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MATERNAL ALCOHOLISM AND INTELLECTUAL DEVELOPMENT OF OFFSPRING
218 may be considered to be one of the most medically orientated
of those available devotes 7-8% of its
hormones, electrolytes, 5-9% to text to
0-5% to immunology, 0-3% to nutrition, but 47% to metabolism. Another highly rated textbook of biochemistry popular with medical students contains no information on hormones, immunology, electrolytes, or nutrition, but gives 61 % to " metabolism ". These findings seem to vindicate critics who have for so long complained of the irrelevance of a large section of conventional biochemistry to clinical medicine and tend support the views expressed by you (Feb. 23, p. 297) and Professor Whitby (April 13, p. 683). In the design of future courses of biochemistry for medical students, it would be unwise to exclude completely or curtail very drastically the fundamentals of structure or metabolism, but it is evident that the emphasis on these topics should be much reduced and diverted to more applied areas of the subject such as hormones, nutrition, and immunology. Attention should also be given to the following trends: increasing attention is being devoted in school A-level courses to biochemistry, especially in zoology and biology courses and in the Nuffield chemistry course (biochemistry option). Although the standard reached may not be very high as yet, many students are now entering medical school with some knowledge and understanding of such basic biochemistry as glycolysis, citric-acid cycle, energetics, D.N.A., and protein synthesis. Unless courses of biochemistry with a stronger application to clinical medicine are introduced, biochemists teaching in preclinical courses may, to avoid repeating the more elementary school biochemistry, be forced to teach more and more academic biochemistry which will then become increasingly irrelevant to the medical course. Although this very academic teaching may be allowed to proceed for a few years, pressure for severe curtailment or even abolition of the " academic biochemistry course " would almost certainly increase. The bridging of the gap from school biochemistry to clinical biochemistry may not be so formidable as appears at present, especially if the teaching of human nutrition is, as recommended by many nutritionists, instigated as a separate preclinical or clinical If this comes about, all nutrition and related course. could be removed from the domain of biochemistry. subjects Preclinical biochemistry courses have made an important contribution to medical education, but now rethinking of their purpose, content, and relevance is necessary as a matter of urgency for all those concerned with planning, teaching and organisation, who should attempt to understand the nature of the roads they are taking and their final goals.
to
’
,
Department of Biochemistry, St. Bartholomew’s Hospital Medical College, Charterhouse Square, London EC1M 6BQ.
E. D. WILLS.
MATERNAL ALCOHOLISM AND INTELLECTUAL DEVELOPMENT OF OFFSPRING
SIR,—Iquestion the validity of the suggestion by Jones al. that " the frequency of adverse outcome in the pregnancies of chronically alcoholic women is of such a magnitude that serious consideration should be given toward early termination of pregnancy in such women." Their sample of 23 alcoholic women was drawn from a prospective study of 55,000 pregnant women. There had been no direct prospective question related to maternal alcoholism. On the basis of a national survey of drinking practices conducted throughout the United States in
1964-65 based on 2746 personal interviews,2 one could estimate that 5% of the women could be classified as heavy drinkers. Thus, the 23 cases selected were probably the most conspicuous among the possible universe of 2750, and may represent extremes in terms of the physical, psychological, and sociological ravages of this disease. The profound detrimental effects of the disorganised multi-problem family on the psychological and intellectual development of children have been documented.3 The alcoholic mother often fails to provide for her children’s physical and emotional needs in a consistent manner. Only 12 children were available for adequate evaluation at age 7. The 6 who lived with their mothers had a lower mean i.Q. at 7 years of age (73) than the 6 who spent some time with relatives or in foster homes (i.Q. 84). Impaired intellectual performance was greater at the 7-year evaluation than at the 4-year one. While the population size is too small for statistical comparisons, the data suggest that the intellectual development of these children may have been adversely affected by their environment throughout the early years of life. Early and intensive educational and psychotherapeutic intervention with alcoholic women and their offspring seems more appropriate than early The need for prospective termination of pregnancy. studies in which the quantity, frequency, and variability of maternal drinking is evaluated on several occasions throughout pregnancy and the early years of the child’s life is apparent. Further observations of the effects of maternal intoxication on the mother-child interaction, and the child’s personality and intellectual development, is needed before effective prevention can be devised. University School of Medicine, 889 Harrison Avenue, Boston, Massachusetts 02218,
Boston
U.S.A.
MEBENDAZOLE AND HYDATID CYSTS SIR,--We should like to draw the attention of your readers to the lethal effect of the anthelmintic drug mebendazole on secondary Echinococcus granulosus cysts in mice. Until now no chemotherapeutic agent has been known to kill hydatid cysts. If mebendazole is as effective in man as it is in mice, much of the danger of secondary infection inherent in surgical removal of hydatid cysts Mebendazole will also probably kill may be avoided. primary hydatid cysts, which- may obviate the need for surgery in many cases. Mebendazole (methyl 5-benzoyl benzimidazole-2-carbamate) (Janssen Pharmaceutica, Belgium) is a broadspectrum anthelmintic that affects both nematodes and cestodes4 and also Trichinella spiralis larvae in muscle.’ It appears to affect glucose uptake and/or utilisation by the parasites. 5-7 We 8 tested various formulations and modes of administration of microfine mebendazole on tetrathyridia of Mesocestoides corti in mice, on mature and immature cysticerci of Tcenia pisiformis in rabbits, and on experimental secondary Echinococcus granulosus cysts in mice.9
et
1.
Jones, K. L., Smith, D. W., Streissguth, A. P., Myrianthopoulos, N. C. Lancet, 1974, i, 1076.
HENRY L. ROSETT.
2.
Cahalan, D., Cisin, I. H., Crossley, H. M. American Drinking Practices: A National Study of Drinking Behaviour and Attitudes. Rutgers Centre of Alcohol Studies, New Brunswick, New Jersey,
3.
Pavenstedt, E. (editor). The Drifters: Children of Disorganised Lower Class Families. Boston, 1967. Vanparijs, O., Thienpont, D. Dt. tierärztl. Wschr. 1973, 80, 320. De Nollin, S., Van Den Bossche, H. J. Parasit. 1973, 59, 970. Van Den Bossche, H. in Comparative Biochemistry of Parasites (edited by H. Van Den Bossche); p. 139. New York, 1972. Van Den Bossche, H., De Nollin, S. Int. J. Parasit. 1973, 3, 401. Heath, D. D., Christie, M., Chevis, R. A. F. Parasitology (in the press). Heath, D. D. ibid. 1970, 60, 449.
1969.
4. 5. 6. 7. 8.
9.
of those available devotes 7-8% of its
hormones, electrolytes, 5-9% to text to
0-5% to immunology, 0-3% to nutrition, but 47% to metabolism. Another highly rated textbook of biochemistry popular with medical students contains no information on hormones, immunology, electrolytes, or nutrition, but gives 61 % to " metabolism ". These findings seem to vindicate critics who have for so long complained of the irrelevance of a large section of conventional biochemistry to clinical medicine and tend support the views expressed by you (Feb. 23, p. 297) and Professor Whitby (April 13, p. 683). In the design of future courses of biochemistry for medical students, it would be unwise to exclude completely or curtail very drastically the fundamentals of structure or metabolism, but it is evident that the emphasis on these topics should be much reduced and diverted to more applied areas of the subject such as hormones, nutrition, and immunology. Attention should also be given to the following trends: increasing attention is being devoted in school A-level courses to biochemistry, especially in zoology and biology courses and in the Nuffield chemistry course (biochemistry option). Although the standard reached may not be very high as yet, many students are now entering medical school with some knowledge and understanding of such basic biochemistry as glycolysis, citric-acid cycle, energetics, D.N.A., and protein synthesis. Unless courses of biochemistry with a stronger application to clinical medicine are introduced, biochemists teaching in preclinical courses may, to avoid repeating the more elementary school biochemistry, be forced to teach more and more academic biochemistry which will then become increasingly irrelevant to the medical course. Although this very academic teaching may be allowed to proceed for a few years, pressure for severe curtailment or even abolition of the " academic biochemistry course " would almost certainly increase. The bridging of the gap from school biochemistry to clinical biochemistry may not be so formidable as appears at present, especially if the teaching of human nutrition is, as recommended by many nutritionists, instigated as a separate preclinical or clinical If this comes about, all nutrition and related course. could be removed from the domain of biochemistry. subjects Preclinical biochemistry courses have made an important contribution to medical education, but now rethinking of their purpose, content, and relevance is necessary as a matter of urgency for all those concerned with planning, teaching and organisation, who should attempt to understand the nature of the roads they are taking and their final goals.
to
’
,
Department of Biochemistry, St. Bartholomew’s Hospital Medical College, Charterhouse Square, London EC1M 6BQ.
E. D. WILLS.
MATERNAL ALCOHOLISM AND INTELLECTUAL DEVELOPMENT OF OFFSPRING
SIR,—Iquestion the validity of the suggestion by Jones al. that " the frequency of adverse outcome in the pregnancies of chronically alcoholic women is of such a magnitude that serious consideration should be given toward early termination of pregnancy in such women." Their sample of 23 alcoholic women was drawn from a prospective study of 55,000 pregnant women. There had been no direct prospective question related to maternal alcoholism. On the basis of a national survey of drinking practices conducted throughout the United States in
1964-65 based on 2746 personal interviews,2 one could estimate that 5% of the women could be classified as heavy drinkers. Thus, the 23 cases selected were probably the most conspicuous among the possible universe of 2750, and may represent extremes in terms of the physical, psychological, and sociological ravages of this disease. The profound detrimental effects of the disorganised multi-problem family on the psychological and intellectual development of children have been documented.3 The alcoholic mother often fails to provide for her children’s physical and emotional needs in a consistent manner. Only 12 children were available for adequate evaluation at age 7. The 6 who lived with their mothers had a lower mean i.Q. at 7 years of age (73) than the 6 who spent some time with relatives or in foster homes (i.Q. 84). Impaired intellectual performance was greater at the 7-year evaluation than at the 4-year one. While the population size is too small for statistical comparisons, the data suggest that the intellectual development of these children may have been adversely affected by their environment throughout the early years of life. Early and intensive educational and psychotherapeutic intervention with alcoholic women and their offspring seems more appropriate than early The need for prospective termination of pregnancy. studies in which the quantity, frequency, and variability of maternal drinking is evaluated on several occasions throughout pregnancy and the early years of the child’s life is apparent. Further observations of the effects of maternal intoxication on the mother-child interaction, and the child’s personality and intellectual development, is needed before effective prevention can be devised. University School of Medicine, 889 Harrison Avenue, Boston, Massachusetts 02218,
Boston
U.S.A.
MEBENDAZOLE AND HYDATID CYSTS SIR,--We should like to draw the attention of your readers to the lethal effect of the anthelmintic drug mebendazole on secondary Echinococcus granulosus cysts in mice. Until now no chemotherapeutic agent has been known to kill hydatid cysts. If mebendazole is as effective in man as it is in mice, much of the danger of secondary infection inherent in surgical removal of hydatid cysts Mebendazole will also probably kill may be avoided. primary hydatid cysts, which- may obviate the need for surgery in many cases. Mebendazole (methyl 5-benzoyl benzimidazole-2-carbamate) (Janssen Pharmaceutica, Belgium) is a broadspectrum anthelmintic that affects both nematodes and cestodes4 and also Trichinella spiralis larvae in muscle.’ It appears to affect glucose uptake and/or utilisation by the parasites. 5-7 We 8 tested various formulations and modes of administration of microfine mebendazole on tetrathyridia of Mesocestoides corti in mice, on mature and immature cysticerci of Tcenia pisiformis in rabbits, and on experimental secondary Echinococcus granulosus cysts in mice.9
et
1.
Jones, K. L., Smith, D. W., Streissguth, A. P., Myrianthopoulos, N. C. Lancet, 1974, i, 1076.
HENRY L. ROSETT.
2.
Cahalan, D., Cisin, I. H., Crossley, H. M. American Drinking Practices: A National Study of Drinking Behaviour and Attitudes. Rutgers Centre of Alcohol Studies, New Brunswick, New Jersey,
3.
Pavenstedt, E. (editor). The Drifters: Children of Disorganised Lower Class Families. Boston, 1967. Vanparijs, O., Thienpont, D. Dt. tierärztl. Wschr. 1973, 80, 320. De Nollin, S., Van Den Bossche, H. J. Parasit. 1973, 59, 970. Van Den Bossche, H. in Comparative Biochemistry of Parasites (edited by H. Van Den Bossche); p. 139. New York, 1972. Van Den Bossche, H., De Nollin, S. Int. J. Parasit. 1973, 3, 401. Heath, D. D., Christie, M., Chevis, R. A. F. Parasitology (in the press). Heath, D. D. ibid. 1970, 60, 449.
1969.
4. 5. 6. 7. 8.
9.