- Email: [email protected]
ROLE OF THE ERYTHROPOIETIC HORMONE
777
the stated scatter of observations. The tests for significance apply to results including these errors. With 59Fe autoradiodifference in grain-counts graphs we have found"no significant control " and " stimulated " animals, over normoblasts in although the proportion of normoblasts --present is greatly reduced in the former. Reticulocytes do, of course, contribute to the iron utilisation, particularly if we take the 24-hour value, " unstimulated " polybut as the reticulocyte-count in cythaemic animals is of the order of 0-03%, factors stimulating haem synthesis alone will not give rise to false-positive results. The London Hospital, London, E.1.
D. G. PENINGTON.
NEUROLOGICAL COMPLICATIONS OF INFLUENZA recent influenza SIR,-The epidemic here, affecting especially the elderly, provided a forceful reminder of the many neurological complications in this disease.1 In descending order of incidence, these were:
(1) Brain-stem involvement with dysphagia, vomiting, &c. (2) Encephalitis with headache, photophobia, giddiness, vomiting, &c.
(3) Encephalomyelitis. (4) Autonomic neuropathy with diarrhoea, vomiting, and tachycardia. (5) Polyneuritis. City Hospital,
T. K. BOSE.
Chester.
OXYTETRACYCLINE PROPHYLAXIS IN CHRONIC BRONCHITIS
SIR,-From October, 1958,
to
March, 1959, 59
with severe chronic bronchitis were admitted with acute respiratory illnesses.
to
men
hospital
When they left, 32 men selected at random were each given 20 tablets (0-5 g.) of oxytetracycline and the following instructions : " If you have a severe head cold, or the phlegm becomes yellow or green, or you feel that you are beginning with a chest illness, take 1 tablet after breakfast, dinner, tea, and supper." Further tablets were given if necessary. Before the trial ended in March, 1960, 20 of these patients had taken 36 courses of oxytetracycline, which prevented serious respiratory illnesses in 15. 5 men were readmitted, 2 because of bronchospasm, and 3 with reinfection; 1 of the latter had failed to follow the instructions. None of the trial patients died. 7 of the 27 controls were readmitted to this hospital, and 2 died; 6 other control patients died during the trial period. These results are encouraging, and we prefer this method to the continuous administration of antibiotics. 23 Whiston Hospital, Prescot, Lancashire. Pfizer Ltd., Folkestone, Kent.
E. SHERWOOD JONES J. E. FORSTER.
J. K. MORRISON.
TREATMENT OF RECENT BELL’S PALSY BY CERVICAL SYMPATHETIC BLOCK
SIR,-The treatment of the complete type of Bell’s palsy by cervical sympathetic block recently reported by Mr. Boyes Korkis (Feb. 4) has made a great difference to the work of physical medicine departments. Before, such cases could be divided into those which recovered within three to four weeks of onset, and those in which recovery was extremely slow and which finally were left with weakness, contractures, or overaction, after three years of
physiotherapy. With sympathetic block, most recent cases (93%) can now be placed in the first category, with immediate or nearly immediate recovery; and no call is made upon the physio-
therapy services. 1. 2. 3.
Leigh, A. D. Brit. med. J. 1946, ii, 936. Edwards, G., Fear, E. C. Brit. med. J. 1958, ii, 1010. Murdoch, J. M., Leckie, W. J. H., Downie, J., Swain, R. H. A., Gould, J. C. ibid. 1959, ii, 1277.
Facial palsy is now rarely seen in the physical medicine department. Only late and complicated cases (thrombotic, arteriosclerotic, infective, post-traumatic, and those with geniculate herpes) are encountered. Very nearly all cases of facial palsy appear to be of the vasospastic type (true Bell’s palsy); and by early and rapid relief of angiospasm facial nerve function can be completely restored without physiotherapy. Hillingdon Hospital, Hillingdon, Middlesex.
R.
J. TALBOT.
BEHAVIOUR THERAPY IN TRANSVESTISM
SIR,-In their interesting letters, Dr. Barker and his colleagues (March 4) and Dr. Glynn and Dr. Harper (March 18) describe the apparently successful treatment of transvestism by aversion therapy using apomorphine injections. I should like to point out that the treatment of cases of transvestism along these lines may not always be so straightforward. Experience of the apparent cure by this treatment of rubberclothing fetishism (follow-up fifteen months and six months) led me to apply similar treatment recently to a 37-year-old fetishist, whose practices dated from early childhood. Apomorphine injections two-hourly, combined with dressing up in female clothing, were used day and night for five days, with pilocarpine nitrate in addition when the effects of the apomorphine began to wane. In the course of treatment, the patient, unlike the fetishists, failed to show aggression or refusal to don the clothes, and previously underestimated masochistic traits became evident. This treatment was carried out in the week before the letter of Dr. Barker and his colleagues. It is not yet certain whether, like the two fetishists, this man will have become indifferent to the clothing, but, since the time of treatment, he has remained in a condition of severe agitation and depression, with suicidal
thoughts. Department of Psychological Medicine,
University of Edinburgh.
SIR,-In would like
IAN OSWALD.
SKELETAL FLUOROSIS reply to Dr. Alcock’s letter
(March 11) I dental fluorosis, and on the of adding sodium fluoride to
to comment on
safety and desirability public water-supplies. In my original letter (Feb. 18) I did not say that I was confining my remarks on dental fluorosis to the situation in temperate climates, since the proposal to fluoridate water is a matter which may affect people in all climates. Galagan and Lamson1 show quite clearly that at concentrations of less than 1 part per million (p.p.m.) objectionable mottling occurs in the hot zone (temp. 69-3°F) and less objectionable mottling in the temperate zone (temp. 50’6°F). The more objectionable mottling, as the authors suggest, is probably related to the increased water consumption and the fact that the preparation of the dietary staple (beans) could concentrate the fluorides. Since the question of temperature has been raised, readers may like to know that marked dental mottling can occur with low concentrations of fluorine in water in this country. Kemp et al.2 describe severe dental fluorosis in two villages in Oxfordshire where the watersupplies contained 0-8 p.p.m. and 0-3-1-2 p.p.m. respectively. Forrestdescribes objectionable mottling in Essex and Surrey where the fluorine content is 0-1-0-2 p.p.m., but regards this as a developmental hypoplasia. Despite the assurance of the W.H.O. report that 1-0-1-5 p.p.m. will cause only slight flecking of the enamel, it has been estimated that more than 200,000 children in the U.S.A. have already become victims of definite life-time mottling since artificial 1. Galagan, D. J., Lamson, G. G., Jr. Publ. Hlth Rep., Wash. 1953, 68, 497. 2. Kemp, F. H., Murray, M. M., Wilson, D. C. Lancet, 1942, ii, 93. 3. Forrest, J. R. Roy. Soc. Hlth J. 1957, 77, 349. 4. World Health Organisation Technical Report Series, 1958, no, 146;
p. 5.
the stated scatter of observations. The tests for significance apply to results including these errors. With 59Fe autoradiodifference in grain-counts graphs we have found"no significant control " and " stimulated " animals, over normoblasts in although the proportion of normoblasts --present is greatly reduced in the former. Reticulocytes do, of course, contribute to the iron utilisation, particularly if we take the 24-hour value, " unstimulated " polybut as the reticulocyte-count in cythaemic animals is of the order of 0-03%, factors stimulating haem synthesis alone will not give rise to false-positive results. The London Hospital, London, E.1.
D. G. PENINGTON.
NEUROLOGICAL COMPLICATIONS OF INFLUENZA recent influenza SIR,-The epidemic here, affecting especially the elderly, provided a forceful reminder of the many neurological complications in this disease.1 In descending order of incidence, these were:
(1) Brain-stem involvement with dysphagia, vomiting, &c. (2) Encephalitis with headache, photophobia, giddiness, vomiting, &c.
(3) Encephalomyelitis. (4) Autonomic neuropathy with diarrhoea, vomiting, and tachycardia. (5) Polyneuritis. City Hospital,
T. K. BOSE.
Chester.
OXYTETRACYCLINE PROPHYLAXIS IN CHRONIC BRONCHITIS
SIR,-From October, 1958,
to
March, 1959, 59
with severe chronic bronchitis were admitted with acute respiratory illnesses.
to
men
hospital
When they left, 32 men selected at random were each given 20 tablets (0-5 g.) of oxytetracycline and the following instructions : " If you have a severe head cold, or the phlegm becomes yellow or green, or you feel that you are beginning with a chest illness, take 1 tablet after breakfast, dinner, tea, and supper." Further tablets were given if necessary. Before the trial ended in March, 1960, 20 of these patients had taken 36 courses of oxytetracycline, which prevented serious respiratory illnesses in 15. 5 men were readmitted, 2 because of bronchospasm, and 3 with reinfection; 1 of the latter had failed to follow the instructions. None of the trial patients died. 7 of the 27 controls were readmitted to this hospital, and 2 died; 6 other control patients died during the trial period. These results are encouraging, and we prefer this method to the continuous administration of antibiotics. 23 Whiston Hospital, Prescot, Lancashire. Pfizer Ltd., Folkestone, Kent.
E. SHERWOOD JONES J. E. FORSTER.
J. K. MORRISON.
TREATMENT OF RECENT BELL’S PALSY BY CERVICAL SYMPATHETIC BLOCK
SIR,-The treatment of the complete type of Bell’s palsy by cervical sympathetic block recently reported by Mr. Boyes Korkis (Feb. 4) has made a great difference to the work of physical medicine departments. Before, such cases could be divided into those which recovered within three to four weeks of onset, and those in which recovery was extremely slow and which finally were left with weakness, contractures, or overaction, after three years of
physiotherapy. With sympathetic block, most recent cases (93%) can now be placed in the first category, with immediate or nearly immediate recovery; and no call is made upon the physio-
therapy services. 1. 2. 3.
Leigh, A. D. Brit. med. J. 1946, ii, 936. Edwards, G., Fear, E. C. Brit. med. J. 1958, ii, 1010. Murdoch, J. M., Leckie, W. J. H., Downie, J., Swain, R. H. A., Gould, J. C. ibid. 1959, ii, 1277.
Facial palsy is now rarely seen in the physical medicine department. Only late and complicated cases (thrombotic, arteriosclerotic, infective, post-traumatic, and those with geniculate herpes) are encountered. Very nearly all cases of facial palsy appear to be of the vasospastic type (true Bell’s palsy); and by early and rapid relief of angiospasm facial nerve function can be completely restored without physiotherapy. Hillingdon Hospital, Hillingdon, Middlesex.
R.
J. TALBOT.
BEHAVIOUR THERAPY IN TRANSVESTISM
SIR,-In their interesting letters, Dr. Barker and his colleagues (March 4) and Dr. Glynn and Dr. Harper (March 18) describe the apparently successful treatment of transvestism by aversion therapy using apomorphine injections. I should like to point out that the treatment of cases of transvestism along these lines may not always be so straightforward. Experience of the apparent cure by this treatment of rubberclothing fetishism (follow-up fifteen months and six months) led me to apply similar treatment recently to a 37-year-old fetishist, whose practices dated from early childhood. Apomorphine injections two-hourly, combined with dressing up in female clothing, were used day and night for five days, with pilocarpine nitrate in addition when the effects of the apomorphine began to wane. In the course of treatment, the patient, unlike the fetishists, failed to show aggression or refusal to don the clothes, and previously underestimated masochistic traits became evident. This treatment was carried out in the week before the letter of Dr. Barker and his colleagues. It is not yet certain whether, like the two fetishists, this man will have become indifferent to the clothing, but, since the time of treatment, he has remained in a condition of severe agitation and depression, with suicidal
thoughts. Department of Psychological Medicine,
University of Edinburgh.
SIR,-In would like
IAN OSWALD.
SKELETAL FLUOROSIS reply to Dr. Alcock’s letter
(March 11) I dental fluorosis, and on the of adding sodium fluoride to
to comment on
safety and desirability public water-supplies. In my original letter (Feb. 18) I did not say that I was confining my remarks on dental fluorosis to the situation in temperate climates, since the proposal to fluoridate water is a matter which may affect people in all climates. Galagan and Lamson1 show quite clearly that at concentrations of less than 1 part per million (p.p.m.) objectionable mottling occurs in the hot zone (temp. 69-3°F) and less objectionable mottling in the temperate zone (temp. 50’6°F). The more objectionable mottling, as the authors suggest, is probably related to the increased water consumption and the fact that the preparation of the dietary staple (beans) could concentrate the fluorides. Since the question of temperature has been raised, readers may like to know that marked dental mottling can occur with low concentrations of fluorine in water in this country. Kemp et al.2 describe severe dental fluorosis in two villages in Oxfordshire where the watersupplies contained 0-8 p.p.m. and 0-3-1-2 p.p.m. respectively. Forrestdescribes objectionable mottling in Essex and Surrey where the fluorine content is 0-1-0-2 p.p.m., but regards this as a developmental hypoplasia. Despite the assurance of the W.H.O. report that 1-0-1-5 p.p.m. will cause only slight flecking of the enamel, it has been estimated that more than 200,000 children in the U.S.A. have already become victims of definite life-time mottling since artificial 1. Galagan, D. J., Lamson, G. G., Jr. Publ. Hlth Rep., Wash. 1953, 68, 497. 2. Kemp, F. H., Murray, M. M., Wilson, D. C. Lancet, 1942, ii, 93. 3. Forrest, J. R. Roy. Soc. Hlth J. 1957, 77, 349. 4. World Health Organisation Technical Report Series, 1958, no, 146;
p. 5.