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TREATMENT OF ANURIA
201 as
osteopaths
are
quick
to
whereas the clinical results of Hingson’s (’Pavex’) caudal technique supported the theory of spasm and recovery from it even in late stages. Since then the remarkable results of Dr. Chatterjee1 have given the strongest evidenee of the eorreetness of mv view. JOHN SOPHIAN. London, W.1.
orthodox should all benefit
appreciate good
methods, also when appropriate,
we
-including the patient. Osteopathic Publishing Company Ltd., 4, New Zealand Avenue, London, E.C.1.
-
A. WILLIAM ELLIS.
PLEA FOR PSYCHOTHERAPY SrR,-In recent years there has been a spectacular advance in the physical treatment of psychiatric illness.
THE NORMAL TEMPERATURE
SIR,-What is the normal human temperature ? It alone has revolutionised has been long accepted as 98-4°-98-6°F taken by clinical thermometer in the mouth. I no longer For the prognosis of involntional depression. In schizoof a remission are sufficiently good the chances this as correct. I not have accept kept records, but I phrenia to justify treatment by insulin coma., Leucotomy has long ago came to the conclusion that for most people the undoubtedly made bearable and even useful the lives of normal sublingual temperature is rarely higher than patients who have hitherto been a misery to themselves 97·6°F and not infrequently is less by up to a degree and Various abreactive and a burden to their friends. a half. There are, I think, slight environmental variatechniques have made it possible to release deeply tions-due to atmospheric conditions, the processes of these variations are by no means repressed,. painful complexes and thereby, in some digestion, &c.-but considerable. cases, have produced a dramatic relief of symptoms and in others have shortened analytic procedures. I base my contention on observation over many years. On the other hand, the glowing hopes aroused by the In fact I have come to regard a temperature of over pioneer work of Freud for the solution of all psychiatric 97-6°F in an ambulant patient as a raised temperature problems by psycho-analysis have faded after many requiring further investigation ; more often than not disappointments, and the pendulum has undoubtedly I have been justified, although the lesion may have proved to be no worse, than a, mild gingivitis or a rhinitis. swung away from treatment along mental lines to treatment by physical methods. G. RALSTON. London, W.C.2. The problem of body-mind relationship has so far been insoluble ; but one can perhaps claim that there is PLACENTAL CONTENT OF A.C.T.H. no proof that mind has not an autonomy of its own, SIR,—Dr. Boe and Mr. Salvesen (June 14) describe and that there is a case for attacking some problems data which show that adrenocorticotrophic hormone is along mental lines. In the past psychotherapy has had, not contained in the human placenta. These workers as well as many failures, considerable successes. These have used physiological saline with 0-25% acetic acid must depend firstlv on correct diagnosis, and secondly to prepare their extracts. on a flexible attitude to the methods of attack to be In this laboratory we have attempted to confirm the used in each case. At the present time there would work of Tarantino,2Jailer,3 and Opsahl,4all of whom seem to be a danger that in the altogether laudable claim to have demonstrated the presence of A.C.T.H. in search for short-cut methods, preferably physical, the the placenta. We have utilised the glacial-acetic-acid value of psychotherapy may be forgotten. Even where extraction method of Payne et al.,5 followed by oxyphysical methods or abreactive techniques relieve cellulose adsorption.6 20 g. lyophilised tissue (full-term symptoms in a dramatic way, relief may not be per- placenta) yielded 40 mg. of solids in the oxycellulose manent without a change of mental attitude ; and in eluate. The material isolated by these procedures was other cases nothing but a patient understanding and assayed by the ascorbic-acid depletion method of Sayers. unravelling of the patient’s psychological problems et al. and was found to contain approximately 0.01 can give the help which is required. international units (i.u.) of corticotrophin per mg. MARION GREAVES. Thus placental tissue may be calculated to contain London, W.1. 4-5 i.u. of A.C.T.H. activity per kg. fresh tissue, which TREATMENT OF ANURIA represents a much larger concentration of corticotrophic SiR,-In referring -(July 5) to my short contribution activity than may be ascribed to the blood present in to the discussion on the Treatment of Anuria at the the tissue, inasmuch as Sydnor and Sayershave found Royal Society of Medicine on June 26, you unfortunately the concentration of normal blood to be less than misquoted my remarks on its therapeusis. 0-01 i.u. per litre, whereas Granirer- has shown that I had attempted to show that embryologically the plasma contains about 1 i.u. per litre. postpartum kidney was a " neurile " organ ; that the comparative Research Department, HERMAN COHEN Princeton Laboratories Inc. physiology of the salmon and of the eel afforded evidence WILLIAM KLEINBERG. New U.S.A. Princeton, Jersey, that change of environment produced prolonged " anuria " from which renal recovery was complete ; that controlled INFORMATION SOUGHT ON PORPHYRIA CASES experiments had evoked acute tubular necrosis by SIR,—I and my colleagues at University College nervous pathways ; that there was considerable pathoare making a chemical study of urines from Hospital logical evidence to show that cortical renal ischsemia and acute porphyria. Our work has come to with patients medullary congestion was the post-mortem change in the stage when we need large supplies of material. I such states, and that all this could be explained by the would be very grateful if anyone having knowledge of a Trueta mechanism of whose occurrence under physiological and experimental pathological circumstances I case of acute porphyria would contact me as soon as brought strong proof. Especially I emphasised Bykov’s possible. Department of Chemical Pathology, conditioned-reflex experiments where antidiuresis could University College Hospital Medical School, be provoked in animals with diabetes insipidus, indicating C. RIMINGTON. London. W.C.1. the paramount importance of the glomerulus in urine Electric convulsive
therapy
myself,
-
production.
1Iy theme
was that anuria was due to the " shunt," reversible even at late stages by conduction anaesthesia ; also that the disturbance the "shunt " produced in the electrolyte and water environment itself offered a stimulus to renal shut-down. Modern therepeutics were content to deal with the latter alone,
and
was
Chatteriee, H. N. Lancet, July 12, 1952, p. 90. Tarantino, C. Fol. endocrinol. Jap. 1951, 4, 197. Jailer, J. W., Knowlton, A. I. J. clin. Invest. 1950, 29, 1430. Opsahl, J. C. Tale J. Biol. Med. 1951, 24, 199. Payne, R. W., Raben, M. S., Astwood, E. B. J. biol. Chem. 1950, 187, 719. 6. Astwood, E. B., Raben, M. S., Payne, R. W. J. Amer. chem. Soc. 1951, 73, 2969. 7. Sydnor, A., Sayers, G. Endocrine Society Meeting Abstracts, 1952, p. 25. 8. Granirer, L. W. N.Y. St. J. Med. 1951, 95, 2767. 1. 2. 3. 4. 5.
osteopaths
are
quick
to
whereas the clinical results of Hingson’s (’Pavex’) caudal technique supported the theory of spasm and recovery from it even in late stages. Since then the remarkable results of Dr. Chatterjee1 have given the strongest evidenee of the eorreetness of mv view. JOHN SOPHIAN. London, W.1.
orthodox should all benefit
appreciate good
methods, also when appropriate,
we
-including the patient. Osteopathic Publishing Company Ltd., 4, New Zealand Avenue, London, E.C.1.
-
A. WILLIAM ELLIS.
PLEA FOR PSYCHOTHERAPY SrR,-In recent years there has been a spectacular advance in the physical treatment of psychiatric illness.
THE NORMAL TEMPERATURE
SIR,-What is the normal human temperature ? It alone has revolutionised has been long accepted as 98-4°-98-6°F taken by clinical thermometer in the mouth. I no longer For the prognosis of involntional depression. In schizoof a remission are sufficiently good the chances this as correct. I not have accept kept records, but I phrenia to justify treatment by insulin coma., Leucotomy has long ago came to the conclusion that for most people the undoubtedly made bearable and even useful the lives of normal sublingual temperature is rarely higher than patients who have hitherto been a misery to themselves 97·6°F and not infrequently is less by up to a degree and Various abreactive and a burden to their friends. a half. There are, I think, slight environmental variatechniques have made it possible to release deeply tions-due to atmospheric conditions, the processes of these variations are by no means repressed,. painful complexes and thereby, in some digestion, &c.-but considerable. cases, have produced a dramatic relief of symptoms and in others have shortened analytic procedures. I base my contention on observation over many years. On the other hand, the glowing hopes aroused by the In fact I have come to regard a temperature of over pioneer work of Freud for the solution of all psychiatric 97-6°F in an ambulant patient as a raised temperature problems by psycho-analysis have faded after many requiring further investigation ; more often than not disappointments, and the pendulum has undoubtedly I have been justified, although the lesion may have proved to be no worse, than a, mild gingivitis or a rhinitis. swung away from treatment along mental lines to treatment by physical methods. G. RALSTON. London, W.C.2. The problem of body-mind relationship has so far been insoluble ; but one can perhaps claim that there is PLACENTAL CONTENT OF A.C.T.H. no proof that mind has not an autonomy of its own, SIR,—Dr. Boe and Mr. Salvesen (June 14) describe and that there is a case for attacking some problems data which show that adrenocorticotrophic hormone is along mental lines. In the past psychotherapy has had, not contained in the human placenta. These workers as well as many failures, considerable successes. These have used physiological saline with 0-25% acetic acid must depend firstlv on correct diagnosis, and secondly to prepare their extracts. on a flexible attitude to the methods of attack to be In this laboratory we have attempted to confirm the used in each case. At the present time there would work of Tarantino,2Jailer,3 and Opsahl,4all of whom seem to be a danger that in the altogether laudable claim to have demonstrated the presence of A.C.T.H. in search for short-cut methods, preferably physical, the the placenta. We have utilised the glacial-acetic-acid value of psychotherapy may be forgotten. Even where extraction method of Payne et al.,5 followed by oxyphysical methods or abreactive techniques relieve cellulose adsorption.6 20 g. lyophilised tissue (full-term symptoms in a dramatic way, relief may not be per- placenta) yielded 40 mg. of solids in the oxycellulose manent without a change of mental attitude ; and in eluate. The material isolated by these procedures was other cases nothing but a patient understanding and assayed by the ascorbic-acid depletion method of Sayers. unravelling of the patient’s psychological problems et al. and was found to contain approximately 0.01 can give the help which is required. international units (i.u.) of corticotrophin per mg. MARION GREAVES. Thus placental tissue may be calculated to contain London, W.1. 4-5 i.u. of A.C.T.H. activity per kg. fresh tissue, which TREATMENT OF ANURIA represents a much larger concentration of corticotrophic SiR,-In referring -(July 5) to my short contribution activity than may be ascribed to the blood present in to the discussion on the Treatment of Anuria at the the tissue, inasmuch as Sydnor and Sayershave found Royal Society of Medicine on June 26, you unfortunately the concentration of normal blood to be less than misquoted my remarks on its therapeusis. 0-01 i.u. per litre, whereas Granirer- has shown that I had attempted to show that embryologically the plasma contains about 1 i.u. per litre. postpartum kidney was a " neurile " organ ; that the comparative Research Department, HERMAN COHEN Princeton Laboratories Inc. physiology of the salmon and of the eel afforded evidence WILLIAM KLEINBERG. New U.S.A. Princeton, Jersey, that change of environment produced prolonged " anuria " from which renal recovery was complete ; that controlled INFORMATION SOUGHT ON PORPHYRIA CASES experiments had evoked acute tubular necrosis by SIR,—I and my colleagues at University College nervous pathways ; that there was considerable pathoare making a chemical study of urines from Hospital logical evidence to show that cortical renal ischsemia and acute porphyria. Our work has come to with patients medullary congestion was the post-mortem change in the stage when we need large supplies of material. I such states, and that all this could be explained by the would be very grateful if anyone having knowledge of a Trueta mechanism of whose occurrence under physiological and experimental pathological circumstances I case of acute porphyria would contact me as soon as brought strong proof. Especially I emphasised Bykov’s possible. Department of Chemical Pathology, conditioned-reflex experiments where antidiuresis could University College Hospital Medical School, be provoked in animals with diabetes insipidus, indicating C. RIMINGTON. London. W.C.1. the paramount importance of the glomerulus in urine Electric convulsive
therapy
myself,
-
production.
1Iy theme
was that anuria was due to the " shunt," reversible even at late stages by conduction anaesthesia ; also that the disturbance the "shunt " produced in the electrolyte and water environment itself offered a stimulus to renal shut-down. Modern therepeutics were content to deal with the latter alone,
and
was
Chatteriee, H. N. Lancet, July 12, 1952, p. 90. Tarantino, C. Fol. endocrinol. Jap. 1951, 4, 197. Jailer, J. W., Knowlton, A. I. J. clin. Invest. 1950, 29, 1430. Opsahl, J. C. Tale J. Biol. Med. 1951, 24, 199. Payne, R. W., Raben, M. S., Astwood, E. B. J. biol. Chem. 1950, 187, 719. 6. Astwood, E. B., Raben, M. S., Payne, R. W. J. Amer. chem. Soc. 1951, 73, 2969. 7. Sydnor, A., Sayers, G. Endocrine Society Meeting Abstracts, 1952, p. 25. 8. Granirer, L. W. N.Y. St. J. Med. 1951, 95, 2767. 1. 2. 3. 4. 5.