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MERIT AWARDS
829
possible conservative
to compare
directly
the results of
surgical and
treatment it would be wrong to declare that
operation is always indicated.-ED.
L.
CORTICOSTEROID PURPURA
Sn:,ňWe
were
in
extremely interested in Professor
Lovell’s comments (March 5) on our preliminary communication and regret the omission of reference to his work on the effect of corticosteroids on the resorption of blood. Unfortunately, it was not possible to present all of our experimental evidence in a short communication but we hope to do this in a future publication. Professor Lovell’s suggestion is that the delayed resorption of blood from the skin produced by corticosteroids is due to a diminished dispersal of blood between the collagen fibres rather than to suppression of phagocytosis. We are unwilling to accept his view for two reasons. The first is that increased spreading of blood through the skin is characteristic of both corticosteroid purpura, and also of senile purpura. The second is that the role of the phagocyte in promoting the resorption of extravasated blood has been described by Rich,3 and further, that the different rates of resorption of blood injected into the skin of the rabbit, rat, and mouse appear to be due to a species difference in the phagocytic response.4 It is possible, therefore, that the sluggish phagocytosis of erythrocytes found by Lovell et al. in the guineapig may be a peculiarity of this species. The
Royal Infirmary, Cardiff.
H. SCARBOROUGH. S. SHUSTER. MERIT AWARDS
Sm,ňThose recommendations of the Royal Commission which relate to merit awards serve to highlight the figures you published last year.5 At that time, the expectation in cash from merit awards to a consultant physician or surgeon was more than E590 a year. To a consultant in mental health it was a little more than E130. If the recommendations of the Commission are adopted without changes in the proportionate distribution of the awards, the figures I have given would become approximately E780 and S180. The figures as they stand also show that the consultant physician or surgeon is more likely than not to have some award; his chance of a higher award is more than six times that of the psychiatrist; consultant anesthetists alone of all specialists have as low a chance as the psychiatrist of gaining some award (Royal Commission, p. 76). The probability of such disproportion arising by chance in even one year is so small as to be almost beyond computing. It is certainly much less than one in a thousand. For awards grouped in a two-by-two contingency table (some award, no award; psychiatrist, and physician or surgeon) chi-square with Yates’ correction is 17-1 with one degree of freedom, and for the higher awards chi-square runs to three figures. An assessment over the whole life of the service would give an incomprehensibly small figure for the probability of chance occurrence of the disproportion. If any of the unrecognised 85% of consultants in mental health are inclined to accept an association between merit awards and clinical ability, they may, perhaps, console themselves with the reflection that they are practising one of the most difficult of the medical arts, and they will no doubt keep an eye open for the effect of a psychiatrist having been appointed to the committee on these awards.
JUNIOR 1.
MEDICAL OFFICER.
Lovell, R. R. H., Scott, G. B. D., Hudson, B., Osborne, exp. Path. 1953, 34, 535. 2. Scarborough, H., Shuster, S. Lancet, Jan. 9, 1960, p. 93. 3. Rich, A. R. Physiol. rev. 1925, 5, 182. 4. Muir, R., Niven, J. S. F. J. Path. Bact. 1935, 41, 183. 5. Lancet, 1959, i, 1274.
PEPTIC ULCER IN TOWN AND COUNTRY Sirhave studied with interest your editorial of Feb. 27, especially as you stress that Pulvertaft, probably for the first time, has estimated ulcer frequencies accurately
J. A. Brit. J.
an
unselected population.
I should like to draw your attention to the investigations in 1950-52 by one of my assistants, N. Sponheim.1 He made similar inquiries in a part of a Norwegian county. During a period of 21/2 years 811 ulcers were found in a population of 124,279. All ulcers were verified by expert X-ray examinations. The mean annual incidence per 1000 population aged 10 years and over was 4-0 in men, and 1-2 in women. In males the incidence was found to be highest between 30 and 39 years of age-i.e., 61; and in females highest between 40 and 49i.e., 2-0. Medical Department, Rogaland County Hospital, Stavanger, Norway.
PER HANSSEN.
ADENOVIRUS TYPE-15 AND HUMAN-THYROID TISSUE-CULTURE
SIR,-Adenovirus type-15 was originally found in conjunctival scrapings from 5 babies in Saudi Arabia during field studies on trachoma,2-4 and it does not appear to have been reported elsewhere until now. The first of 2 patients from whom the virus was isolated in this laboratory was a 7-month-old baby who was admitted to this hospital in March, 1959, with severe diarrhoea complicating a pyrexial upper respiratory illness. An adenovirus was isolated from her faeces, and no specific bacterial pathogens were cultured from repeated stool specimens. An adenovirus was later isolated from the stool of a 6-year-old girl with a Salmonella typhimurium infection admitted to the same ward shortly after the first patient. The second child may have been cross-infected from the baby. Both these strains failed to react in this laboratory with typing antisera against adenoviruses types 1 to 8. Dr. H. G. Pereira very kindly offered to examine them and found them both to be type-15. These 2 isolations of adenovirus type-15 were made in human-thyroid tissue-culture. Pulvertaft and his colleagues,5 who first described thyroid tissue-culture, considered that because of its susceptibility to toxic factors in faeces it probably would have a place in virus isolation from stools only if monkey kidney or human amnion were not available. In this laboratory it has proved a valuable addition to monkey kidney. From January to December, 1959, 650 stool specimens were tested in parallel in human-thyroid and monkey-kidney tissuecultures. Toxicity of stool extracts for thyroid tissue caused little trouble. Of 143 viruses isolated, 37 were isolated in both tissues, 28 in kidney but not in thyroid, and 71 in thyroid but not in kidney. The 71 viruses grown only in thyroid include 10 adenoviruses-of types 1, 2, 3, 5, 7, and 15-and 61 enteroviruses including Echo types 6, 7, and 11 and Coxsackie B5. Many of the enteroviruses not yet fully typed appear to be Coxsackie viruses. Most of the enteroviruses were recovered from patients with aseptic meningitis. Thyroid was found to equal HeLa cells in susceptibility to all of 16 prototype strains of adenovirus examined, and in addition was as sensitive as fresh monkey-kidney tissue to infection by the 3 types of poliovirus and by 18 of the 28 prototypes of Echo virus. Echo 21 and 28 were not tested, Echo 25 gave a lower titre in thyroid than in kidney, and Echo types 4, 10 (not now classified with the Echo group 6), 14, 15, 16, 25, 26, and 27 failed to produce any cytopathic effect in thyroid. The susceptibility of thyroid tissue to both adenoSponheim, N. Nord. med. 1960 (in the press). Murray, E. S., Chang, R. S., Bell, S. D., Tarizzo, M. L., Snyder, J. C. Amer. J. Ophthal. 1957, 43 (no. 4, part II), 32. 3. Bell, S. D., McComb, D. E., Murray, E. S., Chang, R. S., Snyder, J. C. Amer. J. trop. Med. 1959, 8, 492. 4. Rowe, W. P., Hartley, J. W., Huebner, R. J. Proc. Soc. exp. Biol., N.Y. 1958, 97, 465. 5. Pulvertaft, R. J. V., Davies, J. R., Weiss, L., Wilkinson, J. H. J. Path. Bact. 1959, 77, 19. 6. Sabin, A. B. Science, 1959, 130, 1387. 1. 2.
possible conservative
to compare
directly
the results of
surgical and
treatment it would be wrong to declare that
operation is always indicated.-ED.
L.
CORTICOSTEROID PURPURA
Sn:,ňWe
were
in
extremely interested in Professor
Lovell’s comments (March 5) on our preliminary communication and regret the omission of reference to his work on the effect of corticosteroids on the resorption of blood. Unfortunately, it was not possible to present all of our experimental evidence in a short communication but we hope to do this in a future publication. Professor Lovell’s suggestion is that the delayed resorption of blood from the skin produced by corticosteroids is due to a diminished dispersal of blood between the collagen fibres rather than to suppression of phagocytosis. We are unwilling to accept his view for two reasons. The first is that increased spreading of blood through the skin is characteristic of both corticosteroid purpura, and also of senile purpura. The second is that the role of the phagocyte in promoting the resorption of extravasated blood has been described by Rich,3 and further, that the different rates of resorption of blood injected into the skin of the rabbit, rat, and mouse appear to be due to a species difference in the phagocytic response.4 It is possible, therefore, that the sluggish phagocytosis of erythrocytes found by Lovell et al. in the guineapig may be a peculiarity of this species. The
Royal Infirmary, Cardiff.
H. SCARBOROUGH. S. SHUSTER. MERIT AWARDS
Sm,ňThose recommendations of the Royal Commission which relate to merit awards serve to highlight the figures you published last year.5 At that time, the expectation in cash from merit awards to a consultant physician or surgeon was more than E590 a year. To a consultant in mental health it was a little more than E130. If the recommendations of the Commission are adopted without changes in the proportionate distribution of the awards, the figures I have given would become approximately E780 and S180. The figures as they stand also show that the consultant physician or surgeon is more likely than not to have some award; his chance of a higher award is more than six times that of the psychiatrist; consultant anesthetists alone of all specialists have as low a chance as the psychiatrist of gaining some award (Royal Commission, p. 76). The probability of such disproportion arising by chance in even one year is so small as to be almost beyond computing. It is certainly much less than one in a thousand. For awards grouped in a two-by-two contingency table (some award, no award; psychiatrist, and physician or surgeon) chi-square with Yates’ correction is 17-1 with one degree of freedom, and for the higher awards chi-square runs to three figures. An assessment over the whole life of the service would give an incomprehensibly small figure for the probability of chance occurrence of the disproportion. If any of the unrecognised 85% of consultants in mental health are inclined to accept an association between merit awards and clinical ability, they may, perhaps, console themselves with the reflection that they are practising one of the most difficult of the medical arts, and they will no doubt keep an eye open for the effect of a psychiatrist having been appointed to the committee on these awards.
JUNIOR 1.
MEDICAL OFFICER.
Lovell, R. R. H., Scott, G. B. D., Hudson, B., Osborne, exp. Path. 1953, 34, 535. 2. Scarborough, H., Shuster, S. Lancet, Jan. 9, 1960, p. 93. 3. Rich, A. R. Physiol. rev. 1925, 5, 182. 4. Muir, R., Niven, J. S. F. J. Path. Bact. 1935, 41, 183. 5. Lancet, 1959, i, 1274.
PEPTIC ULCER IN TOWN AND COUNTRY Sirhave studied with interest your editorial of Feb. 27, especially as you stress that Pulvertaft, probably for the first time, has estimated ulcer frequencies accurately
J. A. Brit. J.
an
unselected population.
I should like to draw your attention to the investigations in 1950-52 by one of my assistants, N. Sponheim.1 He made similar inquiries in a part of a Norwegian county. During a period of 21/2 years 811 ulcers were found in a population of 124,279. All ulcers were verified by expert X-ray examinations. The mean annual incidence per 1000 population aged 10 years and over was 4-0 in men, and 1-2 in women. In males the incidence was found to be highest between 30 and 39 years of age-i.e., 61; and in females highest between 40 and 49i.e., 2-0. Medical Department, Rogaland County Hospital, Stavanger, Norway.
PER HANSSEN.
ADENOVIRUS TYPE-15 AND HUMAN-THYROID TISSUE-CULTURE
SIR,-Adenovirus type-15 was originally found in conjunctival scrapings from 5 babies in Saudi Arabia during field studies on trachoma,2-4 and it does not appear to have been reported elsewhere until now. The first of 2 patients from whom the virus was isolated in this laboratory was a 7-month-old baby who was admitted to this hospital in March, 1959, with severe diarrhoea complicating a pyrexial upper respiratory illness. An adenovirus was isolated from her faeces, and no specific bacterial pathogens were cultured from repeated stool specimens. An adenovirus was later isolated from the stool of a 6-year-old girl with a Salmonella typhimurium infection admitted to the same ward shortly after the first patient. The second child may have been cross-infected from the baby. Both these strains failed to react in this laboratory with typing antisera against adenoviruses types 1 to 8. Dr. H. G. Pereira very kindly offered to examine them and found them both to be type-15. These 2 isolations of adenovirus type-15 were made in human-thyroid tissue-culture. Pulvertaft and his colleagues,5 who first described thyroid tissue-culture, considered that because of its susceptibility to toxic factors in faeces it probably would have a place in virus isolation from stools only if monkey kidney or human amnion were not available. In this laboratory it has proved a valuable addition to monkey kidney. From January to December, 1959, 650 stool specimens were tested in parallel in human-thyroid and monkey-kidney tissuecultures. Toxicity of stool extracts for thyroid tissue caused little trouble. Of 143 viruses isolated, 37 were isolated in both tissues, 28 in kidney but not in thyroid, and 71 in thyroid but not in kidney. The 71 viruses grown only in thyroid include 10 adenoviruses-of types 1, 2, 3, 5, 7, and 15-and 61 enteroviruses including Echo types 6, 7, and 11 and Coxsackie B5. Many of the enteroviruses not yet fully typed appear to be Coxsackie viruses. Most of the enteroviruses were recovered from patients with aseptic meningitis. Thyroid was found to equal HeLa cells in susceptibility to all of 16 prototype strains of adenovirus examined, and in addition was as sensitive as fresh monkey-kidney tissue to infection by the 3 types of poliovirus and by 18 of the 28 prototypes of Echo virus. Echo 21 and 28 were not tested, Echo 25 gave a lower titre in thyroid than in kidney, and Echo types 4, 10 (not now classified with the Echo group 6), 14, 15, 16, 25, 26, and 27 failed to produce any cytopathic effect in thyroid. The susceptibility of thyroid tissue to both adenoSponheim, N. Nord. med. 1960 (in the press). Murray, E. S., Chang, R. S., Bell, S. D., Tarizzo, M. L., Snyder, J. C. Amer. J. Ophthal. 1957, 43 (no. 4, part II), 32. 3. Bell, S. D., McComb, D. E., Murray, E. S., Chang, R. S., Snyder, J. C. Amer. J. trop. Med. 1959, 8, 492. 4. Rowe, W. P., Hartley, J. W., Huebner, R. J. Proc. Soc. exp. Biol., N.Y. 1958, 97, 465. 5. Pulvertaft, R. J. V., Davies, J. R., Weiss, L., Wilkinson, J. H. J. Path. Bact. 1959, 77, 19. 6. Sabin, A. B. Science, 1959, 130, 1387. 1. 2.