532

to learn from. A doctor who had been many years in Sarawaksaid: " You see everything here."As regards posts in this country afterwards, one of the

advantages of such a short appointment is that one canmake some tentative arrangements beforehand. SinceI returned the only interviewing committee I have metfound it, as the chairman put it,

" unusual ", but certainlyof interest. Such short-term appointments must surelybecome more and more widespread, as the new Common-wealth Development Plan proposals indicate.

Professor Hill and Mr. Zealey remark on the success ofVoluntary Service Overseas. The very first V.S.O.volunteers on the pilot scheme went out to Sarawak, andindeed the concept of V.S.O. sprang largely from a visitto Sarawak by the founders of that scheme-the Dicksons.1Sarawak’s latest venture deserves similar success.

JOHN G. CRUIKSHANK.Royal Infirmary,Edinburgh.

PSYCHOSOMATIC MEDICINE AND THE

BRAIN-MIND RELATIONSHIP

JOHN APLEY.

SIR,-" That subtile knot, which makes us man"rounds off delightfully a paper (Aug. 15) which was apleasure to read. Of course, Lord Brain will not havemissed the significance of those earlier lines from TheExtasie where Donne writes (of bodies):

" They are ours, though they are not wee, Wee areThe intelligences, they the spheare."

John Donne may have been in love, but here his error wasnot due to faulty temporal-lobe control of the hypothalamicmating centre.

In an age when psychological curiosity daringly beganto probe not only love but religion, the metaphysical poetsdid not do badly. But they believed that psyche and somawere separate parts of the individual. With much less

excuse, some of our contemporaries, even in medicine,cling to the same belief. Witness the doctor’s letter,handed to me by the mother of " a little belly-acher ",which ended " Kindly examine the soma and leave thepsyche to me ". The dichotomy is now philosophicallyoutmoded. It is also clinically unsound, and, on evidencewhich this erudite paper skilfully marshals, physiologicallyand anatomically indefensible.

Unfortunately the artificial separation of body and mindis perpetuated when, for want of a better, we use the word" psychosomatic ". Could we not replace it ?RnstnL 7 JOHN APLEY.

INTRAVENOUS GLUCOSE TOLERANCE IN OBESE

ADOLESCENTS

MANUEL LUIS MARTÍFÉLIX ERNESTO PUCHULU.

Universidad de Buenos Aires,Facultad de Ciencias Medicas,

Hospital de Clinicas.

SIR, The importance of genetic predisposition to

diabetes seems to have been forgotten in the paper byDr. Vajda et al. 2

German and Lieberman,3 studying the glucose-tolerancetest after cortisone administration in obese and non-obese

men, found no difference between obese and non-obese

groups without genetic predisposition to diabetes, andbelieved that obesity per se could not be regarded as aprediabetic state.

Dr. Vajda’s report, though very interesting, does notclarify the relation between obesity and diabetes, or theproblem of carbohydrate metabolism in obese patientswithout genetic predisposition to diabetes. Some obese

1. Dickson, M. A Season in Sarawak. London, 1962.2. Vajda, B., Heald, F. P., Mayer, J. Lancet, 1964, i, 902.3. German, J. L., Lieberman, J. E. Diabetes, 1958, 7, 261

adolescents may be genetically predisposed to this disease.

HYPERALDOLASÆMIA IN TRICHINOSIS

K. RACHOŃJ. JANUSZKIEWICZH. WEHR.

1st Infectious Diseases Clinicof The Medical School,

Warsaw, Poland.

biR,ňIn a previous communication the increasedactivity of some serum-enzymes (serum-glutamic-oxalo-acetic-transaminase , serum-glutamic-pyruvic-transaminase [S.G.P.T.], and aldolase) in trichinosis wasreported.

Recent investigations 2 3 show that variations in aldolaseactivity against its two substrates, fructose-1-phosphate (F.-l-p.),and fructose-1,6-diphosphate (F.-1,6-p.) depend on their tissueorigin-e.g., liver aldolase is much more active against F.-1-p.as compared with muscle enzyme.To determine the tissue origin of the serum-aldolase activity

in trichinosis we investigated the F.-1.6-P./F.-1-P. aldolaseactivity ratio in this disease. We found that the mean ratio was22-2 (sixteen determinations) as against 3-2 (ten determinations)in normal subjects and 3-5 (ten determinations) in patients withhepatitis.These results point to the muscular origin of hyper-

aldolasasmia in trichinosis.

ELECTROCARDIOGRAM IN IDIOPATHICRESPIRATORY DISTRESS SYNDROME OF

NEWBORN

SIR,-Left ventricular preponderance has been reportedin the electrocardiographic tracings of the more severeinstances of the idiopathic respiratory distress syndromeof the newborn. 4 p-wave changes such as broadening and

flattening or absence of the wave havebeen related to the potassium level.5We wish to draw attention to an electro-

cardiographic pattern, which we believeto be of value in this syndrome.

Electrocardiographic tracings were rou-tinely done on infants admitted to a specialunit for the intensive investigation andtreatment of this syndrome. In reviewing,emphasis was placed on the width and thecontour of the P wave and the length ofthe P-R segment in the right precordialleads.

Preliminary studies indicate that, whenthe P wave was interpreted with due regardto the concomitant QRS, a specific patternwas found, which correlated closely withthe clinical severity at the time and hadsome bearing on the prognosis.

In those mildly involved, the presence ofright ventricular preponderance, previouslyreported,4 was confirmed. In the presentseries, the mildly involved group in additionshowed the P wave to be either notched or

peaked in V and V2. In the moderatelyand severely involved infants, in additionto the reported left ventricular preponder-ance 4 the P wave was found to behave ina definite manner. In infants only moder-ately involved, the P wave was invariably

Examples of patterns discussed.

(a) Peaked p in Vl and V20 (b) Biphasic p in Vi, peaked p in V2.(c) Biphasic p in Vi> notched P in V2. (d) Notched p in Vl and V2.Note short PR segment.1. Malik, A., Niewiarowski, S., Rachon, K. Lancet, 1960, ii, 439.2. Rutter, W. J., Richards, O. C., Woodfin, B. M. J. biol. Chem. 1961,

236, 3193.3. Schapira, F. Bull. Soc. Chim. Biol. 1961, 43, 1357.4. Keith, J. D., Rose, V., Braudo, M., Rowe, R. D. J. Pediat. 1961, 59, 167.5. Usher, R. Pediatrics, 1959, 24, 562.