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FOOD-POISONING DUE TO COPPER
520 a frequently hospitalised psychiatric patient to that of a happy and efficient individual, while on others it produces only a relative diminution in the frequency of recurrences, and that there is also a group of patients who receive little or no benefit from lithium given prophylactically. At this hospital it is our experience that lithium given at the maintenance-dosage level (i.e., 500-1500 mg. lithium carbonate per diem in divided doses) is a relatively safe form of treatment, provided that the patients are carefully supervised at the outpatient clinic, and that patients with renal or severe cardiac
of
diseases
are
excluded.
St. Patrick’s Hospital and Trinity Dublin.
College,
P. I. MELIA.
FOOD-POISONING DUE TO COPPER SIR,-The article by Dr. Nicholas (July 6, p. 40) prompts me to write of some personal experiences of the acid waters of Exmoor. Some months ago, shortly after they moved here, my farmbailiff’s wife and young baby developed a rash which, it was suggested, might have been caused by copper in the water. We knew from the blue colour and metallic taste of the water that much copper was present, and analyses (kindly undertaken by the chemist to the West Somerset Water Board, and by the Public Analyst to the County of Devon) gave the following results:
Wardle’s letter2 until after we had sent off our article. Dr. Wardle speculates on the possible role of disseminated intravascular coagulation (D.I.C.) in stillbirth, asphyxia, intracranial harmorrhage, and R.D.S. He also mentions the work of Boyd,’ who found intravascular fibrin thrombi in infants who died of R.D.S. Shortly after publication of our article Boyd wrote to us of his involvement with similar ideas for the preceding 14 years. He regarded earlier work by Wade-Evans4 as support for the hypothesis, but felt that his own necropsy investigations tended to disprove it. Like Dr. Wardle, however, we believe that, because of active fibrinolysis before and after death, any necropsy findings of fibrin deposition are strong evidence for antemortem D.i.c. Finally, Dr. M. Markarian has told us that she had proposed exactly the same hypothesis in a 1963 postdoctoral fellowship application and again in abstracts read by title at the 1966 meeting of the Society for Pediatric Research in Atlantic City, U.S.A. or
We are now testing several key concepts which will invalidate the hypothesis.
CHARLES R. STARK DAVID C. ABRAMSON N. VILDAN ERKAN.
Department of Pediatrics, Georgetown University, Washington, D.C., U.S.A. 2. 3. 4.
directly support
Wardle, E. N. ibid. p. 691. Boyd, J. F. J. Path. Bact. 1965, 90, 53; Archs Dis. Childh. 1967, 42, 401. Wade-Evans, T. Archs Dis. Childh. 1961, 36, 286.
Obituary The pH of this soft water was 5-7-6-2 at different analyses and no other metallic contamination was found-in particular, lead was absent. Investigation showed that much of the supplypipe from the spring to the house was made of copper (about 500 yards[457 m.]), and since this has been replaced by a polythene pipe the copper content of the cold supply at second draw has been reduced to 0-2 p.p.m. The copper pipe has been in use for about ten years, during which time no demonstrable harm has come to various people who have lived here and used the water except, possibly, the skin-rash mentioned. This rash disappeared following the use of other water. The suggestion that harm may be caused to the liver or other organs by long-term ingestion of small quantities of copper does, however, make it desirable to reduce the copper content, at least of the drinking-water, to the lowest possible level. Many people who live in hill-farming areas depend on private water-supplies. In some of these the unwise use of copper supply-pipes will result in excessive copper pick-up by soft, acid waters. Furthermore, it seems that in such circumstances householders should be specifically warned that water which has passed through or stood in the internal hot or cold water systems of a house should not be drunk. Such water may be expected to contain much more than 2 p.p.m. of copper, which Dr. Nicholas suggests as a reasonable maximum. Exford, nr. Minehead, C. H. PAINE. Somerset.
INTRAVASCULAR COAGULATION AND HYALINE-MEMBRANE DISEASE
Sm,,-Since publication of our hypothesis,’ we have learned that it is not new-though it is indeed original as far as we are concerned. The principal components of the hypothesis were conceived in late March, 1968. At that time a patient on the ward had a giant hasmangioma with associated consumption coagulopathy, and earlier experiences with hxmorrhage in premature infants with respiratory-distress syndrome (R.D.S.) prompted the thought that the vascular bed in the lungs of such infants could act as a giant hxmangioma. We did not read Dr. 1.
Stark, C. R., Abramson, D., Erkan, V. Lancet, 1968, i, 1180.
JOHN WILKIE M.B., M.Sc. Sheff., F.F.R. Dr. John Wilkie, consultant radiologist to the United Sheffield Hospitals, died on Aug. 14 at the age of 69. He was educated at King Edward VII School, Sheffield, and at Sheffield University. He graduated B.SC. in physiology in 1923 and M.B. with first-class honours in 1925, and he held house-appointments at the Sheffield Royal Infirmary, before becoming resident surgical officer there in 1927. After taking his D.M.R.E. in 1928 he followed Dr. Rupert Hallam as honorary radiologist to the Sheffield Royal Infirmary. His career coincided with interesting and important changes in medical practice and, although responsible for a busy hospital and private practice, he gave a great deal of time to medical committees-he
was
chairman of the medical staff of his hos-
pital and, later, chairman of the medical committee of the United Sheffield Hospitals. At the same time he was radiologist to the Wharncliffe Hospital and the Sheffield Children’s Hospital; and during his earlier years he carried out all the radiology at the hospitals in Rotherham, Barnsley, and Mexboro’. He was also lecturer in radiology at the University of Sheffield until his retirement in 1964. He was elected F.F.R. in 1948, and his wide interest in his specialty was recognised by his being chosen to be chairman of the North of England branclr of the British Institute of Radiology, president of the Section of Radiology of the Royal Society of Medicine in 1952, and vice-president of the Faculty of Radiology in 1953-54. He is survived by his wife and their two daughters, one of whom is a doctor.
A. B. N. writes: John Wilkie studied physiology under Prof. J. B. Leathes, whose influence could undoubtedly be seen during the whole of his subsequent career, giving him a critical and balanced judgment in his approach to clinical medicine. As resident "
surgical officer at Sheffield Royal Infirmary he showed a ability in the handling of colleagues and in the organisaa busy general hospital. His personality made a great impact on the whole hospital staff from the lowest to the highest; he had the common touch and he was always trusted and loved. He carried out his committee responsibilities with
natural tion of
of
diseases
are
excluded.
St. Patrick’s Hospital and Trinity Dublin.
College,
P. I. MELIA.
FOOD-POISONING DUE TO COPPER SIR,-The article by Dr. Nicholas (July 6, p. 40) prompts me to write of some personal experiences of the acid waters of Exmoor. Some months ago, shortly after they moved here, my farmbailiff’s wife and young baby developed a rash which, it was suggested, might have been caused by copper in the water. We knew from the blue colour and metallic taste of the water that much copper was present, and analyses (kindly undertaken by the chemist to the West Somerset Water Board, and by the Public Analyst to the County of Devon) gave the following results:
Wardle’s letter2 until after we had sent off our article. Dr. Wardle speculates on the possible role of disseminated intravascular coagulation (D.I.C.) in stillbirth, asphyxia, intracranial harmorrhage, and R.D.S. He also mentions the work of Boyd,’ who found intravascular fibrin thrombi in infants who died of R.D.S. Shortly after publication of our article Boyd wrote to us of his involvement with similar ideas for the preceding 14 years. He regarded earlier work by Wade-Evans4 as support for the hypothesis, but felt that his own necropsy investigations tended to disprove it. Like Dr. Wardle, however, we believe that, because of active fibrinolysis before and after death, any necropsy findings of fibrin deposition are strong evidence for antemortem D.i.c. Finally, Dr. M. Markarian has told us that she had proposed exactly the same hypothesis in a 1963 postdoctoral fellowship application and again in abstracts read by title at the 1966 meeting of the Society for Pediatric Research in Atlantic City, U.S.A. or
We are now testing several key concepts which will invalidate the hypothesis.
CHARLES R. STARK DAVID C. ABRAMSON N. VILDAN ERKAN.
Department of Pediatrics, Georgetown University, Washington, D.C., U.S.A. 2. 3. 4.
directly support
Wardle, E. N. ibid. p. 691. Boyd, J. F. J. Path. Bact. 1965, 90, 53; Archs Dis. Childh. 1967, 42, 401. Wade-Evans, T. Archs Dis. Childh. 1961, 36, 286.
Obituary The pH of this soft water was 5-7-6-2 at different analyses and no other metallic contamination was found-in particular, lead was absent. Investigation showed that much of the supplypipe from the spring to the house was made of copper (about 500 yards[457 m.]), and since this has been replaced by a polythene pipe the copper content of the cold supply at second draw has been reduced to 0-2 p.p.m. The copper pipe has been in use for about ten years, during which time no demonstrable harm has come to various people who have lived here and used the water except, possibly, the skin-rash mentioned. This rash disappeared following the use of other water. The suggestion that harm may be caused to the liver or other organs by long-term ingestion of small quantities of copper does, however, make it desirable to reduce the copper content, at least of the drinking-water, to the lowest possible level. Many people who live in hill-farming areas depend on private water-supplies. In some of these the unwise use of copper supply-pipes will result in excessive copper pick-up by soft, acid waters. Furthermore, it seems that in such circumstances householders should be specifically warned that water which has passed through or stood in the internal hot or cold water systems of a house should not be drunk. Such water may be expected to contain much more than 2 p.p.m. of copper, which Dr. Nicholas suggests as a reasonable maximum. Exford, nr. Minehead, C. H. PAINE. Somerset.
INTRAVASCULAR COAGULATION AND HYALINE-MEMBRANE DISEASE
Sm,,-Since publication of our hypothesis,’ we have learned that it is not new-though it is indeed original as far as we are concerned. The principal components of the hypothesis were conceived in late March, 1968. At that time a patient on the ward had a giant hasmangioma with associated consumption coagulopathy, and earlier experiences with hxmorrhage in premature infants with respiratory-distress syndrome (R.D.S.) prompted the thought that the vascular bed in the lungs of such infants could act as a giant hxmangioma. We did not read Dr. 1.
Stark, C. R., Abramson, D., Erkan, V. Lancet, 1968, i, 1180.
JOHN WILKIE M.B., M.Sc. Sheff., F.F.R. Dr. John Wilkie, consultant radiologist to the United Sheffield Hospitals, died on Aug. 14 at the age of 69. He was educated at King Edward VII School, Sheffield, and at Sheffield University. He graduated B.SC. in physiology in 1923 and M.B. with first-class honours in 1925, and he held house-appointments at the Sheffield Royal Infirmary, before becoming resident surgical officer there in 1927. After taking his D.M.R.E. in 1928 he followed Dr. Rupert Hallam as honorary radiologist to the Sheffield Royal Infirmary. His career coincided with interesting and important changes in medical practice and, although responsible for a busy hospital and private practice, he gave a great deal of time to medical committees-he
was
chairman of the medical staff of his hos-
pital and, later, chairman of the medical committee of the United Sheffield Hospitals. At the same time he was radiologist to the Wharncliffe Hospital and the Sheffield Children’s Hospital; and during his earlier years he carried out all the radiology at the hospitals in Rotherham, Barnsley, and Mexboro’. He was also lecturer in radiology at the University of Sheffield until his retirement in 1964. He was elected F.F.R. in 1948, and his wide interest in his specialty was recognised by his being chosen to be chairman of the North of England branclr of the British Institute of Radiology, president of the Section of Radiology of the Royal Society of Medicine in 1952, and vice-president of the Faculty of Radiology in 1953-54. He is survived by his wife and their two daughters, one of whom is a doctor.
A. B. N. writes: John Wilkie studied physiology under Prof. J. B. Leathes, whose influence could undoubtedly be seen during the whole of his subsequent career, giving him a critical and balanced judgment in his approach to clinical medicine. As resident "
surgical officer at Sheffield Royal Infirmary he showed a ability in the handling of colleagues and in the organisaa busy general hospital. His personality made a great impact on the whole hospital staff from the lowest to the highest; he had the common touch and he was always trusted and loved. He carried out his committee responsibilities with
natural tion of