ENDEMIC GOITRE IN IRAQ

681 TABLE II-DEVELOPMENTAL MILESTONES IN 19 CHILDREN WITH THE SYNDROMES OF ISOLATED FAMILIAL G.H. DEFICIENCY (GROUP I) AND PITUITARY DWARFISM WITH HIGH SERUM G.H. (GROUP II).

findings,

we

suggest that foetal

pituitary

G.H.

affects foetal

growth and development, and that its absence from early gestation onwards (foetal hormonal insufficiency) also affects postnatal development. Our findings will be

reported in

full elsewhere."

Pædiatric Metabolic and Endocrine Service, Beilinson Hospital, ZVI LARON Tel Aviv University Medical School, Israel.

ATHALIA PERTZELAN.

SULPHONYLUREAS AND HYPOTHYROIDISM SIR,-In 1965 Hunton et al. published a report 12 on the incidence of hypothyroidism in a large population of diabetic patients. They found a much higher incidence among patients taking chlorpropamide and tolbutamide than among those treated with insulin, biguanides, or diet alone. They also found that the incidence of hypothyroidism increased with the duration of sulphonylurea therapy. Burke et al.,13 studying two smaller groups of diabetic patients, reached the opposite conclusion, but their study was less authoritative because of its smaller size and shorter duration. From 2900 diabetic patients we selected 200 who had been treated with tolbutamide for 1-7 years, and in each of these we estimated the T4-131I resin/serum distribution coefficient. Like Hunton et al.12 we found a comparatively large number (3%) with results suggesting thyroid hypofunction: this exceeded the percentage in the general population and in diabetic patients not receiving sulphonylureas. However, our results differed from those of Hunton et al. in that there was no association between the incidence of thyroid hypofunction and the duration of sulphonylurea treatment, and in addition none of our patients was clinically hypothyroid. In those patients with low distribution coefficients the results of other thyroid-function tests (1311 uptake, 1311 conversion ratio at 24 hours, basal metabolic rate, serum-cholesterol, &c.) were at the hypothyroid end of the normal range. These results substantiate the published observations14 -17 that clinical hypothyroidism is extremely rare after sulphonylurea treatment. I. PORTIOLI General Medical Clinic, F. ROCCHI. University of Parma, Italy. 11.

12. 13. 14. 15. 16. 17.

E. J. W. (editors) Proceedings of the Nottingham Conference on Hormones in Development. The National Foundation, New York (in the press). Hunton, R. B., Wells, M. V., Skipper, E. W. Lancet, 1965, ii, 449. Burke, G., Silverstein, G. E., Sorkin, A. I. Metabolism, 1967, 16, 651. Castleman, B., Kibbee, B. New Engl. J. Med. 1959, 261, 911. Mamou, H. Sem. Hôp. Paris, 1957, 33, 1044. Montenero, P. Medsche Welt, Stuttg. 1957, 44, 1622. Walker, G., Slater, J. D. H., Westlake, E. K., Nabarro, J. D. N. Br. med. J. 1957, ii, 323.

IDENTIFICATION OF A BURKITT-CELL VIRUS SiR-After isolating1 the herpes-type virus, MDH-1, from P3-JJ Burkitt-lymphoma-cell culture superinfected with Moloney sarcoma virus, we screened other herpes-type viruses and their antisera for antigenic relationships to MDH-1by serum neutralisation. The viruses studied included those of herpes simplex, herpes B, pseudorabies, infectious bovine rhinotracheitis (I.B.R.), and three strains of canine herpes. Only I.B.R. seemed to have antigenic relationship to MDH-1. The reaction between I.B.R. and MDH-1 was reciprocal in that antiserum produced against either virus would neutralise the other at nearly the same dilution. In the light of the serumneutralisation results and the demonstration of the herpestype morphology of MDH-1 virus,2 we must conclude that MDH-1 virus is a strain of I.B.R. virus. The origin of MDH-1 virus has not been determined. We have made several attempts to repeat the isolation without If the isolation was the result of the presence of success. extraneous I.B.R. virus, the most likely source would have been the foetal-calf serum used in the cell-culture medium. This is unlikely, however, because the serum in use at the time of the isolation had been used to grow and maintain more than a thousand tubes and bottles of cells susceptible to MDH-1 without evidence of virus infection. One of these cell lines, canine thymus, was passaged before use, allowing more than enough time for the development of virus lesions. One factor in the original experiment that could not be reproduced was a loss of viability of the P3-J stock culture which had apparently begun at the time of the isolation but which did not become obvious for a week or two after the isolation. This culture was nearly lost during the succeeding two months. We do not know the cause of this decline nor the role it might have played in the isolation of MDH-1. The identification of MDH-1 as a strain of I.B.R. virus does not exclude the possibility of its being the herpes-type virus (or one of several herpes-type viruses) associated with Burkitt-lymphoma-cell cultures. Human beings are often exposed to bovine viruses and occasionally are infected, at least with vesicular stomatitis virus.3 A study of the epidemiology of herpes-type virus infections in African cattle and their human contacts might be very helpful in providing leads to the identification of the Burkitt virus. Division of Biologic Products, Bureau of Laboratories, Michigan Department of Public Health, JOHN R. MITCHELL GEORGE R. ANDERSON. Lansing, Michigan 48914, U.S.A.

ENDEMIC GOITRE IN IRAQ SIR,-In 1965 the late Dr. Richard H. Follis and I reported4 on endemic goitre and iodine malnutrition in Iraq (Mosul Province). In our studies we used the W.H.O. classification,5

follows:

as

0 (normal): a gland not seen and not palpable. 1 (small): a gland visible and/or palpable which causes slight alteration in the contour of the neck with the head thrown back. Group 2 (medium): a gland clearly visible and readily palpable which causes anterior and lateral bulging. Group 3 (large): a very large gland which causes gross deformity.

Group Group

On the basis of this classification, in a girls’ intermediate school, we found that 98% of adolescent girls had goitre. Later, Salem,swho had spent 2 years in Baghdad, expressed the view, based on a clinical impression only, that the figures given by Professor Caughey and Dr. Follis are very much exaggerated ". "

Hamburgh, M., Barrington,

In replv 1. 2.

3. 4. 5. 6.

at

this late stase, I wish to draw attention

to a recent

Mitchell, J., Anderson, G., Bowles, C., Hinz, R. Lancet, 1967, i, 1358. Hinz, R., Bowles, C., Conner, G., Mitchell, J., Anderson, G. J. natn. Cancer Inst. 1968, 40, 477. Shelokov, A., Peralta, P. Am. J. Epidem. 1967, 86, 149. Caughey, J. E., Follis, R. H. Lancet, 1965, i, 1032. Perez, C., Scrimshaw, N. S., Munoz, J. A. Monogr. Ser. W.H.O. 1960, no. 44, p. 369. Salem, S. N. Lancet, 1965,ii, 85.

682 of goitre in the Mosul Province by Ghalioungui et awl.4 These workers used a slightly different classification. They " state: In comparing our results with that of Caughey and Follis, account must be taken of the difference in our standard of classification. As they included in their Group 1 ’any gland that is visible and/or palpable and one causing slight alteration in the contour of the neck ’, glands that we classified as ’X ’ would belong to their Group 1. Adding our ’X ’ figures would thus bring our figures very near to theirs ". The figures are as follows (in percentages):

study

Medical School, Pahlavi University, Shiraz, Iran.

J. E. CAUGHEY.

PRECISION IN DEATH CERTIFICATION Sirshould like to draw the attention of doctors to the need for having certain details of diagnosis on death certificates. The International Statistical Classification of Diseases, Injuries and Causes of Death (I.C.D.) is used the world over to classify the causes of death from a death certificate and it is of course from these certificates that mortality statistics are derived. The I.C.D. is revised every ten years, and, as medical progress leads to more precise diagnosis, so the classification becomes more detailed. The 8th Revision of the I.C.D. came into use in 1968. In response to requests from epidemiologists and other research workers, category 151, malignant neoplasm of stomach, is now broken down into 151-0 cardia, 151-1pylorus, 151-8 other specified parts, and 151-9 part unspecified. Where the certifying doctor writes only " cancer of the stomach " an inquiry form is sent from the General Register Office, since more precise information may be available, and the replies confirm that it often is. Such inquiries are a nuisance to the doctor especially if further information is not available. They could be avoided if doctors would specify the part of the stomach involved where this is known, or write " part of stomach unknown " otherwise. In addition to this particular example there are other sections of the I.C.D. which have been improved by greater precision, and so it is important in general, when writing diagnoses for death certificates, to be as specific as the available information allows. The histological type of cancer should be given if known. Doctors may be assured that their efforts in this field are greatly appreciated; the certificates are essential for the production of statistics and for many research projects. A. M. ADELSTEIN Chief Medical Statistician, General Register Office (England and Wales).

Somerset House, London W.C.2. 4.

Ghalioungui, P., Demarchi, M., Abudl Mawjoud, A. M., Dabbagh, T., Dabbagh, Z., Abdulnabi, M., Taj El-Din, H., Shafik, S. J. Fac. Med. Baghdad, 1968, 10, 41.

Appointments H.: deputy M.O.H., M.B. Mane. D.P.H., D.OBST., D.T.M. & deputy principal school M.o., and deputy port M.o.H., Portsmouth. NEWTON, M. A., M.D. Cantab., M.R.C.P. : consultant physician, Central Middlesex Hospital and Neasden Hospital, London. NICHOLAS, A. D. G., M.B. Cantab., F.F.A. R.C.S.: consultant anaesthetist, United Sheffield Hospitals. SMITH, H. G., M.A., M.D. Dubl., M.R.C.P. : consultant in infectious diseases, Neasden Hospital, London. ZINNA, R. F., M.D. Naples: consultant child psychiatrist, Bournemouth,

HILTON, D. D.,

Wessex R.H.B.

London Transport Board: ACRES, G. C., M.R.C.S., D.I.H.:

M.o.

in

charge, south-west division,

Chiswick.

GILKS, A. W., M.B. Lond., D.P.H., D.I.H.: senior M.o. MYERS, C. E. N., M.B.E., M.R.C.S., D.I.H.: M.O.H. in charge, north-east

division,

Manor House.

RAFFLE, P. A. B.,

M.D.

Lond., M.R.C.P.,

D.P.H., D.I.H.: chief M.O.

Obituary PHILIP CYRIL POWTER CLOAKE

M.D., B.Sc. Lond., M.D. Birm., F.R.C.P. Prof. Cyril Cloake, who held the chair of neurology at the University of Birmingham, died on March 14 at the age of 78. After an early career in science, in which he obtained a from the University of London at the age of 19, he studied medicine at the London Hospital, qualifying in 1915. During the 1914-18 war he served with the R.A.M.C. In 1923 he took the M.D., and he held posts as medical registrar at the Hospital for Epilepsy and Nervous Diseases, Maida Vale, as assistant physician to the Metropolitan Hospital, and as honorary physician to the psychological department at Addenbrooke’s Hospital, Cambridge, before going to Birmingham as physician to outpatients at Queens Hospital in 1925. He was later appointed to the visiting staff of the Birmingham and Midland Hospital for Nervous Diseases and the West Bromwich and District General Hospital, and in 1931 he became honorary physician to Queens Hospital. In 1934 he was appointed to the chair of medicine in the University of Birmingham, and in the following year he took the M.D. Birm., and he was elected F.R.C.P. In 1947 he became professor of neurology, and at Queen Elizabeth Hospital he built up a large university department which included neurosurgery and psychiatry as well as neurology. Under his leadership the department maintained a considerable output of valuable research and trained many who are among the leading neurologists of today. He contributed a number of papers on neurology, including one of the earliest accounts of temporal arteritis. In 1947 he gave the first Humphry Davy Rolleston lecture to the Royal College of Physicians, taking as his subject disseminated sclerosis-a disease in which he had always been especially interested. He was a member of the Association of Physicians of Great Britain and Ireland and of the Association of British Neurologists, and he was president of the West Midlands Physicians Association. For many years he served on the Central Consultants and Specialists Committee. He retired from the university in 1955. He is survived by three daughters and his second wife, whom he married in 1958.

B.sc.

A. G. W. W. writes: " Professor Cloake made invaluable contributions to the University of Birmingham, to the United Birmingham Hospitals, to medicine in the Midlands, and to neurology throughout the world. He devoted his life to his profession and to his family, and those who worked with him and knew him well were his life-long admirers and friends. His retirement from the hospital and the chair of neurology brought memorable demonstrations of the regard in which he was held, and since his retirement his occasional appearances at the hospital and at meetings of the West Midlands Physicians Association have given great pleasure. His later years were marred by serious illness, which he faced with a courage and cheerfulness that excited the admiration of all who knew him. He was a delightful companion whose death will bring sorrow to all his colleagues, his old students, and those whom he trained so ably and so kindly in neurology."

GEORGE EDGAR SEPTIMUS WARD M.B. Lond., F.R.C.P., hon. F.F.R. Dr. G. E. S. Ward, who was on the consultant staff of the Middlesex Hospital for thirty-five years, died on March 19 at the age of 80. He was educated at Epsom College before entering the Middlesex Hospital Medical School in 1906. After graduating M.B. in 1911 he was a house-physician and medical registrar at the Middlesex, taking the M.D. in 1913 and the M.R.C.P. in the