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TOXIC EFFECTS OF RESERPINE
1126 FEAR OF CANCER
SIR,-I read with interest Mr. Donaldson’s article in your issue of May 7, and I should like to mention two aspects of the fear of cancer which add, I believe, in many instances not inconsiderably to the mental suffering of patients and to the distress of those around them. These apprehensions are that cancer is contagious and, again, that it forbodes malignancy in the offspring. In the case of a man who was under my care some years ago the differential diagnosis between bronchial carcinoma and lung abscess could not be settled. The patient’s wife asked whether it was necessary for her to take precautions in case the illness proved to be cancer. I told her that cancer When the was not contagious, but she was unconvinced. patient died his wife was the first to speak about a postmortem examination, and on hearing that an abscess had been found in the lung, but no cancer, her face lit up with relief and she exclaimed " Thank God for that."
I am inclined to think the belief that cancer is infectious is a widespread and deeply rooted one. It may be thought of as a modern version of man’s primitive response to dangerous illness against which he used to protect himself by the system of taboo. Since this system has no currency in advanced society, tendencies of avoidance entering into the attitudes towards the sufferer are bound to impart a sense of guilt which cannot but render the relation to him a conflicting one. For his part, the sufferer who, of course, shares in" the notions of the undeclared taboo senses his position as that of a feararousing outcast. Here Mr. Donaldson’s personal experiences provide a telling illustration of how, in keeping with the rules of taboo, even the mention or alone the thought of cancer come under the restrictions of the ban. The notion of cancer heredity, looked at as an irrational belief, may be only an extension of the idea of its infectiousness. West Park
Hospital,
Epsom, Surrey.
JOSEPH ZELMANOWITS.
will continue to present interesting and useful medical programmes. The technique is still developing and we feel that much remains to be learnt about the proper balance between demonstration and explanation necessary to avoid misinterpretation. In order that, as broadcasters, we may continue to maintain our anonymity we sign ourselves, Dr. A, Dr. B, and Dr. C. -
TOXIC EFFECTS OF RESERPINE
SiR,-We read with interest the letter from Dr. Stead and Dr. Wing in your issue of April 16 on the toxic effects of reserpine. They describe two cases of parkinsonism developing during treatment with large doses, but they suggest that toxic effects are slight with small doses. In our experience of mentally ill patients treated on dosage of 0.5-2 mg. daily, side-effects may be trouble. some. The degree of disturbance varies widely but is generally greater in the neurotic than in the psychotic. Drowsiness, loss of energy, nasal stuffiness, and tremor are commonest, and are most marked at the end of the first and during the second weeks of treatment. Aches in the limbs occur infrequently. Unless warned of these effects, many outpatients may stop the drug before there is any chance of benefit. Wilkinshas reported the development of agitated depression in cases of hyper. tension treated with reserpine. Frequently the side-effects may so add to the burden of the patient with endogenous depression, that admission to hospital may be necessary. We feel that in these cases the drug is contra-indicated. We have noted the develop. ment of parkinsonism in some cases treated with oral dosage of 4-8 mg. daily for one to three months. Facial immobility and restlessness are common on this dosage, Elderly patients may easily become tremulous and unsteady with consequent danger of fractures. Frequency of micturition is fairly common and nocturnal incontin. of urine has been noted in some cases. Increase in dreams pleasant or unpleasant sometimes occurs. Kline2 has reported that 2% of patients treated with reserpine have epileptic convulsions for the first time, but we have not observed this in any case. ence
MEDICAL TELEVISION PROGRAMMES
SiR,—We are sorry that Mr. Welsh (May 14) was revolted by the television programme of May 2 on Mind and Body. Human physiological demonstrations can only be made on living subjects. In this programme all three subjects were professional associates of the doctors taking part. We fail to see how the first two simple demonstrations of physiological response to stress could appear revolting. The cigarette " burn " was used to demonstrate that the physiological response to a threat -can be greater than the stimulus itself. The " burn " was not only suggested as a suitable stimulus by the subject (himself a doctor) but was accepted by him quite willingly on a number of occasions during rehearsals. Of course the only contact made was a light touch, producing no more than erythema. Some people have reported to us that they themselves experienced a feeling of mounting tension whilst observing the threat, and it is clear that it was this communicated anxiety that they found disturbing. We have yet to meet anyone to whom it had even occurred that " sadism" was a motive in presentation, and perhaps if he had not switched off at a crucial moment Mr. Welsh would not have retained a distorted impression. To judge by correspondence received by the B.B.C., there has been no general adverse public reaction. Indeed, two general practitioners have reported to us that, since viewing the programme, patients of theirs have been able to accept the emotional basis of some of their somatic symptoms and have requested psychological
help. The educational value of television programmes on medical subjects has recently been referred to in your columns,l and we hope that the B.B.C.
appropriate
1. Lancet,
1954, ii, 279.
with parenteral reserpine has been mostly 25 inpatients who were given 10 mg. intramuscularly and 3 mg. orally daily for three to seven weeks. Drowsiness, loss of energy, nasal stuffiness, and rest. lessness occur in every patient to some degree..Drowsiness may be so bad that most of the day is spent in bed. Nasal congestion may be complicated by nose bleeds or much less commonly by necrosis of nasal mucosa or sinusitis or head. aches possibly due to vacuum changes in the sinuses. Breathlessness and a sensation of smothering may occur. Restlessness may reach a degree in which rest is unattainable without heavy sedation and may bring about impulsive behaviour, Impaired mobility of facial expression and increased salivation are common. Parkinsonism to the degree described by Wick and Stead has been noted in 5 of the series. Klinedoes not consider this a contra-indication to continued treatment and in this we concur. Reduction of the intramuscular dosage to5 mg. daily usually provides relief where the patient is unable to get about freely or to feed himself. Sometimes the patients complain of pain in the back of the neck or in the lumbar region, or of aches in the limbs. Appetite is usually increased, but where side-effects are marked, it may be greatly reduced. We have noted also in individual cases postural hypotension and unexplained oedema of the face and ankles. Delay in initiating micturition and impairment of accommodation may occur to a minor degree. The 10 mg. injection is 4 ml. in volume and is frequently painful.
Our
in
a
experience
series
of
It is evident that parenteral reserpine therapy in this dosage can be a very unpleasant treatment. We hope that modifications in the regime will make it less so. Patients require frequent encouragement and explanation. Adjustment of dosage is fairly often necessary. 1. Wilkins, R. W. Ann. N.Y. Acad. Sci. 1954, 59, 36. 2. Kline, N. S. Address to American Psychiatric Association. Berkeley, California, Dec. 30, 1954.
1127
We have found barbiturates best in the control of restlessPrivine ’ nebuliser for nasal cona mixture for excessive salivation. and belladonna gestion, these Despite disadvantages our results have been such as to encourage us to continue trial of the drug. ness, an’Antistin
indebted to Ciba Laboratories Ltd. for supplies of in the form of ’Serpasil ’ and for supplies of ’Antistin Privine.’ We
are
reserpine
St. Patrick’s
Hospital, Dublin.
J. N. P. MOORE E. A. MARTIN.
CORTISONE, CORTICOTROPHIN, AND INFECTION most enlightening paper by Dr. Shaper and (April 30) prompts me to draw attention to the relationship of an allied drug (hydrocortisone) to infection. In view of the increasing popularity of the use of hydrocortisone in local treatment of joint and soft-tissue lesions it may be timely to report a case of suppurative arthritis after an intra-articular hydrocortisone injection.
SIR,-The
Dr. Dyson
A woman of 75-was admitted to hospital with an infective arthritis of her knee. She gave a six weeks’ history of general malaise followed by pain and swelling of her right knee. Two weeks before admission she attended the outpatient department of another hospital where physiotherapy was ordered and hydrocortisone was injected into the knee-joint. Following this her condition deteriorated. On admission she had a mild pyrexia and a moderate effusion in the knee-joint with restricted movements. Thick pus was obtained on aspiration of the joint, which had to be incised. The culture yielded a profuse growth of penicillin-sensitive pneumococci. The infection subsided completely with local and systemic penicillin.
There
are
three
She had
possible
causes
of the
joint
infection
infection with
(1) pneumococcal lung secondary pneumococcal arthritis, the hydrocortisone causing the latter to flare up.
a
-
(2) The knee condition was an exacerbation of an osteoarthritis and the pneumococci were introduced during the
hydrocortisone injection (unlikely). (3) She had a non-specific " toxic " synovitis following pneumonia. The trauma of the injection and the hydrocortisone in the joint caused a locus rninori8 re8i8tentiae and the deposition of pneumococci in the joint. The first is the most likely explanation, but if the last be true, intra-articular hydrocortisone should be contraindicated not only in an infective joint lesion but also in the presence of an infective focus elsewhere. Clatterbridge Hospital, Bebington, Cheshire.
E. H. STRACH.
STAPHYLOCOCCAL INFECTION IN THE NEWBORN
SIR,-I have followed the recent correspondence with interest and I note that Dr. Forfar and his colleagues (May 21) have now referred to what are probably the most important aspects-namely, the unsuspected pathogenicity and the prevention of staphylococcal infections in the newborn. That certain staphylococci can be dangerous was realised last century when Ogsten, the illustrious " discoverer " of the organism, suffered from a lung abscess which yielded a pure culture of staphylococci. His remark that he had hitherto regarded the staphylococcus as a " friendly little chap " is still echoed today. The unfriendly strains can now be differentiated with reasonable accuracy by phagetyping, but it must be confessed that facilities for typing are not readily available to everyone investigating staphylococcal outbreaks. This is particularly unfortunate since it makes it impossible to confirm the route of
infection.
Dr. Forfar and his colleagues rightly suspect that the arrival in the household may introduce a virulent (and resistant) organism acquired in the maternity hospital. Within twenty-four hours of its residence new
in the hospital nursery the infant acquires the flora and fauna of its fellows, and it is capable of infecting the mother’s breast with any pathogenic staphylococci
present in its nasopharynx. The evidence of this has been conclusively demonstrated by Colbeckand confirmed by Isbister.2 I am indebted to these investigators for their personal communications which solved the problem of why the incidence of mastitis was infinitely higher in mothers who had been confined in the Burgh maternity hospital than in those confined at home. It is probable that a household may become tolerant of its own domestic strain of the staphylococcus without developing any resistance to others. That is why congregation in hospitals carries such risks and why the nursery-where such still exists-is the danger spot, nullifying as it must the most rigid precautions applied to the mother alone. While I endorse the first part of Dr. Forfar’s remark that " prevention not treatment of neonatal staphylococcal infection must be the ultimate goal but as yet that appears to be unattainable," I think that he might be disposed to amend the latter part after he has put into practice the principle of strict cubicle isolation of the mother with her infant. Health and Welfare Department,
Kirkcaldy.
J. R. W. HAY.
HASHIMOTO’S STRUMA LYMPHOMATOSA AND RIEDEL’S THYROIDITIS TREATED BY RADIUM
interested to read that Dr. Cooke and have studied about 25 patients, in nearly two-thirds of whom the diagnosis has been -confirmed by histological section," " ... that not infrequently the patient first visits her doctor for symptoms not quickly ascribed to thyroid disturbance, such as lassitude, muscle and joint pains, increasing weight, and changed facial appearance," and that " the efficacy of modern treatment by oral dried thyroid emphasises the need for the diagnosis of Hashimoto’s disease to beconsidered more readily." I was particularly interested in their remark that " one of our patients, observed forseven years, now has a liver which is greatly enlarged ..." In a paper 3 in 1938 by J. Mill Renton and A. A. Charteris, I contributed to a report on 5 cases which had been treated successfully with radium (1800r-4000r), and remained well, to the time of reporting, for from two to five years. Of these 5 cases, 3 were diagnosed on histological evidence and 2 on clinical and therapeutic grounds, the response to radium being so astonishingly rapid, without local or general reaction, and quite unlike that given by any other condition.
SiR,-I
was
Dr. Luxton
(May 7)
"
Our definition of Riedel’s thyroiditis included " struma and lymphadenoid goitre," and our cases 1 and 4 were of this state, confirmed histologically. They were middle-aged women who complained of discomfort and swelling in the neck with dysphonia and dysphagia ; tissue was removed from the isthmus of the gland. Following mistaken histological diagnosis of malignancy in case 1 a radium collar was applied (2500r), and within ten days the patient was symptom-free and within thirteen days the thyroid swelling had gone. On account of such favourable and ready response, 3 other cases were treated with radium ; in 2 a
lymphomatosa
"
"
was taken, but in 1 treatment was begun clinical diagnosis of Riedel’s thyroiditis had been made, and a like response to radium was considered diagnostic. The 5th case was culled from the records, having been diagnosed clinically as thyroid carcinoma and given a palliative dose of radium estimated to be 1800r. She showed great improvement of voice, and the neck swelling subsided at the end of a week. As she was alive and well almost five years later, when we reviewed the hospital records prior to publication, she was considered to have suffered from Riedel’s -
biopsy specimen after
a
thyroiditis. 1. Colbeck, J. C. Canad. med. Ass. J. 1949, 2. Isbister, C. Med. J. Aust. 1952, ii, 801. 3. Brit. J. Surg. 1938, 26, 54.
61, 537.
SIR,-I read with interest Mr. Donaldson’s article in your issue of May 7, and I should like to mention two aspects of the fear of cancer which add, I believe, in many instances not inconsiderably to the mental suffering of patients and to the distress of those around them. These apprehensions are that cancer is contagious and, again, that it forbodes malignancy in the offspring. In the case of a man who was under my care some years ago the differential diagnosis between bronchial carcinoma and lung abscess could not be settled. The patient’s wife asked whether it was necessary for her to take precautions in case the illness proved to be cancer. I told her that cancer When the was not contagious, but she was unconvinced. patient died his wife was the first to speak about a postmortem examination, and on hearing that an abscess had been found in the lung, but no cancer, her face lit up with relief and she exclaimed " Thank God for that."
I am inclined to think the belief that cancer is infectious is a widespread and deeply rooted one. It may be thought of as a modern version of man’s primitive response to dangerous illness against which he used to protect himself by the system of taboo. Since this system has no currency in advanced society, tendencies of avoidance entering into the attitudes towards the sufferer are bound to impart a sense of guilt which cannot but render the relation to him a conflicting one. For his part, the sufferer who, of course, shares in" the notions of the undeclared taboo senses his position as that of a feararousing outcast. Here Mr. Donaldson’s personal experiences provide a telling illustration of how, in keeping with the rules of taboo, even the mention or alone the thought of cancer come under the restrictions of the ban. The notion of cancer heredity, looked at as an irrational belief, may be only an extension of the idea of its infectiousness. West Park
Hospital,
Epsom, Surrey.
JOSEPH ZELMANOWITS.
will continue to present interesting and useful medical programmes. The technique is still developing and we feel that much remains to be learnt about the proper balance between demonstration and explanation necessary to avoid misinterpretation. In order that, as broadcasters, we may continue to maintain our anonymity we sign ourselves, Dr. A, Dr. B, and Dr. C. -
TOXIC EFFECTS OF RESERPINE
SiR,-We read with interest the letter from Dr. Stead and Dr. Wing in your issue of April 16 on the toxic effects of reserpine. They describe two cases of parkinsonism developing during treatment with large doses, but they suggest that toxic effects are slight with small doses. In our experience of mentally ill patients treated on dosage of 0.5-2 mg. daily, side-effects may be trouble. some. The degree of disturbance varies widely but is generally greater in the neurotic than in the psychotic. Drowsiness, loss of energy, nasal stuffiness, and tremor are commonest, and are most marked at the end of the first and during the second weeks of treatment. Aches in the limbs occur infrequently. Unless warned of these effects, many outpatients may stop the drug before there is any chance of benefit. Wilkinshas reported the development of agitated depression in cases of hyper. tension treated with reserpine. Frequently the side-effects may so add to the burden of the patient with endogenous depression, that admission to hospital may be necessary. We feel that in these cases the drug is contra-indicated. We have noted the develop. ment of parkinsonism in some cases treated with oral dosage of 4-8 mg. daily for one to three months. Facial immobility and restlessness are common on this dosage, Elderly patients may easily become tremulous and unsteady with consequent danger of fractures. Frequency of micturition is fairly common and nocturnal incontin. of urine has been noted in some cases. Increase in dreams pleasant or unpleasant sometimes occurs. Kline2 has reported that 2% of patients treated with reserpine have epileptic convulsions for the first time, but we have not observed this in any case. ence
MEDICAL TELEVISION PROGRAMMES
SiR,—We are sorry that Mr. Welsh (May 14) was revolted by the television programme of May 2 on Mind and Body. Human physiological demonstrations can only be made on living subjects. In this programme all three subjects were professional associates of the doctors taking part. We fail to see how the first two simple demonstrations of physiological response to stress could appear revolting. The cigarette " burn " was used to demonstrate that the physiological response to a threat -can be greater than the stimulus itself. The " burn " was not only suggested as a suitable stimulus by the subject (himself a doctor) but was accepted by him quite willingly on a number of occasions during rehearsals. Of course the only contact made was a light touch, producing no more than erythema. Some people have reported to us that they themselves experienced a feeling of mounting tension whilst observing the threat, and it is clear that it was this communicated anxiety that they found disturbing. We have yet to meet anyone to whom it had even occurred that " sadism" was a motive in presentation, and perhaps if he had not switched off at a crucial moment Mr. Welsh would not have retained a distorted impression. To judge by correspondence received by the B.B.C., there has been no general adverse public reaction. Indeed, two general practitioners have reported to us that, since viewing the programme, patients of theirs have been able to accept the emotional basis of some of their somatic symptoms and have requested psychological
help. The educational value of television programmes on medical subjects has recently been referred to in your columns,l and we hope that the B.B.C.
appropriate
1. Lancet,
1954, ii, 279.
with parenteral reserpine has been mostly 25 inpatients who were given 10 mg. intramuscularly and 3 mg. orally daily for three to seven weeks. Drowsiness, loss of energy, nasal stuffiness, and rest. lessness occur in every patient to some degree..Drowsiness may be so bad that most of the day is spent in bed. Nasal congestion may be complicated by nose bleeds or much less commonly by necrosis of nasal mucosa or sinusitis or head. aches possibly due to vacuum changes in the sinuses. Breathlessness and a sensation of smothering may occur. Restlessness may reach a degree in which rest is unattainable without heavy sedation and may bring about impulsive behaviour, Impaired mobility of facial expression and increased salivation are common. Parkinsonism to the degree described by Wick and Stead has been noted in 5 of the series. Klinedoes not consider this a contra-indication to continued treatment and in this we concur. Reduction of the intramuscular dosage to5 mg. daily usually provides relief where the patient is unable to get about freely or to feed himself. Sometimes the patients complain of pain in the back of the neck or in the lumbar region, or of aches in the limbs. Appetite is usually increased, but where side-effects are marked, it may be greatly reduced. We have noted also in individual cases postural hypotension and unexplained oedema of the face and ankles. Delay in initiating micturition and impairment of accommodation may occur to a minor degree. The 10 mg. injection is 4 ml. in volume and is frequently painful.
Our
in
a
experience
series
of
It is evident that parenteral reserpine therapy in this dosage can be a very unpleasant treatment. We hope that modifications in the regime will make it less so. Patients require frequent encouragement and explanation. Adjustment of dosage is fairly often necessary. 1. Wilkins, R. W. Ann. N.Y. Acad. Sci. 1954, 59, 36. 2. Kline, N. S. Address to American Psychiatric Association. Berkeley, California, Dec. 30, 1954.
1127
We have found barbiturates best in the control of restlessPrivine ’ nebuliser for nasal cona mixture for excessive salivation. and belladonna gestion, these Despite disadvantages our results have been such as to encourage us to continue trial of the drug. ness, an’Antistin
indebted to Ciba Laboratories Ltd. for supplies of in the form of ’Serpasil ’ and for supplies of ’Antistin Privine.’ We
are
reserpine
St. Patrick’s
Hospital, Dublin.
J. N. P. MOORE E. A. MARTIN.
CORTISONE, CORTICOTROPHIN, AND INFECTION most enlightening paper by Dr. Shaper and (April 30) prompts me to draw attention to the relationship of an allied drug (hydrocortisone) to infection. In view of the increasing popularity of the use of hydrocortisone in local treatment of joint and soft-tissue lesions it may be timely to report a case of suppurative arthritis after an intra-articular hydrocortisone injection.
SIR,-The
Dr. Dyson
A woman of 75-was admitted to hospital with an infective arthritis of her knee. She gave a six weeks’ history of general malaise followed by pain and swelling of her right knee. Two weeks before admission she attended the outpatient department of another hospital where physiotherapy was ordered and hydrocortisone was injected into the knee-joint. Following this her condition deteriorated. On admission she had a mild pyrexia and a moderate effusion in the knee-joint with restricted movements. Thick pus was obtained on aspiration of the joint, which had to be incised. The culture yielded a profuse growth of penicillin-sensitive pneumococci. The infection subsided completely with local and systemic penicillin.
There
are
three
She had
possible
causes
of the
joint
infection
infection with
(1) pneumococcal lung secondary pneumococcal arthritis, the hydrocortisone causing the latter to flare up.
a
-
(2) The knee condition was an exacerbation of an osteoarthritis and the pneumococci were introduced during the
hydrocortisone injection (unlikely). (3) She had a non-specific " toxic " synovitis following pneumonia. The trauma of the injection and the hydrocortisone in the joint caused a locus rninori8 re8i8tentiae and the deposition of pneumococci in the joint. The first is the most likely explanation, but if the last be true, intra-articular hydrocortisone should be contraindicated not only in an infective joint lesion but also in the presence of an infective focus elsewhere. Clatterbridge Hospital, Bebington, Cheshire.
E. H. STRACH.
STAPHYLOCOCCAL INFECTION IN THE NEWBORN
SIR,-I have followed the recent correspondence with interest and I note that Dr. Forfar and his colleagues (May 21) have now referred to what are probably the most important aspects-namely, the unsuspected pathogenicity and the prevention of staphylococcal infections in the newborn. That certain staphylococci can be dangerous was realised last century when Ogsten, the illustrious " discoverer " of the organism, suffered from a lung abscess which yielded a pure culture of staphylococci. His remark that he had hitherto regarded the staphylococcus as a " friendly little chap " is still echoed today. The unfriendly strains can now be differentiated with reasonable accuracy by phagetyping, but it must be confessed that facilities for typing are not readily available to everyone investigating staphylococcal outbreaks. This is particularly unfortunate since it makes it impossible to confirm the route of
infection.
Dr. Forfar and his colleagues rightly suspect that the arrival in the household may introduce a virulent (and resistant) organism acquired in the maternity hospital. Within twenty-four hours of its residence new
in the hospital nursery the infant acquires the flora and fauna of its fellows, and it is capable of infecting the mother’s breast with any pathogenic staphylococci
present in its nasopharynx. The evidence of this has been conclusively demonstrated by Colbeckand confirmed by Isbister.2 I am indebted to these investigators for their personal communications which solved the problem of why the incidence of mastitis was infinitely higher in mothers who had been confined in the Burgh maternity hospital than in those confined at home. It is probable that a household may become tolerant of its own domestic strain of the staphylococcus without developing any resistance to others. That is why congregation in hospitals carries such risks and why the nursery-where such still exists-is the danger spot, nullifying as it must the most rigid precautions applied to the mother alone. While I endorse the first part of Dr. Forfar’s remark that " prevention not treatment of neonatal staphylococcal infection must be the ultimate goal but as yet that appears to be unattainable," I think that he might be disposed to amend the latter part after he has put into practice the principle of strict cubicle isolation of the mother with her infant. Health and Welfare Department,
Kirkcaldy.
J. R. W. HAY.
HASHIMOTO’S STRUMA LYMPHOMATOSA AND RIEDEL’S THYROIDITIS TREATED BY RADIUM
interested to read that Dr. Cooke and have studied about 25 patients, in nearly two-thirds of whom the diagnosis has been -confirmed by histological section," " ... that not infrequently the patient first visits her doctor for symptoms not quickly ascribed to thyroid disturbance, such as lassitude, muscle and joint pains, increasing weight, and changed facial appearance," and that " the efficacy of modern treatment by oral dried thyroid emphasises the need for the diagnosis of Hashimoto’s disease to beconsidered more readily." I was particularly interested in their remark that " one of our patients, observed forseven years, now has a liver which is greatly enlarged ..." In a paper 3 in 1938 by J. Mill Renton and A. A. Charteris, I contributed to a report on 5 cases which had been treated successfully with radium (1800r-4000r), and remained well, to the time of reporting, for from two to five years. Of these 5 cases, 3 were diagnosed on histological evidence and 2 on clinical and therapeutic grounds, the response to radium being so astonishingly rapid, without local or general reaction, and quite unlike that given by any other condition.
SiR,-I
was
Dr. Luxton
(May 7)
"
Our definition of Riedel’s thyroiditis included " struma and lymphadenoid goitre," and our cases 1 and 4 were of this state, confirmed histologically. They were middle-aged women who complained of discomfort and swelling in the neck with dysphonia and dysphagia ; tissue was removed from the isthmus of the gland. Following mistaken histological diagnosis of malignancy in case 1 a radium collar was applied (2500r), and within ten days the patient was symptom-free and within thirteen days the thyroid swelling had gone. On account of such favourable and ready response, 3 other cases were treated with radium ; in 2 a
lymphomatosa
"
"
was taken, but in 1 treatment was begun clinical diagnosis of Riedel’s thyroiditis had been made, and a like response to radium was considered diagnostic. The 5th case was culled from the records, having been diagnosed clinically as thyroid carcinoma and given a palliative dose of radium estimated to be 1800r. She showed great improvement of voice, and the neck swelling subsided at the end of a week. As she was alive and well almost five years later, when we reviewed the hospital records prior to publication, she was considered to have suffered from Riedel’s -
biopsy specimen after
a
thyroiditis. 1. Colbeck, J. C. Canad. med. Ass. J. 1949, 2. Isbister, C. Med. J. Aust. 1952, ii, 801. 3. Brit. J. Surg. 1938, 26, 54.
61, 537.