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RESIDENTIAL CHARGES ALLOWABLE AS INCOME-TAX EXPENSES
1393
possibly acquired and symptomatic, in which probably a sequel of dysproteinxmia. In the "hunger camps " of Java adults suffered from osteoporosis with spontaneous fractures as a result of protein (or general) deficiency. An explanation of the hypoproteinaemia in this case might be found in pancreatic insufficiency, since there was condition case
it
was
was
considerable creatorrhcea.
girl was treated with a high-protein diet and pancreatic (’ Cotazym ’ tablets). She was also given injections of the synthetic anabolic nor-steroid, nor-androstenolone phenylpropionate (’Durabolin’). The initial dose was 1/3 ml. (about 8 mg.) every two weeks, subsequently reduced to the same quantity once a month. After seven months her appearance had considerably improved; she was alert and active and had shed her fear of falling. The creatorrhoca had disappeared. Body-weight had increased to 15-4 kg. and height to 102 cm. The E.s.R. had risen to 4 mm. in lst hour, and 13 mm. in 2nd, and the total blood-protein to 7-2 mg. per 100 ml. During the initial period of treatment she still had an occasional fracture under mild strain (e.g., turning while standing on a car seat). Since the seventh month after treatment began, however, she has had no further fractures in spite of increasing activity and playfulness, which involved repeated falls causing swelling and The
enzyme
hxmatomas. The blue discoloration of the sclerae has changcd. even
not
A. K. J. KOUMANS. TREATMENT OF ASTHMA AND HAYFEVER BY HYPNOSIS
SIR,-Having rejected the " intradermal, patch, scratch and prick " tests, we are grateful to Dr. Pepys (June 7) for finally putting us right about the " multiple-pressure " test, which turns out to be only the " prick test " masquerading under another name. Clearly, publication in your journal has many advantages, not least of which is the subsequent dialectic analysis in the correspondence columns and the varied suggestions as to how future research should be conducted. Not all these, however, are very easy to understand. We learn from Dr. Moynahan (June 14), for example, that in order to find out how suggestion works, we should make controlled studies of random samples of the population. We are under the impression, on the other hand, that such studies would indicate only if, not how, such treatment works-and, of course, as now stated several times, the therapeutic effects were never under investigation anyway. As
we see
it, investigations of the effects of suggestion under
hypnosis only be carried out on hypnotised subjects who respond to suggestion-and the controls should be unhypnotised subjects, or hypnotised subjects to whom no suggestions or different suggestions have been made according to the nature of the experiment. The attempted hypnosis of random samples of the population would show, as is already well known, that 20%, can be put into a deep trance, 35% into a medium trance, 35% into a light trance, and that 10% will be unhypnotisable-by any single therapist. 10% of these in turn will fail to react to any attempt at hypnosis by anyone, leaving a hard core of 1% of unhypnotisable individuals in the populacan
tion. To carry
apart from suitable have a rota of about 10 deep-trance subjects, most of whom have been well conditioned to go into a deep trance on the speaking of a single code word: thus saving time otherwise wasted on induction at experimental sessions. These helpful people provide the experimental material with which we operate in our attempts to discover how, not if, suggestion under hypnosis produces physical changes in the out our
patients, who
investigations-quite
are rare-we
human body. In addition
we
should like
to
his really timely correction of
thank Dr. Moynahan for reference to what we
our
on " the original the be the case, allergic response allergy ". If, to old tuberculin can be inhibited by suggestion under hypnosis, whatever the mechanism, how many of the other manifestations of allergy included in von Pirquet’s allgemeiner Begriff might respond as well ? We hope to find out. A. A. MASON
thought
was
the
von
Pirquet paper
as seems to
West London
Hospital, London, W.6.
STEPHEN BLACK.
RESIDENTIAL CHARGES ALLOWABLE AS INCOME-TAX EXPENSES
SIR,-Dr. Harvey-Smith’s successful claim to deduct residential charges as an allowable expense for tax purposes (May 31) is the result of a directive to Inspectors of Taxes following a successful appeal to the General Commissioners of Income Tax undertaken as a test case by the Medical Protection Society. May I therefore venture to amplify the information in Dr. Harvey-Smith’s letter by pointing out that in that case the General Commissioners allowed the appeal because two essential facts were established: (a) The married doctor concerned was required by the terms of his contract to reside at the hospital; and (b) No married quarters were available for his use, thus obliging him to maintain a separate home for his wife at which he resided during periods of leave. To be eligible for this concession, therefore, a resident hospital doctor for whose wife no married quarters are provided by the hospital will have to prove to the satisfaction of his Inspector of Taxes that these two
conditions exist. ALISTAIR FRENCH Secretary,
Medical Protection
Society.
ÆTIOLOGY OF PRE-ECLAMPTIC TOXÆMIA
SiR,-The crux of Professor Browne’s hypothesis (June 14) is that pre-eclamptic toxaemia is caused by deoxycortone (which has not so far been shown to occur naturally), or by another undiscovered mineralocorticoid with similar properties. If any such substance were,the of pre-eclampsia, it would be reasonable to suppose hint of its presence would be reflected in urinary chromatograms in eclampsia. But it is not: in fact, the excretion of formaldehydogenic substances in the urine (which are held to reflect the level of mineralocorticoids in the blood) falls as toxxmia mounts. Again, overproduction would be expected occasionally in conditions other than pregnancy, unless placental production is alone responsible; but there is sound evidence (from a study of adrenalectomised women 1) that the placenta contributes barely one-tenth of the corticoids present in pregnancy. The placenta cannot therefore contribute substantially tQ this hypothetical excess. The occurrence of eclampsia post partum, and its recrudesence at labour when it had earlier subsided on the death of the foetus, also indicate that the placenta plays no active role in the xtiology of pre-eclampsia. Professor Browne holds that there may be no increase in potassium excretion in cortical overactivity, then the absence of an increased potassium excretion in toxaemia when sodium is being retained need not be set against his hypothesis. But that disregards certain data which are impossible to reconcile with his thesis, and which reinforce my view that renal ischxmia is the basis of precause
that
a
1. Laidlaw, J. C., 222.
Cohen, M., Gornall, A. G. J. clin. Endocrin. 1958, 18,
possibly acquired and symptomatic, in which probably a sequel of dysproteinxmia. In the "hunger camps " of Java adults suffered from osteoporosis with spontaneous fractures as a result of protein (or general) deficiency. An explanation of the hypoproteinaemia in this case might be found in pancreatic insufficiency, since there was condition case
it
was
was
considerable creatorrhcea.
girl was treated with a high-protein diet and pancreatic (’ Cotazym ’ tablets). She was also given injections of the synthetic anabolic nor-steroid, nor-androstenolone phenylpropionate (’Durabolin’). The initial dose was 1/3 ml. (about 8 mg.) every two weeks, subsequently reduced to the same quantity once a month. After seven months her appearance had considerably improved; she was alert and active and had shed her fear of falling. The creatorrhoca had disappeared. Body-weight had increased to 15-4 kg. and height to 102 cm. The E.s.R. had risen to 4 mm. in lst hour, and 13 mm. in 2nd, and the total blood-protein to 7-2 mg. per 100 ml. During the initial period of treatment she still had an occasional fracture under mild strain (e.g., turning while standing on a car seat). Since the seventh month after treatment began, however, she has had no further fractures in spite of increasing activity and playfulness, which involved repeated falls causing swelling and The
enzyme
hxmatomas. The blue discoloration of the sclerae has changcd. even
not
A. K. J. KOUMANS. TREATMENT OF ASTHMA AND HAYFEVER BY HYPNOSIS
SIR,-Having rejected the " intradermal, patch, scratch and prick " tests, we are grateful to Dr. Pepys (June 7) for finally putting us right about the " multiple-pressure " test, which turns out to be only the " prick test " masquerading under another name. Clearly, publication in your journal has many advantages, not least of which is the subsequent dialectic analysis in the correspondence columns and the varied suggestions as to how future research should be conducted. Not all these, however, are very easy to understand. We learn from Dr. Moynahan (June 14), for example, that in order to find out how suggestion works, we should make controlled studies of random samples of the population. We are under the impression, on the other hand, that such studies would indicate only if, not how, such treatment works-and, of course, as now stated several times, the therapeutic effects were never under investigation anyway. As
we see
it, investigations of the effects of suggestion under
hypnosis only be carried out on hypnotised subjects who respond to suggestion-and the controls should be unhypnotised subjects, or hypnotised subjects to whom no suggestions or different suggestions have been made according to the nature of the experiment. The attempted hypnosis of random samples of the population would show, as is already well known, that 20%, can be put into a deep trance, 35% into a medium trance, 35% into a light trance, and that 10% will be unhypnotisable-by any single therapist. 10% of these in turn will fail to react to any attempt at hypnosis by anyone, leaving a hard core of 1% of unhypnotisable individuals in the populacan
tion. To carry
apart from suitable have a rota of about 10 deep-trance subjects, most of whom have been well conditioned to go into a deep trance on the speaking of a single code word: thus saving time otherwise wasted on induction at experimental sessions. These helpful people provide the experimental material with which we operate in our attempts to discover how, not if, suggestion under hypnosis produces physical changes in the out our
patients, who
investigations-quite
are rare-we
human body. In addition
we
should like
to
his really timely correction of
thank Dr. Moynahan for reference to what we
our
on " the original the be the case, allergic response allergy ". If, to old tuberculin can be inhibited by suggestion under hypnosis, whatever the mechanism, how many of the other manifestations of allergy included in von Pirquet’s allgemeiner Begriff might respond as well ? We hope to find out. A. A. MASON
thought
was
the
von
Pirquet paper
as seems to
West London
Hospital, London, W.6.
STEPHEN BLACK.
RESIDENTIAL CHARGES ALLOWABLE AS INCOME-TAX EXPENSES
SIR,-Dr. Harvey-Smith’s successful claim to deduct residential charges as an allowable expense for tax purposes (May 31) is the result of a directive to Inspectors of Taxes following a successful appeal to the General Commissioners of Income Tax undertaken as a test case by the Medical Protection Society. May I therefore venture to amplify the information in Dr. Harvey-Smith’s letter by pointing out that in that case the General Commissioners allowed the appeal because two essential facts were established: (a) The married doctor concerned was required by the terms of his contract to reside at the hospital; and (b) No married quarters were available for his use, thus obliging him to maintain a separate home for his wife at which he resided during periods of leave. To be eligible for this concession, therefore, a resident hospital doctor for whose wife no married quarters are provided by the hospital will have to prove to the satisfaction of his Inspector of Taxes that these two
conditions exist. ALISTAIR FRENCH Secretary,
Medical Protection
Society.
ÆTIOLOGY OF PRE-ECLAMPTIC TOXÆMIA
SiR,-The crux of Professor Browne’s hypothesis (June 14) is that pre-eclamptic toxaemia is caused by deoxycortone (which has not so far been shown to occur naturally), or by another undiscovered mineralocorticoid with similar properties. If any such substance were,the of pre-eclampsia, it would be reasonable to suppose hint of its presence would be reflected in urinary chromatograms in eclampsia. But it is not: in fact, the excretion of formaldehydogenic substances in the urine (which are held to reflect the level of mineralocorticoids in the blood) falls as toxxmia mounts. Again, overproduction would be expected occasionally in conditions other than pregnancy, unless placental production is alone responsible; but there is sound evidence (from a study of adrenalectomised women 1) that the placenta contributes barely one-tenth of the corticoids present in pregnancy. The placenta cannot therefore contribute substantially tQ this hypothetical excess. The occurrence of eclampsia post partum, and its recrudesence at labour when it had earlier subsided on the death of the foetus, also indicate that the placenta plays no active role in the xtiology of pre-eclampsia. Professor Browne holds that there may be no increase in potassium excretion in cortical overactivity, then the absence of an increased potassium excretion in toxaemia when sodium is being retained need not be set against his hypothesis. But that disregards certain data which are impossible to reconcile with his thesis, and which reinforce my view that renal ischxmia is the basis of precause
that
a
1. Laidlaw, J. C., 222.
Cohen, M., Gornall, A. G. J. clin. Endocrin. 1958, 18,