- Email: [email protected]
SECRETORY OTITIS MEDIA
1125
genic environment, most of them react in some way other than neoplasia but the few cells that respond in this particular way establish clones which eventually constitute recognisable tumours.
Conversely retrogressive changes undoubtedly occur in some tumour cells, but unless all the previously progressively growing cells undergo such changes they are not likely to be recognised clinically. The
complexity of
appearances in
"
precancerous
"
lesions may be due to a majority of cells which are reacting in ways other than neoplasia and a variable number of cells in different stages of neoplasia but which have not yet established recognisably malignant clones. Neoplasia
i
a rare
phenomenon, though
cancer
is
a
P. R. PEACOCK.
Glasgow.
POSTURE IN CHILDBIRTH SiR,—We all of us know that our patients lie on their faces when asked to lie on their backs, but we must presume that you, Sir, mean what you say when you write " (May 5, p. 957): The prone position has been accepted as normal." Do you mean for the mother, the foetus, or the obstetrician? And could we have a demonstration
please ?
H. V.
Norwich.
JAMES.
SIR,-I should be very interested to know which are the civilised communities referred to in your annotation where the prone position has become accepted as the normal posture for childbirth. The prone position would appear to be almost impossible for childbirth; and if the word is used loosely to mean lying flat I suggest, with deference, Sir, that supine would be less prone to
misinterpretation. Royal Hospital, Hospital,
C. P C P. ^ ALEXANDER. TEXANDER
Sheffield. Sheffield.
** We
are
prostrate.-ED.L.
restored when the head is bent forward so that the fluid moves away from the oval window." In my opinion the reason for the improvement in hearing is that the fluid moves away from the round window. The problem is of more than academic importance, because understanding of the mechanism of the middle ear in disease is essential for the treatment of middle-ear deafness of any kind. One of the requirements for normal hearing is that the sound wave must be transmitted to one of the mobile windows only, and not to both at the same time. Normally the oval window is the receiving window, but in abnormal conditions the round window may serve this function and the oval window may be protected from sound. This is well known to otologists, and has found practical application in the tympanoplastic operation of " sono-inversion " by Garcia Ibanez of Barcelona.1 The cause of deafness from fluid in the middle ear, as in secretory otitis media, is that the sound wave is transmitted not only through the ossicular chain to the oval window as in normal conditions, but also through the fluid in the middle ear from the tympanic membrane to the round window, so that it reaches both windows simultaneously. This leads to movements of the perilymph in both the scala vestibuli and the scala tympani cancelling each other out, and to interference with the movement of the basilar membrane of the cochlea. After removal of the fluid from the middle ear by myringotomy L. Rev. esp.
FRANCIS BAUER.
1.
Liverpool,
SUBUD CRISES
Oto-neuro-oftal. 1959, 102,
SIR,-My respect for Dr. Gabriel Jaffé makes me hesitate to criticise his letter of May 19, but as Subud has taken some hard knocks in your columns, I feel that someone ought to speak up for the 5000-6000 members of the Subud movement in this country, since their leader, Pak Subuh, has forbidden them to enter into any sort of public controversy or make statements to the Press. In the course of my work as a medical journalist, I have had prepare a series of articles on Subud and its followers. While doing this, I recorded the views of a number of men and women close to Subud, among them a well-known consultant psychiatrist, a professor of physiology, and the G.P. who gives medical care to the Subud community at Coombe Springs, Kingston upon Thames. All agreed that the latihan (Subud exercise) could be disto
turbing
to
people already mentally unbalanced, particularly to
schizoid personalities, but I found no evidence to support Dr. Jaffé’s view that members of Subud are more suggestible than average. To say as Dr. Jaffé does that Subud crises are psychogenic is about as illuminating as saying that drunkenness is alcohologenic. The purpose of the exercise in both cases is the same: to liberate the inner core of the psyche from its outer personal wrappings. The difference is that in drunkenness the motives are
less
worthy.
before Subud, Jung pointed out that when archetypal comes up into consciousness, the effects upon the subject may be disturbing. The resulting behaviour may even be alarming to an observer who does not appreciate what is
material
Sm,-May I comment on the statement in your annotation of May 12 that " hearing is sometimes temporarily
Ibáñez,
ceases, but normal transmission to the oval window through the ossicular chain continues, and hearing is restored. There are also conditions in which fluid in the middle ear improves hearing by the same mechanism of transmission of sound to the round windowńe.g., in cases of interrupted ossicular chain, in the immediate postoperative phase after fenestration of the stapedial footplate, and in cases of closed fenestration of the semicircular canal. Fluid in the middle ear (serum, blood) may mislead if postoperative audiograms are done too early. I have discussed these problems elsewhere.B!
Long
SECRETORY OTITIS MEDIA
1. Garcia
aspiration the transmission of sound to the round window
common
disease. Cancer Research Department, Royal Beatson Memorial Hospital,
and
1.
happening. However, there is one very important difference between Subud crises and true psychotic illness: like L.S.D.-induced psychotic episodes which they resemble, Subud crises are selflimiting and can easily be terminated by the administration of a sedative. Neither true schizophrenia nor true mania respond to sedatives in this way. I find the tone of Dr. Jaffe’s letter inconsistent with his " description of himself as a dispassionate medical observer ". Subud is only one of many paths to inner spiritual experience. No better and no worse than Yoga or Zen Buddhismńonly different in its approach. People who follow these paths to spiritual knowledge are mainly seekers after truth and peace. Most of them are dissatisfied with the phoney values of our increasingly material society. In a world in danger of going down before the advancing tide of Communism, any movement like Subud which emphasises spiritual values deserves encouragement in the West. Kew Gardens,
Surrey.
RICHARD MAcKARNEss. MACKARNESS.
SiR,-In response to the request of Dr. Francis and Dr. Kiev,3 I have a little further information which may be of use. Three of my
patients, all remitted schizophrenics, have 2. 3.
Bauer, F. J. Laryng. 1960, 74, Lancet, 1961, ii, 1452.
290.
over
genic environment, most of them react in some way other than neoplasia but the few cells that respond in this particular way establish clones which eventually constitute recognisable tumours.
Conversely retrogressive changes undoubtedly occur in some tumour cells, but unless all the previously progressively growing cells undergo such changes they are not likely to be recognised clinically. The
complexity of
appearances in
"
precancerous
"
lesions may be due to a majority of cells which are reacting in ways other than neoplasia and a variable number of cells in different stages of neoplasia but which have not yet established recognisably malignant clones. Neoplasia
i
a rare
phenomenon, though
cancer
is
a
P. R. PEACOCK.
Glasgow.
POSTURE IN CHILDBIRTH SiR,—We all of us know that our patients lie on their faces when asked to lie on their backs, but we must presume that you, Sir, mean what you say when you write " (May 5, p. 957): The prone position has been accepted as normal." Do you mean for the mother, the foetus, or the obstetrician? And could we have a demonstration
please ?
H. V.
Norwich.
JAMES.
SIR,-I should be very interested to know which are the civilised communities referred to in your annotation where the prone position has become accepted as the normal posture for childbirth. The prone position would appear to be almost impossible for childbirth; and if the word is used loosely to mean lying flat I suggest, with deference, Sir, that supine would be less prone to
misinterpretation. Royal Hospital, Hospital,
C. P C P. ^ ALEXANDER. TEXANDER
Sheffield. Sheffield.
** We
are
prostrate.-ED.L.
restored when the head is bent forward so that the fluid moves away from the oval window." In my opinion the reason for the improvement in hearing is that the fluid moves away from the round window. The problem is of more than academic importance, because understanding of the mechanism of the middle ear in disease is essential for the treatment of middle-ear deafness of any kind. One of the requirements for normal hearing is that the sound wave must be transmitted to one of the mobile windows only, and not to both at the same time. Normally the oval window is the receiving window, but in abnormal conditions the round window may serve this function and the oval window may be protected from sound. This is well known to otologists, and has found practical application in the tympanoplastic operation of " sono-inversion " by Garcia Ibanez of Barcelona.1 The cause of deafness from fluid in the middle ear, as in secretory otitis media, is that the sound wave is transmitted not only through the ossicular chain to the oval window as in normal conditions, but also through the fluid in the middle ear from the tympanic membrane to the round window, so that it reaches both windows simultaneously. This leads to movements of the perilymph in both the scala vestibuli and the scala tympani cancelling each other out, and to interference with the movement of the basilar membrane of the cochlea. After removal of the fluid from the middle ear by myringotomy L. Rev. esp.
FRANCIS BAUER.
1.
Liverpool,
SUBUD CRISES
Oto-neuro-oftal. 1959, 102,
SIR,-My respect for Dr. Gabriel Jaffé makes me hesitate to criticise his letter of May 19, but as Subud has taken some hard knocks in your columns, I feel that someone ought to speak up for the 5000-6000 members of the Subud movement in this country, since their leader, Pak Subuh, has forbidden them to enter into any sort of public controversy or make statements to the Press. In the course of my work as a medical journalist, I have had prepare a series of articles on Subud and its followers. While doing this, I recorded the views of a number of men and women close to Subud, among them a well-known consultant psychiatrist, a professor of physiology, and the G.P. who gives medical care to the Subud community at Coombe Springs, Kingston upon Thames. All agreed that the latihan (Subud exercise) could be disto
turbing
to
people already mentally unbalanced, particularly to
schizoid personalities, but I found no evidence to support Dr. Jaffé’s view that members of Subud are more suggestible than average. To say as Dr. Jaffé does that Subud crises are psychogenic is about as illuminating as saying that drunkenness is alcohologenic. The purpose of the exercise in both cases is the same: to liberate the inner core of the psyche from its outer personal wrappings. The difference is that in drunkenness the motives are
less
worthy.
before Subud, Jung pointed out that when archetypal comes up into consciousness, the effects upon the subject may be disturbing. The resulting behaviour may even be alarming to an observer who does not appreciate what is
material
Sm,-May I comment on the statement in your annotation of May 12 that " hearing is sometimes temporarily
Ibáñez,
ceases, but normal transmission to the oval window through the ossicular chain continues, and hearing is restored. There are also conditions in which fluid in the middle ear improves hearing by the same mechanism of transmission of sound to the round windowńe.g., in cases of interrupted ossicular chain, in the immediate postoperative phase after fenestration of the stapedial footplate, and in cases of closed fenestration of the semicircular canal. Fluid in the middle ear (serum, blood) may mislead if postoperative audiograms are done too early. I have discussed these problems elsewhere.B!
Long
SECRETORY OTITIS MEDIA
1. Garcia
aspiration the transmission of sound to the round window
common
disease. Cancer Research Department, Royal Beatson Memorial Hospital,
and
1.
happening. However, there is one very important difference between Subud crises and true psychotic illness: like L.S.D.-induced psychotic episodes which they resemble, Subud crises are selflimiting and can easily be terminated by the administration of a sedative. Neither true schizophrenia nor true mania respond to sedatives in this way. I find the tone of Dr. Jaffe’s letter inconsistent with his " description of himself as a dispassionate medical observer ". Subud is only one of many paths to inner spiritual experience. No better and no worse than Yoga or Zen Buddhismńonly different in its approach. People who follow these paths to spiritual knowledge are mainly seekers after truth and peace. Most of them are dissatisfied with the phoney values of our increasingly material society. In a world in danger of going down before the advancing tide of Communism, any movement like Subud which emphasises spiritual values deserves encouragement in the West. Kew Gardens,
Surrey.
RICHARD MAcKARNEss. MACKARNESS.
SiR,-In response to the request of Dr. Francis and Dr. Kiev,3 I have a little further information which may be of use. Three of my
patients, all remitted schizophrenics, have 2. 3.
Bauer, F. J. Laryng. 1960, 74, Lancet, 1961, ii, 1452.
290.
over