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MERIT AWARDS
291 munication with the pelvis, and it is to this appearance, presumably, that Duran-Jorda refers. Sinco, however, the renal papilla is a three-dimensional structure with ducts opening over the whole of its surface, and the ducts are relatively large, it is not surprising that a thin two-dimensional slice of tissue usually reveals few or perhaps none of the openings. Again, since the ureter, renal pelvis, and collectingtubules are but progressive divisions of a hollow outgrowth from the wolffian duct, it would be surprising if a mombrano developed at some point in this system.
Bellini
kidney
published
his work
on
the structure of the
We have been unable to obtain a copy of the first edition, but we have used the second edition published in 1664.3 Bellini was denied the advantages of a microscope and did not describe the small part of the excretory duct system now called after him, but established the fact that the kidney consists of a mass of tubules, whereas Highmore had previously described it as a solid organ consisting of numerous fibrous cords. In view of the present question at issue it is interesting, if somewhat ironic, to note the method by which Bellini demonstrated the renal tubules. He opened the kidney longitudinally from the pelvic aspect, compressed the parenchyma, and observed the small drops of fluid coming from the tips of the renal papillse. Our own rough translation of the relevant sentences is as follows : " The urine is clearly seen flowing from the compressed tubules as if effused from so many small fountains. From which we are able clearly to assume that the substance of the kidney ... is nothing else than a collection of small channels and capillary openings through which urine flows into the pelvis."
We offer the accompanying illustration both because of the rarity with which such a complete representation of a renal papilla is seen in routine histological sections of the kidney, and because, we believe, it supplies strong histological evidence for the existence of openings of the ducts of Bellini into the renal pelvis. That it is necessary to do so in 1954 emphasises how much is still to be learnt, or relearnt, about normal anatomy. C. H. JONES Royal Liverpool R. E. REWELL. Children’s Hospital. THE EMOTIONAL VALUE OF SUCKLING as
distinct from the nutritive,
suckling to the child is now well known, but a recent experience has afforded me a new light upon its potentialities as an emotional gain to the mother. value of
had been under treatment for some time on neurotic personality, a principal symptom being her inability to form normal feeling or affect relationships with adults, although she could do so much better with children. One result was a partial inability to enjoy sexual experience. Treatment had, at the time of writing, modified but not When her first child cured these anomalies of personality. was two or three days old the baby sustained a slight hurt to his mouth, as a result of which he refused to suck and had to be spoon fed, and it was decided to wean him. A day or two later the patient came to me and told me of the tragic loss involved. -She described the wonderful feeling suckling gave her by saying : ‘’ It makes you feel as if nothing else matters." She then proceeded further to punish herself by allowing her husband, who was home on holiday for a week, to feed the baby every time, so that she ended the day by hating them both. The position was becoming ominous and in the discussion of this situation she said with much feeling : "I was thinking of what it was like to feed baby and then be told he was to go on the bottle it had been like living for the first time.... Oh, I don’t want to talk about" it." The doctor added : " It was like life being taken away ? The patient replied : " Yes." At the next interview she said she felt completely helpless and that not being able to feed baby had made her so. As a result, evidently, of this discussion, the patient tried putting the child back to the breast, found she could do so, that lie sucked again, and that her milk returned.
The
patient
account of
a
...
It is granted that the feeling aspects of suckling - probably are-unusually strong in this patient. 3.
Bellini, L.
consequences. DAVID T. MACLAY.
Brentwood, Essex.
in 1662.
SIR,—The emotional,
a ray of light is cast upon what suckling can mean emotionally to the mother. Unfortunately patients so often accept their doctors’ instructions without mentioning personal (lilliculties of which the doctors may be unaware, thus laying on them an extra responsibility, for, if an error is made, it will usually not be known until it is too late to make any adjustment. It seems probable that weaning is sometimes advised too lightly and with insutlicient attention to the possible emotional
theless,
De Structura Renum.
may be Never-
2nd ed., Florence, 1664.
THE CARE OF OLD PEOPLE
SIR, Reading the various comments which have been made about the International Congress of Gerontology, reported in your issue of July 31, it occurred to me that it may he of interest to your readers to know that the International Hospital Federation held a congress in Brussels in 1951 which had for its main theme the selfsame subject as that which has been the object of such wide comment during the past week-the Care of Old People. Over 500 delegates from 25 countries attended this congress and took part in the discussions, which brought forth many useful ideas. J. E. E.STONE STONE London, E.C.2
Hon. secretary and treasurer, International Hospital Federation.
MERIT AWARDS his letter of July 24 Mr. Hayton-Williams SIR,—In draws attention to one of the many evils of the present system of remuneration of hospital medical and dental staff by his statement that consultants refrain from public criticism of the merit-award system since they feel that an open expression of their views might be detrimental to their chances of being given a merit award." This timidity is regrettably not confined either to consultants or to the subject of merit awards, but permeates the entire system upon which hospital medical and dental staff has been founded. The houseman, in virtue of his junior position and possible ignorance of the true state of affairs, dare not or does not criticise his conditions since he is obliged to obtain the good will of his consultant ; the registrar and senior registrar likewise have more sense than to complain in public of the meagre remuneration which they receive lest they become dubbed as "political agitators" or "subversive elements" or lest they be adversely judged by selection committees prior to interview, so ruining their chances of being short-listed for a post. The senior hospital medical officer, perennially hopeful of upgrading to consultant, keeps quiet for obvious reasons, whilst the majority of consultants, for reasons "
already expressed, merely grumble amongst themselves lest " a unit of the machinery for gathering information " be in their vicinity, or extraprofessional rewards should fail to come their way. No less than five years ago a correspondent wrote in the British Medical Journal1: "We may well ask ourselves,How could this situation come about ? ’ It has come about because doctors have been, since the National Health Service was first mooted, woefully disunited and disorganised, pursuing selfish aims and sectional interests and failing to come together for their Thus wedges are being driven between own protection. various sections of the profession. If doctors do not now at this late hour organise and unite, then the outlook for the doctor and his family is black indeed. And the time is short." The consultants of this country who are prepared to stand by and see injustice done to their juniors, whilst they may or may not pocket their merit awards, are unfitted for their command. Fortunately a few men in 1. Brit. med. J.
1949, ii, suppl.
p. 192.
292 our profession have spoken up at the annual representative meeting of the British Medical Association, and it would appear that at last a committee to deal with the entire problem of remuneration along well-informed trade-union lines is to be developed. The Crichel Down case should have served to emphasise the extent to which bureaucratic control has entered our daily lives ; and the public repudiation of the Spens Report by the Minister of Health in the House of Commons on July 22 provides yet another example. When we eventually succeed in forming a body whose interests are wholly, solely, and-exclusively the financial and political welfare of the medical and dental profession, let us choose its members with considerable care, bearing in mind Kipling’s words :
" Shall we only threaten and be angry for an hour ? When the storm is ended shall we find How softly but how swiftly they have sidled back to power By the favour and contrivance of their kind ? "
N. L. L. ROWE. ROWE.
Andover.
HOSPITAL MEDICAL RECORDS
SIR,—Tracing a family history of diabetes for research recently, I was glad to be able to see a note of glycosuria in the case-papers of a man admitted to hospital for cataract extraction in 1905. Case-records once destroyed are irreplaceable ; every effort should be made to preserve them as long as possible, certainly longer than the six-year minimum suggested by the Ministry.1
purposes
GEORGE JOHNSON.
Harrogate,
BLOOD-GROUPS AND AGE-GROUPS SIR,—Findings similar to those pointed out2 in Fraser Roberts’s sample3 of 85,438 war-time civilian blooddonors in the six south-western counties of England are obtained from Hart’s sample4 of 10,748 war-time civilian blood-donors in eastern rural districts of Ulster.
First, the mean age of the group-B males is two years lower than that of the A and 0 males (as Hart himself pointed out), while the mean age of the group-B females is between three and four months higher than that of the A and 0 females. Secondly, the percentage of male donors who are group B falls from the second to the sixth decade of life, the figures being respectively 12-5, 11-3, 9-6, 8-5, 7-4. Thirdly, the ratio of male to female group-B donors falls from the TABLE I-RATIO OF MALE TO FEMALE BRITISH BLOOD-DONORS
No. of donors under 30
B
Group of
donors
Ratio of male to female donors
of
No. of donors over 30
donors Male
Male
Female
998
2318
B
0-43
0-66
4933
11,677
A
0-42
0-65
12,665
0
0-41
0-61
5201
Group
O
10,120 9617
A B
1842
Female
15.448
14,910 3042
second to the sixth decade, relative to that of the A and 0 donors ; the figures for the B donors are respectively 0-45, 0-51, 0-54, 0-59, 0-51, and for the A and 0 donors combined they are 0-38, 0-46, 0-66, 0-73, 0-75. Lastly, the over-all sex-ratio of the group-B donors is lower than that of the A and 0 donors, being 0-55 for the 0 donors, 0-54 for the A donors, and 0-51 for the B donors. When, however, Hart’s sample is combined with that of Fraser Roberts’s as in table I, it is seen that the lower sex-ratio of the group-B donors is confined to those over 30 years of age ; and the descending order of sex-ratios in the over-30 donors-namely O-A-Bis found to be the reverse of that in the under-30 donors. Thus, the findings would suggest that the viability of group-B males may, in general, fall more quickly, from a higher level, than that of A or 0 males. 1. See Lancet, July 24, 1954, p. 180. 2. Allan, T. M. Ibid,, 1953, ii, 456. 3. Fraser Roberts, J. A. Ann. Eugen., Lond. 4. Hart, E. W. Ibid, 1944, 12, 89.
1948, 14, 109.
TABLE II—RATIO
OF
MALE
TO FEMALE
ILL AND
WELL FINNS
Group
No. of well
-
No. of ill
Group
people Male
of ill
I Female, people
Ratio of males to females
1060
1109
B
0-96
2633
2978
A
0-88
2010
2313
0
0·87
of
people
well
people
Male
Female
0
2308
1991
1-16
A
2762
2378
1.16
B
1141
980
1-16
Now, if this were indeed the case, as evidenced by the blood-group distribution of what is probably the most healthy - namely, the blood-donating-section of the adult community, one would expect to find complementary evidence of it in the blood-group distribution of what is certainly the least healthy section of the community-i.e., hospital patients. In other words, one would expect to find that B males are, in general, more liable to disease than A or 0 males: and this is found to be so in the only three studies 5-7 of the subject known to me. In all three the descending order of the ratios of male to female patients is B—A—O ; the figures for the three samples combined are given on the left-hand side of table 11. These samples consist of Finnish hospital patients, nearly all adults with medical diseases ; and the right-hand side of table 11 gives the corresponding combined figures for four samples of healthy Finns-the samples of Streng- and Ryti,5 Mustakallio,7 Vuori,8 and Kyrklund,9 Here the sex-ratio of the B subjects is the same as that of the A and 0 subjects, but the aggregation of the samples conceals at least two anomalies. The first of these anomalies is that the sample of Kyrklund consists of school-children, and that its descending order of sex-ratios is O-A-B, whereas the order might, in this context, have been expected to be the same as that of the younger British blood-donors-namely, B—A—O. The second anomaly is that the healthy B subjects both of Streng and Ryti and of Mustakallio have a higher sex-ratio than their A or 0 well subjects, though against this is the fact that the ratio of ill to well B males is higher in both samples than the ratio of ill to well A or 0 males. Moreover, in Mustakallio’s sample the descending order of percentages of group B subjects—namely, ill males (17-9%), well males (16-4%), ill females (150%), well females (13 - 7 %)-is the same as that found in the sample of Streng and Ryti, in which the corresponding figures are 17-5%, 17-2%, 16-8°,0, 161% ; and other parallels are found in the other three ABO groups. It is also of interest that Mustakallio sub-grouped most of his A and AB subjects, and that the descending order of sex-ratios in his ill subjects, namely, 0-90 for AIB (66: 73), 0-77 for Al (475 : 617), 0-75 for A2 217), 0-48 for AB (29 : 61), is the reverse of that in his well subjects-namely, 3-00 for A2B (48 : 16), 1-99 for A2 (153 : 77), 1-57 for Ai (454 : 290), 1-46 for AIB (60 : 41). In my previous letter2I said that the possibility of the ABO blood-groups being of unequal survival value was first suggested and investigated by Graves, but in fact this author had been preceded by several others. Oppenheim and( Voigt,lO in a sample of 500 necropsy subjects in Munich, found the mean age of the 0 subjects to be 53-1, of the A subjects 52-5, and of the B subjects only 50-2, although below the age of forty the mortality of the Bs was slightly lower than that of the As and Os. The lowest mean age at death was that of the B males, and the second lowest that of the B females, the death-rate being at its peak in the forties for the B males and the B females, in the fifties for the 0 males, the 0 females, and the A males, and in the sixties for the A females.
(163 :
These facts led the authors to suggest that B individuals may have, on average, a shorter life-span than A or 0 individuals, and Hirszfeld 11 considered whether the same conclusion might justifiably be drawn from the findings 5. Streng, fasc. 1. 6. Sievers, 7. 8. 9. 10. 11.
O., Ryti, E.
Acta Soc. Med.
’Duodecim,’ 1927, 8,
O. Finska LäkSällsk. Handl. 1929, 71, 836 ; Ibid, 1931, 73. 960. Mustakallio, E. Acta Soc. Med. ’ Duodecim,’ 1937, 20A, fasc. 2. Vuori, A. K. Ibid, 1929, 12, fasc. 1. Kyrklund, R. Ibid, 1932, 15A, 1. Oppenheim, F., Voigt, R. Krankheitsforschung, 1926, 3, 304. Hirszfeld, L. Konstitutionsserologie und Blutgruppenforschung.
Berlin, 1928.
Bellini
kidney
published
his work
on
the structure of the
We have been unable to obtain a copy of the first edition, but we have used the second edition published in 1664.3 Bellini was denied the advantages of a microscope and did not describe the small part of the excretory duct system now called after him, but established the fact that the kidney consists of a mass of tubules, whereas Highmore had previously described it as a solid organ consisting of numerous fibrous cords. In view of the present question at issue it is interesting, if somewhat ironic, to note the method by which Bellini demonstrated the renal tubules. He opened the kidney longitudinally from the pelvic aspect, compressed the parenchyma, and observed the small drops of fluid coming from the tips of the renal papillse. Our own rough translation of the relevant sentences is as follows : " The urine is clearly seen flowing from the compressed tubules as if effused from so many small fountains. From which we are able clearly to assume that the substance of the kidney ... is nothing else than a collection of small channels and capillary openings through which urine flows into the pelvis."
We offer the accompanying illustration both because of the rarity with which such a complete representation of a renal papilla is seen in routine histological sections of the kidney, and because, we believe, it supplies strong histological evidence for the existence of openings of the ducts of Bellini into the renal pelvis. That it is necessary to do so in 1954 emphasises how much is still to be learnt, or relearnt, about normal anatomy. C. H. JONES Royal Liverpool R. E. REWELL. Children’s Hospital. THE EMOTIONAL VALUE OF SUCKLING as
distinct from the nutritive,
suckling to the child is now well known, but a recent experience has afforded me a new light upon its potentialities as an emotional gain to the mother. value of
had been under treatment for some time on neurotic personality, a principal symptom being her inability to form normal feeling or affect relationships with adults, although she could do so much better with children. One result was a partial inability to enjoy sexual experience. Treatment had, at the time of writing, modified but not When her first child cured these anomalies of personality. was two or three days old the baby sustained a slight hurt to his mouth, as a result of which he refused to suck and had to be spoon fed, and it was decided to wean him. A day or two later the patient came to me and told me of the tragic loss involved. -She described the wonderful feeling suckling gave her by saying : ‘’ It makes you feel as if nothing else matters." She then proceeded further to punish herself by allowing her husband, who was home on holiday for a week, to feed the baby every time, so that she ended the day by hating them both. The position was becoming ominous and in the discussion of this situation she said with much feeling : "I was thinking of what it was like to feed baby and then be told he was to go on the bottle it had been like living for the first time.... Oh, I don’t want to talk about" it." The doctor added : " It was like life being taken away ? The patient replied : " Yes." At the next interview she said she felt completely helpless and that not being able to feed baby had made her so. As a result, evidently, of this discussion, the patient tried putting the child back to the breast, found she could do so, that lie sucked again, and that her milk returned.
The
patient
account of
a
...
It is granted that the feeling aspects of suckling - probably are-unusually strong in this patient. 3.
Bellini, L.
consequences. DAVID T. MACLAY.
Brentwood, Essex.
in 1662.
SIR,—The emotional,
a ray of light is cast upon what suckling can mean emotionally to the mother. Unfortunately patients so often accept their doctors’ instructions without mentioning personal (lilliculties of which the doctors may be unaware, thus laying on them an extra responsibility, for, if an error is made, it will usually not be known until it is too late to make any adjustment. It seems probable that weaning is sometimes advised too lightly and with insutlicient attention to the possible emotional
theless,
De Structura Renum.
may be Never-
2nd ed., Florence, 1664.
THE CARE OF OLD PEOPLE
SIR, Reading the various comments which have been made about the International Congress of Gerontology, reported in your issue of July 31, it occurred to me that it may he of interest to your readers to know that the International Hospital Federation held a congress in Brussels in 1951 which had for its main theme the selfsame subject as that which has been the object of such wide comment during the past week-the Care of Old People. Over 500 delegates from 25 countries attended this congress and took part in the discussions, which brought forth many useful ideas. J. E. E.STONE STONE London, E.C.2
Hon. secretary and treasurer, International Hospital Federation.
MERIT AWARDS his letter of July 24 Mr. Hayton-Williams SIR,—In draws attention to one of the many evils of the present system of remuneration of hospital medical and dental staff by his statement that consultants refrain from public criticism of the merit-award system since they feel that an open expression of their views might be detrimental to their chances of being given a merit award." This timidity is regrettably not confined either to consultants or to the subject of merit awards, but permeates the entire system upon which hospital medical and dental staff has been founded. The houseman, in virtue of his junior position and possible ignorance of the true state of affairs, dare not or does not criticise his conditions since he is obliged to obtain the good will of his consultant ; the registrar and senior registrar likewise have more sense than to complain in public of the meagre remuneration which they receive lest they become dubbed as "political agitators" or "subversive elements" or lest they be adversely judged by selection committees prior to interview, so ruining their chances of being short-listed for a post. The senior hospital medical officer, perennially hopeful of upgrading to consultant, keeps quiet for obvious reasons, whilst the majority of consultants, for reasons "
already expressed, merely grumble amongst themselves lest " a unit of the machinery for gathering information " be in their vicinity, or extraprofessional rewards should fail to come their way. No less than five years ago a correspondent wrote in the British Medical Journal1: "We may well ask ourselves,How could this situation come about ? ’ It has come about because doctors have been, since the National Health Service was first mooted, woefully disunited and disorganised, pursuing selfish aims and sectional interests and failing to come together for their Thus wedges are being driven between own protection. various sections of the profession. If doctors do not now at this late hour organise and unite, then the outlook for the doctor and his family is black indeed. And the time is short." The consultants of this country who are prepared to stand by and see injustice done to their juniors, whilst they may or may not pocket their merit awards, are unfitted for their command. Fortunately a few men in 1. Brit. med. J.
1949, ii, suppl.
p. 192.
292 our profession have spoken up at the annual representative meeting of the British Medical Association, and it would appear that at last a committee to deal with the entire problem of remuneration along well-informed trade-union lines is to be developed. The Crichel Down case should have served to emphasise the extent to which bureaucratic control has entered our daily lives ; and the public repudiation of the Spens Report by the Minister of Health in the House of Commons on July 22 provides yet another example. When we eventually succeed in forming a body whose interests are wholly, solely, and-exclusively the financial and political welfare of the medical and dental profession, let us choose its members with considerable care, bearing in mind Kipling’s words :
" Shall we only threaten and be angry for an hour ? When the storm is ended shall we find How softly but how swiftly they have sidled back to power By the favour and contrivance of their kind ? "
N. L. L. ROWE. ROWE.
Andover.
HOSPITAL MEDICAL RECORDS
SIR,—Tracing a family history of diabetes for research recently, I was glad to be able to see a note of glycosuria in the case-papers of a man admitted to hospital for cataract extraction in 1905. Case-records once destroyed are irreplaceable ; every effort should be made to preserve them as long as possible, certainly longer than the six-year minimum suggested by the Ministry.1
purposes
GEORGE JOHNSON.
Harrogate,
BLOOD-GROUPS AND AGE-GROUPS SIR,—Findings similar to those pointed out2 in Fraser Roberts’s sample3 of 85,438 war-time civilian blooddonors in the six south-western counties of England are obtained from Hart’s sample4 of 10,748 war-time civilian blood-donors in eastern rural districts of Ulster.
First, the mean age of the group-B males is two years lower than that of the A and 0 males (as Hart himself pointed out), while the mean age of the group-B females is between three and four months higher than that of the A and 0 females. Secondly, the percentage of male donors who are group B falls from the second to the sixth decade of life, the figures being respectively 12-5, 11-3, 9-6, 8-5, 7-4. Thirdly, the ratio of male to female group-B donors falls from the TABLE I-RATIO OF MALE TO FEMALE BRITISH BLOOD-DONORS
No. of donors under 30
B
Group of
donors
Ratio of male to female donors
of
No. of donors over 30
donors Male
Male
Female
998
2318
B
0-43
0-66
4933
11,677
A
0-42
0-65
12,665
0
0-41
0-61
5201
Group
O
10,120 9617
A B
1842
Female
15.448
14,910 3042
second to the sixth decade, relative to that of the A and 0 donors ; the figures for the B donors are respectively 0-45, 0-51, 0-54, 0-59, 0-51, and for the A and 0 donors combined they are 0-38, 0-46, 0-66, 0-73, 0-75. Lastly, the over-all sex-ratio of the group-B donors is lower than that of the A and 0 donors, being 0-55 for the 0 donors, 0-54 for the A donors, and 0-51 for the B donors. When, however, Hart’s sample is combined with that of Fraser Roberts’s as in table I, it is seen that the lower sex-ratio of the group-B donors is confined to those over 30 years of age ; and the descending order of sex-ratios in the over-30 donors-namely O-A-Bis found to be the reverse of that in the under-30 donors. Thus, the findings would suggest that the viability of group-B males may, in general, fall more quickly, from a higher level, than that of A or 0 males. 1. See Lancet, July 24, 1954, p. 180. 2. Allan, T. M. Ibid,, 1953, ii, 456. 3. Fraser Roberts, J. A. Ann. Eugen., Lond. 4. Hart, E. W. Ibid, 1944, 12, 89.
1948, 14, 109.
TABLE II—RATIO
OF
MALE
TO FEMALE
ILL AND
WELL FINNS
Group
No. of well
-
No. of ill
Group
people Male
of ill
I Female, people
Ratio of males to females
1060
1109
B
0-96
2633
2978
A
0-88
2010
2313
0
0·87
of
people
well
people
Male
Female
0
2308
1991
1-16
A
2762
2378
1.16
B
1141
980
1-16
Now, if this were indeed the case, as evidenced by the blood-group distribution of what is probably the most healthy - namely, the blood-donating-section of the adult community, one would expect to find complementary evidence of it in the blood-group distribution of what is certainly the least healthy section of the community-i.e., hospital patients. In other words, one would expect to find that B males are, in general, more liable to disease than A or 0 males: and this is found to be so in the only three studies 5-7 of the subject known to me. In all three the descending order of the ratios of male to female patients is B—A—O ; the figures for the three samples combined are given on the left-hand side of table 11. These samples consist of Finnish hospital patients, nearly all adults with medical diseases ; and the right-hand side of table 11 gives the corresponding combined figures for four samples of healthy Finns-the samples of Streng- and Ryti,5 Mustakallio,7 Vuori,8 and Kyrklund,9 Here the sex-ratio of the B subjects is the same as that of the A and 0 subjects, but the aggregation of the samples conceals at least two anomalies. The first of these anomalies is that the sample of Kyrklund consists of school-children, and that its descending order of sex-ratios is O-A-B, whereas the order might, in this context, have been expected to be the same as that of the younger British blood-donors-namely, B—A—O. The second anomaly is that the healthy B subjects both of Streng and Ryti and of Mustakallio have a higher sex-ratio than their A or 0 well subjects, though against this is the fact that the ratio of ill to well B males is higher in both samples than the ratio of ill to well A or 0 males. Moreover, in Mustakallio’s sample the descending order of percentages of group B subjects—namely, ill males (17-9%), well males (16-4%), ill females (150%), well females (13 - 7 %)-is the same as that found in the sample of Streng and Ryti, in which the corresponding figures are 17-5%, 17-2%, 16-8°,0, 161% ; and other parallels are found in the other three ABO groups. It is also of interest that Mustakallio sub-grouped most of his A and AB subjects, and that the descending order of sex-ratios in his ill subjects, namely, 0-90 for AIB (66: 73), 0-77 for Al (475 : 617), 0-75 for A2 217), 0-48 for AB (29 : 61), is the reverse of that in his well subjects-namely, 3-00 for A2B (48 : 16), 1-99 for A2 (153 : 77), 1-57 for Ai (454 : 290), 1-46 for AIB (60 : 41). In my previous letter2I said that the possibility of the ABO blood-groups being of unequal survival value was first suggested and investigated by Graves, but in fact this author had been preceded by several others. Oppenheim and( Voigt,lO in a sample of 500 necropsy subjects in Munich, found the mean age of the 0 subjects to be 53-1, of the A subjects 52-5, and of the B subjects only 50-2, although below the age of forty the mortality of the Bs was slightly lower than that of the As and Os. The lowest mean age at death was that of the B males, and the second lowest that of the B females, the death-rate being at its peak in the forties for the B males and the B females, in the fifties for the 0 males, the 0 females, and the A males, and in the sixties for the A females.
(163 :
These facts led the authors to suggest that B individuals may have, on average, a shorter life-span than A or 0 individuals, and Hirszfeld 11 considered whether the same conclusion might justifiably be drawn from the findings 5. Streng, fasc. 1. 6. Sievers, 7. 8. 9. 10. 11.
O., Ryti, E.
Acta Soc. Med.
’Duodecim,’ 1927, 8,
O. Finska LäkSällsk. Handl. 1929, 71, 836 ; Ibid, 1931, 73. 960. Mustakallio, E. Acta Soc. Med. ’ Duodecim,’ 1937, 20A, fasc. 2. Vuori, A. K. Ibid, 1929, 12, fasc. 1. Kyrklund, R. Ibid, 1932, 15A, 1. Oppenheim, F., Voigt, R. Krankheitsforschung, 1926, 3, 304. Hirszfeld, L. Konstitutionsserologie und Blutgruppenforschung.
Berlin, 1928.