that the defendants as ordinary, reasonable people ought to have anticipated and foreseen that if she was exposed to wet and cold conditions rheumatoid arthritis was likely to be caused or aggravated. The jury, by a majority of seven to five, found for the on these three points and assessed the damages at 2000.
plaintiff
It is not
yet known whether the corporation intend case is clearly of unusual interest.
appeal. This
1. Scotsman,
May 19, 1955.
to
stage what
REACTION TO VITAMIN
B12
SiR,-I read with interest the account by Dr. Gillhespy of a patient in whom an injection of vitamin B12 produced an anaphylactoid reaction with urticaria of the skin. In 1952 I reported4 that, whereas side-effects occasionally occurred following the administration of certain preparations of vitamin B12 derived from cultures of Streptomyces griseus, there were no adverse reactions to a preparation of vitamin B12 derived from liver. It would be of interest to know the nature of the vitamin-B12 preparation which produced the sensitivity reaction in Dr. Gillhespy’s patient. Cowley
Road
Hospital,
Oxford.
P. D. BEDFORD.
INFORMATION FROM HOSPITAL
SiR,—Working in the vicinity of several of the teaching hospitals, I am impressed by the frequent complaints from relatives of inpatients and from outpatients themselves that they find it almost impossible to obtain adequate information from the hospital about their progress and about the proposed investigations and treatment. Whilst I always find house-officers extremely coöperative when asked for information over the telephone, this is a time-consumin business both for them
and for me. Would it be worth appointing a general practitioner to each large hospital whose sole and very much fulltime function would be to act as a medical liaison and information officer, and who would always be available to those patients, relatives, and general practitioners in the district, needing immediate clinical details, rather than the usual nurse’s bulletin ? BENJAMIN LEE. London, S.W.7. DRUGS IN THE TREATMENT OF DEPRESSION SiR,-Your annotation of May 21 does not mention opium. I think this is still a valuable drug in the treatment of minor depressive syndromes, many of them with
anxiety, which are so commonly seen in psychiatric outpatient practice. It may be dispensed in the form of a mixture containing 10 minims of tincture of opium (B.P.) to the half-ounce of chloroform water (its constipating effect being offset by the addition of a few minims of liquid extract of cascara) taken thrice daily. Its soothing effect is as great as that of the barbiturates, though not produced so rapidly. I have been prescribing a mixture of this kind for many years. I have never seen a patient become addicted to it (it is extremely unpleasant to take) and only once to my knowledge has a patient attempted to use it for ostensible suicidal purposes. He swallowed an estimated quantity of six ounces of the mixture, slept for about fourteen hours, and woke up feeling better than he had done for months. Considering, too, the ease with which patients may hoard barbiturate tablets or capsules, and the frequency with which they are used in suicidal attempts, I think there is still much to be said for the old-fashioned opium 3. Ibid, May 7, 1955, p. 1153. 4. Bedford, P. D. Ibid, 1952, i, 690.
mixture. Dispensed in the strength I have mentioned, the mixture is not subject to the Dangerous Drugs Regulations. It can be used safely for many weeks at a time and it goes well with the amphetamine group of drugs. I have generally found that it is only when insomnia is severe that it is necessary to add a nocturnal barbiturate to this regime. Warneford Hospital, IAN SKOTTOWE. Oxford.
REGISTRARS AND REGISTRARS SIR,-If, for some, my letter of April 23 expressed malevolence I can only retort, as did the mediocre marksman at the firing-point, Well, Sarge, it left here A Letter to the Editor may appear in various alright ! " styles ; and if a correspondent thinks it more effective to make his point with very obvious exaggeration and a bit of fun-poking, surely it is in accordance with accepted practice-particularly if the subject is a political "
one.
May I take the opportunity of repeating the previous theme : that registrars at the periphery-registrars (p) if you like-deserve far more encouragement. REGISTRAR (W PLUS). METCHNIKOFF, LISTER, AND EHRLICH Dr. Leonard Crome, honorary secretary of the medical committee of the- Society for Cultural Relations with the TJ.S.S.R. (14, Kensington Square, London, W.8), writes : "
A request has come to the Society from the Metchnikoff Museum in the U.S.S.R. for information concerning the whereabouts of letters from Metchnikoff to Lord Lister and Paul Ehrlich. We should be most grateful if any of your readers could help us to trace these letters."
Medicine and the Law Damages for Rheumatoid Arthritis A Scottish school-teacher has been awarded E2000 damages against her employers, the for rheumatoid arthritis contracted
unhealthy
Glasgow Corporation, through working
in
conditions.1
The plaintiff, a woman aged 28, averred that as a result she had become unfit for her professional duties and claimed f 10,000 damages. She said that the classroom in which she taught was badly ventilated and inadequately heated. The corporation maintained that the room was not in an unhealthy or dangerous condition and called medical evidence to the effect that conditions of damp and cold had no relevance in considering the cause or aggravation of rheumatoid arthritis. The judge, in summing up, told the jury that there were three questions which they must decide. The first was whether they held it proved on the evidence that the plaintiff’s teaching place was cold, damp, and ill-ventilated throughout the whole period of two and a half years that she was there. If they were not satisfied that the room was unduly cold and damp during that period, then they must find for the defendants. If they were satisfied that the room was unduly cold and damp, then they must consider whether those conditions caused or aggravated the rheumatoid arthritis from which the plaintiff suffered. The third question was whether the development of rheumatoid arthritis in the plaintiff was something that the defendants should have anticipated from the exposure of the plaintiff to the conditions in the room. The law required that the plaintiff must prove that the defendants as ordinary, reasonable people ought to have anticipated and foreseen that if she was exposed to wet and cold conditions rheumatoid arthritis was likely to be caused or aggravated. The jury, by a majority of seven to five, found for the on these three points and assessed the damages at 2000.
plaintiff
It is not
yet known whether the corporation intend case is clearly of unusual interest.
appeal. This
1. Scotsman,
May 19, 1955.
to