- Email: [email protected]
MERIT AWARDS AND SENIORITY PAYMENTS
985 appear normal. There are no consistent structural deviations in spermatozoa. A variety of mental tests indicate an i.Q. of 70-80. Chromosomal analysis of blood-cultures revealed an XYY sex-chromosome constitution and 47 chromosomes. Since 21 years of age the patient has had a varicose ulcer of the right shin which, despite skin grafting and a Trendelenburg for varicose veins, has never healed. Carr et al.1 operation noted " extensive venous varicosities on the legs, accompanied " in a 52-year-old XXYY by considerable infected ulceration " male, and Ellis at el. observed large patches of inflamed skin on the lower anterior aspects of his shins which tend to
ulcerate." The
patient’s blood-pressure was 110/65 mm. Hg. In 1955 recorded as 95/65, and bradycardia was noted. Of several other recordings noted, none showed a systolic pressure it
was
above 110. We report these observations to record homosexuality, varicose veins and ulceration, and low blood-pressure, in case these might prove to be significant features of XYY subjects. B. W. RICHARDS St. Lawrence’s Hospital, A. STEWART. Caterham, Surrey.
CHROMOSOMES IN MALIGNANT LYMPHOMAS
SIR,-We agree with Professor Lejeune and Dr. de Grouchy (April 16) on the desirability of discussion of the nomenclature of human cytogenic abnormalities. We are perhaps less optimistic than they that a commission, even under the auspices of the International Congress of Human Genetics, would necessarily formulate a generally acceptable terminology. The history of attempts to produce rational systems of nomenclature in medicine, if not in biology, is hardly encouraging. The general use of a particular term is more often determined by brevity than by accuracy of description. Thus PhI is now generally accepted for partial deletion of the long arm of chromosome 21 associated with chronic granulocytic leukxmia." Where a structurally indistinguishable chromosome has been found unassociated with chronic granulocytic leukarmia,344 workers have been content to use the longer descriptive term and have avoided Ph-which indicates a particular disease association. We have suggested (March 5) the use of the term "Melbourne chromosome (M 1)," not, as Professor Lejeune and Dr. de Grouchy seem to believe, for deletion of the short "
"
"
"
of chromosome 18 but for deletion of the short arm of chromosome 17 or 18 associated with malignant lymphoma." We feel that we made it clear that our suggestion was conditional on the association between the chromosomal abnormality and malignant lvmphoma being confirmed bv further studv. arm
University of Melbourne, Department of Medicine, St. Vincent’s Hospital,
A. G. BAIKIE A. S. D. SPIERS.
Melbourne, Australia.
MENTAL SYMPTOMS IN VITAMIN-B12 DEFICIENCY
SIR,-Your leaderand the paper by Edwin
et al. 6 on the consecutive series of patients admitted to a psychiatric department prompt me to report here a short survey of the results of a similar investigation in this department.7
blood-vitamin-B12
concentration in
a
For 11 months (June 1, 1963-May 1, 1964) all patients above the age of 65 had their blood-vitamin-B12 concentrations estimated by the Lactobacillus leichmanii method on admission. 127 patients in all were examined. Schilling’s test and bonemarrow examination were performed, if possible, in those with concentrations below 165 pg. per ml. 1. 2.
Carr, D. H. Barr, M. L. Plunkett, E. R. Can. med. Ass. J. 1961, 84, 873. Ellis, J. R. Miller, O. J. Penrose, L. S. Scott, G. E. B. Ann. hum. Genet. 1961, 25, 145. 3. Dent, T., Edwards, J. H., Delhanty, J. D. A. Lancet, 1963, ii, 484. 4. Goh, K. ibid. March 19, 1966, p. 659. 5. Lancet, 1965, ii, 628. 6. Edwin, E., Holten, K., Norum, K. R., Schrumpf, A., Skaug, O. E. Acta med. scand. 1965, 177, 689. 7. Nielsen, B. Acta neurol. scand. 1965, 41, 513.
21 patients (16-5%) showed concentrations below 200 pg. per ml., and 15 (11-8%) below 165 pg. per ml. With one exception all the values were above 100 pg. per ml. 9 patients
(7-1%) showed signs
of either
impaired absorption
of the
subnormal effect of it on the bone-marrow. No correlation could be detected between low plasma-concentrations of vitamin-B12 and either presence of paraesthesia or
vitamin,
or
reduction of vibration sense. A group of younger patients admitted during the same period was similarly examined. The only correlation between age and vitamin-B12 concentration that could be established was the significantly higher mean blood-vitamin-B12 value of this group compared with those of the older patients. Neurological Department, BENT NIELSEN. Municipal Hospital, Copenhagen K.
&bgr;-SYMPATHETIC BLOCKADE IN HYPERTHYROIDISM reference to the letter of Dr. Singer last week SIR,-With I draw his attention to the fact that not only did Dr. may Howitt and Dr. Rowlands describe the effect of propranolol on atrial fibrillation in patients with thyrotoxicosis in their article (March 19) but they had already described this in similar cases in an earlier publication.1 St. Bartholomew’s Hospital, PAUL TURNER. London E.C.1.
MERIT AWARDS AND SENIORITY PAYMENTS be worth all the money we should lose by refusal of seniority payments, if these are to be linked with merit awards, to avoid, in general practice, that unseemly shuffling for advantage which has brought so much personal unhappiness to some of our friends who work in the hospital service. One of the greatest compensations of general practice has been that, until recently (until the formation of the College of General Practitioners ?), it has been free of this blight. It is bad enough that the Health Service is at the mercy of party politics. For general practitioners to put themselves, in order to obtain long-overdue recognition for experience and devoted service, at the mercy of those of their colleagues who enjoy ambitions for medico-political power and influence, will be a contemptible bargain. BENJAMIN LEE.
SIR,-It would
a stout
GROUP PRESSURE SIR,-I was one of the 723 who voted against the formation of an independent association of hospital junior medical staff, as reported in your annotation (April 16). I am surprised that all commentators, including yourself, have assumed that the 723 support-or want to remain in, as some have even put itthe B.M.A. It is surprising how often questions of this type contain assumptions impossible to negate by answering either " yes " " or no ". In this case the assumption is that one supports political action and chooses the body most likely to promote it.
My answer was accompanied by a note that I opposed political action, by whomsoever conducted. The support for the B.M.A. revealed by the referendum is 722, or less. Summerfield
Hospital,
Birmingham
18.
ROBERT
J. HETHERINGTON.
*** The only comment we made on the result of the referendum was that it expressed profound dissatisfaction with the efforts of those who had hitherto represented the junior hospital doctors. We did not speculate on the motives of those who answered " no ".-ED. L. 1. Rowlands,
D. J.,
Howitt, G., Markman,
P. Br.
med. J. 1965, i, 891.
ulcerate." The
patient’s blood-pressure was 110/65 mm. Hg. In 1955 recorded as 95/65, and bradycardia was noted. Of several other recordings noted, none showed a systolic pressure it
was
above 110. We report these observations to record homosexuality, varicose veins and ulceration, and low blood-pressure, in case these might prove to be significant features of XYY subjects. B. W. RICHARDS St. Lawrence’s Hospital, A. STEWART. Caterham, Surrey.
CHROMOSOMES IN MALIGNANT LYMPHOMAS
SIR,-We agree with Professor Lejeune and Dr. de Grouchy (April 16) on the desirability of discussion of the nomenclature of human cytogenic abnormalities. We are perhaps less optimistic than they that a commission, even under the auspices of the International Congress of Human Genetics, would necessarily formulate a generally acceptable terminology. The history of attempts to produce rational systems of nomenclature in medicine, if not in biology, is hardly encouraging. The general use of a particular term is more often determined by brevity than by accuracy of description. Thus PhI is now generally accepted for partial deletion of the long arm of chromosome 21 associated with chronic granulocytic leukxmia." Where a structurally indistinguishable chromosome has been found unassociated with chronic granulocytic leukarmia,344 workers have been content to use the longer descriptive term and have avoided Ph-which indicates a particular disease association. We have suggested (March 5) the use of the term "Melbourne chromosome (M 1)," not, as Professor Lejeune and Dr. de Grouchy seem to believe, for deletion of the short "
"
"
"
of chromosome 18 but for deletion of the short arm of chromosome 17 or 18 associated with malignant lymphoma." We feel that we made it clear that our suggestion was conditional on the association between the chromosomal abnormality and malignant lvmphoma being confirmed bv further studv. arm
University of Melbourne, Department of Medicine, St. Vincent’s Hospital,
A. G. BAIKIE A. S. D. SPIERS.
Melbourne, Australia.
MENTAL SYMPTOMS IN VITAMIN-B12 DEFICIENCY
SIR,-Your leaderand the paper by Edwin
et al. 6 on the consecutive series of patients admitted to a psychiatric department prompt me to report here a short survey of the results of a similar investigation in this department.7
blood-vitamin-B12
concentration in
a
For 11 months (June 1, 1963-May 1, 1964) all patients above the age of 65 had their blood-vitamin-B12 concentrations estimated by the Lactobacillus leichmanii method on admission. 127 patients in all were examined. Schilling’s test and bonemarrow examination were performed, if possible, in those with concentrations below 165 pg. per ml. 1. 2.
Carr, D. H. Barr, M. L. Plunkett, E. R. Can. med. Ass. J. 1961, 84, 873. Ellis, J. R. Miller, O. J. Penrose, L. S. Scott, G. E. B. Ann. hum. Genet. 1961, 25, 145. 3. Dent, T., Edwards, J. H., Delhanty, J. D. A. Lancet, 1963, ii, 484. 4. Goh, K. ibid. March 19, 1966, p. 659. 5. Lancet, 1965, ii, 628. 6. Edwin, E., Holten, K., Norum, K. R., Schrumpf, A., Skaug, O. E. Acta med. scand. 1965, 177, 689. 7. Nielsen, B. Acta neurol. scand. 1965, 41, 513.
21 patients (16-5%) showed concentrations below 200 pg. per ml., and 15 (11-8%) below 165 pg. per ml. With one exception all the values were above 100 pg. per ml. 9 patients
(7-1%) showed signs
of either
impaired absorption
of the
subnormal effect of it on the bone-marrow. No correlation could be detected between low plasma-concentrations of vitamin-B12 and either presence of paraesthesia or
vitamin,
or
reduction of vibration sense. A group of younger patients admitted during the same period was similarly examined. The only correlation between age and vitamin-B12 concentration that could be established was the significantly higher mean blood-vitamin-B12 value of this group compared with those of the older patients. Neurological Department, BENT NIELSEN. Municipal Hospital, Copenhagen K.
&bgr;-SYMPATHETIC BLOCKADE IN HYPERTHYROIDISM reference to the letter of Dr. Singer last week SIR,-With I draw his attention to the fact that not only did Dr. may Howitt and Dr. Rowlands describe the effect of propranolol on atrial fibrillation in patients with thyrotoxicosis in their article (March 19) but they had already described this in similar cases in an earlier publication.1 St. Bartholomew’s Hospital, PAUL TURNER. London E.C.1.
MERIT AWARDS AND SENIORITY PAYMENTS be worth all the money we should lose by refusal of seniority payments, if these are to be linked with merit awards, to avoid, in general practice, that unseemly shuffling for advantage which has brought so much personal unhappiness to some of our friends who work in the hospital service. One of the greatest compensations of general practice has been that, until recently (until the formation of the College of General Practitioners ?), it has been free of this blight. It is bad enough that the Health Service is at the mercy of party politics. For general practitioners to put themselves, in order to obtain long-overdue recognition for experience and devoted service, at the mercy of those of their colleagues who enjoy ambitions for medico-political power and influence, will be a contemptible bargain. BENJAMIN LEE.
SIR,-It would
a stout
GROUP PRESSURE SIR,-I was one of the 723 who voted against the formation of an independent association of hospital junior medical staff, as reported in your annotation (April 16). I am surprised that all commentators, including yourself, have assumed that the 723 support-or want to remain in, as some have even put itthe B.M.A. It is surprising how often questions of this type contain assumptions impossible to negate by answering either " yes " " or no ". In this case the assumption is that one supports political action and chooses the body most likely to promote it.
My answer was accompanied by a note that I opposed political action, by whomsoever conducted. The support for the B.M.A. revealed by the referendum is 722, or less. Summerfield
Hospital,
Birmingham
18.
ROBERT
J. HETHERINGTON.
*** The only comment we made on the result of the referendum was that it expressed profound dissatisfaction with the efforts of those who had hitherto represented the junior hospital doctors. We did not speculate on the motives of those who answered " no ".-ED. L. 1. Rowlands,
D. J.,
Howitt, G., Markman,
P. Br.
med. J. 1965, i, 891.