PEPTIC ULCER
1
554 UNDE VENIS? G. E. BREEN. South Middlesex Hospital, Isleworth. SIR,-May I support Professor Maegraith’s thesis (Feb. 23) with another tragic story. Some time ago a man was flown here from the Cameroons for operation, with a diagnosis of " cancer and dysentery ". In the event he proved to have an unusual amoebic liver abscess, which was successfully dealt with. Meantime, his wife, who had been living in Australia with the children, flew home to be with him. She arranged to stay in the country with her sister. About the time his discharge was in contemplation she failed to attend for a discussion of future plans and we heard she had " innuenza ". We then heard that she was better, but later that she had been taken ill again. Finally we heard that she had " collapsed " and been admitted to hospital. We knew that there was no malaria in Perth, whence she had come, but that en route she had stopped overnight at Brazzaville where she had been bothered by the insects. We tried several times to phone the doctors concerned to voice our suspicions, but unfortunately without success. Ultimately we heard that she had died-of " malignant malaria ". As we are close to London Airport, around which many of the airline personnel live, malaria is no great rarity in this hospital, but as air travel increases it is bound to become more frequent and more widely spread. Indeed, the infectious-diseases physician of the future will require to have more than a nodding acquaintance with tropical diseases. But not, of course, with these alone. One of the most severe post-war epidemics of smallpox might well have been aborted if the doctor who first saw the patient had asked him the simple question: "Where were you a fortnight ago ?" PEPTIC ULCER SIR,-Your review (Feb. 16) of my book 1 states that the relation of the gastric secretion to the calorific value of the food eaten seems to be a pure deduction on my part. In short, it would seem a pure deduction to say that, in the case of a carbohydrate food, two slices of bread call forth more secretion than one slice, and, in the case of a protein food, that two eggs call forth more secretion than one egg. You pay me the compliment of saying that my book shows great common sense, but I submit that, inasmuch as the gastric and other juices are secreted in order to digest the food eaten, it would be extremely flattering to include under com- mon sense the deduction that more gastric-juice is secreted to digest a larger quantity of nutrients than to digest a smaller quantity. Assuming, as in my book, that no exact relation- ship is put forward between calories and secretion, such a deduction should be regarded as more in the nature of an axiom. The importance of such an axiom is explained in the book itself, where a considerable reference is also made to the very deep pitfalls in physiological experiments of the test- meal type, the results of which seldom seem to be accepted even by physiologists themselves for more than a few years, and which certainly should never be allowed to prejudice the following of laws that govern natural feeding throughout the created world. Actually, I tried to avoid conjecture in my book and, instead, to set out a series of facts. No-one, I think, who studies the extraordinary variations not only in the incidence of peptic ulcer geographically, but also in the prisoner-of-war camps in Japan and Russia and in the German army before Stalingrad, in which the disease became a plague when the carbohydrates had been refined, but disappeared almost completely when they had not been refined, can fail to be struck by the significance of these variations, many of which were recorded in important 1. Peptic Ulcer. Bristol, 1962. papers long before any supplementary inquiries were made b? me. Do not these sombre histories of what took place in large bodies of incarcerated men, subsisting on a very simple food structure, count as the experimental evidence called for by your review ? ? You also refer to " the present melancholy therapeutic situation " in this disease, where, it may be added, the existing orthodox type of ulcer diet fails to prevent the sacrificing of some 30,000 stomachs annually in the operating-theatres of these islands alone. I am not the only one who has discovered the value of almost exactly the opposite type of diet, so strongly and so safely indicated by natural considerations, and so unequivocally supported by the evidence I have tried to assemble. T. L. CLEAVE. HOMOGRAFTS IN CHORIONEPITHELIOMA FREDERICK HECHT. SIR,-Dr. Robinson and others (Feb. 9) describe 2 cases of chorionepithelioma in which the patients and their husbands showed " genetic similarity " in their tissues. The authors propose the challenging hypothesis that the tumour, which is a herni-homograft, might have been allowed to take because of the unusual histocom- patibility between the donor-husband and recipient-wife. Ironically, the authors fail to specify in either of their case-histories whether the patient and her husband are related. The amount of inbreeding is of obvious perti. nence to their hypothesis. One test of the hypothesis would be to compare the frequency of consanguineous marriages contracted by women with chorionepithelioma and women with other tumours, for example. &agr;-HYDROXYBUTYRATE-DEHYDROGENASE SIR,—The disproportionately high serum-K-hydroxy- butyrate-dehydrogenase (S.H.B.D.) activity of the faster- moving serum-lactate-dehydrogenase (S.L.D.) isoenzymes’ 1 has recently been confirmed using the simple enzyme staining technique described below. Sera are separated by electrophoresis on cellulose-acetate membranes in barbitone buffer pH 8’6, using a constant current of 0-5 mA per cm. for 11/4 hours. Following separation the cellulose acetate is divided longitudinallv and one half strip is stained for lactate- dehydrogenase (L.D.) activity using the technique of Barnett.2 The re- maining half-strip is simultaneously stained for x-hy- droxybutyrate-de- hydrogenase (H.B,D.) activity. For this a 2 M solution of K-hydroxybutyraK (Aldrich Chemical Company), adjusted to pH 7, replaces the 1 M lactate solution used for L.D. stain- ing. Using this tech- nique, the higher order of H.B.D. acti- vity of the faster- moving S.L.D. iso- enzymes is clearly shown. 1. Rosalki, S. B., Wilkinson, J. H. Nature, Lond. 1960, 188, 1110. 2. Barnett, H. Lancet, 1962, ii, 199.
Transcript of PEPTIC ULCER
554
UNDE VENIS?
G. E. BREEN.South Middlesex Hospital,
Isleworth.
SIR,-May I support Professor Maegraith’s thesis
(Feb. 23) with another tragic story.Some time ago a man was flown here from the Cameroons
for operation, with a diagnosis of " cancer and dysentery ". Inthe event he proved to have an unusual amoebic liver abscess,which was successfully dealt with.Meantime, his wife, who had been living in Australia with
the children, flew home to be with him. She arranged to stayin the country with her sister. About the time his dischargewas in contemplation she failed to attend for a discussion offuture plans and we heard she had " innuenza ". We thenheard that she was better, but later that she had been takenill again. Finally we heard that she had " collapsed " andbeen admitted to hospital.We knew that there was no malaria in Perth, whence she
had come, but that en route she had stopped overnight atBrazzaville where she had been bothered by the insects. Wetried several times to phone the doctors concerned to voiceour suspicions, but unfortunately without success. Ultimatelywe heard that she had died-of " malignant malaria ".As we are close to London Airport, around which many
of the airline personnel live, malaria is no great rarity inthis hospital, but as air travel increases it is bound tobecome more frequent and more widely spread. Indeed,the infectious-diseases physician of the future will
require to have more than a nodding acquaintance withtropical diseases. But not, of course, with these alone.One of the most severe post-war epidemics of smallpoxmight well have been aborted if the doctor who first sawthe patient had asked him the simple question: "Wherewere you a fortnight ago ?"
PEPTIC ULCER
SIR,-Your review (Feb. 16) of my book 1 states thatthe relation of the gastric secretion to the calorific value ofthe food eaten seems to be a pure deduction on my part.In short, it would seem a pure deduction to say that, inthe case of a carbohydrate food, two slices of bread callforth more secretion than one slice, and, in the case of aprotein food, that two eggs call forth more secretion thanone egg.You pay me the compliment of saying that my book shows
great common sense, but I submit that, inasmuch as the
gastric and other juices are secreted in order to digest the foodeaten, it would be extremely flattering to include under com-mon sense the deduction that more gastric-juice is secreted todigest a larger quantity of nutrients than to digest a smallerquantity. Assuming, as in my book, that no exact relation-ship is put forward between calories and secretion, such a
deduction should be regarded as more in the nature of anaxiom. The importance of such an axiom is explained inthe book itself, where a considerable reference is also made tothe very deep pitfalls in physiological experiments of the test-meal type, the results of which seldom seem to be acceptedeven by physiologists themselves for more than a few years,and which certainly should never be allowed to prejudice thefollowing of laws that govern natural feeding throughout thecreated world.
Actually, I tried to avoid conjecture in my book and, instead,to set out a series of facts. No-one, I think, who studies theextraordinary variations not only in the incidence of pepticulcer geographically, but also in the prisoner-of-war camps inJapan and Russia and in the German army before Stalingrad,in which the disease became a plague when the carbohydrateshad been refined, but disappeared almost completely when theyhad not been refined, can fail to be struck by the significance ofthese variations, many of which were recorded in important
1. Peptic Ulcer. Bristol, 1962.
papers long before any supplementary inquiries were made b?me. Do not these sombre histories of what took place in largebodies of incarcerated men, subsisting on a very simple foodstructure, count as the experimental evidence called for byyour review ? ?You also refer to
" the present melancholy therapeuticsituation " in this disease, where, it may be added, the existingorthodox type of ulcer diet fails to prevent the sacrificing ofsome 30,000 stomachs annually in the operating-theatres ofthese islands alone. I am not the only one who has discoveredthe value of almost exactly the opposite type of diet, so stronglyand so safely indicated by natural considerations, and so
unequivocally supported by the evidence I have tried to
assemble.T. L. CLEAVE.
HOMOGRAFTS IN CHORIONEPITHELIOMA
FREDERICK HECHT.
SIR,-Dr. Robinson and others (Feb. 9) describe 2cases of chorionepithelioma in which the patients andtheir husbands showed " genetic similarity " in theirtissues. The authors propose the challenging hypothesisthat the tumour, which is a herni-homograft, might havebeen allowed to take because of the unusual histocom-patibility between the donor-husband and recipient-wife.
Ironically, the authors fail to specify in either of theircase-histories whether the patient and her husband arerelated. The amount of inbreeding is of obvious perti.nence to their hypothesis. One test of the hypothesiswould be to compare the frequency of consanguineousmarriages contracted by women with chorionepitheliomaand women with other tumours, for example.
&agr;-HYDROXYBUTYRATE-DEHYDROGENASE
SIR,—The disproportionately high serum-K-hydroxy-butyrate-dehydrogenase (S.H.B.D.) activity of the faster-moving serum-lactate-dehydrogenase (S.L.D.) isoenzymes’ 1has recently been confirmed using the simple enzymestaining technique described below.
Sera are separated by electrophoresis on cellulose-acetatemembranes in barbitone buffer pH 8’6, using a constant currentof 0-5 mA per cm. for 11/4 hours. Following separation thecellulose acetate is divided longitudinallv and one half strip is
stained for lactate-
dehydrogenase(L.D.) activity usingthe technique ofBarnett.2 The re-
maining half-stripis simultaneouslystained for x-hy-droxybutyrate-de-hydrogenase (H.B,D.)activity. For this a2 M solution ofK-hydroxybutyraK(Aldrich ChemicalCompany), adjustedto pH 7, replaces the1 M lactate solutionused for L.D. stain-ing.
Using this tech-nique, the higherorder of H.B.D. acti-vity of the faster-
moving S.L.D. iso-
enzymes is clearlyshown.
1. Rosalki, S. B., Wilkinson, J. H. Nature, Lond. 1960, 188, 1110.2. Barnett, H. Lancet, 1962, ii, 199.
