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RELAXATION IN LABOUR
1116
Aquinas, which argues from contingent to necessary being. The application of this is particularly apt at the present time, when science is becoming increasingly confused within the jungle of discovered facts where unification on the natural plane is ever more impossible. According to this reasoning, the creational act of God is to be considered not only as ultimate but as immediate, since by the continuous operation of the divine Will everything is held in existence and every contingent act permitted. Thus the work of creation underlies every mutation of the genes (if such in fact occur), though when described scientifically they could only appear to be chance effects. So too, directly and immediately, is the human soul created at the moment of conception. JOSEPH V. WALKER Medical Officer of Health.
Darlington.
RELAXATION IN LABOUR
SIR,—While agreeing with Dr. Newbold (May 24) on the value of hypnotism in childbirth, I should like to point out that the relaxation produced is of great use in a far larger range of medical conditions than is generally realised. Ultimately, no matter what technique is used, success in hypnotherapy depends upon skilful, scientific suggestion (not mere removal of symptoms) ; and for the purpose of providing postgraduate -training in the subject, the London School of Medical Hypnotism has been established under the auspices of the British Society of Medical Hypnotists. S. J. VAN PELT. London, W.I. FUNCTIONAL DISORDERS AFTER GASTRECTOMY
SIR,—Dr. Haler and Dr. Blond, pleading last week "for reconsideration of the aetiology of gastroduodenal ulceration," made two statements so inaccurate that I feel they should not go unchallenged. They state : a surgeon removes the bulk of a healthy stomach-in order to treat an ulcer in the duodenum, which is left intact with its ulcer." The operation for a duodenal ulcer is a gastroduodenectomy. A major portion of the stomach and the part of the duodenum containing the ulcer are removed. Nor is the stomach invariably " healthy," for it may show very severe hypertrophic gastritis with gross bulging - of the mucous membrane, such as is not seen in the normal stomach. B. E. CRAWFORD STANLEY. Maidstone. CARDIAC ARREST
SIR,—The following case may be of interest, for it illustrates how, when the heart has stopped beating for
long periods,
the
injection of adrenaline into the heartbring back life to the dead-even
muscle may virtually at an advanced age.
The patient, aged 82, an ex-varnish-maker of sturdy build, collapsed suddenly in the hospital gardens. When he reached the ward he was pulseless with Cheyne-Stokes breathing. He was given oxygen and nikethamide, which restored his pulse for about 3 minutes, only to vanish again. He was given artificial respiration, and after a time his heart again gave a few feeble beats. It then stopped apparently for good. Over the next 15 minutes the only signs of life were two longdrawn-out, rattling sighs characteristic of death. After this he was apparently lifeless ; his eyes had glazed and become soft to the touch, and his face had the yellow, waxy appearance of death. Hisbody had cooled despite hot-water
bottles. 0-5 ml. of adrenaline hydrochloride was then injected into the heart-muscle, with surprising results. After about 30 seconds the heart began beating again, at first with irregular rhythm and inconsistent volume, but improving rapidly. After 3 minutes the patient took a spontaneous breath. In 5 minutes the corneal reflex had returned, and in 10 minutes he moved an arm. The patient was muttering after 20 minutes, and after an hour he had recovered consciousness. It is
given
active for
to the time he of adrenaline, his heart had not been than 5 minutes in all.
to note
interesting was
the
that, for the 35 minutes up
injection
more
There have been no after-effects and the patient is well physically as he has ever been. Curiously enough, as part of his pre-existing psychotic illness, the old man expresses the strange delusion that his body will not carry out its natural functions. now as
I
am
indebted to Dr. R. Macdonald, the physician-super. to publish this case.
intendent, for permission Banstead Hospital,
C. G. F. SMARTT. SMAETT.
’
Sutton, Surrey.
VARIATION OF EOSINOPHIL-COUNTS your issue of May 17 Dr. M. J. H. Smith the validity of a conclusion based on eosinophil. counts made on blood taken in the morning, as "It has recently been emphasised that the morning is an unsuit. able time for measuring induced falls in eosinophils, becausespontaneous ’ decreases may be as large as 50% (Swanson et al. [Lancet, 1952, i, 129])." We have in a large series of observations1 come to the conclusion that counts taken at 10 A.M. and 2 p.M. under standard conditions of observation (physical and mental rest) very rarely show spontaneous decreases of any magnitude, and that they are a reliable and sensitive index of induced adrenocortical stimulation. The importance of standardising the conditions under which these observations are made has not been sufficiently stressed, and it would be regrettable if the conclusion that morning counts are unreliable were generally
SIR,—In
questions
accepted. Clinical Research Unit, Three Counties Hospital, Arlesey, Beds.
F. MACKENZIE SHATTOCK.
COÖPERATION IN RESEARCH ON HEART-DISEASE
SIR,—Special inquiries were sent recently from the General Register Office to all doctors in London and the Home Counties who certified the death of a patient, aged 40 or over, from cardiovascular, renal, or respiratory disease, during the first fortnight of March, 1952. The doctors were asked to provide additional information about their late patients in order to assist the Social
Medicine Research Unit of the Medical Research Council in its studies of the prevalence of heart-disease and hypertension in the population. The response has been very gratifying, and we wish to thank the large numbers of practitioners who cooperated in the inquiry ; there is no doubt that valuable information has been obtained. However, the value of an inquiry of this type is much enhanced if something like a 100% response can be obtained. We appeal therefore to any practitioner who received a questionnaire and has not yet returned it to do so now. In particular it would be helpful if doctors who have not returned the questionnaire because they no longer have access to the patient’s records-for example, at the hospital where he died-would send the form to the hospital (to the medical registrar, for instance) for completion and return. If this is not practicable we should be grateful if the form were returned uncompleted to the first of the undersigned, with a note about the reason, at Kenworthy’s Hydro, Southport. As is emphasised in the covering letter to the questionnaire, the method adopted for the inquiry fully preserves the confidential nature of the additional medical information being provided.
W. P. D. LOGAN London, W.C.2.
Chief Medical Statistician, General Register Office.
J. N. MORRIS Central Middlesex Hospital, London, N.W.10. 1. Shattock, F. M., Micklem, L. P.
Director,
Social Medicine Research Unit, Medical Research Council. J. ment. Sci.
1952, 98, 287.
Aquinas, which argues from contingent to necessary being. The application of this is particularly apt at the present time, when science is becoming increasingly confused within the jungle of discovered facts where unification on the natural plane is ever more impossible. According to this reasoning, the creational act of God is to be considered not only as ultimate but as immediate, since by the continuous operation of the divine Will everything is held in existence and every contingent act permitted. Thus the work of creation underlies every mutation of the genes (if such in fact occur), though when described scientifically they could only appear to be chance effects. So too, directly and immediately, is the human soul created at the moment of conception. JOSEPH V. WALKER Medical Officer of Health.
Darlington.
RELAXATION IN LABOUR
SIR,—While agreeing with Dr. Newbold (May 24) on the value of hypnotism in childbirth, I should like to point out that the relaxation produced is of great use in a far larger range of medical conditions than is generally realised. Ultimately, no matter what technique is used, success in hypnotherapy depends upon skilful, scientific suggestion (not mere removal of symptoms) ; and for the purpose of providing postgraduate -training in the subject, the London School of Medical Hypnotism has been established under the auspices of the British Society of Medical Hypnotists. S. J. VAN PELT. London, W.I. FUNCTIONAL DISORDERS AFTER GASTRECTOMY
SIR,—Dr. Haler and Dr. Blond, pleading last week "for reconsideration of the aetiology of gastroduodenal ulceration," made two statements so inaccurate that I feel they should not go unchallenged. They state : a surgeon removes the bulk of a healthy stomach-in order to treat an ulcer in the duodenum, which is left intact with its ulcer." The operation for a duodenal ulcer is a gastroduodenectomy. A major portion of the stomach and the part of the duodenum containing the ulcer are removed. Nor is the stomach invariably " healthy," for it may show very severe hypertrophic gastritis with gross bulging - of the mucous membrane, such as is not seen in the normal stomach. B. E. CRAWFORD STANLEY. Maidstone. CARDIAC ARREST
SIR,—The following case may be of interest, for it illustrates how, when the heart has stopped beating for
long periods,
the
injection of adrenaline into the heartbring back life to the dead-even
muscle may virtually at an advanced age.
The patient, aged 82, an ex-varnish-maker of sturdy build, collapsed suddenly in the hospital gardens. When he reached the ward he was pulseless with Cheyne-Stokes breathing. He was given oxygen and nikethamide, which restored his pulse for about 3 minutes, only to vanish again. He was given artificial respiration, and after a time his heart again gave a few feeble beats. It then stopped apparently for good. Over the next 15 minutes the only signs of life were two longdrawn-out, rattling sighs characteristic of death. After this he was apparently lifeless ; his eyes had glazed and become soft to the touch, and his face had the yellow, waxy appearance of death. Hisbody had cooled despite hot-water
bottles. 0-5 ml. of adrenaline hydrochloride was then injected into the heart-muscle, with surprising results. After about 30 seconds the heart began beating again, at first with irregular rhythm and inconsistent volume, but improving rapidly. After 3 minutes the patient took a spontaneous breath. In 5 minutes the corneal reflex had returned, and in 10 minutes he moved an arm. The patient was muttering after 20 minutes, and after an hour he had recovered consciousness. It is
given
active for
to the time he of adrenaline, his heart had not been than 5 minutes in all.
to note
interesting was
the
that, for the 35 minutes up
injection
more
There have been no after-effects and the patient is well physically as he has ever been. Curiously enough, as part of his pre-existing psychotic illness, the old man expresses the strange delusion that his body will not carry out its natural functions. now as
I
am
indebted to Dr. R. Macdonald, the physician-super. to publish this case.
intendent, for permission Banstead Hospital,
C. G. F. SMARTT. SMAETT.
’
Sutton, Surrey.
VARIATION OF EOSINOPHIL-COUNTS your issue of May 17 Dr. M. J. H. Smith the validity of a conclusion based on eosinophil. counts made on blood taken in the morning, as "It has recently been emphasised that the morning is an unsuit. able time for measuring induced falls in eosinophils, becausespontaneous ’ decreases may be as large as 50% (Swanson et al. [Lancet, 1952, i, 129])." We have in a large series of observations1 come to the conclusion that counts taken at 10 A.M. and 2 p.M. under standard conditions of observation (physical and mental rest) very rarely show spontaneous decreases of any magnitude, and that they are a reliable and sensitive index of induced adrenocortical stimulation. The importance of standardising the conditions under which these observations are made has not been sufficiently stressed, and it would be regrettable if the conclusion that morning counts are unreliable were generally
SIR,—In
questions
accepted. Clinical Research Unit, Three Counties Hospital, Arlesey, Beds.
F. MACKENZIE SHATTOCK.
COÖPERATION IN RESEARCH ON HEART-DISEASE
SIR,—Special inquiries were sent recently from the General Register Office to all doctors in London and the Home Counties who certified the death of a patient, aged 40 or over, from cardiovascular, renal, or respiratory disease, during the first fortnight of March, 1952. The doctors were asked to provide additional information about their late patients in order to assist the Social
Medicine Research Unit of the Medical Research Council in its studies of the prevalence of heart-disease and hypertension in the population. The response has been very gratifying, and we wish to thank the large numbers of practitioners who cooperated in the inquiry ; there is no doubt that valuable information has been obtained. However, the value of an inquiry of this type is much enhanced if something like a 100% response can be obtained. We appeal therefore to any practitioner who received a questionnaire and has not yet returned it to do so now. In particular it would be helpful if doctors who have not returned the questionnaire because they no longer have access to the patient’s records-for example, at the hospital where he died-would send the form to the hospital (to the medical registrar, for instance) for completion and return. If this is not practicable we should be grateful if the form were returned uncompleted to the first of the undersigned, with a note about the reason, at Kenworthy’s Hydro, Southport. As is emphasised in the covering letter to the questionnaire, the method adopted for the inquiry fully preserves the confidential nature of the additional medical information being provided.
W. P. D. LOGAN London, W.C.2.
Chief Medical Statistician, General Register Office.
J. N. MORRIS Central Middlesex Hospital, London, N.W.10. 1. Shattock, F. M., Micklem, L. P.
Director,
Social Medicine Research Unit, Medical Research Council. J. ment. Sci.
1952, 98, 287.