- Email: [email protected]
WINTER IN EUROPE
634 to be
desirable than family life and has led.to a in which a really large family is penalised. Economic factors reinforce and are reinforced by fashion, WINTER IN EUROPE but as the standard of life declines and becomes SIR,-Sir John Boyd Orr said recently at Geneva thatnecessarily less artificial it may be that people, provided that they can avoid starvation, will be driven back more millions in Europe would be worse fed this winter even and more to the basic natural satisfactions and that than during the war. We have our own difficulties, but families will become not only more frequent but larger with that of lot our in thousands many comparing Germany, Poland, Austria, Hungary, and Rumania, in size. whose diet is little more than half of ours, we must Philosophically considered, of two evils’it is better that should avoid parenthood for the real reasonsthere that is feel if a which people something, only little, surely because they regard children as a nuisance and a social and we can do to help. economic drag-than because they think the world too Here I am appealing particularly for money for our European Relief Fund ; for relief supplies, if they are bad a place to be born into. In this latter case we should be faced by an insidious defeatism and Manito arrive in time, must be purchased soon. chaeism that boded even worse for our country and Of the four beneficiaries of the fund, far the biggest civilisation than the obvious facts allow. amount is required by the Friends Relief Service for the JOSEPH V. WALKER. Whitley Bay. purchase of food, clothing, and medicines for their work in Austria, Germany, and Poland. They could spend EARLY RISING AFTER OPERATION 20,000 on food alone immediately if they had the money ; for such supplies, unsuitable for distribution in the SrR,-In your leading article of Sept. 20 (p. 427} normal ration, are still available in the sterling areas of you refer to our series of 629 surgical Cases1 in which the world. Smaller yet substantial sums are needed by rising " was the routine. Since that was completed the Ecumenical Refugee Commission for the household we have had another year’s experience of early rising, medicines they send to Germany and Austria, and for the and nothing has occurred to alter our opinion. We have work of German Educational Reconstruction in fostering found no disadvantages and our belief in its great the rebirth of democratic education in Germany. Finally, advantages is still further confirmed. a comparatively small sum is needed for our own Supplies An outstanding fact is that no case of femoral thromFund to meet the costs of handling and shipping the bosis has occurred in four years—i.e., in about 850-900 food parcels and other supplies which we send to nine cases. This is perhaps the most concrete and objective European countries-Austria, France, Germany, Greece, feature and one which cannot be effected by faith or
Letters
to
the Editor
more
society
,
’
" early
Hungary, Italy, Poland, Rumania, and Yugoslavia. Cheques and postal orders should be made out to Savee Europe Now European Relief Fund " and may be ear"
marked for any one of the beneficiaries listed above, all of which are registered war charities. We shall also be grateful for help with any other of the needs listed in our circulated leaflet, which explains fully the ways in which help can be sent. The need is desperate : a few warm clothes, a little flour, and a bar or two of chocolate can make a tremendous difference to the lot of one of the many families who have to survive this winter on so little. We ask for help in giving practical expression to those Christian tenets of brotherhood and love on which our European civilisation is grounded. HENRY CARTER Save Europe Now, Hon. Treasurer. 15, James Street, London, W.C.2. VOLUNTARY INFERTILITY S]IR,-In his article on Oct. 11 Dr. Alex Comfort said that at the Camberwell childhood advisory clinics the reasons adduced for limiting the family " were strikingly uniform, war coming first, fear of renewed war second, and the consequences of war, particularly housing, third, followed by economic considerations." There is, I suggest, room for doubt whether these are usually the true reasons for voluntary sterility. War, or the threat of it, or the perils and dangers of the world have been quoted so often in this context that they have become cliches-useful verbal masks behind which to hide one’s real thoughts. To avoid parenthood because of these alleged reasons out of solicitude for the unborn may appear unselfish and even noble to some, including the potential parents themselves; but the facts, for what they are worth, are usually against this explanation of
voluntary sterility. conditions and a perilous state of nonwould be a hardy optimist who called it peace) have led since 1941 to a continuously rising birthrate ; and even in the late ’thirties, when early war was becoming more and more certain, the rate tended to rise. Whether this increase was due mainly to the foundation of more families or to the birth of more children in families already existing is at present undisclosed. Clearly the former and more likely alternative is less significant of change in fertility habit since it is little more than a function of more marriages ; but in either case no supportis given to the " war and wretched world " argument. If it is antisocial to have more children, it is equally antisocial to have any children ; but most married people do in fact have one or two children. The underlying cause of voluntary infertility is surely the fashion of the times, which declares so many things Actual
war
belligerency (he
gratitude.
-
W. A. POCOCK.
Johannesburg.
ALKYLAMINE TREATMENT OF LEUKÆMIA AND HODGKIN’S DISEASE article SIR,-The by Dr. Wilkinson and Dr. Fletcher (Oct. 11) gives ample food for thought. Of the 8 cases of myeloid leukaemia which they treated with alkylamine, 1 reached the refractory stage in twelve months and another in six months ; 1 showed no significant response ; 2 were complica,ted by coexistent pernicious anaemia; and 1 showed a remission for four months. For 2 there is claimed well-marked improvement; we are not told how long the improvement lasted, but since the authors state that they deal only with immediate effects it appears to have been short. The 8th case lived eight months. In 4 there was no considerable increase in survival (compared with untreated cases). Of the 3 cases of lymphatic leukaemia, 2 needed blood-transfusion after treatment. Of the 4 Hodgkin cases 1, which was certainly advanced, deteriorated " in spite of " treatment. For the others the most that can be said is that they remained satisfactory and without remission for seventeen weeks. The drug has " potent nucleotoxic and cytotoxic effects," and unless treatment is controlled by daily white-cell counts and bi-weekly full blood-counts, by other hsematoperiodic sternal puncture and " various " logical and biochemical examinations there is a risk of aplastic anaemia, agranulocytosis, thrombocytopenic purpura, and severe aplasia of the bone-marrow, not to mention nausea, anorexia, vomiting, diarrhoea, and thrombosis at the site of injection. These many and great dangers are hardly surprising in view of the fact that the substance used was originally intended for the destruction of human life. The results, which I think I have summarised fairly. should be compared not with those in untreated cases but with those in cases treated by X rays. With radiotherapy patients have a reasonable expectation of survival for five years or more, in a state of modified comfort, happiness, and efficiency, with very little, if any, constitutional disability and without further interference beyond occasional blood-counts. By this standard the alkylamine treatment is a disastrous failure. This, however, is not the view of the authors, for they are prosecuting their researches by new methods of administration and control. In so doing they are victims of the all-too-common delusion that because an agency modifies the appearance of disease it must inevit,
1. Pocock, W. A.,
Kark, W.
S.
Afr. med. J. July 12, 1947, p. 473.
desirable than family life and has led.to a in which a really large family is penalised. Economic factors reinforce and are reinforced by fashion, WINTER IN EUROPE but as the standard of life declines and becomes SIR,-Sir John Boyd Orr said recently at Geneva thatnecessarily less artificial it may be that people, provided that they can avoid starvation, will be driven back more millions in Europe would be worse fed this winter even and more to the basic natural satisfactions and that than during the war. We have our own difficulties, but families will become not only more frequent but larger with that of lot our in thousands many comparing Germany, Poland, Austria, Hungary, and Rumania, in size. whose diet is little more than half of ours, we must Philosophically considered, of two evils’it is better that should avoid parenthood for the real reasonsthere that is feel if a which people something, only little, surely because they regard children as a nuisance and a social and we can do to help. economic drag-than because they think the world too Here I am appealing particularly for money for our European Relief Fund ; for relief supplies, if they are bad a place to be born into. In this latter case we should be faced by an insidious defeatism and Manito arrive in time, must be purchased soon. chaeism that boded even worse for our country and Of the four beneficiaries of the fund, far the biggest civilisation than the obvious facts allow. amount is required by the Friends Relief Service for the JOSEPH V. WALKER. Whitley Bay. purchase of food, clothing, and medicines for their work in Austria, Germany, and Poland. They could spend EARLY RISING AFTER OPERATION 20,000 on food alone immediately if they had the money ; for such supplies, unsuitable for distribution in the SrR,-In your leading article of Sept. 20 (p. 427} normal ration, are still available in the sterling areas of you refer to our series of 629 surgical Cases1 in which the world. Smaller yet substantial sums are needed by rising " was the routine. Since that was completed the Ecumenical Refugee Commission for the household we have had another year’s experience of early rising, medicines they send to Germany and Austria, and for the and nothing has occurred to alter our opinion. We have work of German Educational Reconstruction in fostering found no disadvantages and our belief in its great the rebirth of democratic education in Germany. Finally, advantages is still further confirmed. a comparatively small sum is needed for our own Supplies An outstanding fact is that no case of femoral thromFund to meet the costs of handling and shipping the bosis has occurred in four years—i.e., in about 850-900 food parcels and other supplies which we send to nine cases. This is perhaps the most concrete and objective European countries-Austria, France, Germany, Greece, feature and one which cannot be effected by faith or
Letters
to
the Editor
more
society
,
’
" early
Hungary, Italy, Poland, Rumania, and Yugoslavia. Cheques and postal orders should be made out to Savee Europe Now European Relief Fund " and may be ear"
marked for any one of the beneficiaries listed above, all of which are registered war charities. We shall also be grateful for help with any other of the needs listed in our circulated leaflet, which explains fully the ways in which help can be sent. The need is desperate : a few warm clothes, a little flour, and a bar or two of chocolate can make a tremendous difference to the lot of one of the many families who have to survive this winter on so little. We ask for help in giving practical expression to those Christian tenets of brotherhood and love on which our European civilisation is grounded. HENRY CARTER Save Europe Now, Hon. Treasurer. 15, James Street, London, W.C.2. VOLUNTARY INFERTILITY S]IR,-In his article on Oct. 11 Dr. Alex Comfort said that at the Camberwell childhood advisory clinics the reasons adduced for limiting the family " were strikingly uniform, war coming first, fear of renewed war second, and the consequences of war, particularly housing, third, followed by economic considerations." There is, I suggest, room for doubt whether these are usually the true reasons for voluntary sterility. War, or the threat of it, or the perils and dangers of the world have been quoted so often in this context that they have become cliches-useful verbal masks behind which to hide one’s real thoughts. To avoid parenthood because of these alleged reasons out of solicitude for the unborn may appear unselfish and even noble to some, including the potential parents themselves; but the facts, for what they are worth, are usually against this explanation of
voluntary sterility. conditions and a perilous state of nonwould be a hardy optimist who called it peace) have led since 1941 to a continuously rising birthrate ; and even in the late ’thirties, when early war was becoming more and more certain, the rate tended to rise. Whether this increase was due mainly to the foundation of more families or to the birth of more children in families already existing is at present undisclosed. Clearly the former and more likely alternative is less significant of change in fertility habit since it is little more than a function of more marriages ; but in either case no supportis given to the " war and wretched world " argument. If it is antisocial to have more children, it is equally antisocial to have any children ; but most married people do in fact have one or two children. The underlying cause of voluntary infertility is surely the fashion of the times, which declares so many things Actual
war
belligerency (he
gratitude.
-
W. A. POCOCK.
Johannesburg.
ALKYLAMINE TREATMENT OF LEUKÆMIA AND HODGKIN’S DISEASE article SIR,-The by Dr. Wilkinson and Dr. Fletcher (Oct. 11) gives ample food for thought. Of the 8 cases of myeloid leukaemia which they treated with alkylamine, 1 reached the refractory stage in twelve months and another in six months ; 1 showed no significant response ; 2 were complica,ted by coexistent pernicious anaemia; and 1 showed a remission for four months. For 2 there is claimed well-marked improvement; we are not told how long the improvement lasted, but since the authors state that they deal only with immediate effects it appears to have been short. The 8th case lived eight months. In 4 there was no considerable increase in survival (compared with untreated cases). Of the 3 cases of lymphatic leukaemia, 2 needed blood-transfusion after treatment. Of the 4 Hodgkin cases 1, which was certainly advanced, deteriorated " in spite of " treatment. For the others the most that can be said is that they remained satisfactory and without remission for seventeen weeks. The drug has " potent nucleotoxic and cytotoxic effects," and unless treatment is controlled by daily white-cell counts and bi-weekly full blood-counts, by other hsematoperiodic sternal puncture and " various " logical and biochemical examinations there is a risk of aplastic anaemia, agranulocytosis, thrombocytopenic purpura, and severe aplasia of the bone-marrow, not to mention nausea, anorexia, vomiting, diarrhoea, and thrombosis at the site of injection. These many and great dangers are hardly surprising in view of the fact that the substance used was originally intended for the destruction of human life. The results, which I think I have summarised fairly. should be compared not with those in untreated cases but with those in cases treated by X rays. With radiotherapy patients have a reasonable expectation of survival for five years or more, in a state of modified comfort, happiness, and efficiency, with very little, if any, constitutional disability and without further interference beyond occasional blood-counts. By this standard the alkylamine treatment is a disastrous failure. This, however, is not the view of the authors, for they are prosecuting their researches by new methods of administration and control. In so doing they are victims of the all-too-common delusion that because an agency modifies the appearance of disease it must inevit,
1. Pocock, W. A.,
Kark, W.
S.
Afr. med. J. July 12, 1947, p. 473.