- Email: [email protected]
JENNER MUSEUM
54
by diazoxide, reported one infant (who had had other therapy) who had leucopenia and eosinophilia. In our small series to date two patients receiving 400 mg. diazoxide per day have had mild depression of w.s.c. count but no change in platelet count, and one patient receiving 800 mg. per day had a more pronounced fall in W.B.C. count. Three other patients on 400 mg. per day have had no change of any hasmatological index. Diazoxide is well bound to plasma-proteins and there are appreciable blood-levels for 6-8 days after therapy has been discontinued. This may explain the prolonged fall in w.B.c.s in our patient. The side-effects of diazoxide, as described in this patient, suggest that it should not be used indiscriminately. Frequent checks on the hsmatological state of the patient is required whenever the drug is used and even after it has been discontinued. Research Foundation, Washington Hospital Center, 110 Irving Street, N.W., and Department of Medicine, George Washington University, Washington, D.C. 20010.
JOHN K. WALES
significant number of cases occurred in the AA genotype of haemoglobin-presumably those who would be more susceptible to persistent malaria. The main lesions of malaria are found in the reticuloendothelial system, of which Burkitt’s tumour is a neoplasm; and the peak of age incidence of the tumour coincides with the decisive immunological changes in children exposed to holoendemic malaria. The histocytes which give such a characteristic histological picture to Burkitt’s tumour are found in other lymphomas but not so regularly or in such quantities. Could these cells be more than phagocytic cells in a rapidly neoplasm ? Could they be related to the macrophages growingwith which lymphoid hyperplasia form the principal reaction to malaria, and do they in fact have immunological significance ? Recent reports of immunological work on this tumour have been most enlightening, and while the hunt for a virus needs no encouragement it would seem justified to intensify immunological studies and to look again at the biological soil of this tumour, rather than for a specific aetiological agent.
FREDERICK WOLFF.
Medical Research Laboratory, Box 30141, Nairobi, Kenya.
C. A. LINSELL.
A SKINFUL OF ALCOHOL EPIDEMIOLOGY OF BURKITT’S TUMOUR was Sir,-I surprised that Dr. Gold, in his interesting SIR,-I wish to support Dr. Dorfman’s opinion (Oct. 22, report1 of a side-effect from the use of ’Tetmosol ’ solution p. 909) that the definitive diagnosis of this tumour is now far applied direct to the skin, states that the compound " is only from an academic exercise in view of the dramatic response of rarely prescribed in this country for scabies ... ". some of these tumours in Africa to cytotoxic drugs. We see a lot of scabies in this hospital, and it seems that the It may also be valuable to reassess some of the epidemiological mite is now often resistant to benzyl benzoate. As an alternative and clinical aspects of this tumour. It is now clear that cases treatment dilute tetmosol and tetmosol soap is used successfully. morphologically similar to those reported from Uganda have Using the dilute solution we have not encountered the adverse been seen, both within Africa and elsewhere, in areas which do reaction reported by Dr. Gold, and our patients are not necesnot conform to the climatic criteria on which the original sarily abstemious. theory of a vector-borne-virus aetiology was based. On global Dreadnought Seamen’s Hospital, DAVID ERSKINE. London S.E.10. and local distribution, the geography of the disease is marked by incidence in areas rather the occurrence of a some than high precise entity in a unique situation. The clinical manifestations in jaw or ovary which were notable features of the original COLOUR-BLINDNESS AND ALCOHOLISM accounts may be a presentation of childhood lymphoma related to growth and physiological activity at these sites. When SiR,-The apparent association between colour-blindness and collection of childhood lymphomas in those countries where alcoholism reported2 by Dr. Cruz-Coke and Dr. Varela would have interested Francis Galton, who, in 1883, commented3 on these tumours are rare is more complete, these manifestations the high incidence of colour-blindness in Quakers. He said may form a more impressive component of the clinical picture there. It is not suggested that they are an essential part of that it is nearly twice as prevalent among them as among the rest of the community, the proportions being 5-9% to 3-5%. Burkitt’s tumour. To accommodate the theory of a specific viral xtiology for John Dalton, the physicist, who in 1794 discovered the existence of colour-blindness as a peculiarity of his own, was a this tumour to the increasing reports from very varied environQuaker, and Galton believed that the Quaker’s preference for ments, Bell 8 has suggested that a bizarre response is evoked drab clothes and their dislike of the fine arts can be ascribed to a some of which have a more by wide range of viruses, may this defect. efficient portal of entry via an insect vector. It would appear now come full circle and we are back to a with which it is difficult to quarrel for lack of specific evidence. Among the multitude of microbiological and parasitic assaults suffered by children in Africa and New Guinea, O’Conor9 and Dalldorf et a1.1o drew attention to malarial infection. The global distribution of the maximum incidence of Burkitt’s tumour is similar to that of holoendemic malaria, and, although millions are exposed to malaria in areas in which Burkitt’s tumour has only occasionally been reported, it is only in the holoendemic areas that the child is exposed to such intense, continuous infection. In Africa Burkitt’s tumour is certainly commoner in the areas of holoendemic malaria where also the sickle-cell trait and glucose-6-phosphate-dehydrogenase deficiency rates are high. In Nigeria," although no relationship was demonstrated between the ABO g:oups and Burkitt’s tumour, a
that
theory has
statement
7. Viktora, J. K. Personal communication. 8. Bell, T. M., Massie, A., Ross, M. G. R., Simpson, D. I. H., Griffin, E. Br. med. J. 1966, i, 1514. 9. O’Conor, G. T. Cancer, N.Y. 1961, 14, 270. 10. Dalldorf, G., Linsell, C. A., Barnhart, F. E., Martyn, R. Perspect Biol. Med. 1964, 7, 435. 11. Williams, A. O. J. med. Genet. 1966, 3, 177.
Department of Pathology, Joyce Green Hospital, Dartford, Kent.
JENNER
JOHN C. BURNE.
MUSEUM
The secretary, Dr. A. M. G. CAMPBELL (79 Pembroke Road, Bristol 8), and the treasurer, Dr. JAMES MACRAE (Ham Green Hos" pital, Pill, nr. Bristol), to the Jenner Trust write: The inaugural meeting of a trust to commemorate Edward Jenner’s work on vaccination was held in Bristol on Nov. 23. This trust intends to preserve the buildings associated with Jenner at Berkeley, where he lived and worked, and to form a small musuem in the cottage which he built for James Phipps, the first boy he vaccinated. The trust has the support of the Royal Colleges of Physicians and Surgeons, the Royal Society, and other learned bodies, who have representatives on the trust. We appeal for donations from anyone who is interested in this project to help us renovate the buildings and form the museum. We also appeal for the loan or donation of jennerian relics. Donations should be sent to the treasurer." 1. 2. 3.
Gold, S. Lancet, 1966, ii, 1417. Cruz-Coke, R., Varela, A. ibid. p. 1282. Galton, F. Inquiries into Human Faculty; p. 45. London, 1883.
by diazoxide, reported one infant (who had had other therapy) who had leucopenia and eosinophilia. In our small series to date two patients receiving 400 mg. diazoxide per day have had mild depression of w.s.c. count but no change in platelet count, and one patient receiving 800 mg. per day had a more pronounced fall in W.B.C. count. Three other patients on 400 mg. per day have had no change of any hasmatological index. Diazoxide is well bound to plasma-proteins and there are appreciable blood-levels for 6-8 days after therapy has been discontinued. This may explain the prolonged fall in w.B.c.s in our patient. The side-effects of diazoxide, as described in this patient, suggest that it should not be used indiscriminately. Frequent checks on the hsmatological state of the patient is required whenever the drug is used and even after it has been discontinued. Research Foundation, Washington Hospital Center, 110 Irving Street, N.W., and Department of Medicine, George Washington University, Washington, D.C. 20010.
JOHN K. WALES
significant number of cases occurred in the AA genotype of haemoglobin-presumably those who would be more susceptible to persistent malaria. The main lesions of malaria are found in the reticuloendothelial system, of which Burkitt’s tumour is a neoplasm; and the peak of age incidence of the tumour coincides with the decisive immunological changes in children exposed to holoendemic malaria. The histocytes which give such a characteristic histological picture to Burkitt’s tumour are found in other lymphomas but not so regularly or in such quantities. Could these cells be more than phagocytic cells in a rapidly neoplasm ? Could they be related to the macrophages growingwith which lymphoid hyperplasia form the principal reaction to malaria, and do they in fact have immunological significance ? Recent reports of immunological work on this tumour have been most enlightening, and while the hunt for a virus needs no encouragement it would seem justified to intensify immunological studies and to look again at the biological soil of this tumour, rather than for a specific aetiological agent.
FREDERICK WOLFF.
Medical Research Laboratory, Box 30141, Nairobi, Kenya.
C. A. LINSELL.
A SKINFUL OF ALCOHOL EPIDEMIOLOGY OF BURKITT’S TUMOUR was Sir,-I surprised that Dr. Gold, in his interesting SIR,-I wish to support Dr. Dorfman’s opinion (Oct. 22, report1 of a side-effect from the use of ’Tetmosol ’ solution p. 909) that the definitive diagnosis of this tumour is now far applied direct to the skin, states that the compound " is only from an academic exercise in view of the dramatic response of rarely prescribed in this country for scabies ... ". some of these tumours in Africa to cytotoxic drugs. We see a lot of scabies in this hospital, and it seems that the It may also be valuable to reassess some of the epidemiological mite is now often resistant to benzyl benzoate. As an alternative and clinical aspects of this tumour. It is now clear that cases treatment dilute tetmosol and tetmosol soap is used successfully. morphologically similar to those reported from Uganda have Using the dilute solution we have not encountered the adverse been seen, both within Africa and elsewhere, in areas which do reaction reported by Dr. Gold, and our patients are not necesnot conform to the climatic criteria on which the original sarily abstemious. theory of a vector-borne-virus aetiology was based. On global Dreadnought Seamen’s Hospital, DAVID ERSKINE. London S.E.10. and local distribution, the geography of the disease is marked by incidence in areas rather the occurrence of a some than high precise entity in a unique situation. The clinical manifestations in jaw or ovary which were notable features of the original COLOUR-BLINDNESS AND ALCOHOLISM accounts may be a presentation of childhood lymphoma related to growth and physiological activity at these sites. When SiR,-The apparent association between colour-blindness and collection of childhood lymphomas in those countries where alcoholism reported2 by Dr. Cruz-Coke and Dr. Varela would have interested Francis Galton, who, in 1883, commented3 on these tumours are rare is more complete, these manifestations the high incidence of colour-blindness in Quakers. He said may form a more impressive component of the clinical picture there. It is not suggested that they are an essential part of that it is nearly twice as prevalent among them as among the rest of the community, the proportions being 5-9% to 3-5%. Burkitt’s tumour. To accommodate the theory of a specific viral xtiology for John Dalton, the physicist, who in 1794 discovered the existence of colour-blindness as a peculiarity of his own, was a this tumour to the increasing reports from very varied environQuaker, and Galton believed that the Quaker’s preference for ments, Bell 8 has suggested that a bizarre response is evoked drab clothes and their dislike of the fine arts can be ascribed to a some of which have a more by wide range of viruses, may this defect. efficient portal of entry via an insect vector. It would appear now come full circle and we are back to a with which it is difficult to quarrel for lack of specific evidence. Among the multitude of microbiological and parasitic assaults suffered by children in Africa and New Guinea, O’Conor9 and Dalldorf et a1.1o drew attention to malarial infection. The global distribution of the maximum incidence of Burkitt’s tumour is similar to that of holoendemic malaria, and, although millions are exposed to malaria in areas in which Burkitt’s tumour has only occasionally been reported, it is only in the holoendemic areas that the child is exposed to such intense, continuous infection. In Africa Burkitt’s tumour is certainly commoner in the areas of holoendemic malaria where also the sickle-cell trait and glucose-6-phosphate-dehydrogenase deficiency rates are high. In Nigeria," although no relationship was demonstrated between the ABO g:oups and Burkitt’s tumour, a
that
theory has
statement
7. Viktora, J. K. Personal communication. 8. Bell, T. M., Massie, A., Ross, M. G. R., Simpson, D. I. H., Griffin, E. Br. med. J. 1966, i, 1514. 9. O’Conor, G. T. Cancer, N.Y. 1961, 14, 270. 10. Dalldorf, G., Linsell, C. A., Barnhart, F. E., Martyn, R. Perspect Biol. Med. 1964, 7, 435. 11. Williams, A. O. J. med. Genet. 1966, 3, 177.
Department of Pathology, Joyce Green Hospital, Dartford, Kent.
JENNER
JOHN C. BURNE.
MUSEUM
The secretary, Dr. A. M. G. CAMPBELL (79 Pembroke Road, Bristol 8), and the treasurer, Dr. JAMES MACRAE (Ham Green Hos" pital, Pill, nr. Bristol), to the Jenner Trust write: The inaugural meeting of a trust to commemorate Edward Jenner’s work on vaccination was held in Bristol on Nov. 23. This trust intends to preserve the buildings associated with Jenner at Berkeley, where he lived and worked, and to form a small musuem in the cottage which he built for James Phipps, the first boy he vaccinated. The trust has the support of the Royal Colleges of Physicians and Surgeons, the Royal Society, and other learned bodies, who have representatives on the trust. We appeal for donations from anyone who is interested in this project to help us renovate the buildings and form the museum. We also appeal for the loan or donation of jennerian relics. Donations should be sent to the treasurer." 1. 2. 3.
Gold, S. Lancet, 1966, ii, 1417. Cruz-Coke, R., Varela, A. ibid. p. 1282. Galton, F. Inquiries into Human Faculty; p. 45. London, 1883.