Poliomyelitis Hypothesis

818

2 October 1965

MEICAL JOURNAL

Correspondence
Medical Education and Medical Practice

Letters to the Editor should not exceed 500 words.
Multiple Sclerosis and Poliomyelitis
SIR,-We were very interested in Dr. E. D. Acheson 's suggestion (10 July, p. 107) of a method which would test the Poskanzer hypothesis ' that multiple sclerosis with clinical poliomyelitis represents the occasional neurological manifestation of a widespread subclinical enteric infection. Dr. Acheson believes: " In order to demonstrate that the epidemiology of poliomyelitis and multiple sclerosis in Australasia are consistent with Poskanzer 's hypothesis it is necessary to show that where multiple sclerosis is thought to be rare (Queensland and Western
1471) employs an unsuitable correlate. We could accept his view if our intention had been what Dr. Acheson seems to imply it was-to test the Poskanzer hypothesis by the approach he advocates. But we had merely intended to see if there was a relation between the geographical distributions of multiple SIR,-May I comment on Sir Robert sclerosis and poliomyelitis in parts of Platt 's sad and wise "Thoughts on TeachAustralasia, as it was on the basis of such a ing Medicine" (4 September, p. 551), on relation throughout the world that Poskanzer the Bradshaw Lecture by Dr. Alastair Hunter based his hypothesis, though he did not (p. 552) in the same issue, and on Professor publish his data. Thus our study was in- L. J. Witts 's characteristic reaction to Sir tended merely to supply one of the pre- Robert 's thoughts (18 September, p. 699) ? requisites to the Poskanzer hypothesis, using Both latter utterances unwittingly illustrate data perhaps not readily available outside Sir Robert 's quotation from an Observer Australia, not to test the validity of the article, which, in effect, is his theme. This hypothesis itself ; and in these circumstances article deplores the virtual exclusion from we feel the method we employed was not academic institutions of studies, now 70 years inappropriate.-We are, etc., old, of " the workings of the unconscious mind "-that is, the growing
SIR,-I read with interest Professor and showing evidence of one of these condi- During all Sir Francis 's immensely influT. N. A. Jeffcoate 's lecture on amenorrhoea tions exemplifies the type of case in which ential active work in medical education, in (14 August, p. 383). I should like to com- time does not work on her side. In my own the battles I had with him, he would only ment upon one aspect. relatively long series of cases I have found concede the need for the study of man as an When dealing with the Stein-Leventhal that the great majority show progressive organism or a " statistic," and saw the future syndrome-a subject which I have been atrophic change in the uterus and endo- of medicine as measurement of " hard data." interested in for many years ' 2-Jeffcoate metrium and that the functional outlook Dr. Hunter, in more guarded terms, expresses says that, " treatment of this condition is becomes progressively poorer as these changes the same caution and doubt about " what to generally accepted as being by resection of a become more established. My own practice teach" (p. 555). I read him as saying, in wedge from each of the polycystic ovaries." has always been to allow for at least one year effect, how dangerous it is to let students With this, of course, I