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ELECTROPHORESIS OF PLASMA-PROTEINS
1227 We believe that at the present time the use of the powerful antibiotics should be restricted to the If we cannot prevent the babies taking minimum. staphylococci home with them, we can at least try to reduce the risk of their organisms being resistant to the drugs on which their lives, and those of their household contacts may later depend. S. D. M. COURT C. A. GREEN J. G. P. HUTCHISON Princess Mary Maternity Hospital, G. A. NELIGAN. Newcastle upon Tyne. more
HEROIN
SiR.-The Government have decided that supplies of heroin shall be withdrawn at the end of the year. All practitioners realise the dangers of addiction to this drug, but surely the addict obtains his supplies from different sources ? There are three dangers in this legislation :
(1)
The
which has
profession a
will be
definite
place
deprived of a powerful drug in both medical and surgical
treatment. (2) It will no longer be possible to treat established addicts with decreasing doses of heroin. (3) Practitioners who use this drug will be tempted to buy a large quantity of heroin before Dec. 31 for their future use.
This is the first occasion that it has been necessary to
prohibit the use of a drug. Surely the amount of addiction in this country does not warrant such a severe measure ? West London Hospital, W. -By. F. BY. W. SOUTHWOOD. London, W.6. was
Kommunehospitalet, Aarhus, Denmark.
, CHRISTIANSEN. H.V. LAUTRUP LAUTRUP CHEISTIANSEN. V. .
THE DEPARTMENT OF PHYSICAL MEDICINE
SIR,—I was very interested to read the report (May 28) of the annual meeting of the British Association of Physical Medicine. It is a deplorable fact that at present patients can be treated only in central departments of physical medicine because " only there could be found the requisite medical and technical staff and equpiment." This entails much loss of time in travelling and waiting by patients. At the inception of the National Health Service various alternatives were offered to the Minister of Health for setting up peripheral clinics staffed by qualified physiotherapists, to avoid the anticipated difficulty of waitinglists, expensive hospital transport, and harassed physiotherapists. The Minister saw fit to rebuff all these efforts. Dr. Fell, it seems, did not specify whose brains should be pooled to solve these problems. Dr. Cooksey voiced the concern of many at the shortage of physiotherapists. May I point out one reason for lack of recruitment ? Parents see little advantage in educating their children at university level for three years when the eventual remuneration just does not compare with other
professions
and
occupations. LEONORA MASON.
Bristol, 4.
explained
at the
representative meeting of the British Medical Association reported on p. 1218, the ban is being imposed by this country as part of an international effort to prevent heroin addiction. We should prejudice the success of this effort if we
As
syndrome. When heparin was given after a fatty meal, separation of &bgr;-globulins occurred, and no separation was observed in post-heparin sera from patients with recent diabetes mellitus or from non-diabetic patients with chronic kidney diseases. no
dissociated ourselves from it.-ED. L.
emphasise
ELECTROPHORESIS OF PLASMA-PROTEINS SIR,—In his letter of April 23, Dr. Owen reported that under certain circumstances, using a ’Veronal’ buffer for paper electrophoresis, he has obtained a separation of the p-globulin into two components. This is contrary to the usual experience, also shared by us, that B-globulins travel as a single band in such systems,
when no other ions are added. We have found recently, however, that in
(see accompanying figure) heparin
causes a
PROLONGED JAUNDICE
SIR,—I read with interest the paper by Dr. Klajman and Dr. Efrati in your issue of March 12. They refer to the condition described by Dubin and Johnson, and in that " clinical examinatheir summary they tion revealed nothing abnormal except jaundice and slight enlargement of the liver." I would like to draw attention to a similar, if not the same, disease (or perhaps I should say condition) described in 1948 by Rotor, Manahan, and Florentin.2 In their cases the van den Bergh reaction was directly positive, and the blood-bilirubin showed a considerable increase in hepatic or crystalloid bilirubin ; but there were no symptoms of obstructive jaundice, the urine did not contain bile, and the stools were normal in colour. I had the chance to observe the children of one of the families in this series. In my paper 3 I said that the syndrome was marked by jaundice, the accumulation of hepatic crystalloid bilirubin in the body, and the absence of occlusion of the biliary passages or any other liver damage. It was congenital and familial. Although the first signs could be observed in early infancy, it seemed that the jaundice became latent during infancy for some unknown reason, but manifested itself again later and persisted throughout life. The ætiology was completely unknown. The liver disturbance was confined to bile
some patients splitting of the
metabolism. It has been said that this kind of jaundice is quite different from the " familial non-haemolytic jaundice " described by Dameshek and Singer in 1941.4 I believe that the condition described by Dubin and Johnson and by Dr. Klajman and Dr. Efrati are similar if not identical, and I wonder whether the disease really is a new clinicopathologic entity if it is, in fact, due to an inborn error In that case one would expect the of metabolism." condition to be familial and inherited, as we found it to "
Electrophoresis
of
serum
(o) before
and
(b) after heparin injection.
&bgr;-globulin band. This phenomenon has been observed only when heparin was injected in the fasting state, and hitherto we have found it only in sera from patients with severe diabetic angiopathy and the Kimmelstiel-Wilson
1. 2. 3. 4.
Dubin, I. N., Johnson, F. B. Medicine, Baltimore, 1954, 33, 155. Rotor, A. B., Manahan, L., Florentin, A. A. Acta. med. philipp. 1948, 5, 27. Stransky, E. Ann. pœdiat. 1950, 175, 301. Dameshek, W., Singer, K. Arch. intern. Med. 1941, 67, 259.
HEROIN
SiR.-The Government have decided that supplies of heroin shall be withdrawn at the end of the year. All practitioners realise the dangers of addiction to this drug, but surely the addict obtains his supplies from different sources ? There are three dangers in this legislation :
(1)
The
which has
profession a
will be
definite
place
deprived of a powerful drug in both medical and surgical
treatment. (2) It will no longer be possible to treat established addicts with decreasing doses of heroin. (3) Practitioners who use this drug will be tempted to buy a large quantity of heroin before Dec. 31 for their future use.
This is the first occasion that it has been necessary to
prohibit the use of a drug. Surely the amount of addiction in this country does not warrant such a severe measure ? West London Hospital, W. -By. F. BY. W. SOUTHWOOD. London, W.6. was
Kommunehospitalet, Aarhus, Denmark.
, CHRISTIANSEN. H.V. LAUTRUP LAUTRUP CHEISTIANSEN. V. .
THE DEPARTMENT OF PHYSICAL MEDICINE
SIR,—I was very interested to read the report (May 28) of the annual meeting of the British Association of Physical Medicine. It is a deplorable fact that at present patients can be treated only in central departments of physical medicine because " only there could be found the requisite medical and technical staff and equpiment." This entails much loss of time in travelling and waiting by patients. At the inception of the National Health Service various alternatives were offered to the Minister of Health for setting up peripheral clinics staffed by qualified physiotherapists, to avoid the anticipated difficulty of waitinglists, expensive hospital transport, and harassed physiotherapists. The Minister saw fit to rebuff all these efforts. Dr. Fell, it seems, did not specify whose brains should be pooled to solve these problems. Dr. Cooksey voiced the concern of many at the shortage of physiotherapists. May I point out one reason for lack of recruitment ? Parents see little advantage in educating their children at university level for three years when the eventual remuneration just does not compare with other
professions
and
occupations. LEONORA MASON.
Bristol, 4.
explained
at the
representative meeting of the British Medical Association reported on p. 1218, the ban is being imposed by this country as part of an international effort to prevent heroin addiction. We should prejudice the success of this effort if we
As
syndrome. When heparin was given after a fatty meal, separation of &bgr;-globulins occurred, and no separation was observed in post-heparin sera from patients with recent diabetes mellitus or from non-diabetic patients with chronic kidney diseases. no
dissociated ourselves from it.-ED. L.
emphasise
ELECTROPHORESIS OF PLASMA-PROTEINS SIR,—In his letter of April 23, Dr. Owen reported that under certain circumstances, using a ’Veronal’ buffer for paper electrophoresis, he has obtained a separation of the p-globulin into two components. This is contrary to the usual experience, also shared by us, that B-globulins travel as a single band in such systems,
when no other ions are added. We have found recently, however, that in
(see accompanying figure) heparin
causes a
PROLONGED JAUNDICE
SIR,—I read with interest the paper by Dr. Klajman and Dr. Efrati in your issue of March 12. They refer to the condition described by Dubin and Johnson, and in that " clinical examinatheir summary they tion revealed nothing abnormal except jaundice and slight enlargement of the liver." I would like to draw attention to a similar, if not the same, disease (or perhaps I should say condition) described in 1948 by Rotor, Manahan, and Florentin.2 In their cases the van den Bergh reaction was directly positive, and the blood-bilirubin showed a considerable increase in hepatic or crystalloid bilirubin ; but there were no symptoms of obstructive jaundice, the urine did not contain bile, and the stools were normal in colour. I had the chance to observe the children of one of the families in this series. In my paper 3 I said that the syndrome was marked by jaundice, the accumulation of hepatic crystalloid bilirubin in the body, and the absence of occlusion of the biliary passages or any other liver damage. It was congenital and familial. Although the first signs could be observed in early infancy, it seemed that the jaundice became latent during infancy for some unknown reason, but manifested itself again later and persisted throughout life. The ætiology was completely unknown. The liver disturbance was confined to bile
some patients splitting of the
metabolism. It has been said that this kind of jaundice is quite different from the " familial non-haemolytic jaundice " described by Dameshek and Singer in 1941.4 I believe that the condition described by Dubin and Johnson and by Dr. Klajman and Dr. Efrati are similar if not identical, and I wonder whether the disease really is a new clinicopathologic entity if it is, in fact, due to an inborn error In that case one would expect the of metabolism." condition to be familial and inherited, as we found it to "
Electrophoresis
of
serum
(o) before
and
(b) after heparin injection.
&bgr;-globulin band. This phenomenon has been observed only when heparin was injected in the fasting state, and hitherto we have found it only in sera from patients with severe diabetic angiopathy and the Kimmelstiel-Wilson
1. 2. 3. 4.
Dubin, I. N., Johnson, F. B. Medicine, Baltimore, 1954, 33, 155. Rotor, A. B., Manahan, L., Florentin, A. A. Acta. med. philipp. 1948, 5, 27. Stransky, E. Ann. pœdiat. 1950, 175, 301. Dameshek, W., Singer, K. Arch. intern. Med. 1941, 67, 259.