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THE TONSIL AND ADENOID PROBLEM
1202 schools and another a private school. Of those over the age of four whose intelligence quotients have been assessed, 6 out of 15 have an intelligence quotient of 70 or over, the best 3 being 100, 98, and 95, while 6 have intelligence quotients of 50 or less. I fully realise that children with kernicterus are often mentally retarded, but to summarily dismiss a severe in infancy, as being hopelessly mentally deficient is fair neither to the parents nor to the child.
case,
especially
The Children’s
JOHN GERRARD Lecturer in Pædiatrics, University of Birmingham.
Hospital,
Birmingham.
IRON POISONING me to add the following case to series mentioned in your columns.1
SIR,—Will you allow the most On
interesting
April 23, 1949,
at 2 P.M.,
a
healthy 14-month-old
male
hour, swallowed 30FersoOn re-joining the child, the mother noticed that
child, while left alone for half
an
late ’ tablets. he was in pain, and fortunately perceived at once that he had swallowed the tablets. She administered an emetic of salt and water. The child was sick twice and brought up 15 tablets with the coating still intact. He was admitted to hospital forthwith and the stomach was washed out, considerable quantities of iron being removed. On admission, his colour was poor and the pulse was weak and rapid. By 8 P.M. his colour and pulse were normal and he appeared to have recovered. He had a good night, and next morning seemed little the worse for his mishap, being discharged to his home later in the day.
to
The
cases
me
of the
you listed have been a salutary reminder potential gravity of the above case.
North Devon Infirmary, Barnstaple.
R. M. J. HARPER.
OBSTETRICAL BRAINS TRUST
SIR,—Though Dr. Hugh Jolly (Dec. 10) may have the support of the Oxford English Dictionary in stating that the first ovulation (or the occurrence of spermatogenesis) marks the exact beginning of puberty-"the state or condition of having become functionally capable of procreating offspring "-—I venture to suggest that this definition often becomes unworkable. Would Dr. Jolly, for example, regard a woman of 25, whose menarche occurred at 13 but who has had only anovular cycles, as prepuberal ; or a man with fully developed accessory sexual organs, but with azoospermia not of acquired type, as similarly prepuberal ? The position in circumstances such as these (which are not purely hypothetical) is surely untenable. Indeed, the O.E.D. definition breaks down more completely and more frequently than does Dr. Jolly’s ; for according to the former, a woman with blocked tubes, or a man with blocked vasa deferentia, being " functionally incapable of procreating offspring would ipso facto be excluded from the state of puberty. I think the clue to the problem lies in the fact that the gonads have a dual function : they produce both sex hormones and gametes, and whereas there may be hormones without gametes there are never gametes without hormones. Morphologically and psychologically the changes traditionally associated with puberty depend on the incretory function of the gonads ; only the reproductive function depends on gametogenesis. Hence it seems illogical to deny the status of puberty to an individual who differs from one accepted as puberal solely in the failure to produce gametes. The fact that the incretory function of the ovary precedes gametogenesis is recognised by the distinction sometimes made between " puberty," defined as the morphopsychological state resulting from the action of the sex hormones, and nubility," the condition in which gametogenesis is also occurring (strictly meaning "marriageable"). It seems "
reasonable, therefore, to regard puberty 1. Leading article, Lancet, Nov. p. 1060.
as
dependent
12, p. 898. Porter, H. Ibid, Dec. 3,
the action of the sex hormones and independent of gametogenesis ; in which case Dr. Jolly’s differentiation between sexual precocity and precocious puberty becomes little more than a quibble. Obstetric Hospital, University College G. I. M. SWYER. on
Hospital, London, W.C.1.
CHILDREN REFERRED TO THE PSYCHIATRIST
SIR,—It does not
seem
to
me
that
Dr.
s Moodle
the persistence of enuresis nocturna will bold water-if you will pardon the metaphor. Taken literally, it would imply an automatic bladder," whereas the condition is nothing like that. The enuresis is nocturnal, which means that inhibition must be functioning satisfactorily, on the whole, in the daytime ; in fact, there clearly is what Dr. Moodie calls " a definite sensory impulse," and in the absence of some special abnormality in the nervous system there is no physical reason why it should not give warning in sleep as well as in waking life. If it fails to do so, we are justified in regarding the symptom, from the point of view of treatment, as psychological. A small bladder, whether inherited or acquired, may be a slight handicap, since it demands more of the patient than mere inhibition -he must actually get out of bed. But I do not see how otherwise than psychologically Dr. Moodie would treat it, short of blowing it up through a catheter. I assume, of course, that a training procedure would be classed as a form of psychological treatment (though an etymologist might argue that point). Much the same may be said of crossed cerebral laterality, to which Dr. Moodie attributes many cases of stammer and backwardness. Whether given or not, I suggest it should be regarded merely as a slight handicap, which is of little or no real importance in adult life, but which can be made to loom very large in the mind of the child, as indeed can almost anything.
explanation (Dec. 10) of
"
The Psychological Laboratory,
Cambridge.
W. E. HICK.
THE TONSIL AND ADENOID PROBLEM
SIR,—I wish to draw your attention to an error-of word in your report (Dec. 10, p. 1087) of my remarks
one
at the Royal Society of Medicine on Dec. 2. This occurs in the last sentence, where I am quoted as having said :o " For over two hundred years tonsillectomy has proved a beneficial operation." I actually said " two thousands
years." Oxford.
RONALD MACBETH.
DEOXYCORTONE ACETATE AND ASCORBIC ACID IN RHEUMATOID ARTHRITIS
SIR,—With the supplies of ’Cortisone’ restricted as they are in this country at the moment, many rheumatologists will have been anxious to confirm the preliminary report of Lewin and Wassen in your issue of Nov. 26. In the last three weeks we have investigated the effect of this therapy on 17 patients, all cases of rheumatoid arthritis. The results have been disappointing ; we have never seen anything like the response obtained with cortisone in rheumatoid arthritis as demonstrated to one of us at the Mayo Clinic earlier this year. The cases were in three groups : (a) 7 inpatients in Harrogate ; (b) 8 inpatients in Leeds ; and (c) 2 outpatients in Leeds-all under the care of one of us (S. J. H.). We may summarise our results as follows :
(a) 7 patients have received combined deoxycortone-acetate (DOCA) and ascorbic-acid therapy, in the dosage suggested by Lewin and Wassen, daily for eleven days. They have also had basic minimal physical treatment. Of these patients, none have shown improvement greater than expected from the simple physical treatment they have received ; one is rather worse. Several have shown variations
.
case,
especially
The Children’s
JOHN GERRARD Lecturer in Pædiatrics, University of Birmingham.
Hospital,
Birmingham.
IRON POISONING me to add the following case to series mentioned in your columns.1
SIR,—Will you allow the most On
interesting
April 23, 1949,
at 2 P.M.,
a
healthy 14-month-old
male
hour, swallowed 30FersoOn re-joining the child, the mother noticed that
child, while left alone for half
an
late ’ tablets. he was in pain, and fortunately perceived at once that he had swallowed the tablets. She administered an emetic of salt and water. The child was sick twice and brought up 15 tablets with the coating still intact. He was admitted to hospital forthwith and the stomach was washed out, considerable quantities of iron being removed. On admission, his colour was poor and the pulse was weak and rapid. By 8 P.M. his colour and pulse were normal and he appeared to have recovered. He had a good night, and next morning seemed little the worse for his mishap, being discharged to his home later in the day.
to
The
cases
me
of the
you listed have been a salutary reminder potential gravity of the above case.
North Devon Infirmary, Barnstaple.
R. M. J. HARPER.
OBSTETRICAL BRAINS TRUST
SIR,—Though Dr. Hugh Jolly (Dec. 10) may have the support of the Oxford English Dictionary in stating that the first ovulation (or the occurrence of spermatogenesis) marks the exact beginning of puberty-"the state or condition of having become functionally capable of procreating offspring "-—I venture to suggest that this definition often becomes unworkable. Would Dr. Jolly, for example, regard a woman of 25, whose menarche occurred at 13 but who has had only anovular cycles, as prepuberal ; or a man with fully developed accessory sexual organs, but with azoospermia not of acquired type, as similarly prepuberal ? The position in circumstances such as these (which are not purely hypothetical) is surely untenable. Indeed, the O.E.D. definition breaks down more completely and more frequently than does Dr. Jolly’s ; for according to the former, a woman with blocked tubes, or a man with blocked vasa deferentia, being " functionally incapable of procreating offspring would ipso facto be excluded from the state of puberty. I think the clue to the problem lies in the fact that the gonads have a dual function : they produce both sex hormones and gametes, and whereas there may be hormones without gametes there are never gametes without hormones. Morphologically and psychologically the changes traditionally associated with puberty depend on the incretory function of the gonads ; only the reproductive function depends on gametogenesis. Hence it seems illogical to deny the status of puberty to an individual who differs from one accepted as puberal solely in the failure to produce gametes. The fact that the incretory function of the ovary precedes gametogenesis is recognised by the distinction sometimes made between " puberty," defined as the morphopsychological state resulting from the action of the sex hormones, and nubility," the condition in which gametogenesis is also occurring (strictly meaning "marriageable"). It seems "
reasonable, therefore, to regard puberty 1. Leading article, Lancet, Nov. p. 1060.
as
dependent
12, p. 898. Porter, H. Ibid, Dec. 3,
the action of the sex hormones and independent of gametogenesis ; in which case Dr. Jolly’s differentiation between sexual precocity and precocious puberty becomes little more than a quibble. Obstetric Hospital, University College G. I. M. SWYER. on
Hospital, London, W.C.1.
CHILDREN REFERRED TO THE PSYCHIATRIST
SIR,—It does not
seem
to
me
that
Dr.
s Moodle
the persistence of enuresis nocturna will bold water-if you will pardon the metaphor. Taken literally, it would imply an automatic bladder," whereas the condition is nothing like that. The enuresis is nocturnal, which means that inhibition must be functioning satisfactorily, on the whole, in the daytime ; in fact, there clearly is what Dr. Moodie calls " a definite sensory impulse," and in the absence of some special abnormality in the nervous system there is no physical reason why it should not give warning in sleep as well as in waking life. If it fails to do so, we are justified in regarding the symptom, from the point of view of treatment, as psychological. A small bladder, whether inherited or acquired, may be a slight handicap, since it demands more of the patient than mere inhibition -he must actually get out of bed. But I do not see how otherwise than psychologically Dr. Moodie would treat it, short of blowing it up through a catheter. I assume, of course, that a training procedure would be classed as a form of psychological treatment (though an etymologist might argue that point). Much the same may be said of crossed cerebral laterality, to which Dr. Moodie attributes many cases of stammer and backwardness. Whether given or not, I suggest it should be regarded merely as a slight handicap, which is of little or no real importance in adult life, but which can be made to loom very large in the mind of the child, as indeed can almost anything.
explanation (Dec. 10) of
"
The Psychological Laboratory,
Cambridge.
W. E. HICK.
THE TONSIL AND ADENOID PROBLEM
SIR,—I wish to draw your attention to an error-of word in your report (Dec. 10, p. 1087) of my remarks
one
at the Royal Society of Medicine on Dec. 2. This occurs in the last sentence, where I am quoted as having said :o " For over two hundred years tonsillectomy has proved a beneficial operation." I actually said " two thousands
years." Oxford.
RONALD MACBETH.
DEOXYCORTONE ACETATE AND ASCORBIC ACID IN RHEUMATOID ARTHRITIS
SIR,—With the supplies of ’Cortisone’ restricted as they are in this country at the moment, many rheumatologists will have been anxious to confirm the preliminary report of Lewin and Wassen in your issue of Nov. 26. In the last three weeks we have investigated the effect of this therapy on 17 patients, all cases of rheumatoid arthritis. The results have been disappointing ; we have never seen anything like the response obtained with cortisone in rheumatoid arthritis as demonstrated to one of us at the Mayo Clinic earlier this year. The cases were in three groups : (a) 7 inpatients in Harrogate ; (b) 8 inpatients in Leeds ; and (c) 2 outpatients in Leeds-all under the care of one of us (S. J. H.). We may summarise our results as follows :
(a) 7 patients have received combined deoxycortone-acetate (DOCA) and ascorbic-acid therapy, in the dosage suggested by Lewin and Wassen, daily for eleven days. They have also had basic minimal physical treatment. Of these patients, none have shown improvement greater than expected from the simple physical treatment they have received ; one is rather worse. Several have shown variations
.