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THE GOVERNMENT AND THE PROFESSION
652
given case into trying to decide whether the organ- collaborators on phytic acid and iron absorption, reported in the Lancet of July 31. The value of the extra vitamin isms within the tonsil are neutral to the host or whether they are living in the crypts in a state of true or false B in our 100% extraction flour has also been noticed, symbiosis; for it is only in the last case that tonsillectomy so that I think the whole subject of the scientifically best percentage of extraction of wheaten flour requires is effective. " Pretonsillectomy throat cultures " merely pick up organisms which are on their way to be destroyed very expert handling. E. HARVEY. in the tonsil while being conveyed there by the ciliary Royal City of Dublin Hospital. action of the’nose. To say that unnecessary tonsillectomy is " common FEEDING WITH AMINO-ACIDS particularly among well-to-do families " suggests that SIR,—May I comment on your leader of June 12 ? medical men allow their judgment to be swayed either I think the term " animo-acids " is one which should by the wish of the layman or by the desire for gain. be avoided, and " casein hydrolysate," which is more Attempts are certainly made by parents to urge a doctor accurate and more informative, should be used instead. to advise this operation ; and in border-line cases-and Very few investigators have used amino-acids clinically, there are many-weight should be given to this wish. and the preparations which are used for therapeutic In a case where the balance of evidence is against operapurposes contain only about 60% of their nitrogen in tion the advice to wait six months will usually be taken. amino form. The other products of protein disin. Sometimes they go to someone else, be they rich or be tegration and the residues of the pancreas which furthey poor. That the financial factor is not the cause is nished the enzymes are also present. In any event, shown by the fact that the greatest excess is among those " amino-acid hydrolysates " is incorrect. children who are dealt with under the Children Acts of It is stated : " It is hard to see why a solution of 1906 and 1918. mixed amino-acids prepared from casein should be any Some medical officers of health strive to control the better for a -man than a good glass of milk. It is hard habit of tonsillectomy among their staffs. The question to see, therefore, why they should ever be given by arises how much the administrator may use his power mouth." I consider this a very careless statement. ,to guide the clinician, but it should be possible to draw Milk contains other factors than protein. Our published work has shown that infants with acute gastroup administrative instructions which would have the effect of eliminating unnecessaryoperations without intestinal disturbances tolerate casein hydrolysate and interfering with the judgment of the true clinician. carbohydrate mixtures better than milk. In addition, I would like, in this context, to pay tribute to one who infants allergic to milk can take casein hydrolysate cannot speak for himself since he is in the hands of the orally to good advantage. Further, it should be obvious Japanese-Prof. K. H. Digby of Hong-Kong. In 1919, that in cases in which the enzymes for the splitting of when many were saying that the tonsils were a useless protein are lacking it might be both good physiology relic devoid of function, he put forward on anatomical and good therapeutics to feed a preparation which was and clinical grounds the view that not only were they not beyond the digestive capacity of the patient. filters to the entry of organisms into the body, but also At the end of the second paragraph it is indicated that they had a definite function in raising the acquired that some of the work has been poorly done with inaderesistance by the production of antibodies (Immunity quate controls, and it is implied that the conclusions in Health, London. See also Lancet, 1923, ii, 1077). reached may have been arrived at because of prejudiced financial interest. I think it unfair thus to make a T. B. LAYTON. Guy’s Hospital, S.E.I. general condemnation either of the quality of the work or of the scientific honesty of the investigators cited. CLAVICULAR SHEAR Such words as " skilful advertising " and " fashionable " SIR,—To those who studied applied anatomy years cast a slur on the scientific validity of this work and " ago it "is interesting to see the mechanism of clavicular that it is a matter merely of commercial exploitaimply shear into its own The effect of this coming again. tion. I am entirely sympathetic to this attitude with mechanism on the subclavian vessels, convincingly regard to commercial advertising, especially to many demonstrated in your issue of Oct. 30 by Major M. A. vitamin preparations. However, I think one should Falconer and Captain G. Weddell will recall to some of differentiate sharply between scientific papers and the us its agency in producing Duchenne and Erb’s paralysis commercial developments following them. of’the brachial plexus and also the varieties known as I have the conviction that the lives of many British anaesthetic paralysis, climber’s paralysis, as well as and American soldiers may be saved by the adminisseveral others. The active muscular agent which protration of casein hydrolysate, and I hope that your duces the shearing effect is not the scalenus anterior article will not create a prejudice against its use in but the clavicular portion of the trapezius, the function Great Britain. of this being to carry the outer portion of the clavicle Harvard Medical School, Department ALFRED T. SHOHL. of Pediatrics, Boston. directly backwards across the first rib and so maintain apposition of the scapula to the thoracic wall when the The shearing stress is exerted between arm is abducted. THE GOVERNMENT AND THE PROFESSION the clavicle and the first rib. The forward curve of the SIR,—We wish to add our names to those of the 238 inner part of the clavicle is a safeguard in this movement. members of the BMA and of the group of Sheffield The muscular mechanism of the shoulder is, usually, not doctors who wrote in your issue of Oct. 30 deploring the sufficient to produce a harmful shear, but force must be action of the BMA in advocating an extension of the to the arm. raised Hence and applied abducted, usually panel system in place of a comprehensive national the birth lesion in the infant occurs when the arm is service. We agree that the Government will find no extended above the head, the climber’s paralysis when difficulty in obtaining the necessary support in the prothe weight of the body hangs on the arm in hand-overfession for a really progressive plan based on a salaried hand climbing, and the nursemaid-induced paralysis service - organised by grouped local health authorities, when a child is grasped and suspended by the wrist in and consider that this is the only satisfactory method removal from a perambulator or in crossing a road. of implementing this essential part of a social security CHARLES R. BOX. act. Hanley House, N.W.I. C. C. CONNOCHIE (Fort William). RISING HÆMOGLOBIN IN EIRE A. M. FRASER FRASER(Inverness). (Inverness). G. A. JAMIESON (Inverness) SIR,—The haemoglobin content of the blood of patients of this hospital has seemed to show a definite increase A. LAMONT (Uig, Skye). during the past year or. more. The only explanation D. G. LEYS LEYs (Inverness). which has occurred to me is that the government of Eire A. MACDONALD (Carbost, Skye). has made the use of 100% extraction wheaten flour comI. H. I. H. MACIVER (Fort William). pulsory in all bread manufactured. I understand that J. T. MACKENZIE (Edinbane, Skye) Skye). another large hospital in this city has noticed a similar M. MACLEAN (Duirurish, Skye). rise in the haemoglobin level of its patients. I must E. M. ROSE (Inverness). leave it to others more qualified than myself to work ALICIA SYMONDSON (Inverness). out how far this bears on the work of McCance and his any
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given case into trying to decide whether the organ- collaborators on phytic acid and iron absorption, reported in the Lancet of July 31. The value of the extra vitamin isms within the tonsil are neutral to the host or whether they are living in the crypts in a state of true or false B in our 100% extraction flour has also been noticed, symbiosis; for it is only in the last case that tonsillectomy so that I think the whole subject of the scientifically best percentage of extraction of wheaten flour requires is effective. " Pretonsillectomy throat cultures " merely pick up organisms which are on their way to be destroyed very expert handling. E. HARVEY. in the tonsil while being conveyed there by the ciliary Royal City of Dublin Hospital. action of the’nose. To say that unnecessary tonsillectomy is " common FEEDING WITH AMINO-ACIDS particularly among well-to-do families " suggests that SIR,—May I comment on your leader of June 12 ? medical men allow their judgment to be swayed either I think the term " animo-acids " is one which should by the wish of the layman or by the desire for gain. be avoided, and " casein hydrolysate," which is more Attempts are certainly made by parents to urge a doctor accurate and more informative, should be used instead. to advise this operation ; and in border-line cases-and Very few investigators have used amino-acids clinically, there are many-weight should be given to this wish. and the preparations which are used for therapeutic In a case where the balance of evidence is against operapurposes contain only about 60% of their nitrogen in tion the advice to wait six months will usually be taken. amino form. The other products of protein disin. Sometimes they go to someone else, be they rich or be tegration and the residues of the pancreas which furthey poor. That the financial factor is not the cause is nished the enzymes are also present. In any event, shown by the fact that the greatest excess is among those " amino-acid hydrolysates " is incorrect. children who are dealt with under the Children Acts of It is stated : " It is hard to see why a solution of 1906 and 1918. mixed amino-acids prepared from casein should be any Some medical officers of health strive to control the better for a -man than a good glass of milk. It is hard habit of tonsillectomy among their staffs. The question to see, therefore, why they should ever be given by arises how much the administrator may use his power mouth." I consider this a very careless statement. ,to guide the clinician, but it should be possible to draw Milk contains other factors than protein. Our published work has shown that infants with acute gastroup administrative instructions which would have the effect of eliminating unnecessaryoperations without intestinal disturbances tolerate casein hydrolysate and interfering with the judgment of the true clinician. carbohydrate mixtures better than milk. In addition, I would like, in this context, to pay tribute to one who infants allergic to milk can take casein hydrolysate cannot speak for himself since he is in the hands of the orally to good advantage. Further, it should be obvious Japanese-Prof. K. H. Digby of Hong-Kong. In 1919, that in cases in which the enzymes for the splitting of when many were saying that the tonsils were a useless protein are lacking it might be both good physiology relic devoid of function, he put forward on anatomical and good therapeutics to feed a preparation which was and clinical grounds the view that not only were they not beyond the digestive capacity of the patient. filters to the entry of organisms into the body, but also At the end of the second paragraph it is indicated that they had a definite function in raising the acquired that some of the work has been poorly done with inaderesistance by the production of antibodies (Immunity quate controls, and it is implied that the conclusions in Health, London. See also Lancet, 1923, ii, 1077). reached may have been arrived at because of prejudiced financial interest. I think it unfair thus to make a T. B. LAYTON. Guy’s Hospital, S.E.I. general condemnation either of the quality of the work or of the scientific honesty of the investigators cited. CLAVICULAR SHEAR Such words as " skilful advertising " and " fashionable " SIR,—To those who studied applied anatomy years cast a slur on the scientific validity of this work and " ago it "is interesting to see the mechanism of clavicular that it is a matter merely of commercial exploitaimply shear into its own The effect of this coming again. tion. I am entirely sympathetic to this attitude with mechanism on the subclavian vessels, convincingly regard to commercial advertising, especially to many demonstrated in your issue of Oct. 30 by Major M. A. vitamin preparations. However, I think one should Falconer and Captain G. Weddell will recall to some of differentiate sharply between scientific papers and the us its agency in producing Duchenne and Erb’s paralysis commercial developments following them. of’the brachial plexus and also the varieties known as I have the conviction that the lives of many British anaesthetic paralysis, climber’s paralysis, as well as and American soldiers may be saved by the adminisseveral others. The active muscular agent which protration of casein hydrolysate, and I hope that your duces the shearing effect is not the scalenus anterior article will not create a prejudice against its use in but the clavicular portion of the trapezius, the function Great Britain. of this being to carry the outer portion of the clavicle Harvard Medical School, Department ALFRED T. SHOHL. of Pediatrics, Boston. directly backwards across the first rib and so maintain apposition of the scapula to the thoracic wall when the The shearing stress is exerted between arm is abducted. THE GOVERNMENT AND THE PROFESSION the clavicle and the first rib. The forward curve of the SIR,—We wish to add our names to those of the 238 inner part of the clavicle is a safeguard in this movement. members of the BMA and of the group of Sheffield The muscular mechanism of the shoulder is, usually, not doctors who wrote in your issue of Oct. 30 deploring the sufficient to produce a harmful shear, but force must be action of the BMA in advocating an extension of the to the arm. raised Hence and applied abducted, usually panel system in place of a comprehensive national the birth lesion in the infant occurs when the arm is service. We agree that the Government will find no extended above the head, the climber’s paralysis when difficulty in obtaining the necessary support in the prothe weight of the body hangs on the arm in hand-overfession for a really progressive plan based on a salaried hand climbing, and the nursemaid-induced paralysis service - organised by grouped local health authorities, when a child is grasped and suspended by the wrist in and consider that this is the only satisfactory method removal from a perambulator or in crossing a road. of implementing this essential part of a social security CHARLES R. BOX. act. Hanley House, N.W.I. C. C. CONNOCHIE (Fort William). RISING HÆMOGLOBIN IN EIRE A. M. FRASER FRASER(Inverness). (Inverness). G. A. JAMIESON (Inverness) SIR,—The haemoglobin content of the blood of patients of this hospital has seemed to show a definite increase A. LAMONT (Uig, Skye). during the past year or. more. The only explanation D. G. LEYS LEYs (Inverness). which has occurred to me is that the government of Eire A. MACDONALD (Carbost, Skye). has made the use of 100% extraction wheaten flour comI. H. I. H. MACIVER (Fort William). pulsory in all bread manufactured. I understand that J. T. MACKENZIE (Edinbane, Skye) Skye). another large hospital in this city has noticed a similar M. MACLEAN (Duirurish, Skye). rise in the haemoglobin level of its patients. I must E. M. ROSE (Inverness). leave it to others more qualified than myself to work ALICIA SYMONDSON (Inverness). out how far this bears on the work of McCance and his any
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