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DIAGNOSIS OF COLOUR-VISION DEFECTS IN YOUNG CHILDREN
569 related is entirely morphological. Attempts at tissue-culture and transmission have so far been negative. Antibody titres for measles have been found significantly raised in patients with systemic lupus erythematosus,8 as have the titres in subacute sclerosing panencephalitis-a disease in which measles virus has been isolated and cultured. Although the evidence for viral participation in the aetiology of Sjogren’s syndrome is most fragile, this is an intriguing possibility since it could explain a number of puzzling features about the syndrome. It might, for example, explain the familial occurrence of Sjogren’s syndrome ; in addition, an increase in humoral-antibody concentration with depression of cell-mediated immunity, a feature characteristic of Sjogren’s syndrome, is observed in viral disease.9 Also, the development of lymphoma in patients with Sjogren’s syndrome would have its counterpart in virus-induced lymphoma of animals (such as RPL virus in chicks) or Burkitt’s lymphoma in man. M. A. SHEARN Kaiser Foundation Hospital, W. H. TU. Oakland, California. University of California B. G. STEPHENS School of Medicine, San Francisco, California. J. C. LEE.
AS A MAN SEWS .. SIR,-The finding of metallic foreign bodies, wherever they are, has always presented great problems. This is particularly true when they are lost in the cavities of the heart. A solution for this difficulty was recently found when a magnet was used to remove part of a needle broken during mitral-valve replacement. woman, great During the operation, on a 58-year-old " difficulty was experienced in " sewing in a Starr-Edwards valve because of heavy calcification of the atrioventricular ring. The needle broke, and one portion disappeared into a pool of blood in the depths of the opened left atrium. It could be neither seen nor felt, in the atrium or the ventricle. A small 1-5 cm. diameter magnet was obtained, sterilised in ’ Hibitane ’-in-alcohol solution, and lowered into the bloodfilled atrium. The needle was promptly retrieved, and from the site of the magnet in the atrium it was thought that it had been removed from the right-Iowèr-lobe vein. The London Chest Hospital, P. A. DUPONT. E.2.
DIAGNOSIS OF COLOUR-VISION DEFECTS IN YOUNG CHILDREN have devised a simple addition to the children’s SIR,-We version of the Ishihara test which does away with the need for any description of symbols and can be carried in a handbag. The addition consists of black-on-white plastic cutouts matching the designs seen by the normal and the colour-blind individual. These do not have to be named: they are chosen and identified either by handling or by pointing with the finger or toe. In the most severely handicapped children they can be identified by question and answer by an experienced operator. We are now evaluating this modification, and have satisfactorily tested several hundred children (normal, and physically, visually, and mentally handicapped) from the age of 3 upwards. Unlike the Farnsworth ’D 15 ’ test used by Dr. Sassoon and Dr. Wise (Feb. 21, p. 419), the test does not necessitate manipulation, so a much wider range of handicapped children can be tested. Only those with very low intelligence or the grossest forms of incoordination 8. 9.
produce equivocal
results.
Phillips, P. A., Christian, C. L. Meeting of the American Rheumatism Association, Tuscon, Arizona, 1969. Good, R. A. Natn. Fdn Birth Defects Orig. Artic. Ser. 1968, 4, 4, 5.
Our experience suggests that, once this test is available in large numbers, it will be practicable and desirable for all children to have their colour vision tested at school entry. We hope that our completed results will throw some light on the question of whether defective colour vision is an educational handicap. Production is in the hands of C. Davis Keeler Ltd.,
Marylebone
Lane, London W.1. Departments of Ophthalmology and Psychology, Guy’s Hospital, London S.E.1.
PETER A. GARDINER M. SEREDA.
DOWN’S SYNDROME AND INFECTIOUS HEPATITIS on children born with malformations in the C.S.S.R. between 1961 and 1966 (total about 15,500) I have made two observations which support Stoller and Collmann’s suggestion that there is an association between Down’s syndrome and infectious hepatitis.1 The first was a striking association between congenital abnormalities of the liver and Down’s syndrome. Con-
SIR,-While analysing data
congenital
TABLE I-CONGENITAL ABNORMALITIES OF THE LIVER IN RELATION TO DOWN’S SYNDROME
*
Down’s
t All but
also. also had cystic
syndrome two
kidneys.
TABLE II-CONTACTS WITH HEPATITIS OF MOTHERS OF CHILDREN WITH DOWN’S SYNDROME COMPARED WITH THE CONTACTS OF MOTHERS OF NORMAL CHILDREN
The first control series was matched for ages and sexes of children. The second control series was matched for the ages of the mothers of the children with Down’s syndrome. Significant difference when compared with 1st control series (x2=2-34 at
p=0’05).
versely, congenital abnormalities of the liver
were about 20 times commoner in children with Down’s syndrome than in children with other congenital anomalies (table I). Secondly, contact with infectious hepatitis around the time of conception was significantly more frequent among mothers of children with Down’s syndrome than among mothers of normal children (table 11). This is a preliminary result of a study of the 1049 cases of Down’s syndrome born during the six-year period. This possible association requires further study. 1.
Stoller, A., Collmann, R. D. Lancet, 1965, ii,
1221.
AS A MAN SEWS .. SIR,-The finding of metallic foreign bodies, wherever they are, has always presented great problems. This is particularly true when they are lost in the cavities of the heart. A solution for this difficulty was recently found when a magnet was used to remove part of a needle broken during mitral-valve replacement. woman, great During the operation, on a 58-year-old " difficulty was experienced in " sewing in a Starr-Edwards valve because of heavy calcification of the atrioventricular ring. The needle broke, and one portion disappeared into a pool of blood in the depths of the opened left atrium. It could be neither seen nor felt, in the atrium or the ventricle. A small 1-5 cm. diameter magnet was obtained, sterilised in ’ Hibitane ’-in-alcohol solution, and lowered into the bloodfilled atrium. The needle was promptly retrieved, and from the site of the magnet in the atrium it was thought that it had been removed from the right-Iowèr-lobe vein. The London Chest Hospital, P. A. DUPONT. E.2.
DIAGNOSIS OF COLOUR-VISION DEFECTS IN YOUNG CHILDREN have devised a simple addition to the children’s SIR,-We version of the Ishihara test which does away with the need for any description of symbols and can be carried in a handbag. The addition consists of black-on-white plastic cutouts matching the designs seen by the normal and the colour-blind individual. These do not have to be named: they are chosen and identified either by handling or by pointing with the finger or toe. In the most severely handicapped children they can be identified by question and answer by an experienced operator. We are now evaluating this modification, and have satisfactorily tested several hundred children (normal, and physically, visually, and mentally handicapped) from the age of 3 upwards. Unlike the Farnsworth ’D 15 ’ test used by Dr. Sassoon and Dr. Wise (Feb. 21, p. 419), the test does not necessitate manipulation, so a much wider range of handicapped children can be tested. Only those with very low intelligence or the grossest forms of incoordination 8. 9.
produce equivocal
results.
Phillips, P. A., Christian, C. L. Meeting of the American Rheumatism Association, Tuscon, Arizona, 1969. Good, R. A. Natn. Fdn Birth Defects Orig. Artic. Ser. 1968, 4, 4, 5.
Our experience suggests that, once this test is available in large numbers, it will be practicable and desirable for all children to have their colour vision tested at school entry. We hope that our completed results will throw some light on the question of whether defective colour vision is an educational handicap. Production is in the hands of C. Davis Keeler Ltd.,
Marylebone
Lane, London W.1. Departments of Ophthalmology and Psychology, Guy’s Hospital, London S.E.1.
PETER A. GARDINER M. SEREDA.
DOWN’S SYNDROME AND INFECTIOUS HEPATITIS on children born with malformations in the C.S.S.R. between 1961 and 1966 (total about 15,500) I have made two observations which support Stoller and Collmann’s suggestion that there is an association between Down’s syndrome and infectious hepatitis.1 The first was a striking association between congenital abnormalities of the liver and Down’s syndrome. Con-
SIR,-While analysing data
congenital
TABLE I-CONGENITAL ABNORMALITIES OF THE LIVER IN RELATION TO DOWN’S SYNDROME
*
Down’s
t All but
also. also had cystic
syndrome two
kidneys.
TABLE II-CONTACTS WITH HEPATITIS OF MOTHERS OF CHILDREN WITH DOWN’S SYNDROME COMPARED WITH THE CONTACTS OF MOTHERS OF NORMAL CHILDREN
The first control series was matched for ages and sexes of children. The second control series was matched for the ages of the mothers of the children with Down’s syndrome. Significant difference when compared with 1st control series (x2=2-34 at
p=0’05).
versely, congenital abnormalities of the liver
were about 20 times commoner in children with Down’s syndrome than in children with other congenital anomalies (table I). Secondly, contact with infectious hepatitis around the time of conception was significantly more frequent among mothers of children with Down’s syndrome than among mothers of normal children (table 11). This is a preliminary result of a study of the 1049 cases of Down’s syndrome born during the six-year period. This possible association requires further study. 1.
Stoller, A., Collmann, R. D. Lancet, 1965, ii,
1221.