246

statistician. The above figures of 2 deaths out of 769 wouldI feel compare favourably with any method.

In the series reported the cases were undoubtedlyselected, and it would be unwise to adhere rigidly to anyform of anæsthetic in old people. The alternative usedwas not, as stated by Mr. Burn, a variation of the heavysedation method, since the pethidine was given intra-

muscularly and not intravenously.Enough cataract operations have now been done under

general anæsthesia to establish that this method is a satis-factory one.

J. GIBSON MOOREJ. L. ANDERSON.

Edgware General Hospital,Edgware, Middlesex.

SURGERY OF ROAD ACCIDENTS

ROBERT HOWARD.

SiR,ńIn reply to the letter of July 14 by Mr. Londonand the organisers of the accident symposium of the Col-lege of General Practitioners, they unfortunately mistookthe point I wished to make-the lack of field knowledgeof accidents by the " accident experts ", not their lack ofinterest. This lack of knowledge is exemplified inthe quality of ambulance transport, using commerciallorry chassis.

I am glad to say that, owing to the progressive policyof the Hampshire county medical officer of health, Dr. I. A.McDougall, Hampshire Ambulance Service will have inoperation in a few weeks the first really comfortableshock-reducing transport in England. I hope that theorganisers of the Accident Service will insist on somesimilar type of vehicles as standard transport for theiracute cases, and in this way give practical expression totheir knowledge and interest in the treatment of casualtiesoutside hospital portals.

BACTERIAL OR VIRAL PNEUMONIA?

JOHN MACKAY-DICK.

SIR,-Because inflammation of the lung (i.e., pneu-monia) may be a manifestation of infection with the Eatonagent is surely no reason for a diagnosis of primaryatypical pneumonia being made. You are not alone indisliking that term.1 In the non-specific, and thereforeancillary, treatment of pulmonary opacities due to

inflammation of the lung, irrespective of whether they aresegmental, subsegmental, or of larger extent, the value ofaccurate radiography must never be underestimated asWing-Commander Robertson and Dr. Morle (July 7) sorightly emphasise.

Nevertheless no-one should be encouraged to make a

diagnosis on clinico-radiological grounds alone. We areindebted to Caughey and Dudgeon for a salutary lesson inthis respect. It is not denied that segmental pneumonias maybe the result of aspiration from the upper respiratory passages,but may they not also be the result of exceedingly tenaciousand adhesive bronchial secretion causing local areas of atelect-asis of varying extent and degree ? I believe that a better

descriptive term for pulmonary opacities than " aspirationsegmental pneumonia " would be segmental (or zonal)atelectasis due to adhesive bronchial pneumonia.3

That, of course, is essentially of academic interest and in noway detracts from the management of such cases as advocated

by Robertson and Morle or from the excellence and undoubtedvalue of their work on this subject. However, in my experienceof medicine in Egypt, the Sudan, Eritrea, Syria, Palestine,Belgium, Germany, Japan, and Malaya, as well as in the

1. Mackay-Dick, J. Brit. med. J. 1947, ii, 972.2. Caughey, J. E., Dudgeon, J. A. ibid. ii, 64.3. Mackay-Dick, J., Elliott, J. G., Jones, C. H. J. R. Army med. Cps,

1955, 101, 292.

United Kingdom, skilled laboratory investigations are not

infrequently necessary to establish a diagnosis and so avoidpneumotyphus, pneumotyphoid, &c., from being labelled" primary atypical pneumonia ".

Delhi House,Tidworth, Hants. JOHN MACKAY-DICK.

FATAL REACTION ASSOCIATED WITH TRANYL-CYPROMINE AND METHYLAMPHETAMINE

J. M. PARKERNORAH HILDEBRAND.

Research Laboratories,Charles E. Frosst & Co,

Montreal.

SIR,-We wish to comment on the suggestion of Dr,Dally (June 9) that patients suffering a hypertensive crisisfrom methylamphetamine given after monoamine-oxidaseinhibitors might respond to dibenamine.We have been very interested in the central effects of dibena.

mine and have shown that it will prevent overt signs of mesca-line intoxication in the cat. Dibenamine is also very effective inantagonising the excitement and rage produced in cats andrats after parachlorophenylethylamine. Parachlorophenylethyl-amine is a sympathomimetic amine with marked central activity.Cats in particular show a rage or fear reaction when given thisdrug. They growl and hiss and lash out at any object placednear them. The fear component is manifested by the fact thatanimals under the influence of this drug move back into a

corner preparatory to defending themselves. However, diben.amine was unable to block the lethal effects of parachloro.phenylethylamine after monoamine-oxidase inhibitors such asP-phenyl isopropyl hydrazine (JB-516) and iproniazid. Also,dibenamine did not prevent either amphetamine or JB-516arousal responses in reserpinised cats.

LOGIC AND HYPERTENSION

SIR,-It is indeed rash for an outsider to intervene inthe renewed debate about essential hypertension, but I ammoved to do so by the terminological obscurities that havecrept into the correspondence in its prose, if not into whatJohn McMichael might call its " semi-poetical " content.

George Pickering speaks of the odium scholasticumwhere I should have thought that the simple term

" con-

troversy " would have been more apt. After all, contro-

versy is prone to be a sharp rather than a blunt instru-ment, and produces its reactions accordingly. Possibly,scientific controversy is more muted now than in a morerobust age. In medicine, particularly, controversy aboutideas has become scarcely respectable. Can it be that weno longer think them sufficiently important to battleabout ? Certainly the only perennially attractive topic forcontroversy amongst us seems to be about remuneration,and in this another boom is on the way.However this may be, for the past century at least

controversy in science has been brisk, unsparing, and notsilent save in fields of knowledge in stagnation. This is

inevitable, for in advancing fields of knowledge an intel-lectual ferment infuses the workers, and intellectual pas-sions enter into all original scientific thought and work.Those who dislike the fact may be referred to that pene-trating and erudite study of the nature of scientific know-ledge, Prof. Michael Polanyi’s Gifford lectures, entitledPersonal Knowledge.Here they will discover that scientific progress has

never been a smooth, wholly objectively-determined pro-gress from truth to wider truth, from triumph to greatertriumph, but metaphorically speaking, a ding-dong battleabout facts and ideas in which heads have fallen, idolsbeen dethroned, and theories of the most respectable, evenof professorial, parentage have been exploded or sunkwithout trace. Only the fittest survive and the casualties