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CHILDREN'S ACCIDENT UNITS
1223
forms is the most important piece of evidence for there being two genetically determined cell clones. I found appearances, like the ones shown by Papayannopoulou and Stamatoyannopoulos, in heterozygous carriers of the autosomal inherited, enzymopenic methaemoglobinaemia. From this I have concluded that there do not exist two cell populations but a great variability within the distribution of the remaining enzyme activity. This variability can very well be linked to the cell age. The same conclusion ought to be drawn from the authors’ neures for males with mild G.-6-P.D. deficiencv. Department of Pediatrics, University of Berne, Switzerland.
O. TÖNZ.
GLUCOSE-6-PHOSPHATE DEHYDROGENASE AND ERYTHROCYTES IN THYROTOXICOSIS
SIR,-Dr. Baikie and Norma Lawson (Jan. 9) attempt relate the reduction of osmotic fragility of the erythrocytes of some thyrotoxic patients to elevated activity of the enzyme glucose-6-phosphate dehydrogenase (G.-6-P.D.) in the erythrocytes. I wish to suggest the stabilising effect of reduced glutathione (G.S.H.) on erythrocytes. In cases of G.-6-P.D. deficiency, to
Hexose-monophosphate shunt. N.A.D.p.=mcotinamide-adenine dinucleotide phosphate N.A.D.P. 2H+=reduced N.A.D.P. G.S.S.G.=oxidised G.S.H.
(T.P.N.).
G.S.H. concentration in the erythrocytes is below the normal level and thought to be the cause of the increased haemolysis in such patients. If the G.-6-P.D. activity in the erythrocytes of thyrotoxic patients is high then G.S.H. concentration is also high, and in consequence the erythrocytes would be more stable. The correlation between a high level of G.S.H. and high G.-6-P.D. activity is explained by enhanced metabolism of glucose through the hexose-monophosphate shunt (see accomoanving figure).
Department of Hæmatology, Hadassah Medical School, Jerusalem, Israel.
have the necessary knowledge and experience, which are unlikely to be possessed to the same degree by the staff of a large accident centre-for emergencies among children necessarily constitute only a small part of their work. The children’s accident unit should therefore be closely linked to the children’s hospital or department, so that the full range of paediatric facilities is available.
is being designed, it is not enough merely to provide a separate entrance for children: all the accommodation used by 1.
a new
Department of Child Health, University of Aberdeen.
R. G. MITCHELL.
PHENYLTHIOCARBAMIDE-TASTING IN THE MENTALLY IMMATURE
SIR,-We observed among children under eight years of age a significant excess of non-tasters for phenylthiocarbamide (P.T.C.) over the proportion found in older persons, and we have investigated the possibility that this might be characteristic of mentally immature individuals. the method of Harris and Kalmus2 as modified by tested the responses to P.T.C. in 118 mentally retarded patients at the Waimanalo Home in Honolulu, and in a random sample of 80 students at the University of Hawaii. Of the 118 patients 20 (17%) refused to cooperate and 19 (16%) refused to complete the test. Among the remaining 79 patients, 6 (5% of the total) gave unclassifiable responses, 26 (22%) were able to describe their reactions, and 47 (40%) had to be classified from their facial responses. 34% of the classifiable patients were non-tasters-significantly higher than the 18% found in the controls (xB== 5-48, 0.01
Using
Nance,
we
TASTE RESPONSE TO P.T.C. IN
80
70 MENTALLY RETARDED PATIENTS AND STUDENT CONTROLS
ISSAM MANSOUR.
CHILDREN’S ACCIDENT UNITS SIR,- The disquiet caused by the report on accident and emergency servicesamong those interested in the welfare of children must have been enhanced by the special articles on casualty services by Mr. Garden (April 24), and Mr. Abson and Mr. Caro (May 29), neither of which makes any reference to the needs of infants and children. When plans are being made throughout the country for new accident and emergency centres, it is imperative that recognition be given to the necessity for separate reception and accommodation for children, for equipment and techniques expressly designed for pxdiatric use, and above all for medical, nursing, and technical staff who understand young children and are skilled in their management. Those working in children’s hospitals or children’s departments of general hospitals
When
children should be primarily designed for this purpose and completely separate from the adult accommodation. The emergency department, as described by Mr. Garden, " milling with violent drunks, patients with trivial injuries, casual attenders, and distracted relatives " is no place for children.
accident and emergency
centre
Report of the Subcommittee on Accident and Emergency Services, Ministry of Health Standing Medical Advisory Committee of the Central Health Services Council. H.M. Stationery Office, 1962.
geneity does not affect the excess patients (x21=7.43, P < 0.01).
of non-tasters among
our
The recorded excess of non-tasters in children under 8 and in the mentally retarded may not reflect a true excess-this is difficult to conceive among children under 8. There are two other explanations for the results. First, a patient or young child who is a taster may tend to refuse to continue the test after the first contact with the most dilute solution, with a consequent excess of non-tasters among those who do cooperate. Second, it is possible that patients and young children may be unreliable in their responses, and give the false impression that they are non-tasters. Shepard and Gartler,6 Shepard,’ and Fraser8 reported an excess of non-tasters of P.T.C. among athyreotic cretins. Fraser found an excess of non-tasters among the parents of non-tasting cretins, compared to the proportion of non-tasters in the general population. Such an excess is of course to be 1.
Azevedo, E., Krieger, H., Mi, M. P., Morton, N. E. Am. J. hum. Genet. 1965 (in the press). 2. Harris H., Kalmus, H. Ann. Eugen. 1949, 15, 24. 3. Barnicot, N. A. ibid. 1950, 15, 248. 4. Beiguelman, B. Rev. bras. Biol. 1962, 22, 93. 5. Woolf, B. Ann. hum. Genet. 1955, 19, 251. 6. Shepard, T. H., Gartler, S. M. Science, 1960, 131, 929. 7. Shepard, T. H. J. clin. Invest. 1961, 40, 1751. 8. Fraser, G. R. Lancet, 1961, i, 964.
forms is the most important piece of evidence for there being two genetically determined cell clones. I found appearances, like the ones shown by Papayannopoulou and Stamatoyannopoulos, in heterozygous carriers of the autosomal inherited, enzymopenic methaemoglobinaemia. From this I have concluded that there do not exist two cell populations but a great variability within the distribution of the remaining enzyme activity. This variability can very well be linked to the cell age. The same conclusion ought to be drawn from the authors’ neures for males with mild G.-6-P.D. deficiencv. Department of Pediatrics, University of Berne, Switzerland.
O. TÖNZ.
GLUCOSE-6-PHOSPHATE DEHYDROGENASE AND ERYTHROCYTES IN THYROTOXICOSIS
SIR,-Dr. Baikie and Norma Lawson (Jan. 9) attempt relate the reduction of osmotic fragility of the erythrocytes of some thyrotoxic patients to elevated activity of the enzyme glucose-6-phosphate dehydrogenase (G.-6-P.D.) in the erythrocytes. I wish to suggest the stabilising effect of reduced glutathione (G.S.H.) on erythrocytes. In cases of G.-6-P.D. deficiency, to
Hexose-monophosphate shunt. N.A.D.p.=mcotinamide-adenine dinucleotide phosphate N.A.D.P. 2H+=reduced N.A.D.P. G.S.S.G.=oxidised G.S.H.
(T.P.N.).
G.S.H. concentration in the erythrocytes is below the normal level and thought to be the cause of the increased haemolysis in such patients. If the G.-6-P.D. activity in the erythrocytes of thyrotoxic patients is high then G.S.H. concentration is also high, and in consequence the erythrocytes would be more stable. The correlation between a high level of G.S.H. and high G.-6-P.D. activity is explained by enhanced metabolism of glucose through the hexose-monophosphate shunt (see accomoanving figure).
Department of Hæmatology, Hadassah Medical School, Jerusalem, Israel.
have the necessary knowledge and experience, which are unlikely to be possessed to the same degree by the staff of a large accident centre-for emergencies among children necessarily constitute only a small part of their work. The children’s accident unit should therefore be closely linked to the children’s hospital or department, so that the full range of paediatric facilities is available.
is being designed, it is not enough merely to provide a separate entrance for children: all the accommodation used by 1.
a new
Department of Child Health, University of Aberdeen.
R. G. MITCHELL.
PHENYLTHIOCARBAMIDE-TASTING IN THE MENTALLY IMMATURE
SIR,-We observed among children under eight years of age a significant excess of non-tasters for phenylthiocarbamide (P.T.C.) over the proportion found in older persons, and we have investigated the possibility that this might be characteristic of mentally immature individuals. the method of Harris and Kalmus2 as modified by tested the responses to P.T.C. in 118 mentally retarded patients at the Waimanalo Home in Honolulu, and in a random sample of 80 students at the University of Hawaii. Of the 118 patients 20 (17%) refused to cooperate and 19 (16%) refused to complete the test. Among the remaining 79 patients, 6 (5% of the total) gave unclassifiable responses, 26 (22%) were able to describe their reactions, and 47 (40%) had to be classified from their facial responses. 34% of the classifiable patients were non-tasters-significantly higher than the 18% found in the controls (xB== 5-48, 0.01
Using
Nance,
we
TASTE RESPONSE TO P.T.C. IN
80
70 MENTALLY RETARDED PATIENTS AND STUDENT CONTROLS
ISSAM MANSOUR.
CHILDREN’S ACCIDENT UNITS SIR,- The disquiet caused by the report on accident and emergency servicesamong those interested in the welfare of children must have been enhanced by the special articles on casualty services by Mr. Garden (April 24), and Mr. Abson and Mr. Caro (May 29), neither of which makes any reference to the needs of infants and children. When plans are being made throughout the country for new accident and emergency centres, it is imperative that recognition be given to the necessity for separate reception and accommodation for children, for equipment and techniques expressly designed for pxdiatric use, and above all for medical, nursing, and technical staff who understand young children and are skilled in their management. Those working in children’s hospitals or children’s departments of general hospitals
When
children should be primarily designed for this purpose and completely separate from the adult accommodation. The emergency department, as described by Mr. Garden, " milling with violent drunks, patients with trivial injuries, casual attenders, and distracted relatives " is no place for children.
accident and emergency
centre
Report of the Subcommittee on Accident and Emergency Services, Ministry of Health Standing Medical Advisory Committee of the Central Health Services Council. H.M. Stationery Office, 1962.
geneity does not affect the excess patients (x21=7.43, P < 0.01).
of non-tasters among
our
The recorded excess of non-tasters in children under 8 and in the mentally retarded may not reflect a true excess-this is difficult to conceive among children under 8. There are two other explanations for the results. First, a patient or young child who is a taster may tend to refuse to continue the test after the first contact with the most dilute solution, with a consequent excess of non-tasters among those who do cooperate. Second, it is possible that patients and young children may be unreliable in their responses, and give the false impression that they are non-tasters. Shepard and Gartler,6 Shepard,’ and Fraser8 reported an excess of non-tasters of P.T.C. among athyreotic cretins. Fraser found an excess of non-tasters among the parents of non-tasting cretins, compared to the proportion of non-tasters in the general population. Such an excess is of course to be 1.
Azevedo, E., Krieger, H., Mi, M. P., Morton, N. E. Am. J. hum. Genet. 1965 (in the press). 2. Harris H., Kalmus, H. Ann. Eugen. 1949, 15, 24. 3. Barnicot, N. A. ibid. 1950, 15, 248. 4. Beiguelman, B. Rev. bras. Biol. 1962, 22, 93. 5. Woolf, B. Ann. hum. Genet. 1955, 19, 251. 6. Shepard, T. H., Gartler, S. M. Science, 1960, 131, 929. 7. Shepard, T. H. J. clin. Invest. 1961, 40, 1751. 8. Fraser, G. R. Lancet, 1961, i, 964.