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Preference is given to letters commenting on contributions published recently in the JRSM. They should not exceed 300 words and should be typed double spaced
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treating upper respiratory tract infections, particularly in children. Perhaps Stevens had a point after all? E Ernst Complementary Medicine, Peninsula Medical School, Exeter, UK
Stevens’ cure for tuberculosis
I was fascinated by Dr Newsom’s account of Stevens’ cure (September 2002 JRSM1). In 1927 my father was apparently close to death in Talgarth TB sanatorium, South Wales, with severe bilateral lung disease and multiple haemoptyses. He was considered too ill for the thoracoplasty operation fashionable at the time. His father, himself dying of TB, had advised him on his deathbed to try Stevens’ cure and at this stage of his illness he did. His recovery started from that date. He never had another haemoptysis and within 3–4 years was able to obtain life insurance and marry. The medical examiner was said to have flung down his stethoscope in amazement, declaring ‘no sign of disease at all’. My father continued to take the umckaloabo root on and off for years but never had another attack. The distinctive pungent odour of what seemed to be an infusion would often fill the house and signal that Dad was not feeling too good for some reason. He worked as a chemistry teacher till he was 65 with never a day ‘off sick’ and died of heart failure at 77. When I went to Oxford to read medicine in 1958 I was found, to my surprise, to be Mantoux-test negative. My father, who possessed a lot of newspaper articles and one of the books on Stevens’ cure, thought the BMA had been very unfair to Stevens (a non-medic) and very unscientific in their approach to a much needed avenue of possible TB research. Perhaps today, with the widespread resistance to TB drugs, the root should be properly evaluated. Mary Lynette Moss Amberwood, 66 Roman Road, Basingstoke RG 23 8HA, UK E-mail:
[email protected]
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1 Newsom SWB. Stevens’ cure: a secret remedy. J R Soc Med 2002;95:463–7
Dr Newsom (September 2002 JRSM1) states that he found 266 items relating to umckaloabo on the Internet. Searches in medical databases yield more information on this herbal medicine, and go some way towards answering his question, ‘did the cure work?’. Since Stevens’ days, several clinical trials of this remedy (which has been commercially available in Germany for about 50 years) have been published2–5. Most of these studies are methodologically weak and therefore inconclusive. Yet their results collectively imply that umckaloabo is effective and probably safe in
E-mail:
[email protected]
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1 Newsom SWB. Stevens’ cure: a secret remedy. J R Soc Med 2002;95:463–7 2 Heil C, Reitermann U. Atemwegs-und HNO-Infektionen. Therapeutische Erfahrungen mit dem Phytotherapeutikum Umckaloabo1. Therapiewoche Pa¨diatrie 1994;7:523–5 3 Ko¨nig I. Naturnahe atemswegstherapie. Van der Umckaloabo-Droge zur Therapie von Atemwegsinfekten. Therapiewoche 1995;45:1123–4 4 Haidvogl M, Schuster R, Heger M. Akute Bronchitis im KindesalterMultizenter-Studie zur Wirkamseit und Verglichkeit des Phytotherapeutikums Umckaloabo. Z Phytother 1996;17:300–13 5 Dome L, Schuster R. Umckaloabo—eine phytotherapeutische Alternative bei akuter Bronchitis im Kindesalter? Arztezeitschrift Naturheilverfahren 1996;37:216–22
Dr Newsom (September 2002 JRSM1) refers to the BMA’s Secret Remedies and More Secret Remedies, published in 1909 and 1912, but not to a reply, The Shameless Analysis of Secret Remedies by the British Medical Association’ analysed and exposed by WH Box, 161 King Street, Plymouth (price twopence). Box had earlier attacked the medical profession’s stance on patent medicines in a work entitled The Famous Bird That Speaks one Word (quack): in this he castigated Dr Walsh, editor of the Medical Press (London) in the language of the Old Testament and proposed an interesting and early clinical trial:
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‘Bring together in the London Hospitals the 22,500 Rheumatic cripples, warped and bent with the force of the disease, and divide them between you and myself, and I will undertake to cure 20 to your 1 or you shall take my head off at the close of the test. And if you fail to cure 1 to my 20, your heads shall come off. You shall take my head off if I fail, and I will take your heads off if you fail.’ Box extended his offer to 40 000 cancer cases, 70 000 consumptives and 30 000 blind—displaying an excellent grasp of the need for large samples. The date of Box’s book is not known to me, but it must be 1914 or later because it records that in that year his Pills and Golden Fire won gold medals at the Paris Exhibition. R L Maynard Department of Health, Skipton House, 80 London Road, London SE1 6LH, UK E-mail:
[email protected]
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1 Newsom SWB. Stevens’ cure: a secret remedy. J R Soc Med 2002;95: 463–7
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Feral children
In his excellent and feeling editorial (September 2002 JRSM1) Dr Chambers stresses the need to establish causes for ‘feral behaviour’ in children and mentions attention deficit and hyperactivity disorder. Treatment of this condition can be life-changing both to the patient and to his/her family and wider environment. Moreover, the behaviour patterns can persist into adult life. Some years ago I had a patient in his 50s with a history of violence persisting through childhood into adult life resulting in numerous prison sentences for grievous bodily harm. After treatment with methylphenidate he became socially tractable and reported a state of mental calm replacing the ‘Piccadilly Circus’ which had formally been his usual mental experience. Over the past 5 years I have seen numerous cases of attention deficit and hyperactivity disorder in adults that had been undiagnosed through childhood. I suspect that many offenders now in custody have this syndrome and that a vast social service could be performed by diagnosing and treating these individuals. K D Phillips 10 Harley Street, London W1N 1AA, UK E-mail:
[email protected]
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the case. This, in my view, was an unreasonable delay. The date fixed was 26 February 2001. At this meeting it was agreed that junior counsel would make a further abstract of certain parts of the notes. By the middle of April this had not taken place. I therefore made the necessary abstraction and sent this to the solicitors on 25 April. In August I was asked to attend a video conference which took place at the end of the month. At this I pointed out to the solicitors that they had already lost one of their medical experts through death and if the case continued to drag on they ran a real risk of losing another. I was assured that I looked healthy (nice to know). On 29 September I requested that my fees, now long overdue, be paid, and again on 10 December; payment was finally received on 17 December. I was then asked to provide a further statement in accordance with the new Civil Procedures Rule and it was suggested that a local solicitor should visit me to help with this new assignment. The meeting took place on 26 February this year and the statement was posted on 25 March. Since then there has been no obvious progress. This case has now dragged on for two years and nine months since I was first approached and the delays have all been on the part of the complainant’s legal team or the defence. J M Walshe
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58 High Street, Hemingford Grey, Huntingdon PE28 9BN, UK
1 Chambers TL. Feral children. J R Soc Med 2002;95:429–30
E-mail:
[email protected]
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Expert witnesses, courts and the law
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Dame Elizabeth Butler-Sloss and Ananda Hall (September 2002 JRSM 1) blame medical expert witnesses for delays in reaching a settlement. They state ‘Medical experts must get their reports out in time . . .’. I fully agree that the time taken for complainants to get a satisfactory settlement is unacceptable, but to blame the medical professional alone is hardly fair. Let me narrate a recent, and ongoing, experience. In November 1999 the parents of patient A approached their solicitors to lodge a complaint against their doctor on behalf of their son, who they said had been negligently treated. The solicitors approached a consultant paediatrician to see if he would act on their behalf. Having considered the relevant documents he suggested an alternative expert witness. On 28 December of the same year I was asked to act. I agreed to review the documents and write a report together with my opinion on the viability of the claim, replying on 5 January 2000. On 9 February I received a pile of photocopied notes 9 cm thick, in some chaos and not all legible. I sent my report on 25 February—hardly an unreasonable delay. On 7 April I examined the patient and sent my report on 11 April. On 18 December I was asked to agree a date for a conference with Counsel to consider
1 Butler-Sloss E, Hall A. Expert witnesses, courts and the law. J R Soc Med 2002;95:431–4
Mendel—both ignored and forgotten
Contesting the notion that Mendel’s work languished unread for thirty-four years, Dr Ross Kessel (September 2002 JRSM1) writes of a dozen references to it in the scientific literature between first publication and ‘rediscovery’. It seems necessary to detail the twelve references to Mendel’s paper2 between 1866 and 1900. They are given in Orel’s biography of Gregor Mendel3 of 1996, and included slight mentions in the German botanical journal Flora in 1866, 1867 and 1872, and the Proceedings of the Viennese Academy of Science in 1871 and 1879. The paper was mentioned in the thesis of C A Blomberg for Stockholm University in 1872, and in the thesis of I F Schmalhausen for St Petersburg University in 1874. It was listed in the Royal Society’s Catalogue of Scientific papers (1864–1873) issued in 1879;4:338. There was a more substantial reference to Mendel in a book4 by Hermann Hoffmann in 1869 on the determination of species and varieties, written to refute Darwin’s theory of evolution. There was mention of Mendel’s pea
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experiments in the book5 of 1881 by W O Focke, which was then cited in two books6,7 by L H Bailey in 1892 and 1894. And G J Romanes included Mendel’s name, which he had found in Focke’s book, in a list of hybridists in the section on ‘Hybridism’ in the Encyclopaedia Britannica8 of 1881–1895. All this is hardly a reason for refuting that Mendel’s work was both ignored and forgotten for 34 years until its importance was recognized by William Bateson in his paper9 published in 1901. Milo Keynes 3 Brunswick Walk, Cambridge CB5 8DH, UK
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1 Kessel R. Mendel—forgotten or ignored? J R Soc Med 2002;95:474 2 Mendel G. Versuche u¨ber Pflanzen-Hybriden. Verhandl d Naturfsch Ver in Bru¨nn 1866;4:3–47 3 Orel V. Gregor Mendel—the First Geneticist. Oxford: Oxford University Press, 1996 4 Hoffmann H. Untersuchungen zur Bestimmung des Werthes von Species und Varieta¨t: ein Beitrag zur Kritik der Darwinschen Hypothese. Giessen: J Richter, 1869 5 Focke WO. Die Pflanzen-Mischlinge. Ein Beitrag zur Biologie der Gewa¨chse. Berlin: Gebru¨der Borntra¨ger, 1881 6 Bailey LH. Cross-breeding and hybridizing. In: The Rural Library Series, Vol. 1. New York: Rural Publishing, 1892:1–44 7 Bailey LH. Plant Breeding. New York: Macmillan, 1895 8 Romanes GJ. Hybridism. In Encyclopaedia Britannica, Vol. 12, 9th edn. London: Encyclopaedia Britannica, 1881–1895:422–6 9 Bateson W. Problems of heredity as a subject for horticultural investigation. J R Hort Soc 1901;25:54–61
The real Dr Frankenstein: Christian Gottlieb Kratzenstein?
Christopher Goulding (May 2002 JRSM 1) explores inspirations for Mary Shelley’s creation Victor Frankenstein including scientific influences and a model, James Lind FRS. Several other contemporary investigators might have strongly influenced her development of the moral/spiritual issues and scientific basis for the book, and acted as a source for Frankenstein. For some three or four decades before the novel, study of ‘vital animation’ had been ongoing in nearby Germany, Italy and Switzerland, and these new concepts on the nature of neuromuscular function began permeating the teaching curricula of medical schools2. In 1752, Albrecht Haller of Switzerland, in particular, propagated his theory of muscle ‘irritability’ and nerve ‘sensibility’, at odds with Glisson’s idea that the soul was the generator of voluntary movements. Haller’s ‘irritability’ was the property by which a part of the human body3 ‘. . . becomes shorter on being touched . . . [while] that sensible part of the human body, which on being touched transmits the impression of it to the soul; and in brutes, the existence of a soul is not so clear, I call those parts sensible, the irritation of which occasions evident signs of pain and disquiet in the animal’.
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(Are there not echoes here of the animation of Frankenstein’s inanimate brute evoking the concept of the reconstituted human without a soul?) In 1762, Haller’s magnum opus4 was published in Lausanne, across the lake from the Villa Diodati and ‘the house of Frankenstein’ at Belrive. In contrast, Georg Stahl, a ‘vitalist’, claimed that only the ‘anima’ could regulate bodily activity2 at death. Curiously enough, this vitalistic approach was linked neither to God nor to any religious doctrine. As Brazier notes, ‘hovering between mind and brain is the ghost of the soul . . . less confusing for English speakers for they have a noun for ‘‘mind’’, as distinct from ‘‘soul’’ or ‘‘spirit’’. The French do not (which raises problems concerning Descartes’ intended meanings)2’. Here again are the echoes of Mary Shelley’s moral dilemma: was there a soul or a spirit in the monster? There clearly was a mind. Johann Unzer, in Hamburg, divided neuromuscular activity into voluntary, involuntary and unconscious types. Unzer believed that even headless animals remained alive in that they continued to have ‘animal spirits’ within their nerves. To illustrate the ‘unconscious’ as occurring in animals without a brain or soul, he used decapitated frogs to show that nerve stimulation alone could induce movement. All these investigators, however, failed to conceive of the possibility of electricity being the inciting element in tissue irritability, until Caldani, the anatomist, provided electricity from a frictional electrostatic machine to stimulate muscles in sheep and frogs: ‘An electrified rod was brought within one, two or three inches . . . and we always saw the muscles of the lower extremity make a movement . . . without a spark being evoked5’. Early in the 18th century, frictional machines were used to produce sparks and static electricity, much to the entertainment of the leisured classes. The recently invented Leyden jar enabled a sudden electrical discharge to pass to tissues under experiment which then led to the use of this tool in electrophysiological experiments. As Musschenbroek relates: ‘I want to tell you of a new but terrible experiment which I advise you never to attempt yourself . . . the arm and the whole body was affected in so terrible a manner that I cannot express: in a word I thought it was the end of me’6. The power of this new electricity used alone was soon amply illustrated by Nollet who lined up a chain of men two miles long, causing them to jump when touching the poles of a Leyden jar2. At age 34, Nollet travelled to England and was elected to the Royal Society. His lectures on electricite´ foudroyante led to speculation that electricity could vitalize a paralysed human7. One such patient reported a ‘tingling in his arms that he had not felt for many years’. Nollet subsequently suspended a naked and partly paralysed patient in a swing, insulated by silk ropes suspended from the
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ceiling. Iron wire wrapped around the body was connected to a frictional machine, producing sparks to an iron bar near the paralysed limb2. Foreshadowing the reanimation evoked in ‘Frankenstein’, Galvani in Italy progressed from working with ‘artifical electricity’ to using ‘atmospheric electricity’— lightning during a thunderstorm8—to stimulate contraction in the legs of a living frog. Galvani’s nephew Aldani would stand by the guillotine, and take freshly decapitated heads of criminals, pass a current through the mouth and ear or exposed brain and mouth, evoking facial grimaces, thus simulating a return to life2. We can now more clearly see the similarity to Mary Shelley’s Frankenstein in these attempts to animate paralysed limbs by means of static electricity in a patient suspended from the ceiling, and in Galvani’s harnessing of electricity from the heavens during a lightning storm to reanimate dead muscles. As recalled by Mary in the 1831 edition of Frankenstein, ‘perhaps a corpse could be reanimated, galvanism had given token of such things. Perhaps the component parts of a creature could be manufactured . . . and endued with vital warmth’. But out of the shadows of Kru¨ger, an investigator of the late 18th century, stepped his pupil, a highly vocal prosyletizer of electrotherapy. Using frictional electricity, he induced movement in paralysed fingers, and even induced ‘electro-sleep’ in humans. The name of this disciple
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of electrical reanimation was . . . Kratzenstein9. The three elements are finally in place—the dilemma of the soul present in, or absent from, the brain–body construct; the harnessing of God’s electrical storm to ressurrect the dead; and a ‘Dr Kratzenstein’, a spectral pupil who demonstrates electrotherapy and reanimation. Peter W Kaplan Chemin de Marly, Bellerive (Belrive)/Geneva 1245, Switzerland
REFERENCES
1 Goulding C. The real Doctor Frankenstein? J R Soc Med 2002;95:257–9 2 Brazier MAB. A History of Neurophysiology in the 17th and 18th Centuries. New York: Raven, 1984 3 Haller A. De partibus corporis humani sensibilibus et irritabilibus. In: Commentarii Societatis Regiae Scientium Gottingensis 1753;2:114–58 (translated into French by A Tissot, 1754, and into English anonymously, London: Nourse 1755) 4 Haller A. Elementa Physiologiae Corporis Humani. Hemmerde Vols 1–5. Lausanne: Bousquet, 1757–63 5 Caldani LM. Letter to Haller, 1756. In: Haller A. Me´moires sur les parties sensibles et irritables du corps animal, Vol 3. Lausanne, 1760:143–4 6 Nollet JA. Essai sur L’Electricite´ du Corps. Paris: Gue´rin, 1746 7 Nollet JA. Expe´riences de l’e´lectricite´applique´e a` des paralytiques. Me´m Acad Sci 1749;11:28 8 Galvani L. Aloysii Galvani de viribus electricitatis in motu musculari. De Bononiensi Scientiarum et Artium Instituto atque Academia 1791;7:363–418 9 Kratzenstein CG. Abhandlung dem Nutzen der Electricita¨t in der Arzneywissenshaft. Halle: Hemmerde, 1744
Arts and craft design for the Belgrave Hospital for Children Charles Holden was aged 25 when he won his first important commission, the design of the Belgrave Hospital for Children (1900– 1903), near Kennington Oval in south London. A feature favoured by followers of the Arts and Craft movement was attention to detail, manifested here in the prominence of the name of the hospital cut out in huge stone lettering high above the gold mosaic arch at the entrance. A century later, because the name was designed as an integral part of the frontage of the distinguished building, its original purpose remains plain for all to see, despite the fact that the building was converted some years ago from a hospital for children to apartments providing private residential accommodation.
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