May 24, 1975 - Calciferol also loks promising, as you state, and we have no evidence of real increase in rat numbers. Dr. P. S. DAVISON (Dunfermline, Fife).
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Review Body Report This does not mean thait I therefore consider myself morally superior or inferior to SIR,-I refer to the intemperate letter from my colleagues, merely thankful that we all Dr. T. B. W. Phillips (10 May, p. 339). still have freedom to choose.-I am, etc., Among those who did not submit their resignations there must be many like myself P. B. SAVEGE who did not because their consciences would not allow them to do so.
Points from Letters Availability of Glyceryl Trinitrate Dr. B. DIXON (London W.C.2) writes: . . . The explanation for the nitroglycerine trade (Dr. S. V. Steinberg, 3 May, p. 278) is, surely, the vicious circle of anxiety, pain, and relief which often drives angina sufferers to become preoccupied with their daily requirements for tablets. Despite assurances from their medical practitioners about the safety of trinitrin, they become obsessively conscious of the relationslhip between their consu.mption of itrinitrin and 'the severity of their condition. Like the alcoholic, if they cannot deceive themselves about their intake, they can a,t least try to fool the doctor. Manipulation in Treatment of Low Back Pain Dr. N. B. EASTWOOD (Lowestoft) writes: Dr. J. H. Cyriax, Dr. A. G. Boag, and Sir Eric Riches (10 May, p. 334) correctly criticize the weaknesses of the paper by Dr. D. M. L. Doran and Professor D. J. Newell (26 April, p. 161). The authors fail to give clear indications for manipulation and they fail to describe the manipulations they used. If they had chosen one form of low back pain-for example, ithat characterized by sacroiliac joint tenderness in the absence of intrapelvic inflanxmation-and had used a single eandard manipulation they would have discovered that manipulation is usually diate.... effective and that the cure is Mr. D. W. YATES (Ghester Royal Infirmary, Chester) writes: In the trial reported by Dr. D. M. L. 'Doran and Professor D. J. Newell (26 April, p. 161) the association between the doctor's prognosis and the clinical outcome are shown to be particularly close in the manipulation group. I would suggest that this is the direct result of the closer doctor/patient relationiship in this group. Epidural injection similarly ties the doctor to the patient for a longer period than is usual in a olinic interview. I have found this enforced liaison most valuable as a source of extra information. I would question the assumption that manipulation is more expensive than the other forms of itreatment-more timeconsunting for the doctor, but not a greater burden to the Health Service as a whole. If this extra time can be used to learn more about low back pain it will be time well spent. ...
Poisoned Children Miss HELEN MCCAUGHEY (Poison Information Centre, Royal Alexandra Hospital for Children, Sydney, Australia) writes: What a breath of fresh air to read the letter by Mr. C. P. de Fonseka (1 March, p. 512)! . . . My experience with callers to our poison
24 MAY 1975
tions showed that cycloispasmol increased the radioactivity in the brain of rats that had received labelled glucose. It is thought, therefore, that cyclospasmol also has an action by making more glucose available for cerebral energy, thus increasing cerebral vascular demand and finally increasing St. Albans, Herts cere,bral blood flow. ... Consideration of all available experimental and clinical data would strongly support the postulate that the value of cyclospasmol in organic brain syndromes lies in a primary metabolic effect rather than a primary vasodilator effect, a centre, be they lay, veterinary, or medical, is concept wh,ich was put forward some years that they believe implicitly the ihistory ag... .2 offered by the patient. .. . The art of good Funcke, A. B. H., et al., Current Medical Rehistory-taking must be the foundation stone search and Opinion, 1974. 2, 37. of good diagnosis, and basically is it not just 2 Ball, J. A. C., and Taylor, A. R., British Medical interest and common sense? With child Yournal, 1967, 3, 525. poisoning the overtreatment of non-poisoned children has led to far more deaths than the poisons themselves-good history-taking Rats Today should prevent all "medicolegal" therapy.... P. L. G. BATEMAN (Rentokil Ltd., East Naturally, the sundry questions about the Mr. Grinstead, Sussex) writes: It is extrainitial quantity in the bottle, the quantity ordinary that your leading article (19 April, left now, the symptoms if enough time has 105) should appear to advocate a return passed for any to be expected, the amount p. to reliance upon cats for rodent control.... on the clothing, the floor, etc. must be asked, That cats can toxoplasmosis as well as but the crux is to relax the parent first parasites is wellcarry documented, and apart from before any attempt is made to differentiate being in food premises they between non-poisonings and real poisonings simply unihy-gienic are not efficient agents of rodent that are in need of inmmediate, energetic, control. A fit cat reared as a mouser, or a and, most of all, correct treatment-not terrier dog reared to deal with rats, may overtreatment. make useful contributions on a farm, but not inside buildings where mice in particular can roam freely through cavities and Essential Fatty Acid Deficiency Due to ducts quite inaccessible to predators. The Artificial Diet in Cystic Fibrosis grocer, alas, is likely to have both an unDrs. J. A. DODGE, D. G. SALTER, and J. G. hygienic cat and a thriving colony of mice YASSA (Department of Ghild Health, Welsh unless he is protected by correctly placed, National School of Medicine, Cardiff) write: properly selected rodentical baits or contact Further to our recent letter on this subject dust. The problem of warfarin-resistant rats (26 April, p. 192) it has been pointed out in Britain is hardly significant. Ready4to-use to us by a connmercial company that we baits containing 0 05 %,, warfarin correotly referred to the dietary regimen which we placed will deal with most infestations were using as an "elemental diet." The only above ground and fluoracetamide is capable complete, prepacked "elemental diet" which of keeping our sewers rat-free. Calciferol is currently marketed in this country con- also loks promising, as you state, and we tains fat in the form of safflower oil and has have no evidence of real increase in rat an adequate content of linoleic acid.... There numbers. are good nutritional and economic reasons why an artificial diet such as we used and which was originally described by Dr. J. D. Dr. P. S. DAVISON (Dunfermline, Fife) Allen might be preferred to a prepacked writes: . . . The gin trap (leading article, formula, but while we are not endorsing the 19 April, p. 105) was made illegal on the use of any particular preparation in cystic impetus of woolly-minded do-gooders and fibrosis, we did not wish to imply that the in the belief 'that effective alternatives "elemental diet" marketed as such was de- existed. As is so often the case with action ficient in essential fatty acids.... based on do-gooders, the information on which it was based was incorrect. . . The warfarin poison which was the do-gooders' Cerebral Vasodilators real weapon is now so ineffective that I, as Dr. I. I. DAINOW (Medical Advisor, Brocades a farmer, have had to give up using it,(Great Britain) Ltd., Weybridge, Surrey) our riats seem perfectly happy to use it as writes: I read with initerest Dr. R. A. a staple diet and warfarin-resistant rats are Wood's article (29 March, p. 723) on now commonplace. The other misconception organic brain syndromes and his subsequent is that removing the gin reduces suffering. letter on the use of vasodilators (26 April, The rat in a gin would spend on average p. 195). Tholugh cyclospasmol can be perhaps half a night gripped in a gin before demonstrated to have vasodilaitor properties merciful dispatch; if it was lucky tthe trapin the clinical situation, it is questionable or its brotheirs-would kill it more quickly. whether this is a primary or secondary Warfarin acts by causing internal bleeding, effect. Recently publiahed data showed a acting veiry slowly over a period of a week metabolic effect in animals in that cyclo- to 10 days when it is effective. The rats in spasmol was found to enhance the resistance the later stages crawl about bloated and of the animals to hypoxia. Since hypoxia stupefied, no doubt by the pain caused by itself is known to induce miaximal cerebral bleeding and swelling. The dogooders see blood flow, the resultant improvemenit in the obvious pain of a few hours in a trap, the animals was thought not to be due to but not the long-drawn-out agony of a week vasodilatation alone. Subsequent investiga- or more slowly dying. ..
