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INSTABILITY OF HETEROZYGOUS HAPTOGLOBIN TYPE 2-1 IN STARCH-GEL ELECTROPHORESIS
1301 nesium gluconate by mouth was inconsistent, which perhaps is a reflection of the opposing influences on the serummagnesium of an increase in urinary excretion and an increase in the intestinal absorption of magnesium. This
study
was
supported by
a
grant from the Medical Research "
Foundation of Texas.
WILLIAM K. GEORGE WILLIAM D. GEORGE, JR. CHU LAI HAAN RICHARD G. FISHER.
University of Texas, Medical Branch, Galveston, Texas.
EVOLUTIONAL APPROACH TO INFANT CARE SIR,-Professor Bostock’s interesting and provocative paper of May 19 does not refer to the fact that one aspect ofthe concept of exterior gestation has already been investigated, with very significant results. Dr. Lee Salk, at the City Hospital, Elmhurst, New York, has investigated the influence of the maternal heart-beat rhythm on the behaviour of newborn infants. This work was first presented at the Edinburgh Mental Health Conference in 19601and more completely at the Third World Congress of Psychiatry in 1961. From the standpoint that imprinting occurs in prenatal life, it is postulated that tactile, kinsesthetic, and auditory stimuli exist then and have the necessary characteristics for imprinting to take place. This is particularly true of the maternal heartbeat, with its repetitive and intermittent quality. In an experiment,recorded normal heartbeat sound was presented continuously at 72 beats per minute for four days, in a nursery for newborn infants. Weight change, food intake, and length of crying were recorded and compared with a control group, whose conditions were identical, except for the absence of this sound. In the experimental group, weight gain was significantly greater and crying significantly less, but there was no difference in food intake. It was concluded that the additional weight gain was due to reduction in crying, which in turn resulted from reduced anxiety, due to the proximity of a stimulus which we can assume to have existed during prenatal life. Other sounds, or different speeds of the heartbeat, had no such effect. In a further experiment, young children in a residential nursery fell asleep, when exposed to the heartbeat sound, in half the time required when there was no sound, or a metronome or recorded lullabies. These results suggest that the sound of the normal heartbeat rhythm has unique effects, which are not obtainable with other sound conditions. Having had the opportunity of observing some of Dr.
Salk’s work, I feel that this line of inquiry has great theoretical importance, in relation both to learning and emotional development. Salford Royal Hospital, Salford.
HUGH FREEMAN.
INSTABILITY OF HETEROZYGOUS HAPTOGLOBIN TYPE 2-1 IN STARCH-GEL ELECTROPHORESIS
SIR,-Up to now no clear explanation has been given change in the pattern of the haptoglobin typesboth homozygous types Hp 1-1 and Hp 2-2, as well as the heterozygous type 2-1. It is usually put down to some for the
instability of older sera. Our
observations
sera, such
as stored believe that the heterozygous type 2-1 is possibly more labile than both homozygous types. For this reason fresh serum from 170 blooddonors was examined in one working shift, using the method of Smithies as modified by Baitsch. 79 sera (46-5%) were found to be type 2-1. A second sample of the same blood was stored without consideration of asepsis for 14 days at +2°C without isolating the sera. All samples were more or less spontaneously hsmolysed by saprophytes. Afterwards repeated examination own
on
hasmolysed
blood between 2 and 10 days old, led
1. World Mental
Health; vol. 12,
us to
no. 4.
November,
1960.
showed that of the original 79 Hp 2-1 patterns, 26 resembled type Hp 2-2. 7 days later the patterns of 70 sera were not sufficiently clear, 8 sera of type HP 2-1 showed a pattern similar to Hp 2-2. Theoretically the heterozygous type Hp 2-1-according to Allison’s plausible idea, a polymerised product of both homozygous types-is more labile, and, in certain circumstances (haemolysis, &c.) which we are now investigating, more easily
disintegrated. We think it not unlikely that exogenous changes in the blood, exaggerated, perhaps, in our investigation, may influence population genetic findings, especially in warmer countries and where distances to laboratories are long. Compare, for example, the high frequency of Hp 2-2 in India and Malaya. Institute of Human Genetics and Institute of Hygiene, University of Göttingen,
G. JÖRGENSEN E. GALLASCH.
Germany.
THE FUNCTIONS OF A HOSPITAL
SIR,-Most general practitioners, I believe, share the view
might
expressed by Dr. Binks (May 26) though they not be able to produce figures to justify it.
a survey of patients discharged from the medical beds large general hospital in Birmingham in 1953-54 Dr. Cross and I concluded1 that 25% had no diagnostic, therapeutic, or nursing requirement at hospital level. Approximately
From
of
a
two-thirds of this group had an absolute social bar to home care, compared with two-fifths of the patients (75% of the total) who had some real apparent medical or nursing need at hospital level. We also estimatedthat, of seven patients with no medical or nursing need at hospital level, six were cared for at home by their relatives and general practitioners; and that for every patient in a geriatric bed who apparently had some medical or nursing need at hospital level, six were cared for at home.
necessity is a very important cause of admission short-stay as well as long-stay medical beds; and, as Dr. Binks says, it is grossly underrated by those concerned with the hospital service. Social
to
D. L. CROMBIE.
SIR,-Ishould like his
accurate account
by anyone trying geriatric service.
to
of
congratulate Dr. F. A. Binks
some
to
on
of the obstacles encountered
establish
an
effective hospital
Few would disagree with his statement that " the hospital service is bearing many of the burdens of the welfare services...", but I doubt that much progress will be made towards reversing this situation merely by indicacing to the local authorities where their responsibilities lie. Those of us in the hospital service would do well to remember that the lot of the local authority in this field is not always a happy one. It is easy to imagine the sorry plight a naive and helpful local authority might get into if it insisted on helping an ineffective hospital service with its geriatric problems. It is easier for us in the hospital service to initiate novel schemes than it is for our colleagues who work in local authority. On this count it is likely that the hospital services will"have to persuade their local authority to try new approaches to geriatric " problems. That this can be done is perhaps shown by our experience in Oldham. A geriatric day hospital has run in relationship to my unit for the past six years. For three years it has been apparent that we have successfully maintained for many months many elderly people in their own homes whilst they waited for places in localauthority residential’hostels. In addition, our hospital experience suggests that there are many elderly people who need more help than
can
practicably
be
given by local-authority domiciliary
services yet do not need the twenty-four-hour care and attention provided by residential accommodation. In the present circumstances such people must deteriorate 1. 2.
Crombie, D. L., Cross, K. W. Med. Pr. 1959, 242, 316. Crombie, D. L., Cross K. W. J. Coll. gen. Practrs 4, 270.
study
was
supported by
a
grant from the Medical Research "
Foundation of Texas.
WILLIAM K. GEORGE WILLIAM D. GEORGE, JR. CHU LAI HAAN RICHARD G. FISHER.
University of Texas, Medical Branch, Galveston, Texas.
EVOLUTIONAL APPROACH TO INFANT CARE SIR,-Professor Bostock’s interesting and provocative paper of May 19 does not refer to the fact that one aspect ofthe concept of exterior gestation has already been investigated, with very significant results. Dr. Lee Salk, at the City Hospital, Elmhurst, New York, has investigated the influence of the maternal heart-beat rhythm on the behaviour of newborn infants. This work was first presented at the Edinburgh Mental Health Conference in 19601and more completely at the Third World Congress of Psychiatry in 1961. From the standpoint that imprinting occurs in prenatal life, it is postulated that tactile, kinsesthetic, and auditory stimuli exist then and have the necessary characteristics for imprinting to take place. This is particularly true of the maternal heartbeat, with its repetitive and intermittent quality. In an experiment,recorded normal heartbeat sound was presented continuously at 72 beats per minute for four days, in a nursery for newborn infants. Weight change, food intake, and length of crying were recorded and compared with a control group, whose conditions were identical, except for the absence of this sound. In the experimental group, weight gain was significantly greater and crying significantly less, but there was no difference in food intake. It was concluded that the additional weight gain was due to reduction in crying, which in turn resulted from reduced anxiety, due to the proximity of a stimulus which we can assume to have existed during prenatal life. Other sounds, or different speeds of the heartbeat, had no such effect. In a further experiment, young children in a residential nursery fell asleep, when exposed to the heartbeat sound, in half the time required when there was no sound, or a metronome or recorded lullabies. These results suggest that the sound of the normal heartbeat rhythm has unique effects, which are not obtainable with other sound conditions. Having had the opportunity of observing some of Dr.
Salk’s work, I feel that this line of inquiry has great theoretical importance, in relation both to learning and emotional development. Salford Royal Hospital, Salford.
HUGH FREEMAN.
INSTABILITY OF HETEROZYGOUS HAPTOGLOBIN TYPE 2-1 IN STARCH-GEL ELECTROPHORESIS
SIR,-Up to now no clear explanation has been given change in the pattern of the haptoglobin typesboth homozygous types Hp 1-1 and Hp 2-2, as well as the heterozygous type 2-1. It is usually put down to some for the
instability of older sera. Our
observations
sera, such
as stored believe that the heterozygous type 2-1 is possibly more labile than both homozygous types. For this reason fresh serum from 170 blooddonors was examined in one working shift, using the method of Smithies as modified by Baitsch. 79 sera (46-5%) were found to be type 2-1. A second sample of the same blood was stored without consideration of asepsis for 14 days at +2°C without isolating the sera. All samples were more or less spontaneously hsmolysed by saprophytes. Afterwards repeated examination own
on
hasmolysed
blood between 2 and 10 days old, led
1. World Mental
Health; vol. 12,
us to
no. 4.
November,
1960.
showed that of the original 79 Hp 2-1 patterns, 26 resembled type Hp 2-2. 7 days later the patterns of 70 sera were not sufficiently clear, 8 sera of type HP 2-1 showed a pattern similar to Hp 2-2. Theoretically the heterozygous type Hp 2-1-according to Allison’s plausible idea, a polymerised product of both homozygous types-is more labile, and, in certain circumstances (haemolysis, &c.) which we are now investigating, more easily
disintegrated. We think it not unlikely that exogenous changes in the blood, exaggerated, perhaps, in our investigation, may influence population genetic findings, especially in warmer countries and where distances to laboratories are long. Compare, for example, the high frequency of Hp 2-2 in India and Malaya. Institute of Human Genetics and Institute of Hygiene, University of Göttingen,
G. JÖRGENSEN E. GALLASCH.
Germany.
THE FUNCTIONS OF A HOSPITAL
SIR,-Most general practitioners, I believe, share the view
might
expressed by Dr. Binks (May 26) though they not be able to produce figures to justify it.
a survey of patients discharged from the medical beds large general hospital in Birmingham in 1953-54 Dr. Cross and I concluded1 that 25% had no diagnostic, therapeutic, or nursing requirement at hospital level. Approximately
From
of
a
two-thirds of this group had an absolute social bar to home care, compared with two-fifths of the patients (75% of the total) who had some real apparent medical or nursing need at hospital level. We also estimatedthat, of seven patients with no medical or nursing need at hospital level, six were cared for at home by their relatives and general practitioners; and that for every patient in a geriatric bed who apparently had some medical or nursing need at hospital level, six were cared for at home.
necessity is a very important cause of admission short-stay as well as long-stay medical beds; and, as Dr. Binks says, it is grossly underrated by those concerned with the hospital service. Social
to
D. L. CROMBIE.
SIR,-Ishould like his
accurate account
by anyone trying geriatric service.
to
of
congratulate Dr. F. A. Binks
some
to
on
of the obstacles encountered
establish
an
effective hospital
Few would disagree with his statement that " the hospital service is bearing many of the burdens of the welfare services...", but I doubt that much progress will be made towards reversing this situation merely by indicacing to the local authorities where their responsibilities lie. Those of us in the hospital service would do well to remember that the lot of the local authority in this field is not always a happy one. It is easy to imagine the sorry plight a naive and helpful local authority might get into if it insisted on helping an ineffective hospital service with its geriatric problems. It is easier for us in the hospital service to initiate novel schemes than it is for our colleagues who work in local authority. On this count it is likely that the hospital services will"have to persuade their local authority to try new approaches to geriatric " problems. That this can be done is perhaps shown by our experience in Oldham. A geriatric day hospital has run in relationship to my unit for the past six years. For three years it has been apparent that we have successfully maintained for many months many elderly people in their own homes whilst they waited for places in localauthority residential’hostels. In addition, our hospital experience suggests that there are many elderly people who need more help than
can
practicably
be
given by local-authority domiciliary
services yet do not need the twenty-four-hour care and attention provided by residential accommodation. In the present circumstances such people must deteriorate 1. 2.
Crombie, D. L., Cross, K. W. Med. Pr. 1959, 242, 316. Crombie, D. L., Cross K. W. J. Coll. gen. Practrs 4, 270.