experiences d o n o t exist. I n t h e same patients w e c a n s e e that t he general adaptation syndrome (GAS) m a y n o t necessarily have Selye's three phases: a schizophrenic ma y have a deep bed- without showing a ny "alarm r e - action"; h is "adaptation" will consist of n o t reacting t o t h e stressor. "Ex- haustion" will, i n fact, become t h e defence o f t h e physically a n d mentally deteriorated organism. H e will survive i n conditions in which a indivi- dual will d i e of septicemia. T h e non- availability of iron ions or certain amino acids will make bacterial growth impossible, according t o Massawe, Muindi a n d Swai.3 Nonspecificity v . specificity: Selye states "These terms m ay be applied to both t h e eliciting agent a n d t h e r e - sponse." Should this b e valid only " i f t h e demand... i s . intense"? I f t h e d e - mand i s n ot intense will t h e reaction b e localized o r will stress n o t occur a t all? Does t h e local adaptation syndrome exist without G A S under normal condi- tions? I d o n ot think that t h e words "eu- stress" a n d "distress" a r e appropriate. They a r e used incorrectly when Selye states that eustress i s "agreeable or healthy" b u t distress is "disagreeable or pathogenic". Electroshock therapy m a y b e distressing b u t i t often improves health. Everybody will agree with t h e "conditioning o f stress" b u t does this mean that a stressor will n o t produce stress a t a n y time, a s Selye states? A t t h e meeting of t h e Canadian S o - ciety on Gerontology held in Toronto Oct. 2 2 t o 24 , 1975 I gave a paper "Senile psychosis a n d stress", i n which I discussed t h e localized reaction t o t h e pathogen i n patients with organic brain syndrome.4 W m a y s e e very frequently that never- theless t h e patient's reaction to t h e patho- g e n w a s inappropriate - i n terms o f "non psychogeriatric" medicine - t h e healing i s normal a n d those patients ma y show a very high biological resistance. T h e stress m a y involve a localized area o f th e damaged tissue or of the affected organ and humoral changes c a n perhaps more effectively take place precisely b e - cause o f t h e diminished neocortical i n - hibition. A s a clinician I ca n hardly agree with t h e differentiation between "di- rect" a n d "indirect" pathogens. There i s n o doubt that the decisive factor i n getting sick i s t h e presence o f a sensi- tive receptor. T h e worst cholera o r smallpox epidemics have h a d their survivors. Therefore i t i s difficult t o accept Selye's statement that "mech- anical trauma, intense heat a n d strong acids o r alkalis will cause tissue damage irrespective o f t h e body's response Selye states that "diseases o f adapta- tion depend primarily upon a n exces- sive o r inappropriate response t o i n - direct pathogens" b ut what will happen if there is no response at all? M an dies more often from fear a n d panic when h e h a s a myocardial infarction (MI) from myocardial necrosis.5 I f w e could prevent ventricular fibrillation only a f e w would d i e o f M I . Does this mean that a schizophrenic w h o does n o t react to a n acute MI h a s t h e a p - propriate reaction? Certainly not. What does mean b y "W e a r e n o t y e t perfect"? A re ants perfect because they a r e in excellent shape after having existed perhaps 1 0 times longer than man? A re mosquitoes n o w perfect b e - cause of their acquired resistance t o chiorophenothane (DDT)? T he statement b y Selye that "gluco- corticoids... suppress many of t h e usually helpful, defensive, inflammatory o r immunologic reactions" shows clear- l y h o w tricky a n d dangerous t h e classi- fication into syntoxic a n d catatoxic agents c a n b e . Glucocorticoids, i f given i n excessive doses o r for an excessive period, produce side effects i n t h e same w a y a s digitalis o r barbiturates. T h e danger in applying concepts with seemingly general a n d definite validity i s that problems m a y b oversimplified a n d appear t o b e solved y being labelled with a word. Lectures about stress induce "eustress", which i s cer- tainly "agreeable" b ut m a y n o t neces- sarily b e "healthy". S . HONTELA, MD Psychogeriatric service Douglas Hospital Montreal, P Q References 1. DARWIN C H: T he Descent o f M a n a nd Selec- tion in Relation t o Sex, London, John Mur- ray, 1871 2 . CANNON W B : Bodily Changes i n Pain, Fear, Hunger a n d Rage, 2 n d e d , repr o f 1929 e d , Washington, McGrath, 1970 3 . MAsst.wa AU, MuINDI J M, SwAl GBR: Iron a n d resistance to infection. Lancet 2 : 314, 1974 4 . HONTELA 5 : Senile psychosis a n d stress, in Proceedings of the 2nd General Biennial Meeting of the Canadian Society o f Geron- tology, Toronto, Oct. 22.24, 1975, p 5 . ANDRUs EC : Emotional factors a n d cardiac function. Biol Psychiatry 1 0: 581, 1975 To t h e editor: 1 a m glad t o have t h e opportunity of seei g D r . Hontela's letter. However, there i s n o point i n discussing h i s innumerable questions in a letter, a s every detail i s dealt with a t length in t h e 2 n d edition o f m y book "The Stress of Life". Interested readers o f t h e Journal will find readily acces- sible, although brief, discussions o f t h e same subjects i n t h e March a n d June 1975 issues o f t h e Journal o f Human Stress - o n e article b y myself, a n d t h e other b y John W. Mason o f Walter Reed Medical Center, Washington. HANS SELYE, C C, M D , PH D , D SC University o f Montreal Montreal, PQ Premature labour To t h e editor: D r . K.S. K o h reviewed t h e role of uterine relaxant drugs i n t h e control premature labour (Can M e d Assoc J 114: 700, 1976) b u t failed to mention that nylidrin hydrochloride i s t h e most effective ft-sympathomimetic drug according t o a controlled, double- blind comparison o f placebo, ethanol, isoxsuprine a n d nylidrin i n t h e treat- ment of 1 9 4 pregnant women in Hel- sinki's University Hospital.1 T h e rela- tive successes o f t h e four treatments a r e summarized i n Fig. 1 . Nylidrin w a s p1005 -. N S - . . -NI-----, RAIE% R. PLAcEDO EThAWL B.JPRINE NYLIORIN FIG. 1-Success rates o f four agents used t o treat premature labour. t h e only form o f treatment significantly superior t o placebo. Otherwise Koh's article w a s excellent. PIERRE BIRON, MD Department o f pharmacology University o f Montreal Montreal, PQ Reference 1 . CASTR.N 0 , GUMMERUS M, SAAiuKosKI 5 : Treatment o f imminent premature labour. Acta Obstet Gynecol Scand 54: 9 5, 1975 To t h e editor: I thank D r . Biron f o r pointing o u t t h e omission of nylidrin a s a uterine relaxant drug in m y review article o n premature labour a n d f or drawing m y .attention t o this valuable drug. However, n e w knowledge is a c - cumulating with such speed that a n y review o f a subject must be read with a retrospective glance to t h e time i t w a s written, rather than when i t w a s pub- lished. T h e time interval between t h e submission a n d publication o f m y paper w a s slightly more than 1 year. K.S. KOH, MD Health Sciences Centre 7 0 0 William Ave. Winnipeg, MB Designing doctor shows restraint To t h e editor: F o r m y o wn safety I have designed a n d constructed a prac- tical automotive passive restraint. Like many people I forget t o fasten my seat belt and t h e seat belt buzzer conked o u t long ago. While t h e seat belt r e - quires active fastening, m y passive restraint i s always there. I wanted something that would b e simple, effective a n d inexpensive. I t h a s 7 18 CMA JOURNAL/OCTOBER 2 3, 1976/VOL. 115