- Email: [email protected]
SMOKING
591
pigment which fluoresces
green and which has
an
absorption
spectrum and other features similar to those of bacterial fluorescin. The skin surface is normally acid (pH 3-6-5-6),
but in clefts and intertriginous areas and regions supplied by apocrine glands the pH is commonly between 6 and 7, which might favour growth and subsequent production of copro-
and this within the ranks of psychiatrists themselves. Until these circumstances change, moreover, psychiatrists may continue to be allotted the disproportionately few, merit awards that have come their way to date. Stone House
Hospital, Dartford,
Our observations suggest that these organisms can grow excessively on the skins of certain susceptible subjects and probably contribute to the scaling and red fluorescence of erythrasma and some other conditions. BETTY M. PARTRIDGE Department of Bacteriology, King’s College Hospital Medical School, F. L. JACKSON. S.E.5. London, CANCER
J. P. CRAWFORD.
Kent.
porphyrin by various gram-positive spore-bearing bacilli.
SMOKING
SiR,—The Royal College of Physicians has given the country the facts about the danger of cigarette smoking. Whether or not all doctors will give up smoking as a result, they will all accept the report. The question the profession must answer is: what sensible lead can we give the country ? May I offer a few suggestions which, with the help of medical officers of health, could be enforced.
SIR,-May I express my gratitude to Professor Smithers for his article last week ? It should be read and reread by everyone in the profession, not merely by research-
(1) No smoking in doctors’ waiting-rooms. (2) No smoking in the public part of any hospital, with the exception of geriatric wards, and those patients for whom
workers.
we can
I have long felt that the cancer research from the cytological angle is repetitive and sterile-that in fact most of the investigations have been narrowly directed to the end-result of a long sequence of events, under the mistaken idea that it was the cause. But, as a general practitioner, I have hesitated to criticise those working in this particular field. It seems clear that the edpidemological approach, with its emphasis on the social matrix of disease, has much more to offer. Let the concept of the " cancer cell " be cast into the limbo of outmoded ideas. R. WINSTON. London, S.W.ll.
(3) No smoking in cinemas and theatres. This has long applied in France and does not keep the patrons away (bad films and plays do that). (4) No smoking in shops and stores. This is also effective
PHYSICAL RESPECTABILITY OF PSYCHOLOGY
SIR,-Le Vayand Wolf2 have shown that the nurse’s and doctor’s conviction of the efficacy of a preparation empowers it with placebo healing property. Presumably their confidence is transmitted to the patient and his raised hope, based on his own physical concepts of medicine, produces the therapeutic effect, whether the illness be mental or psychosomatic. While the patient’s diminished grasp may make it in his interests to be kept in a certain degree of ignorance temporarily until he is well enough to appreciate the situation more fully, it seems a pity that the nurse and doctor should have to be deceived before they can produce a cure. A better understanding of their own mental states as well as those of their patients may lead to the patients accepting psychotherapy more readily and the doctors resorting to it more often. Until both appreciate, however, that psychotherapy depends on physical media such as sound waves and light rays for its transmission, and that the skill and training required may be just as expensive to come by as drugs (or more so) even when the better treatment, placebos are likely to retain their greater
respectability. In psychiatric hospitals the opening of closed wards has led to the replacing of inanimate and unresilient doors largely by the responsive and understanding psyche of the nurse. It should not surprise us really, being the gregarious creatures we are, dependent in varying degrees upon one another within a hierarchical society, that intelligent anticipation by nurses as well as their interest in individual patients’ retained abilities and emotional, social, and occupational needs, has proved more effective than mechanical restraint. Until the physical nature of these psychological processes is more widely understood however, the psychotherapist’s mind, that forged and tempered instrument, is likely to attract fewer recruits and poorer quality than the surgeon’s scalpel or the physician’s stethoscope, 1. Le Vay, M. K. Lancet, 1960, ii, 1403. 2. Wolf, S. Proc. Ass. Res. nerv. Dis. 1959,
37,
147.
do
no more.
in France without any apparent ill effects London, S.E.3.
on
trade.
L. I. NORMAN.
Sirread with amazement your statement last week that " there is nothing to suggest that smoking directly harms anyone but the smoker." Our Society has evidence of patients with respiratory disease, who have to make weekly journeys to hospital, travelling on buses in which they are made to cough almost to suffocation by other people’s smoke. Does that harm nobody ? How many of us have our meals spoilt daily at cafes ? Recently, at a cafeteria, my wife and I found our meal covered with tobacco ash by the time we left the self-service queue. Do you really suggest that a diet of cigarette ash is not harmful ?
HUBERT V. LITTLE Shaftesbury, Dorset.
Secretary, National Society of Non-Smokers.
THALIDOMIDE AND CONGENITAL ABNORMALITIES SIR,-Dr. Margaret Oliver (March 10) asks what steps are being taken to investigate pregnant women who took thalidomide before it was withdrawn from the market. I have attempted this in the Liverpool area. Over 400 obstetric general practitioners have been asked about such cases but the total yield is 8, only 3 of whom took thalidomide in the first trimester. In the light of this result and the fact that thalidomide was used to a far greater extent in north-west England than in the rest of the country, the nation-wide investigation which Dr. Oliver suggests is unlikely to reveal much above 100 potentially malformed foetuses. If abdominal X-rays are to be taken, care will be needed to avoid transferring the doctor’s anxiety to the patient. Furthermore, a normal X-ray will not be entirely reassuring, for it will not reveal microtia-a disfiguring malformation also attributed to thalidomide. Finally, may I plead that inquiries relating to phocomelia should have regard not only to thalidomide but also to other drugs and virus infections in the first trimester. Investigation of 30 recent cases in this area (to be published) suggests that thalidomide is not responsible for all. Alder Hey Children’s Hospital, R. W. SMITHELLS. Liverpool.
SIR,-A recent patient of mine showed how small a dose of thalidomide is sufficient to produce the typical deformities. When she was only a week overdue for a menstrual period she was given 50 mg. a day for a fort-
pigment which fluoresces
green and which has
an
absorption
spectrum and other features similar to those of bacterial fluorescin. The skin surface is normally acid (pH 3-6-5-6),
but in clefts and intertriginous areas and regions supplied by apocrine glands the pH is commonly between 6 and 7, which might favour growth and subsequent production of copro-
and this within the ranks of psychiatrists themselves. Until these circumstances change, moreover, psychiatrists may continue to be allotted the disproportionately few, merit awards that have come their way to date. Stone House
Hospital, Dartford,
Our observations suggest that these organisms can grow excessively on the skins of certain susceptible subjects and probably contribute to the scaling and red fluorescence of erythrasma and some other conditions. BETTY M. PARTRIDGE Department of Bacteriology, King’s College Hospital Medical School, F. L. JACKSON. S.E.5. London, CANCER
J. P. CRAWFORD.
Kent.
porphyrin by various gram-positive spore-bearing bacilli.
SMOKING
SiR,—The Royal College of Physicians has given the country the facts about the danger of cigarette smoking. Whether or not all doctors will give up smoking as a result, they will all accept the report. The question the profession must answer is: what sensible lead can we give the country ? May I offer a few suggestions which, with the help of medical officers of health, could be enforced.
SIR,-May I express my gratitude to Professor Smithers for his article last week ? It should be read and reread by everyone in the profession, not merely by research-
(1) No smoking in doctors’ waiting-rooms. (2) No smoking in the public part of any hospital, with the exception of geriatric wards, and those patients for whom
workers.
we can
I have long felt that the cancer research from the cytological angle is repetitive and sterile-that in fact most of the investigations have been narrowly directed to the end-result of a long sequence of events, under the mistaken idea that it was the cause. But, as a general practitioner, I have hesitated to criticise those working in this particular field. It seems clear that the edpidemological approach, with its emphasis on the social matrix of disease, has much more to offer. Let the concept of the " cancer cell " be cast into the limbo of outmoded ideas. R. WINSTON. London, S.W.ll.
(3) No smoking in cinemas and theatres. This has long applied in France and does not keep the patrons away (bad films and plays do that). (4) No smoking in shops and stores. This is also effective
PHYSICAL RESPECTABILITY OF PSYCHOLOGY
SIR,-Le Vayand Wolf2 have shown that the nurse’s and doctor’s conviction of the efficacy of a preparation empowers it with placebo healing property. Presumably their confidence is transmitted to the patient and his raised hope, based on his own physical concepts of medicine, produces the therapeutic effect, whether the illness be mental or psychosomatic. While the patient’s diminished grasp may make it in his interests to be kept in a certain degree of ignorance temporarily until he is well enough to appreciate the situation more fully, it seems a pity that the nurse and doctor should have to be deceived before they can produce a cure. A better understanding of their own mental states as well as those of their patients may lead to the patients accepting psychotherapy more readily and the doctors resorting to it more often. Until both appreciate, however, that psychotherapy depends on physical media such as sound waves and light rays for its transmission, and that the skill and training required may be just as expensive to come by as drugs (or more so) even when the better treatment, placebos are likely to retain their greater
respectability. In psychiatric hospitals the opening of closed wards has led to the replacing of inanimate and unresilient doors largely by the responsive and understanding psyche of the nurse. It should not surprise us really, being the gregarious creatures we are, dependent in varying degrees upon one another within a hierarchical society, that intelligent anticipation by nurses as well as their interest in individual patients’ retained abilities and emotional, social, and occupational needs, has proved more effective than mechanical restraint. Until the physical nature of these psychological processes is more widely understood however, the psychotherapist’s mind, that forged and tempered instrument, is likely to attract fewer recruits and poorer quality than the surgeon’s scalpel or the physician’s stethoscope, 1. Le Vay, M. K. Lancet, 1960, ii, 1403. 2. Wolf, S. Proc. Ass. Res. nerv. Dis. 1959,
37,
147.
do
no more.
in France without any apparent ill effects London, S.E.3.
on
trade.
L. I. NORMAN.
Sirread with amazement your statement last week that " there is nothing to suggest that smoking directly harms anyone but the smoker." Our Society has evidence of patients with respiratory disease, who have to make weekly journeys to hospital, travelling on buses in which they are made to cough almost to suffocation by other people’s smoke. Does that harm nobody ? How many of us have our meals spoilt daily at cafes ? Recently, at a cafeteria, my wife and I found our meal covered with tobacco ash by the time we left the self-service queue. Do you really suggest that a diet of cigarette ash is not harmful ?
HUBERT V. LITTLE Shaftesbury, Dorset.
Secretary, National Society of Non-Smokers.
THALIDOMIDE AND CONGENITAL ABNORMALITIES SIR,-Dr. Margaret Oliver (March 10) asks what steps are being taken to investigate pregnant women who took thalidomide before it was withdrawn from the market. I have attempted this in the Liverpool area. Over 400 obstetric general practitioners have been asked about such cases but the total yield is 8, only 3 of whom took thalidomide in the first trimester. In the light of this result and the fact that thalidomide was used to a far greater extent in north-west England than in the rest of the country, the nation-wide investigation which Dr. Oliver suggests is unlikely to reveal much above 100 potentially malformed foetuses. If abdominal X-rays are to be taken, care will be needed to avoid transferring the doctor’s anxiety to the patient. Furthermore, a normal X-ray will not be entirely reassuring, for it will not reveal microtia-a disfiguring malformation also attributed to thalidomide. Finally, may I plead that inquiries relating to phocomelia should have regard not only to thalidomide but also to other drugs and virus infections in the first trimester. Investigation of 30 recent cases in this area (to be published) suggests that thalidomide is not responsible for all. Alder Hey Children’s Hospital, R. W. SMITHELLS. Liverpool.
SIR,-A recent patient of mine showed how small a dose of thalidomide is sufficient to produce the typical deformities. When she was only a week overdue for a menstrual period she was given 50 mg. a day for a fort-