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MILK-BOTTLE PROBLEM
618
gut. Although stool tryptic
or chymotryptic activities are screenirlg test for insufficiency of pancreatic proteolytic enzymes, misleading results can still occur even with the more sensitive assays. We have investigated two patients with intestinal enterokinase deficiency. 8,In this condition the proteolytic enzyme precursors trypsinogen and chymotrypsinogen are secreted normally by the
useful
as a
pancreas but cannot be activated in the small intestine because of the absence of enterokinase. Despite the absence of proteolytic activity in the duodenal juice normal concentrations of trypsin and chymotrypsin were found in the stools in both patients. If enterokinase deficiency is suspected, therefore, it is especially important to assay duodenal juice, rather than rely on stool tryptic activity. We thank the Smith Kline and French Foundation for financial support for this investigation and Dr. June K. Lloyd and Dr. Barbara E. Clayton for their advice and encouragement. O. TARLOW Institute of Child Health, M. J. TARLOW.* London W.C.1.
Obituary PATRICIA TROY L.R.C.P.I.
Dr. Patricia
Hospital, died
Troy, assistant psychiatrist at Prestwich on Aug. 26 at the age of 60.
She was born in Dublin in 1910, and received her medical education at the Royal College of Surgeons and the Rotunda She was Hospital, Dublin.
house-surgeon at Scarborough General Hospital and resident medical officer
at
Sharoe Green
Hospital, Preston, and then, for the
of the 1939-45 war on the E.M.S. St. Margaret’s Hospital,
rest
years, served
staff at
Epping. VACUUM EXTRACTION FOLLOWING CORD PROL APSE
SIR,-Prolapse of the umbilical cord is still a major cause mortality. Since 1962 we have used the vacuum extractor to speed delivery in 30 selected cases. The method was used especially for cases of severe fetal asphyxia in multiparæ. The size of the cervical os varied between of fetal
6 cm. and full dilatation, and the time taken for extraction of the fetus (from the time cord prolapse was diagnosed) was between 2 and 15 minutes. 1 patient had had cord prolapse in 2 previous pregnancies, and each time vacuum extraction had been successful. In another case the cervical mucosa tore during delivery and there was a vaginal rupture which necessitated bloodtransfusion and operative repair. In only 2 cases was the infant stillborn. In 9 infants the Apgar score was between 4 and 6, and in 7 it was between 1 and 3. In 13 cases no special neonatal treatment was necessary. We suggest that cord prolapse can be managed successfully in multiparæ by vacuum extraction when the cervix is dilated 6 cm. or more. The rapid completion of delivery by this means reduces the high fetal mortality associated with cord prolapse. N. BENADARET Department of Obstetrics and Gynæcology, H. LEWENTHAL Negev Central Hospital, M. ALTARAS. Beer Sheva, Israel.
MILK-BOTTLE PROBLEM SIR,—The remarks in your note (July 18, p. 159) and in Dr. Tomalin’s letter (Sept. 12, p. 575) concerning the development of non-returnable milk bottles send shudders through me. The key to the world’s present pollution problem lies in one word-" recycle ". The returnable milk bottle, either glass or plastic, is a classical, but all too rare, example of this concept in action. Any change to disposables is a retrograde step which should be resisted as strongly as possible. The U.S.A. has just begun to realise its error. Do we, like Germany at the moment, have to make the same mistake ? Department of Pathology, Frenchay Hospital, Bristol. JAMES BRIGGS. *Present address: Department of Gastroenterology, Strong Memorial Hospital, Rochester, N.Y. 14620, U.S.A. 7. Wohlman, A., Kabakoff, B. L., Avakian, S. Proc. Soc. exp. Biol. Med. 1962, 109, 26. 8. Hadorn, B., Tarlow, M. J., Lloyd, J. K., Wolff, O. H. Lancet, 9.
1969, 1, 812. Tarlow, M. J., Hadorn, B., Arthurton, M. W., Lloyd, J. K. Archs Dis. Childh. (in the press).
A colleague writes: " Patricia Troy was a very congenial and delightful colleague, utterly dedicated to her work and to the care of her patients. As a clinician she had a natural shrewdness, and an intuitive diagnostic ability. She was very painstaking and scrupulous in her work. She brought an immense human kindness, love, and charity to the care of her patients, to whom she gave generously in other ways. She had been in failing health for many years, but carried on valiantly in her work. Her own personal life was not without its tragedies, but they were accepted with uncomplaining courage. She was devoted to her family, and they adored her. She will always be remembered for the warmth of her sympathies, her courage, composure, and kindliness, and for the generosity of her mind and outlook."
Public Health Cholera IN the cholera epidemic the World Health Organisation has now given aid to 38 countries in the form of supplies to prevent or combat the disease. In Africa 22 countries have received vaccine, rehydrating fluid, laboratory reagents, and tetracycline tablets. Large amounts of these supplies have also been sent to Abu Dhabi, Algeria, Ethiopia, St. Helena,
Israel, Jordan, Korea, Lebanon, Libya, Morocco, Saudi Arabia, Sudan, Tunisia, Turkey, and Yemen, as well as to the U.N. Relief and Works Agency for Palestine Refugees in the Near East. Great quantities of cholera vaccine have been provided by other donors or purchased by Governments. Israel has continued to report sporadic cases of cholera, the total on Sept. 9 being 55. In Jordan, 3 cases of cholera have been reported in a refugee camp. In Lebanon, the North Lebanon District has been reported free of cholera; and Syria has reported a few cases near the Iraq border. The presence of cholera around Dubai has been confirmed. In Britain the Health Ministers have decided, as an additional precaution, that travellers from areas where cholera has been notified must produce international certificates of vaccination against cholera. The new requirement will apply to all travellers entering or returning to the United Kingdom who during the five days before arrival have been in any notified cholera area. Certificates, which are valid for six months, will be required from Friday,
Sept. 18.
gut. Although stool tryptic
or chymotryptic activities are screenirlg test for insufficiency of pancreatic proteolytic enzymes, misleading results can still occur even with the more sensitive assays. We have investigated two patients with intestinal enterokinase deficiency. 8,In this condition the proteolytic enzyme precursors trypsinogen and chymotrypsinogen are secreted normally by the
useful
as a
pancreas but cannot be activated in the small intestine because of the absence of enterokinase. Despite the absence of proteolytic activity in the duodenal juice normal concentrations of trypsin and chymotrypsin were found in the stools in both patients. If enterokinase deficiency is suspected, therefore, it is especially important to assay duodenal juice, rather than rely on stool tryptic activity. We thank the Smith Kline and French Foundation for financial support for this investigation and Dr. June K. Lloyd and Dr. Barbara E. Clayton for their advice and encouragement. O. TARLOW Institute of Child Health, M. J. TARLOW.* London W.C.1.
Obituary PATRICIA TROY L.R.C.P.I.
Dr. Patricia
Hospital, died
Troy, assistant psychiatrist at Prestwich on Aug. 26 at the age of 60.
She was born in Dublin in 1910, and received her medical education at the Royal College of Surgeons and the Rotunda She was Hospital, Dublin.
house-surgeon at Scarborough General Hospital and resident medical officer
at
Sharoe Green
Hospital, Preston, and then, for the
of the 1939-45 war on the E.M.S. St. Margaret’s Hospital,
rest
years, served
staff at
Epping. VACUUM EXTRACTION FOLLOWING CORD PROL APSE
SIR,-Prolapse of the umbilical cord is still a major cause mortality. Since 1962 we have used the vacuum extractor to speed delivery in 30 selected cases. The method was used especially for cases of severe fetal asphyxia in multiparæ. The size of the cervical os varied between of fetal
6 cm. and full dilatation, and the time taken for extraction of the fetus (from the time cord prolapse was diagnosed) was between 2 and 15 minutes. 1 patient had had cord prolapse in 2 previous pregnancies, and each time vacuum extraction had been successful. In another case the cervical mucosa tore during delivery and there was a vaginal rupture which necessitated bloodtransfusion and operative repair. In only 2 cases was the infant stillborn. In 9 infants the Apgar score was between 4 and 6, and in 7 it was between 1 and 3. In 13 cases no special neonatal treatment was necessary. We suggest that cord prolapse can be managed successfully in multiparæ by vacuum extraction when the cervix is dilated 6 cm. or more. The rapid completion of delivery by this means reduces the high fetal mortality associated with cord prolapse. N. BENADARET Department of Obstetrics and Gynæcology, H. LEWENTHAL Negev Central Hospital, M. ALTARAS. Beer Sheva, Israel.
MILK-BOTTLE PROBLEM SIR,—The remarks in your note (July 18, p. 159) and in Dr. Tomalin’s letter (Sept. 12, p. 575) concerning the development of non-returnable milk bottles send shudders through me. The key to the world’s present pollution problem lies in one word-" recycle ". The returnable milk bottle, either glass or plastic, is a classical, but all too rare, example of this concept in action. Any change to disposables is a retrograde step which should be resisted as strongly as possible. The U.S.A. has just begun to realise its error. Do we, like Germany at the moment, have to make the same mistake ? Department of Pathology, Frenchay Hospital, Bristol. JAMES BRIGGS. *Present address: Department of Gastroenterology, Strong Memorial Hospital, Rochester, N.Y. 14620, U.S.A. 7. Wohlman, A., Kabakoff, B. L., Avakian, S. Proc. Soc. exp. Biol. Med. 1962, 109, 26. 8. Hadorn, B., Tarlow, M. J., Lloyd, J. K., Wolff, O. H. Lancet, 9.
1969, 1, 812. Tarlow, M. J., Hadorn, B., Arthurton, M. W., Lloyd, J. K. Archs Dis. Childh. (in the press).
A colleague writes: " Patricia Troy was a very congenial and delightful colleague, utterly dedicated to her work and to the care of her patients. As a clinician she had a natural shrewdness, and an intuitive diagnostic ability. She was very painstaking and scrupulous in her work. She brought an immense human kindness, love, and charity to the care of her patients, to whom she gave generously in other ways. She had been in failing health for many years, but carried on valiantly in her work. Her own personal life was not without its tragedies, but they were accepted with uncomplaining courage. She was devoted to her family, and they adored her. She will always be remembered for the warmth of her sympathies, her courage, composure, and kindliness, and for the generosity of her mind and outlook."
Public Health Cholera IN the cholera epidemic the World Health Organisation has now given aid to 38 countries in the form of supplies to prevent or combat the disease. In Africa 22 countries have received vaccine, rehydrating fluid, laboratory reagents, and tetracycline tablets. Large amounts of these supplies have also been sent to Abu Dhabi, Algeria, Ethiopia, St. Helena,
Israel, Jordan, Korea, Lebanon, Libya, Morocco, Saudi Arabia, Sudan, Tunisia, Turkey, and Yemen, as well as to the U.N. Relief and Works Agency for Palestine Refugees in the Near East. Great quantities of cholera vaccine have been provided by other donors or purchased by Governments. Israel has continued to report sporadic cases of cholera, the total on Sept. 9 being 55. In Jordan, 3 cases of cholera have been reported in a refugee camp. In Lebanon, the North Lebanon District has been reported free of cholera; and Syria has reported a few cases near the Iraq border. The presence of cholera around Dubai has been confirmed. In Britain the Health Ministers have decided, as an additional precaution, that travellers from areas where cholera has been notified must produce international certificates of vaccination against cholera. The new requirement will apply to all travellers entering or returning to the United Kingdom who during the five days before arrival have been in any notified cholera area. Certificates, which are valid for six months, will be required from Friday,
Sept. 18.