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FIBROCYSTIC DISEASE OF THE PANCREAS
1147 The term " moderate
respiratory depression "
was
used
to
indicate that a short period was necessary for resuscitation of the baby. 2 of the stillbirths were anencephalic monsters, and in the 3rd death was due to intracranial haemorrhage. In both the normal and abnormal labours, the general clinical impression was that pethilorfan is safe for use in obstetrics and produces no neonatal respiratory depression, either immediate or delayed. R. L. CUMMING Park Hospital, E. B. GARNER. Davyhulme. FIBROCYSTIC DISEASE OF THE PANCREAS SiR,-Dr. Roberts (Nov. 28) suggests that " the primary abnormality in fibrocystic disease is persistent overstimulation of the secreting glands ". It is difficult to see how this can account for the increased sweat electrolyte concentration, since di Sant’Agnese et al. in fact found that it was not accompanied by an increase in the sweat volume. I should like to suggest that the abnormal sweat electrolyte concentration is due to the absence of the mechanism for reabsorbing salt from the sweat, just as cystinuria, which is also a hereditary recessive disease, is due to the absence of the mechanism for reabsorbing cystine and related aminoacids from the urine.2
It has been shown3 that the relationship between the sodium concentration of the sweat and the sweat-rate can be explained by supposing that sweat is formed from a " precursor fluid " in which salt is present in the same concentration as in serum, and that salt is then reabsorbed from this fluid as it passes down the duct by an active mechanism which has a limiting capacity. This reabsorptive mechanism is controlled by the level of circulating corticosteroids, which explains why the sweat-sodium is the same as the serum-sodium concentration in Addison’s disease. di Sant’Agnese et al.1 reported that the mean sweat sodium and chloride concentrations in fibrocystics were 133 and 106 mEq. per litre respectively, very close to normal serum levels, compared with 59 and 32 mEq. per litre in controls. Furthermore, there was no decrease in the sweat electrolytes in response to either salt-loss or administration of deoxycortone. This is just what one would expect if the mechanism for reabsorbing salt from the sweat were absent or unable to function. Unit of Biometry, University of Oxford.
If there has to be a check on the date these certificates in (although, if authentic, why a time limit ?), then by all means impose a fine or penalty on the tardy, but to withhold all payment for such a reason is to me unreasonable, unjust, and downright dishonest. W. A. HERVEY. Lenham, Kent. are sent
DIABETIC PETS
SIR,-There must be amongst members of the medical profession some who own diabetic pets. We are interested in the development of certain complications which do not seem to occur in animals rendered diabetic by the usual experimental means, and I should be most grateful if anyone owning, or knowing of, spontaneously diabetic animals, particularly dogs maintained for any length of time on insulin, would get in touch with me. St.
Medical Unit, Mary’s Hospital, London, W.2.
HARRY KEEN. BLOOD-GROUPS
SIR,-In his response of Nov. 14 to my letter on bloodgroups, Dr. Mourant is unable to contradict the facts. Lest these facts be lost sight of, they must be reiterated: (1) C-D-E protagonists continue to teach triple inheritance of the Rh-Hr factors even though readily available evidence shows that these blood factors are actually transmitted in sets of unequal size containing up to ten or more factors. Moreover, as I have pointed out, the number of factors characterising each agglutinogen is unlimited theoretically, and the number found depends primarily on one’s enterprise and ingenuity in searching for and identifying antibodies of new specificities. (2) The two nomenclatures, Rh-Hr and C-D-E, are not mutually equivalent, so the problem is not simply one of choosing between them, as claimed by C-D-E supporters. This is not the place to repeat once more all the evidence which proves that the C-D-E notations misinterpret and distort the facts, and as a result lead to numerous contradictions and paradoxes. (3) As for the studies on blood-groups and disease, "the proof of the pudding is in the eating ". After the discovery of the Rh factor was announced, Rh-Hr tests were soon incorporated into clinical medicine and this discovery led to tremendous advances in the knowledge of blood-groups, while, in contrast, the reported associations between blood-groups and disease have proved meaningless and found no clinical application, and this type of
"
research " has led nowhere but is still the same stage as when it began 30 years ago. Such studies consist merely of a series of disconnected observations which are mutually contradictory, and instead of illuminating the subject lead only to confusion and chaos. Workers 30 years ago did not need R. A. Fisher or E. B. Ford to stimulate or inspire them to carry out similar investigations, and succeeded in producing results equalling those of modern times in
at
M. G. BULMER.
WITHHOLDING OF SICKNESS BENEFIT SIR,-There is a state of affairs concerning payment of sickness benefit which, in my opinion, should be loudly proclaimed and made widely known-namely, that if the medical certificate for the illness is not sent in within a specified time, and a cause for the delay given which is acceptable to the Insurance authorities, then payment is refused. This fact is known to many people already, but by no means all. I discovered it only by being ill and sending in my certificates some months late. The delay in sending in the certificates was due to a genuine misunderstanding on my part, but my explanation was not enough for the local Insurance office, and payment was immediately refused. This refusal to pay was sent to me on a buff printed form, which can only mean that many such forms are sent out. It would be interesting to know exactly how much per annum is saved on such refused claims. 1. di Sant’Agnese, P. A., Darling, R. C., Perera, G. A., Shea, E. Med. 1953, 15, 777. 2. Harris, H. Human Biochemical Genetics. Cambridge, 1959. 3. Bulmer, M. G., Forwell, G. D. J. Physiol. 1956, 132, 115.
Amer. J.
meaninglessness. (4) While protesting against my suggestion that the reported associations between blood-groups and disease may have resulted from some sort of bias in collecting the data, Dr. Mourant himself offers no alternative explanation of why group-0 persons should be subject to duodenal ulcers, or why group-A persons should be prone to fracture their femurs, &c. The answer is, of course, that the most difficult things to explain are those which are not true. (5) The so-called protest signed by " 33 leading American workers " stating that the nomenclature problem has to be settled by a representative committee " must be challenged. Otherwise, why during the three years which have passed since the American Medical Association report was published have those workers failed to take advantage of the numerous opportunities which have presented themselves for the formation of such a committee ? Will Dr. Mourant himself give the date and place for the meeting of such an international committee ? If "
not,
one must
conclude that C-D-E supporters have
no
inten-
respiratory depression "
was
used
to
indicate that a short period was necessary for resuscitation of the baby. 2 of the stillbirths were anencephalic monsters, and in the 3rd death was due to intracranial haemorrhage. In both the normal and abnormal labours, the general clinical impression was that pethilorfan is safe for use in obstetrics and produces no neonatal respiratory depression, either immediate or delayed. R. L. CUMMING Park Hospital, E. B. GARNER. Davyhulme. FIBROCYSTIC DISEASE OF THE PANCREAS SiR,-Dr. Roberts (Nov. 28) suggests that " the primary abnormality in fibrocystic disease is persistent overstimulation of the secreting glands ". It is difficult to see how this can account for the increased sweat electrolyte concentration, since di Sant’Agnese et al. in fact found that it was not accompanied by an increase in the sweat volume. I should like to suggest that the abnormal sweat electrolyte concentration is due to the absence of the mechanism for reabsorbing salt from the sweat, just as cystinuria, which is also a hereditary recessive disease, is due to the absence of the mechanism for reabsorbing cystine and related aminoacids from the urine.2
It has been shown3 that the relationship between the sodium concentration of the sweat and the sweat-rate can be explained by supposing that sweat is formed from a " precursor fluid " in which salt is present in the same concentration as in serum, and that salt is then reabsorbed from this fluid as it passes down the duct by an active mechanism which has a limiting capacity. This reabsorptive mechanism is controlled by the level of circulating corticosteroids, which explains why the sweat-sodium is the same as the serum-sodium concentration in Addison’s disease. di Sant’Agnese et al.1 reported that the mean sweat sodium and chloride concentrations in fibrocystics were 133 and 106 mEq. per litre respectively, very close to normal serum levels, compared with 59 and 32 mEq. per litre in controls. Furthermore, there was no decrease in the sweat electrolytes in response to either salt-loss or administration of deoxycortone. This is just what one would expect if the mechanism for reabsorbing salt from the sweat were absent or unable to function. Unit of Biometry, University of Oxford.
If there has to be a check on the date these certificates in (although, if authentic, why a time limit ?), then by all means impose a fine or penalty on the tardy, but to withhold all payment for such a reason is to me unreasonable, unjust, and downright dishonest. W. A. HERVEY. Lenham, Kent. are sent
DIABETIC PETS
SIR,-There must be amongst members of the medical profession some who own diabetic pets. We are interested in the development of certain complications which do not seem to occur in animals rendered diabetic by the usual experimental means, and I should be most grateful if anyone owning, or knowing of, spontaneously diabetic animals, particularly dogs maintained for any length of time on insulin, would get in touch with me. St.
Medical Unit, Mary’s Hospital, London, W.2.
HARRY KEEN. BLOOD-GROUPS
SIR,-In his response of Nov. 14 to my letter on bloodgroups, Dr. Mourant is unable to contradict the facts. Lest these facts be lost sight of, they must be reiterated: (1) C-D-E protagonists continue to teach triple inheritance of the Rh-Hr factors even though readily available evidence shows that these blood factors are actually transmitted in sets of unequal size containing up to ten or more factors. Moreover, as I have pointed out, the number of factors characterising each agglutinogen is unlimited theoretically, and the number found depends primarily on one’s enterprise and ingenuity in searching for and identifying antibodies of new specificities. (2) The two nomenclatures, Rh-Hr and C-D-E, are not mutually equivalent, so the problem is not simply one of choosing between them, as claimed by C-D-E supporters. This is not the place to repeat once more all the evidence which proves that the C-D-E notations misinterpret and distort the facts, and as a result lead to numerous contradictions and paradoxes. (3) As for the studies on blood-groups and disease, "the proof of the pudding is in the eating ". After the discovery of the Rh factor was announced, Rh-Hr tests were soon incorporated into clinical medicine and this discovery led to tremendous advances in the knowledge of blood-groups, while, in contrast, the reported associations between blood-groups and disease have proved meaningless and found no clinical application, and this type of
"
research " has led nowhere but is still the same stage as when it began 30 years ago. Such studies consist merely of a series of disconnected observations which are mutually contradictory, and instead of illuminating the subject lead only to confusion and chaos. Workers 30 years ago did not need R. A. Fisher or E. B. Ford to stimulate or inspire them to carry out similar investigations, and succeeded in producing results equalling those of modern times in
at
M. G. BULMER.
WITHHOLDING OF SICKNESS BENEFIT SIR,-There is a state of affairs concerning payment of sickness benefit which, in my opinion, should be loudly proclaimed and made widely known-namely, that if the medical certificate for the illness is not sent in within a specified time, and a cause for the delay given which is acceptable to the Insurance authorities, then payment is refused. This fact is known to many people already, but by no means all. I discovered it only by being ill and sending in my certificates some months late. The delay in sending in the certificates was due to a genuine misunderstanding on my part, but my explanation was not enough for the local Insurance office, and payment was immediately refused. This refusal to pay was sent to me on a buff printed form, which can only mean that many such forms are sent out. It would be interesting to know exactly how much per annum is saved on such refused claims. 1. di Sant’Agnese, P. A., Darling, R. C., Perera, G. A., Shea, E. Med. 1953, 15, 777. 2. Harris, H. Human Biochemical Genetics. Cambridge, 1959. 3. Bulmer, M. G., Forwell, G. D. J. Physiol. 1956, 132, 115.
Amer. J.
meaninglessness. (4) While protesting against my suggestion that the reported associations between blood-groups and disease may have resulted from some sort of bias in collecting the data, Dr. Mourant himself offers no alternative explanation of why group-0 persons should be subject to duodenal ulcers, or why group-A persons should be prone to fracture their femurs, &c. The answer is, of course, that the most difficult things to explain are those which are not true. (5) The so-called protest signed by " 33 leading American workers " stating that the nomenclature problem has to be settled by a representative committee " must be challenged. Otherwise, why during the three years which have passed since the American Medical Association report was published have those workers failed to take advantage of the numerous opportunities which have presented themselves for the formation of such a committee ? Will Dr. Mourant himself give the date and place for the meeting of such an international committee ? If "
not,
one must
conclude that C-D-E supporters have
no
inten-