PREGNANCY TESTS AND PROTEINURIA

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required. I have previously drawn attention1 to one common operation in which this opportunity is usually neglected-i.e., right inguinal herniorrhaphy. After opening the sac and dealing with the contents, since the caecum is adjacent to the internal abdominal ring, it is often a simple

of the incision is

matter to

withdraw the

form

appendicectomy. precludes this procedure, difficulty arises. The patient is surprised

into the wound and then perneck or an adherent caecum but in at least 50% of cases no

narrow

and delighted to know that he has lost an organ which possesses no virtue, but only potentialities for mischief; as with any other incidental appendicectomy, however, it is essential that the patient is fully aware that he has lost his appendix in case he later develops abdominal symptoms. McNEILL LOVE. MCNEILL London W.I.

SKIN-GRAFTING OF FINGERTIP INJURIES SIR,-Dr. Salaman’s article prompts me to add the following observation. Most partial-thickness skin-grafts to digits will take, when held in position by ’Steri-Strips ’. This technique, surgical toilet permitting, saves both the time of suturing and the pain of ring block. It is done as follows: place rubber tourniquet at base of finger, apply skin-graft, and secure with steri-strips, which have been painted with compound benzoin tincture (B.P.C.), in the form of a cross; a non-adherent dressing should be used. Nuffield College, London W.C.2.

H. LORING WEBB.

CHEWING TOBACCO AND RADIOIODINE

SIR,-During the evaluation of a patient with suspected metastatic thyroid carcinoma, the routine total 72-hour urinary 131 I-recovery findings failed to account for a large proportion of the administered dose. This presumed retention was incompatible with the results of manual scintiscanning. Furthermore, the usual identifiable concentration of 1311 in the stomach was not noted. Although the patient’s history had been carefully reviewed, no-one had noted that this patient chewed tobacco during virtually his entire wakeful hours. In addition, he hastened to assure us that during such time he certainly never swallowed. Repeat studies revealed that 24% of the 1311 dose was present in the sputum. Although salivary iodine concentration is well known, it had not heretofore occurred to us that the use of chewing-tobacco might pose a clinical dilemma. MARY S. MCCALL Radioisotope Service, LUCILLE TIMM Veterans Administration Hospital, EUGENE P. FRENKEL. Dallas, Texas 75216.

HYPERSENSITISATION BY MEASLES VIRUS SiR,ńVaccination with formaldehyde-inactivated measles virus may result in unusual or sometimes severe attacks of clinical measles when the vaccinees are exposed to measles infection several years later.2 This result is explained by residual hypersensitising (H.S.) activity with waning immunity. Since the measles virion (i.e., complete virus particle) is composed of two distinct chemical fractions-nucleotideprotein (N.P.) and lipoids-the question arises whether the various effects of the virus can be attributed to these fractions, and if so whether they can be separated from each other. It is well known that the immunising activity of the measles virus-i.e., induction of neutralising, heemagglutination1. 2.

(SCHULTZ-DALE TEST)

csecum

A

Lincoln’s Inn Fields,

HYPERSENSITATION BY MEASLES VIRUS

Love, R. J. McNeill. Br. med. J. 1948, ii, 746. Katz, S. L. (W.H.O./P.A.H.O.) International Conference on Vaccines against Viral and Rickettsial Diseases of Man, October, 1966. Washington.

and complement-fixing antibodies-can be attributed to the N.P. fraction of the virion. Potency tests for vaccines are based on this fact. It is, however, only by exclusion that the lipoid fraction is supposed to be the structure responsible for some other effects of measles virus, most of them unwanted. For this reason we have tried to compare the H.s. activity of the N.P. fraction with that of the lipoids. Our virus fractions were obtained by splitting the virion with ’ Tween-80 Jether.3 In a Schultz-Dale test guineapigs were injected with complete measles virus. Three weeks later their uteri were challenged with either the complete virus, the N.P. fraction, or the lipoid component. From the results, shown in the accompanying table, it is obvious that H.s. activity is localised in the lipoid fraction of the measles virion, that no such activity is found in the N.P. (hamiagglutinin) fraction, and that the complete viria themselves have weak H.s. activity. These preliminary experiments seem to justify using the Schultz-Dale technique as a model for testing H.s. activity of measles virus and its components. Our experiments are to be continued; the results will be published

inhibiting,

elsewhere. Behringwerke AG, 355 Marburg on Lahn, Federal Republic of Germany.

W. HENNESSEN R. MAULER.

PREGNANCY TESTS AND PROTEINURIA to draw attention to a cause of misleading results when immunological methods are used for the diagnosis of pregnancy. Recently we had under our care a Bantu woman, aged 35, with a severe form of nephrotic syndrome. During her stay in the ward she missed a menstrual period, and the ’ Prepuerin ’ haemagglutination-inhibition test of her urine was reported as positive in dilutions 1/5, 1/10, and 1/20. Because her disease was refractory to all therapy, including chlorothiazide diuretics, spironolactone, steroids, and azathioprine, it was decided to terminate pregnancy. Curettage, however, did not show any evidence of pregnancy. A repeat prepuerin test was again reported as positive in all 3 dilutions. A week after curettage the patient died, and at necropsy no signs of pregnancy were found. This experience prompted the investigation we report here. Urines containing 3-4+ protein were obtained from 33 subjects, in whom pregnancy was excluded on grounds of age, sex, disease, or clinical follow-up. On examining these 33 urines with the prepuerin test ring precipitates were observed in 14: in 8 the rings occurred at all 3 dilutions, in 2 at 1/5 and 1/10, and in 4 at 1/5. On close inspection the majority of rings were thicker and their edges less regular than those seen when known pregnancy urines were tested with prepuerin. In a few When instances, however, they were indistinguishable. examined by the ’Pregnosticon ’ test, only 2 of the 33 urines yielded ring precipitates: one was very similar to that found with pregnancy urine, the other was thick and irregular. 7 of the 33 urines were also examined by theHyland H.C.G.’ slide test, and in 3 the results were indistinguishable from true positives. Of the 14 patients with false positive reactions 11 had the nephrotic syndrome and 3 had chronic glomerulo-

SIR,-We wish

nephritis. That urines containing large amounts of protein may give false positive results when examined by immunological preg3. Waterson, A. P., Rott,

R., Enders-Ruckle, G. Z. Naturf. 1963, 18B, 377.

903

Parliament

nancy tests does not appear to be generally recognised. We can find only 1 previous reference and this gives the im-

pression that tinguishable.

and false ring precipitates are always disWe have not found this to be the case and recommend that all urines giving a positive pregnancy test result be examined for protein. The mechanism of the false results is not clear. Nor do we know how frequently they occur with lesser degrees of proteinuria. true

Department of Medicine, University of Witwatersrand, Johannesburg. Clinical Laboratories, Johannesburg.

M. C. KEW H. C. SEFTEL.

B. M. BLOOMBERG.

Obituary ALEXANDER HEPBURNE MACKLIN O.B.E., M.C., T.D., M.D. Manc.

Dr. A. H. Macklin died on March 21 in Aberdeen, where for some fifteen years he was physician to the student-health service. He brought to this academic appointment unusually diverse experience which he had gathered during his work in the Antarctic, in general

practice, and in the Army during two wars. He was born in 1889, and he graduated M.B. from the University of Manchester in 1912. After holding house-appointments in Manchester and Blackburn, he joined Shackleton’s 1914 expedition to the Antarctic. When this was abandoned Macklin returned to serve with the R.A.M.C. at Murmansk, and for this work he was appointed O.B.E. and awarded the M.c. After demobilisation he took the M.D. with commendation, and soon afterwards he joined the Shackleton-Rowett expedition. At this time he published several articles on frost-bite and scurvy. After the death of Shackleton in South Georgia in 1922 the expedition returned, and Macklin settled in general practice in Dundee. He also joined the staff of the Dundee Royal Infirmary, where he was in charge of the electrocardiograph department, and he was a lecturer in clinical medicine in the University of St. Andrews. During the 1939-45 war he again served in the R.A.M.C., this time as A.D.M.S. in East Africa with the rank of colonel. Soon after his return to civilian practice he became the first full-time physician in charge of the student-health service in Aberdeen, and within a year he started a similar service for nurses. As one of the pioneers in this form of medical practice his advice was widely sought, and he was a member of the subcommittee on student health of the Committee of Vice-chancellors and Principals. After he retired from his university appointment in 1960 he busied himself in locums in general practice, and he also worked as house-officer in a great many specialties. At the time of his death, at the age of 77, he was the efficient house-surgeon of a busy orthopaedic ward. Dr. Macklin leaves a widow and two sons.

I. M. R. writes: "

Few men have done so many things and done them all well. General practitioner, physician, soldier, explorer, studenthealth officer, to each of these activities Alec Macklin gave all of himself-and it was a great deal. Even a short acquaintance made one aware that he was no ordinary man; though modest, quietly thoughtful, and always courteous, his speech and action were so directed by principle that he did not hesitate to say what he thought was right. He was listened to because he never asked of others what he could not achieve himself, and, difficult though it was to get him to speak of his past, because his hearers knew that he had faced and conquered the most severe hazards and deprivations, they drew strength from his courage and went on their way better men." 1.

Fulthorpe,

A. J., Parke, J. A. C., Tovey, J. E., Monckton, J. C. Br. med. J. 1963, i, 1049.

Status

Quo

To write report of the Budget from the point of view of the medical and social-welfare services is a negative exercise. Among all the suggestions, hints, and advice offered to the Chancellor over these last months the proposals to give more support to large families with small means seemed most likely to receive consideration, and possible methods were eagerly canvassed.1 But when it came to the bit, discussion was unnecessary, or at any rate premature, for the Chancellor contented himself with praise for social workers " who continue to uncover the poverty that still exists ... among certain families with children " and an avowal of intent " to find the best measures to relieve this hardship ". Modest adjustments to their income-tax allowances will help 450,000 widows and single women with family responsibilities and cost the Exchequer f,33/4 million in a whole year. But children’s allowances remain for the present untouched, unaltered, and unrevised. In his closing speech the Chancellor said that he was conscious that there were many groups, including the elderly and children, who needed to be cared for. The Government had undertaken a review of priorities which would have to be concluded. For instance, to give a general increase of 10s. a week for family allowances would cost E160 million. That was why it was important that we should be able to deal with poverty where it really existed. a

QUESTION

TIME

of Chemical and Biological Warfare Laboratories Mr. HUGH JENKINS asked the Secretary of State for Defence what was the Government’s policy towards the international inspection of chemical and biological warfare laboratories, in the light of the report of the 13th Pugwash Conference.-Mr. DENIS HEALEY replied: The Government would like to see progress made towards international agreement on measures to deal with chemical and biological weapons. The Western Plan for General and Complete Disarmament makes proposals to this end. We hope that it will in due course be possible for the 18-Nation Disarmament Committee at Geneva to examine the problems- involved and we naturally welcome contributions, such as those by the Pugwash Conference, to their solution. Mr. JENKINS: Does the Secretary of State agree that chemical and biological warfare must be mainly directed at the civilian population and that, for this reason, it is a particularly dangerous development, and that the United States Government appear to be trying it out in Vietnam ? Will he, therefore, regard this matter with rather greater urgency than has perhaps been done hitherto ?-Mr. HEALEY: I cannot accept this implied criticism of the urgency with which we regard this matter, but I agree that it would be desirable in all our interests if we could reach an agreement to ensure that these weapons were neither produced nor used.

Inspection

Service Medical Officers’ Pay Mr. JOHN HALL asked the Secretary of State for Defence when he proposed to bring the increase in pay to medical officers in the Armed Forces into line with the increases given to medical general practitioners in the National Health Service, and what representations had been made to him by the British Medical Association that a new structure of pay and conditions should be negotiated for medical officers in the Armed Forces.Mr. HEALEY replied: Service medical officers will receive a pay increase of 10% on July 1 which will be backdated to Oct. 1, 1966. The British Medical Association proposed in discussions last month that a further increase of 8co should be awarded and that any new pay structure should be excepted from the terms of the white-paper on prices and incomes. These proposals could not be accepted by the Government. 1. See

Lancet, Feb. 18, 1967, p. 372.