- Email: [email protected]
CONFIRMATORY MEDICAL CERTIFICATE BEFORE CREMATION
101 as having a normal female chromosome complement. We have, therefore, no evidence to suggest that this patient is a chromosome mosaic. Hoffenberg et al.l and Stewart2 have reported chromatinnegative cases of Turner’s syndrome who had menstruated These cases may have been over a period of several years. first chromatin-negative is the the case but fertile present female in whom fertility has been proved. Such cases illustrate the variability of the phenotype which can be associated with an XO sex chromosome constitution.
preted
Medizinische Poliklinik, University of Heidelberg, Germany. M.R.C. Group for Research on the General Effects of Radiation, Western General Hospital, Edinburgh. Department of Pathology, University of Heidelberg, Germany. Medizinische Universitatsklinik, University of Heidelberg, Germany.
F. G. D. P.
BAHNER SCHWARZ. G. HARNDEN A. JACOBS.
K. WALTER.
I think it would not be suitable for a person who did not witness the postmortem to sign the confirmatory certificate; I don’t think it would be adequate merely to talk to the man who performed it. It would be a way out of the difficulty, if the necropsy authorised the witness to answer attending " yes" to the question " did you make a postmortem examination but I understand this is not the case. I entirely agree that the pathologist has a good claim to sign the confirmatory certificate; in fact, if nobody attends at his postmortem examination, I consider he is the only one who should do so. But sometimes he may not sign because he does not satisfy the necessary conditions. In this hospital, our pathologist has generously agreed to waive his claim in favour of the relevant registrar (provided he attends the necropsy). How should the question be answered then? I feel it would be much better if the form were designed to elicit the desired information : Was a postmortem examination Are you
aware
Whipps Cross Hospital, London, E.11.
of the
2.
derives
no
support.
H. J. B. ATKINS R. D. BULBROOK M. A. FALCONER F. C. GREENWOOD J. L. HAYWARD K. S. MACLEAN P. SCHURR P. ARMITAGE.
Guy’s Hospital, London, S.B.1.
ORNITHOSIS IN RAILWAY GUARDS
SIR,-This is probably a more common industrial hazard than the two cases reported by Dr. Dew and his colleagues (July 2) suggest. In October, 1954, I saw a man of 63 during a febrile illness with cough, which would clinically have fitted with the diagnosis of psittacosis. The Virus Reference Laboratory reported a titre of 1/32 in his serum. He at first denied contact with or interest in birds, but when pressed as to his occupation remembered that as a railway guard he carried a large number of pigeons at least once a week. Kingston Hospital, Kingston upon Thames, Surrey.
D. STARK MURRAY.
THE HARVEST MITE
SIR,-Has Dr. Roantree (July 2) any evidence for his that probably " a substantial percentage of the not attacked at all " by harvest human population is statement
...
mites ? Different men, women, and children may show slight differences in their attractiveness to biting insects and mites, but I have never found anyone who is so repulsive as not to be bitten at all. Great differences in the reaction to bites are found, and the same person may become more or less seriously affected, depending on his
previous
findings ? E. HINDEN
SELECTION OF BREAST-CANCER PATIENTS FOR ADRENALECTOMY AND HYPOPHYSECTOMY SIR,-In his letter of June 11, Dr. Nabarro suggests that the ratio of the urinary 17-hydroxycorticosteroids (17-OHCS) to aetiocholanolone (which we found correlated with response to hypophysectomy) is merely an index of the " general condition " of the patient. He suggests that the ratio of 17-oHCS/aetiocholanolone is high in seriously ill, debilitated subjects and low in patients whose condition is well maintained. We do not believe that a method exists for selecting patients for hypophysectomy on the basis of their " general condition". In our series an independent observer initially rejected only those very few patients he thought unfit to withstand an operation. Approximately a third of the remainder could be classified subjectively as " very ill ". No correlation could be found between the above ratio of urinary steroids and the patient’s condition according to this classification. Furthermore the classification bore no relation to their subsequent response to operation. Whereas 40% of the very sick patients responded well to treatment, 50% apparently fit patients failed to benefit. 1.
appreciate that an attempt to classify patients according to their general health is very inexact. After a careful perusal of our case-records, however, we see no reason for pursuing a hypothesis which from our figures
H. A. HIENZ.
CONFIRMATORY MEDICAL CERTIFICATE BEFORE CREMATION am SiR,—I grateful to my colleagues who have taken to trouble comment on my original letter, and should the like to deal with some of the points raised.
performed ?
We
Hoffenberg, R., Jackson, W. P. U., Muller, W. H. Proc. nat. Acad. Sci., Wash. 1959, 45, 560. Stewart, J. S. S. Acta endocr., Copenhagen, 1960, 33, 89.
exposure to any particular species. Protection from biting mites, as you have stated, is simple. A small quantity (about 1 ml.) of dimethyl phthalate, dibutyl phthalate, or benzyl benzoate smeared on the socks will give protection to those who only walk through infested areas, and this protection persists even when the socks are washed. Those who lie down, for whatever reasons, in infested vegetation, offer more scope to the mites, and it might be worth showing the film which I made during the war to help in the training of troops entering areas in S.E. Asia where mite-borne typhus was a danger. This was based on the methods devised by Australian scientists in New Guinea for treating all the garments of those at risk. Scantily clad holiday-makers are fortunate as mites seem to bite only where some garment, garter, belt, or the like, constricts the skin, and if the fabric of this region is smeared with benzyl benzoate or other poison good protection is obtained (though if applied too liberally some synthetic fabrics are dissolved with possibly embarrassing results). Rothamsted Experimental Station,
Harpenden,
KENNETH MELLANBY.
Herts.
SIR,-Your leading article on this subject was most timely. There are two points of interest about trombiculosis which were not mentioned. It would be interesting know whether entomologists agree with the common view that the most severe nuisance from mite bites always occurs on chalk soils. There is a radical treatment, personally practised for twenty years, which is somewhat painful but effective. to
Thelhard, itching papules 1.
Mellanby,
K.
are
squeezed,
one
Nature, Lond. 1946, 158, 554, 750.
by
one,
preted
Medizinische Poliklinik, University of Heidelberg, Germany. M.R.C. Group for Research on the General Effects of Radiation, Western General Hospital, Edinburgh. Department of Pathology, University of Heidelberg, Germany. Medizinische Universitatsklinik, University of Heidelberg, Germany.
F. G. D. P.
BAHNER SCHWARZ. G. HARNDEN A. JACOBS.
K. WALTER.
I think it would not be suitable for a person who did not witness the postmortem to sign the confirmatory certificate; I don’t think it would be adequate merely to talk to the man who performed it. It would be a way out of the difficulty, if the necropsy authorised the witness to answer attending " yes" to the question " did you make a postmortem examination but I understand this is not the case. I entirely agree that the pathologist has a good claim to sign the confirmatory certificate; in fact, if nobody attends at his postmortem examination, I consider he is the only one who should do so. But sometimes he may not sign because he does not satisfy the necessary conditions. In this hospital, our pathologist has generously agreed to waive his claim in favour of the relevant registrar (provided he attends the necropsy). How should the question be answered then? I feel it would be much better if the form were designed to elicit the desired information : Was a postmortem examination Are you
aware
Whipps Cross Hospital, London, E.11.
of the
2.
derives
no
support.
H. J. B. ATKINS R. D. BULBROOK M. A. FALCONER F. C. GREENWOOD J. L. HAYWARD K. S. MACLEAN P. SCHURR P. ARMITAGE.
Guy’s Hospital, London, S.B.1.
ORNITHOSIS IN RAILWAY GUARDS
SIR,-This is probably a more common industrial hazard than the two cases reported by Dr. Dew and his colleagues (July 2) suggest. In October, 1954, I saw a man of 63 during a febrile illness with cough, which would clinically have fitted with the diagnosis of psittacosis. The Virus Reference Laboratory reported a titre of 1/32 in his serum. He at first denied contact with or interest in birds, but when pressed as to his occupation remembered that as a railway guard he carried a large number of pigeons at least once a week. Kingston Hospital, Kingston upon Thames, Surrey.
D. STARK MURRAY.
THE HARVEST MITE
SIR,-Has Dr. Roantree (July 2) any evidence for his that probably " a substantial percentage of the not attacked at all " by harvest human population is statement
...
mites ? Different men, women, and children may show slight differences in their attractiveness to biting insects and mites, but I have never found anyone who is so repulsive as not to be bitten at all. Great differences in the reaction to bites are found, and the same person may become more or less seriously affected, depending on his
previous
findings ? E. HINDEN
SELECTION OF BREAST-CANCER PATIENTS FOR ADRENALECTOMY AND HYPOPHYSECTOMY SIR,-In his letter of June 11, Dr. Nabarro suggests that the ratio of the urinary 17-hydroxycorticosteroids (17-OHCS) to aetiocholanolone (which we found correlated with response to hypophysectomy) is merely an index of the " general condition " of the patient. He suggests that the ratio of 17-oHCS/aetiocholanolone is high in seriously ill, debilitated subjects and low in patients whose condition is well maintained. We do not believe that a method exists for selecting patients for hypophysectomy on the basis of their " general condition". In our series an independent observer initially rejected only those very few patients he thought unfit to withstand an operation. Approximately a third of the remainder could be classified subjectively as " very ill ". No correlation could be found between the above ratio of urinary steroids and the patient’s condition according to this classification. Furthermore the classification bore no relation to their subsequent response to operation. Whereas 40% of the very sick patients responded well to treatment, 50% apparently fit patients failed to benefit. 1.
appreciate that an attempt to classify patients according to their general health is very inexact. After a careful perusal of our case-records, however, we see no reason for pursuing a hypothesis which from our figures
H. A. HIENZ.
CONFIRMATORY MEDICAL CERTIFICATE BEFORE CREMATION am SiR,—I grateful to my colleagues who have taken to trouble comment on my original letter, and should the like to deal with some of the points raised.
performed ?
We
Hoffenberg, R., Jackson, W. P. U., Muller, W. H. Proc. nat. Acad. Sci., Wash. 1959, 45, 560. Stewart, J. S. S. Acta endocr., Copenhagen, 1960, 33, 89.
exposure to any particular species. Protection from biting mites, as you have stated, is simple. A small quantity (about 1 ml.) of dimethyl phthalate, dibutyl phthalate, or benzyl benzoate smeared on the socks will give protection to those who only walk through infested areas, and this protection persists even when the socks are washed. Those who lie down, for whatever reasons, in infested vegetation, offer more scope to the mites, and it might be worth showing the film which I made during the war to help in the training of troops entering areas in S.E. Asia where mite-borne typhus was a danger. This was based on the methods devised by Australian scientists in New Guinea for treating all the garments of those at risk. Scantily clad holiday-makers are fortunate as mites seem to bite only where some garment, garter, belt, or the like, constricts the skin, and if the fabric of this region is smeared with benzyl benzoate or other poison good protection is obtained (though if applied too liberally some synthetic fabrics are dissolved with possibly embarrassing results). Rothamsted Experimental Station,
Harpenden,
KENNETH MELLANBY.
Herts.
SIR,-Your leading article on this subject was most timely. There are two points of interest about trombiculosis which were not mentioned. It would be interesting know whether entomologists agree with the common view that the most severe nuisance from mite bites always occurs on chalk soils. There is a radical treatment, personally practised for twenty years, which is somewhat painful but effective. to
Thelhard, itching papules 1.
Mellanby,
K.
are
squeezed,
one
Nature, Lond. 1946, 158, 554, 750.
by
one,