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MOBILE CARE IN MYOCARDIAL INFARCTION
466 Harrison and Lawson. In the first 10 patients 20 mg. of frusemide was added to 350 ml. of whole blood before transfusion. In only 4 of these patients was diuresis maximum in the first four hours; in the remaining 6 the diuresis was delayed, and 1 patient died of pulmonary oedema. In the remaining 10 patients, therefore, 20 mg. of frusemide was given intravenously half an hour before starting the bloodtransfusion and, in every case, diuresis was maximum in the first four hours (average 1530 ml.). Haemoglobin rose by 10% on average for every 350 ml. of whole blood. I suggest that patients with severe anaemia and fluid retention can be treated with whole blood, without fear of pulmonary oedema, provided 20 mg. of frusemide is given before transfusion in this wav.
Other studies may be used to test the hypothesis. If an Xlinked recessive gene were involved in alcoholism, 50% of the brothers of alcoholic probands should be affected, since the mother would distribute her alcoholism gene and normal gene equally to her sons. If fathers of some of the alcoholic probands also had alcoholism, 50% of the sisters of these probands should also be affected with alcoholism. Amark obtained morbid risks for alcoholism by considering 349 brothers, 365 sisters, 186 fathers, and 200 mothers of 203 male alcoholic probands.6He found an expectancy of 21 % for brothers of alcoholic male probands. This is less than the 50% needed to fit in with an X-borne recessive hypothesis for alcoholism. Among the fathers and mothers of alcoholic male probands, Amark found a morbid risk of 26% and 2% for alcoholism respectively. One Stanley Medical College, P. K. KRISHNANKUTTI. Madras 1. may assume that the 26% ill fathers account for 26% of the sisters of the alcoholic probands. 26% of the sisters over the age of 20 (348 sisters) gives a figure of 90 sisters. To conform with an X-borne recessive gene hypothesis, 50% (45) of these sisters MOBILE CARE IN MYOCARDIAL INFARCTION should have alcoholism. This number of sisters should have SIR,-Since general-practitioner awareness is imperative if received a recessive gene for alcoholism from both their fathers a mobile intensive-care unit is to be successful in the manageand their heterozygous mothers. In fact, only 3 sisters over age ment of myocardial infarction, I am particularly gratified by the 20 were alcoholics. interest shown by Dr. Fry and Dr. Dillane (Aug. 12, p. 365) It is possible that alcoholism manifests itself as psychopathy in the account by Dr. Pantridge and me (Aug. 5, p. 271) of the rather than alcohol abuse. The Amark monograph contains data results of the operation of such a unit. However, their stateto evaluate the frequency of alcoholism and/or psychopathy in ment that we confirm the feasibility and success of the sons of unaffected parents and in daughters of alcoholic fathers Russian claims " may be misinterpreted. Dr. Pantridge and normal mothers. Because of the early onset of psychopathy initiated the Belfast unit more than one year before we had any and alcoholism, simple prevalence figures will suffice. There information on the Russian work. I have been able to obtain are 102 families in which an unaffected father was married to an only one Russian publication on this subject.l This indicates unaffected mother. These marriages produced 186 sons that their approach is entirely different from ours. They have (excluding probands). The prevalence of alcoholism and/or been orientated towards the management of cardiac failure and psychopathy was 19%. This does not approach the expected shock and appeared to be unaware of the technique of closed50 % of sons necessary for an X-borne recessive gene hypothesis. chest resuscitation. The article did not mention any success in There are 23 families of alcoholic male probands in which an resuscitation outside the hospital. alcoholic parent married a normal parent. Since there were only The mobile coronary unit operating in Belfast is of course 4 cases of alcoholism in mothers in the study, it was assumed an extension of our hospital coronary-care unit. Hospital that all the alcoholic parents were fathers. This kind of mating coronary-care units followed Lown’s introduction to clinical provided 46 daughters. The prevalence of illness in the daughters was 20% (9 daughters with psychopathy) which falls short practice of defibrillation by D.c. shock in 1962. of the 50% required for the X-borne recessive gene hypothesis. Royal Victoria Hospital, Belfast. J. S. GEDDES. It is clear from the data that alcoholism is seen more in men than women, and that a significant familial factor is present. The evidence does not, however, support the hypothesis that alcoholism is transmitted by a single X-borne recessive gene. X-BORNE RECESSIVE GENES IN ALCOHOLISM Department of Psychiatry, SIR,-Cruz-Coke and Varela have advanced the hypothesis Washington University School of Medicine, 4940 Audubon Avenue, St. Louis, that alcoholism is transmitted by an X-borne recessive gene.2 GEORGE WINOKUR. Missouri 63110. The epidemiological and genetic studies of Marconi et al. support this notion.3 The Hardy-Weinberg equilibrium (which is the proportion PSEUDOMOSAICISM AND G.-6-P.D. DEFICIENCY of genotypes in a population, p2/2pq/q2) may be used in SIR,-The controversy about pseudomosaicism in males support of an X-linked recessive factor in alcoholism. For this with mild glucose-6-phosphate dehydrogenase (G.-6-P.D.) it is necessary to have a population in which there is total deficiencyprompted me to study six G.-6-P.D.-deficient ascertainment of the morbid risk or expectancy of alcoholism. males and six female heterozygotes for G.-6-P.D. deficiency by Such data have been reported by Helgason.4 For alcohol the testand the cyanmethaemomethasmoglobin-reduction addiction and habitual excessive drinking, Helgason found an both methylene-blue and globin-elution technique,9 using for men and of alcoholism of 0-42 =h 6-51 0-51% expectancy Nile-blue sulphate as reducing agents. The arithmetical mean the for women. the Hardy-Weinberg 0-13% By equilibrium, of the percentage estimation of eluted erythrocytes (counting square of the male frequency (6-51%) should approximate to 1000 red cells in each subject), and the Helmert-Pearson (X2) is almost a the observed female frequency (0-42%). In fact, it are summarised in the accompanying table. Apparently test, If another one adds the square giving 0-423%. perfect fit, the " mixed-cell effect ", ascribed by Beutler and Baluda 10 to category to the definition of alcoholism, that of irregular excesthe methylene-blue, may be present even when Nile-blue sive drinking, the risk for men goes up to 9-79% and for women is used. men then is of the for to 0-50%. The square 0-96%, sulphate frequency The ;t2-test shows significant differences between the redwhich is almost twice that of the observed frequency for cell populations in males and females. This may imply that, women (0-50%). It is possible, however, that irregular excessive drinking may be a manifestation of manic depressive 6. Åmark, C. Acta psychiat. neurol. scand. 1951, suppl. 70. 7. Papayannopoulou, T., Stamatoyannopoulos, G. Lancet, 1964, ii, 1215. disease, rather than of typical alcoholism.5 1. 2. 3. 4. 5.
Moiseev, S. G. Sov. Med. 1962, 25, 30. Cruz-Coke, R., Varela, A. Lancet, 1966, i, 1282. Marconi, J., Varela, A., Rosenblatt, E., Solari, G., Marchese, I., Alvarado, R., Enriquez, V. Q. Jl Stud. Alcohol. 1955, 16, 438. Helgason, T. Acta psychiat. scand. 1964, suppl. 173. Winokur, G., Pitts, F. N., Jr. J. psychiat. Res. 1965, 3, 113. Pitts, F. N., Jr., Winokur, G. ibid. 1966, 4, 37.
Beutler, E., Collins, Z. ibid. 1965, i, 552. Gall, J. C., Jr., Brewer, G. J., Dern, R. J. Am. J. hum. Genet. 1965, 17, 359. Kaplan, J. C., Dreyfus, J. C., Bessis, M. Nouv. Revue fr. Hémat. 1965, 5, 835. Stamatoyannopoulos, G., Papayannopoulou, T. Lancet, 1965, ii, 392. 8. Brewer, G. J., Tarlov, A. R., Alving, A. S. Bull. Wld Hlth Org. 1960, 22, 633. 9. Kleihauer, E., Betke, K. Nature, Lond. 1963, 199, 1196. 10. Beutler, E., Baluda, M. C. Blood, 1963, 22, 323.
Other studies may be used to test the hypothesis. If an Xlinked recessive gene were involved in alcoholism, 50% of the brothers of alcoholic probands should be affected, since the mother would distribute her alcoholism gene and normal gene equally to her sons. If fathers of some of the alcoholic probands also had alcoholism, 50% of the sisters of these probands should also be affected with alcoholism. Amark obtained morbid risks for alcoholism by considering 349 brothers, 365 sisters, 186 fathers, and 200 mothers of 203 male alcoholic probands.6He found an expectancy of 21 % for brothers of alcoholic male probands. This is less than the 50% needed to fit in with an X-borne recessive hypothesis for alcoholism. Among the fathers and mothers of alcoholic male probands, Amark found a morbid risk of 26% and 2% for alcoholism respectively. One Stanley Medical College, P. K. KRISHNANKUTTI. Madras 1. may assume that the 26% ill fathers account for 26% of the sisters of the alcoholic probands. 26% of the sisters over the age of 20 (348 sisters) gives a figure of 90 sisters. To conform with an X-borne recessive gene hypothesis, 50% (45) of these sisters MOBILE CARE IN MYOCARDIAL INFARCTION should have alcoholism. This number of sisters should have SIR,-Since general-practitioner awareness is imperative if received a recessive gene for alcoholism from both their fathers a mobile intensive-care unit is to be successful in the manageand their heterozygous mothers. In fact, only 3 sisters over age ment of myocardial infarction, I am particularly gratified by the 20 were alcoholics. interest shown by Dr. Fry and Dr. Dillane (Aug. 12, p. 365) It is possible that alcoholism manifests itself as psychopathy in the account by Dr. Pantridge and me (Aug. 5, p. 271) of the rather than alcohol abuse. The Amark monograph contains data results of the operation of such a unit. However, their stateto evaluate the frequency of alcoholism and/or psychopathy in ment that we confirm the feasibility and success of the sons of unaffected parents and in daughters of alcoholic fathers Russian claims " may be misinterpreted. Dr. Pantridge and normal mothers. Because of the early onset of psychopathy initiated the Belfast unit more than one year before we had any and alcoholism, simple prevalence figures will suffice. There information on the Russian work. I have been able to obtain are 102 families in which an unaffected father was married to an only one Russian publication on this subject.l This indicates unaffected mother. These marriages produced 186 sons that their approach is entirely different from ours. They have (excluding probands). The prevalence of alcoholism and/or been orientated towards the management of cardiac failure and psychopathy was 19%. This does not approach the expected shock and appeared to be unaware of the technique of closed50 % of sons necessary for an X-borne recessive gene hypothesis. chest resuscitation. The article did not mention any success in There are 23 families of alcoholic male probands in which an resuscitation outside the hospital. alcoholic parent married a normal parent. Since there were only The mobile coronary unit operating in Belfast is of course 4 cases of alcoholism in mothers in the study, it was assumed an extension of our hospital coronary-care unit. Hospital that all the alcoholic parents were fathers. This kind of mating coronary-care units followed Lown’s introduction to clinical provided 46 daughters. The prevalence of illness in the daughters was 20% (9 daughters with psychopathy) which falls short practice of defibrillation by D.c. shock in 1962. of the 50% required for the X-borne recessive gene hypothesis. Royal Victoria Hospital, Belfast. J. S. GEDDES. It is clear from the data that alcoholism is seen more in men than women, and that a significant familial factor is present. The evidence does not, however, support the hypothesis that alcoholism is transmitted by a single X-borne recessive gene. X-BORNE RECESSIVE GENES IN ALCOHOLISM Department of Psychiatry, SIR,-Cruz-Coke and Varela have advanced the hypothesis Washington University School of Medicine, 4940 Audubon Avenue, St. Louis, that alcoholism is transmitted by an X-borne recessive gene.2 GEORGE WINOKUR. Missouri 63110. The epidemiological and genetic studies of Marconi et al. support this notion.3 The Hardy-Weinberg equilibrium (which is the proportion PSEUDOMOSAICISM AND G.-6-P.D. DEFICIENCY of genotypes in a population, p2/2pq/q2) may be used in SIR,-The controversy about pseudomosaicism in males support of an X-linked recessive factor in alcoholism. For this with mild glucose-6-phosphate dehydrogenase (G.-6-P.D.) it is necessary to have a population in which there is total deficiencyprompted me to study six G.-6-P.D.-deficient ascertainment of the morbid risk or expectancy of alcoholism. males and six female heterozygotes for G.-6-P.D. deficiency by Such data have been reported by Helgason.4 For alcohol the testand the cyanmethaemomethasmoglobin-reduction addiction and habitual excessive drinking, Helgason found an both methylene-blue and globin-elution technique,9 using for men and of alcoholism of 0-42 =h 6-51 0-51% expectancy Nile-blue sulphate as reducing agents. The arithmetical mean the for women. the Hardy-Weinberg 0-13% By equilibrium, of the percentage estimation of eluted erythrocytes (counting square of the male frequency (6-51%) should approximate to 1000 red cells in each subject), and the Helmert-Pearson (X2) is almost a the observed female frequency (0-42%). In fact, it are summarised in the accompanying table. Apparently test, If another one adds the square giving 0-423%. perfect fit, the " mixed-cell effect ", ascribed by Beutler and Baluda 10 to category to the definition of alcoholism, that of irregular excesthe methylene-blue, may be present even when Nile-blue sive drinking, the risk for men goes up to 9-79% and for women is used. men then is of the for to 0-50%. The square 0-96%, sulphate frequency The ;t2-test shows significant differences between the redwhich is almost twice that of the observed frequency for cell populations in males and females. This may imply that, women (0-50%). It is possible, however, that irregular excessive drinking may be a manifestation of manic depressive 6. Åmark, C. Acta psychiat. neurol. scand. 1951, suppl. 70. 7. Papayannopoulou, T., Stamatoyannopoulos, G. Lancet, 1964, ii, 1215. disease, rather than of typical alcoholism.5 1. 2. 3. 4. 5.
Moiseev, S. G. Sov. Med. 1962, 25, 30. Cruz-Coke, R., Varela, A. Lancet, 1966, i, 1282. Marconi, J., Varela, A., Rosenblatt, E., Solari, G., Marchese, I., Alvarado, R., Enriquez, V. Q. Jl Stud. Alcohol. 1955, 16, 438. Helgason, T. Acta psychiat. scand. 1964, suppl. 173. Winokur, G., Pitts, F. N., Jr. J. psychiat. Res. 1965, 3, 113. Pitts, F. N., Jr., Winokur, G. ibid. 1966, 4, 37.
Beutler, E., Collins, Z. ibid. 1965, i, 552. Gall, J. C., Jr., Brewer, G. J., Dern, R. J. Am. J. hum. Genet. 1965, 17, 359. Kaplan, J. C., Dreyfus, J. C., Bessis, M. Nouv. Revue fr. Hémat. 1965, 5, 835. Stamatoyannopoulos, G., Papayannopoulou, T. Lancet, 1965, ii, 392. 8. Brewer, G. J., Tarlov, A. R., Alving, A. S. Bull. Wld Hlth Org. 1960, 22, 633. 9. Kleihauer, E., Betke, K. Nature, Lond. 1963, 199, 1196. 10. Beutler, E., Baluda, M. C. Blood, 1963, 22, 323.