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TREATMENT OF OBESITY
1175
prime importance. Geographical differences in portions of tumours of high and low malignancy much
to
the procould do
explain variations in survival figures.
Department of Surgery, Dalhousie University, Halifax, Nova Scotia,
IAN MACKENZIE.
Canada.
TREATMENT OF OBESITY SIR,-The letters by Dr. Mullins (April 5) and Dr. Badham (April 20) on the treatment of obesity completely ignore the psychosomatic aspects of the over-
weight patient. It is easy
put a patient on a diet, give appetite-reducing considerable reduction in weight. However, this weight is regained almost invariably once supervision is discontinued. While treatment appears to have been a success, long-term follow-up reveals failure of such a therapeutic regimen. The reason for this is that increased appetite is considered to be the basic cause of overweight, whereas in fact it is only a symptom of a particular patient’s reaction to underto
pills, and get
a
lying psychological
stress.
Patients who overeat do so because of unsatisfied oral needs. When they are unable to face their problems on an adult level they regress to the level of infancy. Just as a baby turns to the breast for comfort when he is unhappy, so do obese people overeat during periods of stress. Other manifestations of this regression to the oral phase are excessive smoking during periods of difficulty, nail-biting, and the chewing of gum and tobacco. Obese patients require psychotherapy, which should be devoted to helping them to express themselves and " getting off their chests " those things which are distressing them. If this is done they will no longer find it necessary to regress and
consequently
to overeat.
Central Islip State Hospital, New York.
M. G. JACOBY.
TREATMENT OF ASTHMA AND IIAYFEVER BY HYPNOSIS
SIR,-This correspondence is of great interest who work in the field of
to
those
hypnosis.
allergists hold that the allergic reaction is the only responsible for asthma, while others say that allergic disposition may be present in a patient but under normal conditions the allergy may be latent or mild and yield to conventional treatment. Under the stress of emotions, howSome stimulus
ever, it can become chronic and
disabling. When this occurs can again be eliminated by therapy of the emotional factors even though the skin-sensitivity tests remain the same. Herxheimer’s experimentswith house dust showed that among the patients giving a positive skin reaction a high proportion did not give any bronchial reaction. Conversely, skin reaction was negative, but they had some patients’ bronchial spasms. In 1954 he again stated 2:" we have tested the skin responses of 300 patients with respiratory allergy and of 100 normal subjects, and have found their outcome in the same subject most variable. Only in three out of 21 patients could we reproduce exactly the same result on two different it
occasions."
Bignall says : " Skin testing seldom aids in’ diagnosis and It is generally more profitable to explore the patient’s mind and his environment than the lungs, sinuses or
treatment.
hypersensitivity
reactions." care of people and not just their diseases we cannot help dealing with their emotions. The more knowledge the doctor possesses of the emotional factors in his patient’s illness, the more capable will he be in dealing with him and his disease. In the asthmatic, alteration of the psyche is the rule rather than the exception. One physician quotes the case 1. Herxheimer, H. Int. Arch. Allergy, 1951, 2, 40. 2. Herxheimer, H., McInroy, P., Sutton, K. H., Utidjion, H. L., Utidjion, Since
we
take
H. M. D. Brit. med. J. 1954, i, 1379. 3. Bignall, J. R. Med. Pr. 1953, 230, 526.
a patient who is sensitive to ragweed pollen, but who, interestingly enough, does not have these attacks when his
of
mother-in-law is out of town. With my own asthmatic patients, Sally and Victor were sensitive to feathers. Robert was sensitive not only to feathers but also to cats and birds. Barbara was sensitive to chocolates while Brian could not tolerate onions or plums. Mrs. C could not eat pork, cheese, or eggs, while Theo could not stand dogs. Tim was upset by dust and also got tight and wheezy when the weather was dull and damp (how do you skin-test for that ?). Mrs. B. hates gas and smoke; so does Mrs. P. who works in a pub. Mrs. B. cannot eat fish, potatoes, or milk pudding, while Mrs. D. cannot face milk, fish, cheese, or eggs. With repeated reassurance under hypnosis all these patients have become immune to their so-called asthma-producing
allergies. A. P. MAGONET. CARDIAC SYNCOPE AFTER SWALLOWING SIR,-In his report of a patient with cardiac syncope
induced by swallowing, Dr. James (April 12) has given a rather complete explanation of some of the factors that may have been responsible. He and your readers will find it of interest to review the case described1 by Dr. S. Glatzer, of Brooklyn. The patient, following digitalisation, began to experience syncope immediately after swallowing water. It was demonstrated that carotid-sinus pressure induced a typical syncope. Two days after the digitalis had been discontinued, neither deglutition carotid pressure could cause syncope. Dr. Glatzer felt that the sequence of events in this patient could be attributed to increased sensitivity of the carotid sinus, accompanying digitalis toxicity. He also pointed out that increased carotid-sinus sensitivity occurs in myocardial infarction. Thus, in Dr. James’ patient, the digitalis and the nor
infarction
possibly carotid
undoubtedly aetiological factors, and so midoesophageal diverticulum, with the sinus acting as mediator for the sensitising were
was
the
influences. Seaside Memorial Hospital, Long Beach, California.
GEORGE X. TRIMBLE.
ALPHA TOCOPHEROL AND CONGENITAL ANOMALIES
SIR,-Mr. E. V. Shute2 claims to have demonstrated that the administration of alpha tocopherol to potential fathers prior to conception, in cases where a previous child with an anomaly had already been born, was effective in preventing further malformations. If this were in fact the case, the study would be of very great importance. It is unfortunate therefore that Mr. Shute’s conclusions are open to criticism. He concluded, on the basis of his previous experience, that the risk of a subsequent abnormal child, by his definition, in a family where one has already been born, is 1 in 7. In his experiment he gave alpha tocopherol to 17 such fathers prior The 17 conceptions resulted in 15 normal to conception. anomalous infants ". Professor Randal Cole children and 2 concluded that the chance of getting 15 normals out of 17 in these families with an abnormal child was 1 in 500. This result was obtained, however, by reckoning in the index cases or propositi, who had drawn attention to the families in the first instance. This is inadmissible. Mr. Shute’s own method is the correct one (reckoning the probability by taking account of all the siblings except the index cases) and his experience showed this to be 1 abnormal in 7 sibs, which conforms as nearly as possible to the findings in the cases where alpha tocopherol was given to the fathers. "
1. 2.
Circulation, 1957, 16, 107. Shute, E. V. J. Obstet. Gynœc. Brit. Emp. 1957, 64, 390.
prime importance. Geographical differences in portions of tumours of high and low malignancy much
to
the procould do
explain variations in survival figures.
Department of Surgery, Dalhousie University, Halifax, Nova Scotia,
IAN MACKENZIE.
Canada.
TREATMENT OF OBESITY SIR,-The letters by Dr. Mullins (April 5) and Dr. Badham (April 20) on the treatment of obesity completely ignore the psychosomatic aspects of the over-
weight patient. It is easy
put a patient on a diet, give appetite-reducing considerable reduction in weight. However, this weight is regained almost invariably once supervision is discontinued. While treatment appears to have been a success, long-term follow-up reveals failure of such a therapeutic regimen. The reason for this is that increased appetite is considered to be the basic cause of overweight, whereas in fact it is only a symptom of a particular patient’s reaction to underto
pills, and get
a
lying psychological
stress.
Patients who overeat do so because of unsatisfied oral needs. When they are unable to face their problems on an adult level they regress to the level of infancy. Just as a baby turns to the breast for comfort when he is unhappy, so do obese people overeat during periods of stress. Other manifestations of this regression to the oral phase are excessive smoking during periods of difficulty, nail-biting, and the chewing of gum and tobacco. Obese patients require psychotherapy, which should be devoted to helping them to express themselves and " getting off their chests " those things which are distressing them. If this is done they will no longer find it necessary to regress and
consequently
to overeat.
Central Islip State Hospital, New York.
M. G. JACOBY.
TREATMENT OF ASTHMA AND IIAYFEVER BY HYPNOSIS
SIR,-This correspondence is of great interest who work in the field of
to
those
hypnosis.
allergists hold that the allergic reaction is the only responsible for asthma, while others say that allergic disposition may be present in a patient but under normal conditions the allergy may be latent or mild and yield to conventional treatment. Under the stress of emotions, howSome stimulus
ever, it can become chronic and
disabling. When this occurs can again be eliminated by therapy of the emotional factors even though the skin-sensitivity tests remain the same. Herxheimer’s experimentswith house dust showed that among the patients giving a positive skin reaction a high proportion did not give any bronchial reaction. Conversely, skin reaction was negative, but they had some patients’ bronchial spasms. In 1954 he again stated 2:" we have tested the skin responses of 300 patients with respiratory allergy and of 100 normal subjects, and have found their outcome in the same subject most variable. Only in three out of 21 patients could we reproduce exactly the same result on two different it
occasions."
Bignall says : " Skin testing seldom aids in’ diagnosis and It is generally more profitable to explore the patient’s mind and his environment than the lungs, sinuses or
treatment.
hypersensitivity
reactions." care of people and not just their diseases we cannot help dealing with their emotions. The more knowledge the doctor possesses of the emotional factors in his patient’s illness, the more capable will he be in dealing with him and his disease. In the asthmatic, alteration of the psyche is the rule rather than the exception. One physician quotes the case 1. Herxheimer, H. Int. Arch. Allergy, 1951, 2, 40. 2. Herxheimer, H., McInroy, P., Sutton, K. H., Utidjion, H. L., Utidjion, Since
we
take
H. M. D. Brit. med. J. 1954, i, 1379. 3. Bignall, J. R. Med. Pr. 1953, 230, 526.
a patient who is sensitive to ragweed pollen, but who, interestingly enough, does not have these attacks when his
of
mother-in-law is out of town. With my own asthmatic patients, Sally and Victor were sensitive to feathers. Robert was sensitive not only to feathers but also to cats and birds. Barbara was sensitive to chocolates while Brian could not tolerate onions or plums. Mrs. C could not eat pork, cheese, or eggs, while Theo could not stand dogs. Tim was upset by dust and also got tight and wheezy when the weather was dull and damp (how do you skin-test for that ?). Mrs. B. hates gas and smoke; so does Mrs. P. who works in a pub. Mrs. B. cannot eat fish, potatoes, or milk pudding, while Mrs. D. cannot face milk, fish, cheese, or eggs. With repeated reassurance under hypnosis all these patients have become immune to their so-called asthma-producing
allergies. A. P. MAGONET. CARDIAC SYNCOPE AFTER SWALLOWING SIR,-In his report of a patient with cardiac syncope
induced by swallowing, Dr. James (April 12) has given a rather complete explanation of some of the factors that may have been responsible. He and your readers will find it of interest to review the case described1 by Dr. S. Glatzer, of Brooklyn. The patient, following digitalisation, began to experience syncope immediately after swallowing water. It was demonstrated that carotid-sinus pressure induced a typical syncope. Two days after the digitalis had been discontinued, neither deglutition carotid pressure could cause syncope. Dr. Glatzer felt that the sequence of events in this patient could be attributed to increased sensitivity of the carotid sinus, accompanying digitalis toxicity. He also pointed out that increased carotid-sinus sensitivity occurs in myocardial infarction. Thus, in Dr. James’ patient, the digitalis and the nor
infarction
possibly carotid
undoubtedly aetiological factors, and so midoesophageal diverticulum, with the sinus acting as mediator for the sensitising were
was
the
influences. Seaside Memorial Hospital, Long Beach, California.
GEORGE X. TRIMBLE.
ALPHA TOCOPHEROL AND CONGENITAL ANOMALIES
SIR,-Mr. E. V. Shute2 claims to have demonstrated that the administration of alpha tocopherol to potential fathers prior to conception, in cases where a previous child with an anomaly had already been born, was effective in preventing further malformations. If this were in fact the case, the study would be of very great importance. It is unfortunate therefore that Mr. Shute’s conclusions are open to criticism. He concluded, on the basis of his previous experience, that the risk of a subsequent abnormal child, by his definition, in a family where one has already been born, is 1 in 7. In his experiment he gave alpha tocopherol to 17 such fathers prior The 17 conceptions resulted in 15 normal to conception. anomalous infants ". Professor Randal Cole children and 2 concluded that the chance of getting 15 normals out of 17 in these families with an abnormal child was 1 in 500. This result was obtained, however, by reckoning in the index cases or propositi, who had drawn attention to the families in the first instance. This is inadmissible. Mr. Shute’s own method is the correct one (reckoning the probability by taking account of all the siblings except the index cases) and his experience showed this to be 1 abnormal in 7 sibs, which conforms as nearly as possible to the findings in the cases where alpha tocopherol was given to the fathers. "
1. 2.
Circulation, 1957, 16, 107. Shute, E. V. J. Obstet. Gynœc. Brit. Emp. 1957, 64, 390.