221 infection has so far seemed less of a problem than with transfusion at more peripheral sites. The greatest danger is undoubtedly the ease with which the circulation can be overloaded, and this demands a high, but not unattainable, standard of nursing vigilance. The distance to the heart seems to be variable and not directly related to the size of the child, and we have often been surprised to see the tip of the cannula within the heart shadow on X-rays. A transient high concentration of ions, to which cardiac muscle is sensitive, might well be delivered by injection along the catheter or through the drip tubing; but when citrated blood was given rapidly, or when a potassiumrich solution was infused, no adverse effect was noted. On one occasion, however, there was temporary collapse with profound bradycardia after the injection of a small quantity of calcium
gluconate. Given reasonable safeguards, this valuable aid in psediatric surgery.
W. COCHRAN S. H. S. LOVE.
Royal Belfast Hospital for Sick Children, Belfast, 12.
SIR,-In my preliminary communication (Jan. 12) I stated that " the abdomen is usually opened without the use of a relaxant drug, or a relaxant is given by intramuscular injection ". Some of my anaesthetic colleagues are unhappy about this statement since it is not in accord with their practice or teaching to administer relaxant
drugs of any
kind by intramuscular injection., My statement was intended as a general one and not necessarily to reflect the anaesthetic nolicv or Dractice in this hospital. The
Hospital for Sick Children, London, W.C.1.
A. W. WILKINSON.
CHANGES IN CIGARETTE MANUFACTURE SIR,-Mr. Constantinides’ letter of Dec. 29 contains a number of inaccurate statements. The facts are: (1) In countries producing Virginia-type tobacco leaf, flue-curing and machine redrying of the leaf have been established practices for very many years-and certainly throughout the present century. (2) Neither as the result of the two world wars nor for any other reason have there been substantial-let alone " revolutionary "-changes in the curing of tobacco leaf; nor have there been " vast changes " in overseas packing plant, either in Rhodesia or anywhere else. (3) Although the duration of U.K. stocks of tobacco leaf is lower than it was before World War II, manufacturers here still aim to let their tobacco mature in bond for up to 18 months to 2 years before use. (4) Machine-made cigarettes of flue-cured Virginia-type were widely smoked in this country long before World War I.
A. H. MAXWELL Chairman, Tobacco Advisory Committee.
*** We showed Sir Alexander Maxwell’s letter
Mr. Constantinides, whose reply follows.-ED. L.
SIR,-Ins,tead of refuting
some of my points, it seems that Sir Alexander tends to confirm them. When he says, for example, " In countries producing Virginia-type tobacco leaf, flue-curing and machine redrying
of the leaf have been established practices for very many years", he agrees with my statement that " in Rhodesia.... Enormous ovens were erected for drying tobacco as had long been the practice in American tobacco-curing plants":and when he says " Machine-made cigarettes of flue-cured Virginia-type were widely smoked in this country long before World War I ", he again agrees with me that, " The term ’gasper’ was
applied to cigarettes before 1914." But when he says " nor have there been ’vast changes ’ in packing plant, either in Rhodesia or anywhere else ", there, I am afraid, we differ. Because when I went to Salisbury, overseas
Rhodesia, in 1951 to supervise the curing and packing of over 1,000,000 lb. of flue-cured Virginia-type Rhodesian tobacco, I was proudly shown the enormous new ovens in which it would be dried, and I had some fierce arguments about excessive temperatures and over-drying. Finally, when he says: " Although the duration of U.K. stocks of tobacco is lower than it was before World War II, manufacturers here still aim to let their tobacco mature in bond for up to 18 months to 2 years before use ", it surprises me to think they are still only aiming at it so long after the war. If Sir Alexander would refer to the London trade journal, Tobacco, of March, 1951, he would find an article of mine warning the then Chancellor of the Exchequer against just such a situation as has now arisen in regard to cigarette smoking, if he did not raise the permitted minimum of moisture in tobacco at time of landing. And in the same journal six months later, there was an article by Quentin W. Roop, of the Tobacco Branch, U.S. Department of Agriculture, Production and Marketing Administration, to the effect that: " The findings seem to support the thesis of Mr. Constantinides that the present import regulations of Great Britain affect the flavour of the manufactured tobacco produce " ; and that " in drying tobacco it would be entirely possible to remove an unnecessary amount of moisture thereby disturbing or removing " some desirable chemical components of the leaf."
SIR,-The letter by Dr. Ferrier and others,! drawing attention to the recent discussion on the phenotype of the XY/XO mosaic in man,2-5 prompts us to record another phenotypic male XY/XO mosaic with special features. The patient, whose male sex had never been questioned, was aged 45 and had been happily married for many years but with no children. He had been investigated on three occasions for painless hasmaturia: in 1944, in 1948, and again in 1956. He had congenital hypospadias with a perineal orifice and a bifid scrotum. Only on the last of the three investigations was it . noticed that there was no verumontanum in the posterior urethra, and on withdrawing the endoscope below the triangular ligament a further orifice was discovered which led into a small vagina, at the apex of which was found a cervix which was normal in appearance, except for its reduced size. As the bladder appeared normal, the bleeding was considered to be of uterine origin, though it did not appear in the cyclical intervals of normal menstruation. He had a past history of an operation in 1945 for an ectopic left gonad. The histological report was a " malignant seminoma of undescended testis ". Radiotherapy was given. He was readmitted in 1961, complaining of pain in the lower abdomen. An examination revealed a large tender mass in the pelvis. At laparotomy a uterus was found adherent to the surrounding structures, but it was impossible to determine whether these adhesions were inflammatory or neoplastic at the time of operation. There was a normal rudimentary right fallopian tube and a mass of tissue superficially resembling an ovary. A hysterectomy was performed and a considerable amount of pus was found in an abscess cavity alongside the uterus.
Histological examination of the uterus showed a poorly differentiated columnar-cell adenocarcinoma of the body of the uterus, but the tissue biopsied from the apparent ovary did not reveal any true ovarian tissue. He was readmitted in January, 1962, with extensive metastatic deposits, and a venous sample of blood was taken for chromosome analysis by the method of Moorhead et al.6 Ferrier, P., Ferrier, S., Klein, D., Fernex, C. Lancet, Jan. 5, 1963, p. 54. 2. de La Chapelle, A., Hortling, H. ibid. 1962, ii, 783. 3. Dewhurst, C. J. ibid. 4. Judge, D. L. C., Thompson, J. S., Wilson, D. R., Thompson, M. W. 1.
ibid. p. 407. Willemse, C. H., Van Brink, J. M., Los, P. L. ibid. 1962, i, 488. Moorhead, P. S., Nowell, P. C., Mellman, W. J., Battips, D. M., Hungerford, D. A. Exp. Cell. Res. 1960, 20, 613.