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PREVIOUS HEALTH AND LONGEVITY OF MALE ATHLETES
711 balance is disturbed with lowered plasma-potassium,! which would of course potentiate the arrhythmic effects of digoxin ; (b) blood-pressure is raised in depression2 which could help to precipitate myocardial infarction. Also patients treated with amitriptyline are frequently anxious patients exhibiting excessive adrenergic activity, the dangers of which are rightly pointed to in a somewhat different context by Moir et al. We are told nothing of potassium levels, blood-pressures, and depression and anxiety ratings, all of which are pertinent and feasible. Before amitriptyline is taken to be indicted, we need to know rather more. University Department of Psychiatry, Whiteley Wood Clinic, Woofindin Road, Sheffield 10.
GERALD SILVERMAN.
PREVIOUS HEALTH AND LONGEVITY OF MALE ATHLETES
* During anthropometric examination at Harvard University. t A sample of every fifth consecutive non-athlete measured, who
dead of natural
was
causes.
t None of the major athletes reported two pulmonary diseases, versus 2 minor athletes and 1 non-athlete; none of the subjects reported more than two pulmonary diseases.
reported by Dublin7 8 colleges in the from among 38,269 graduating eastern United States between 1870 and 1905. Athletes graduating in later years (1900-05) reportedly had the lowest mortality-rates of all groups. Dublin attributed this improvement to better selection of college athletes by medical examination, which became " standard practice Somewhat similar trends
were
men
SiR,—Schnohr 3 reported that, under age 50, Danish male athletic champions had a low mortality-rate relative to the general male population, and stated that this finding " does not agree with previous findings" on college athletes. At Cambridge University4 between 1860 and had slightly lower mortality1900, however, 723 sportsmen " rates relative to 362 intellectual " and 325 randomly chosen classmates up to age 45, and slightly lower than the random group up to age 50. Table I shows the survival of 7877 Harvard men born between 1860 and 1889, by athletic status. Deaths from TABLE I-HARVARD MEN*: PERCENTAGES REACHING A GIVEN BY ATHLETIC STATUS AND BIRTH DECADE
TABLE II-PREVIOUS PULMONARY DISEASES REPORTED* BY HARVARD MEN (BORN 1860-69), BY ATHLETIC STATLTS
AGE,
in later years.’ It has been
suggested 3,4 that selection for general health-both by self-selection and by medical examination -may explain the lower mortality among athletes up to age 50, reported by Schnohr3 and in the above-mentioned studies of college athletes. We have no data on the health status of Harvard athletes while they were in college. At the time of anthropometric examination in college (at a mean age of about 19 years), however, each man was asked about previous illnesses. The check-list included four pulmonary diseases-pneumonia, bronchitis, pleurisy, and asthma. Among men in the 1860-69 birth decade (table 11), a significantly higher percentage of non-athletes than major athletes reported a previous pulmonary disease (12-0% vs 63%; p<0-05, t test). On this criterion, therefore, major athletes were indeed healthier than their classmates. in the present series were interested in exercise to extent, since all had voluntarily rented a gymnasium locker. Thus, the non-athletes may have been healthier than the general student population, which makes the differences found more meaningful. Parenthetically, we note that in another study of Harvard men,8 significantly more men without previous pulmonary disease were still alive than those with such disease. Relative to the general male population, Danish national champions must be an even more select group (in terms of general health) than college athletes relative to their classmates. This may account for the rather large difference in survival to age 50 between Danish champions and controls,3 relative to the small differences reported between college athletes and their classmates. After age 50 other factors must have offset the early advantage shown by the Danish champions. One such factor could be physique, as has been suggested for college athletes.5,6c
All
men
some
*
Men dead of natural
causes or
still alive
as
of
June 30, 1967.
other than natural were excluded, following Rook’s 4 procedure. Major athletes were lettermen in varsity sports, while minor athletes participated in varsity sports without winning a letter, or in non-varsity (i.e., inter-class) sports.5.6 Up to age 40 or 45 there is little difference between lettermen and non-athletes. In the last birth decade (1880-89) major athletes had the highest survival-rates up to age 45, but differences again were small. Major athletes graduating in later years, after about 1890, had mortality-rates much lower than those of earlier classes, but only slightly higher than their less-athletic classmates after age 50. causes
1. 2.
Shaw, D. M. Br. med. J. 1966, ii, 262. Heine, B. E., Sainsbury, P., Chynoweth, R. C. J. psychiat. Res. 1969, 7, 119. 3. Schnohr, P. Lancet, 1971, ii, 1364. 4. Rook, A. Br. med. J. 1954, ii, 773. 5. Polednak, A. P., Damon, A. Hum. Biol. 1970, 42, 28. 6. Polednak, A. P. Geriatrics (in the press).
Department of Kinesiology (Health Science Program), University of Waterloo, Waterloo, Ontario, Canada.
ANTHONY P. POLEDNAK.
SIR,-Schnohr’s generalisation on longevity and athletic activity is rightly criticised by Dr. Largey (Aug. 5, p. 286). Combining all sports in mortality tables serves no purpose. Brute " sports such as football shorten lifespans while endurance " sports such as track lengthen them. Kar"
"
Dublin, L. I. Statist. Bull. Metropolitan Life Insurance Co. 1932, 13, 5. 8. Damon, A., McClung, J. P. J. chron. Dis. 1967, 20, 59.
7.
712 vonen1 has shown that long-distance skiers survived seven years longer than controls. The reduction in morto the lowered incidence of coronary tality is primarily due The most atherosclerosis in " endurance " athletes. striking example of this can be seen in the marathon runner. A search of the literature by the American Medical Joggers Association failed to document a single death due to coronary atherosclerosis among marathon finishers. With a third of the control population dying of this disease, the protective aspects of endurance training become quickly evident. Department of Pathology, Valley Community Hospital, Inglewood, California 90307, U.S.A.
Centinela
THOMAS J. BASSLER.
STAPHYLOCOCCAL INFECTION IN CERVICAL GLANDS OF INFANTS
SIR,-We
were most
interested to read the letter
on
this
Ayliffe and others (Sept. 2, p. 479) as there has been recent experience in Morayshire of a similar
subject by
Dr.
outbreak of cervical abscesses in young babies. In early July of this year two infants were admitted to hospital with abscesses in the neck requiring incision. It was then learned that two earlier cases had occurred in June. Subsequent cases have arisen and hitherto nine neck abscesses requiring incision, and two swellings of neck glands which have subsided with conservative treatment, have been recorded. During the same period there occurred one severe staphylococcal infection of an infant’s hand with palmar abscess formation, minor staphylococcal infection of eye and skin in two infants, and a puerperal staphylococcal breast abscess in a breast-feeding mother. All of these cases were associated with the same 17-bed
maternity hospital.
developed neck abscesses requiring born between April 3 and June 19, 1972. When swelling of neck glands was first noticed their ages ranged from 58 days to 102 days, the average being 72 days. Typically there was swelling near the angle of the jaw with little constitutional upset, followed by pus The nine babies who
surgical
treatment were
formation within a few days. The average age of infants who had cervical swellings not requiring surgery was 75
days. When the first few cases came to light, investigations commenced at the maternity hospital. Of the eighteen members of nursing and domestic staff who had nose and throat swabs taken, eleven proved to be carriers of penicillinresistant Staphylococcus pyogenes. The pathogen was isolated from three out of four umbilical cords of babies who were in hospital at the time. It was not isolated from any of the samples taken from the milk kitchen. Inevitably considerable concern became apparent among expectant mothers who were due to be confined in the hospital, and a decision was made in the middle of July to stop admissions and allow for thorough cleaning and redecoration. To date all strains from neck abscesses and from baby skin infections have produced closely similar antibiograms, being insensitive to some penicillins and colistin but sensitive to all other commonly used antibiotics. Bacteriophage typing carried out by the Central Public Health Laboratory at Colindale showed the majority of these strains to be untypable by the routine set of filtrates but lysed by one experimental bacteriophage-type 88. This uncommon typing reaction was reflected in three of the eleven strains isolated from hospital staff. As in the Worcestershire outbreak, infection could not were
1. 2.
Karvonen, M. J. Work and the Heart; p. 199. New York, 1959. Lawrence, R. M. Personal communication.
be related to any
special handling procedure in hospital, in
postnatal clinics, or in the various general practices involved. However, two features of this outbreak are of considerable interest. At the end of February, on receipt of a Scottish Home and Health Department circular warning hospital authorities of possible hexachlorophane toxicity, all products containing this chemical were withdrawn from the hospital. Simple surface-active agents and ordinary talcum powder were substituted for the Phisohex ’ and hexachlorophane powder which had been used for baby bathing and cordstump care, respectively. Secondly, all neck-abscess babies were housed in the same hospital, and, despite the long incubation period, it was seen that the first three cases occurred in babies all born in the same week but some six weeks after the withdrawal of hexachlorophane. From the date of birth of the oldest baby who developed glandular swelling in the neck until the closure of the hospital, a hundred and sixty births were recorded. The nine cases of cervical abscess therefore represent an incidence of 5-6%, which is considerably higher than that reported from mid-Worcestershire by Dr. Ayliffe et al. Health Department,
J. DEWAR.
Elgin.
City Hospital Laboratory,
I. A. PORTER
Aberdeen.
Department of Bacteriology, University of Aberdeen.
H. G. SMYLIE
INTERSTITIAL TRANSLOCATION IN MAN an interstitial non-reciprocal translocation is of great theoretical and practical importance, since it challenges the dogmatic integrity of the telomere and its identification depends on the newer differential chromosomal staining methods. The reports by Dr. Gray and his colleagues (July 8, p. 92) and Mrs. Grace and her colleagues (July 29, p. 231) of an interstitial translocation are, to our knowledge, the first such reports in man, and we should like to report another example of an interstitial translocation involving the distal portion of 2q inserted into the proximal portion
SiR,-The finding of
of 12q. family was ascertained because 3 of the 4 children mentally deficient. The first mentally retarded child is a 17-year-old girl who was the product of a first marriage. She is institutionalised with a diagnosis of " cerebral The
are
agenesis " and was not examined. The mother’s second marriage resulted in 3 liveborn children and 2 spontaneous
Fig.
1-Maternal
chromosomes
involved
(Giemsa banding technique). The arrows indicate the break point the inserted 2q segment into 12q.
on
in
translocation
the normal
no.
2 and
GERALD SILVERMAN.
PREVIOUS HEALTH AND LONGEVITY OF MALE ATHLETES
* During anthropometric examination at Harvard University. t A sample of every fifth consecutive non-athlete measured, who
dead of natural
was
causes.
t None of the major athletes reported two pulmonary diseases, versus 2 minor athletes and 1 non-athlete; none of the subjects reported more than two pulmonary diseases.
reported by Dublin7 8 colleges in the from among 38,269 graduating eastern United States between 1870 and 1905. Athletes graduating in later years (1900-05) reportedly had the lowest mortality-rates of all groups. Dublin attributed this improvement to better selection of college athletes by medical examination, which became " standard practice Somewhat similar trends
were
men
SiR,—Schnohr 3 reported that, under age 50, Danish male athletic champions had a low mortality-rate relative to the general male population, and stated that this finding " does not agree with previous findings" on college athletes. At Cambridge University4 between 1860 and had slightly lower mortality1900, however, 723 sportsmen " rates relative to 362 intellectual " and 325 randomly chosen classmates up to age 45, and slightly lower than the random group up to age 50. Table I shows the survival of 7877 Harvard men born between 1860 and 1889, by athletic status. Deaths from TABLE I-HARVARD MEN*: PERCENTAGES REACHING A GIVEN BY ATHLETIC STATUS AND BIRTH DECADE
TABLE II-PREVIOUS PULMONARY DISEASES REPORTED* BY HARVARD MEN (BORN 1860-69), BY ATHLETIC STATLTS
AGE,
in later years.’ It has been
suggested 3,4 that selection for general health-both by self-selection and by medical examination -may explain the lower mortality among athletes up to age 50, reported by Schnohr3 and in the above-mentioned studies of college athletes. We have no data on the health status of Harvard athletes while they were in college. At the time of anthropometric examination in college (at a mean age of about 19 years), however, each man was asked about previous illnesses. The check-list included four pulmonary diseases-pneumonia, bronchitis, pleurisy, and asthma. Among men in the 1860-69 birth decade (table 11), a significantly higher percentage of non-athletes than major athletes reported a previous pulmonary disease (12-0% vs 63%; p<0-05, t test). On this criterion, therefore, major athletes were indeed healthier than their classmates. in the present series were interested in exercise to extent, since all had voluntarily rented a gymnasium locker. Thus, the non-athletes may have been healthier than the general student population, which makes the differences found more meaningful. Parenthetically, we note that in another study of Harvard men,8 significantly more men without previous pulmonary disease were still alive than those with such disease. Relative to the general male population, Danish national champions must be an even more select group (in terms of general health) than college athletes relative to their classmates. This may account for the rather large difference in survival to age 50 between Danish champions and controls,3 relative to the small differences reported between college athletes and their classmates. After age 50 other factors must have offset the early advantage shown by the Danish champions. One such factor could be physique, as has been suggested for college athletes.5,6c
All
men
some
*
Men dead of natural
causes or
still alive
as
of
June 30, 1967.
other than natural were excluded, following Rook’s 4 procedure. Major athletes were lettermen in varsity sports, while minor athletes participated in varsity sports without winning a letter, or in non-varsity (i.e., inter-class) sports.5.6 Up to age 40 or 45 there is little difference between lettermen and non-athletes. In the last birth decade (1880-89) major athletes had the highest survival-rates up to age 45, but differences again were small. Major athletes graduating in later years, after about 1890, had mortality-rates much lower than those of earlier classes, but only slightly higher than their less-athletic classmates after age 50. causes
1. 2.
Shaw, D. M. Br. med. J. 1966, ii, 262. Heine, B. E., Sainsbury, P., Chynoweth, R. C. J. psychiat. Res. 1969, 7, 119. 3. Schnohr, P. Lancet, 1971, ii, 1364. 4. Rook, A. Br. med. J. 1954, ii, 773. 5. Polednak, A. P., Damon, A. Hum. Biol. 1970, 42, 28. 6. Polednak, A. P. Geriatrics (in the press).
Department of Kinesiology (Health Science Program), University of Waterloo, Waterloo, Ontario, Canada.
ANTHONY P. POLEDNAK.
SIR,-Schnohr’s generalisation on longevity and athletic activity is rightly criticised by Dr. Largey (Aug. 5, p. 286). Combining all sports in mortality tables serves no purpose. Brute " sports such as football shorten lifespans while endurance " sports such as track lengthen them. Kar"
"
Dublin, L. I. Statist. Bull. Metropolitan Life Insurance Co. 1932, 13, 5. 8. Damon, A., McClung, J. P. J. chron. Dis. 1967, 20, 59.
7.
712 vonen1 has shown that long-distance skiers survived seven years longer than controls. The reduction in morto the lowered incidence of coronary tality is primarily due The most atherosclerosis in " endurance " athletes. striking example of this can be seen in the marathon runner. A search of the literature by the American Medical Joggers Association failed to document a single death due to coronary atherosclerosis among marathon finishers. With a third of the control population dying of this disease, the protective aspects of endurance training become quickly evident. Department of Pathology, Valley Community Hospital, Inglewood, California 90307, U.S.A.
Centinela
THOMAS J. BASSLER.
STAPHYLOCOCCAL INFECTION IN CERVICAL GLANDS OF INFANTS
SIR,-We
were most
interested to read the letter
on
this
Ayliffe and others (Sept. 2, p. 479) as there has been recent experience in Morayshire of a similar
subject by
Dr.
outbreak of cervical abscesses in young babies. In early July of this year two infants were admitted to hospital with abscesses in the neck requiring incision. It was then learned that two earlier cases had occurred in June. Subsequent cases have arisen and hitherto nine neck abscesses requiring incision, and two swellings of neck glands which have subsided with conservative treatment, have been recorded. During the same period there occurred one severe staphylococcal infection of an infant’s hand with palmar abscess formation, minor staphylococcal infection of eye and skin in two infants, and a puerperal staphylococcal breast abscess in a breast-feeding mother. All of these cases were associated with the same 17-bed
maternity hospital.
developed neck abscesses requiring born between April 3 and June 19, 1972. When swelling of neck glands was first noticed their ages ranged from 58 days to 102 days, the average being 72 days. Typically there was swelling near the angle of the jaw with little constitutional upset, followed by pus The nine babies who
surgical
treatment were
formation within a few days. The average age of infants who had cervical swellings not requiring surgery was 75
days. When the first few cases came to light, investigations commenced at the maternity hospital. Of the eighteen members of nursing and domestic staff who had nose and throat swabs taken, eleven proved to be carriers of penicillinresistant Staphylococcus pyogenes. The pathogen was isolated from three out of four umbilical cords of babies who were in hospital at the time. It was not isolated from any of the samples taken from the milk kitchen. Inevitably considerable concern became apparent among expectant mothers who were due to be confined in the hospital, and a decision was made in the middle of July to stop admissions and allow for thorough cleaning and redecoration. To date all strains from neck abscesses and from baby skin infections have produced closely similar antibiograms, being insensitive to some penicillins and colistin but sensitive to all other commonly used antibiotics. Bacteriophage typing carried out by the Central Public Health Laboratory at Colindale showed the majority of these strains to be untypable by the routine set of filtrates but lysed by one experimental bacteriophage-type 88. This uncommon typing reaction was reflected in three of the eleven strains isolated from hospital staff. As in the Worcestershire outbreak, infection could not were
1. 2.
Karvonen, M. J. Work and the Heart; p. 199. New York, 1959. Lawrence, R. M. Personal communication.
be related to any
special handling procedure in hospital, in
postnatal clinics, or in the various general practices involved. However, two features of this outbreak are of considerable interest. At the end of February, on receipt of a Scottish Home and Health Department circular warning hospital authorities of possible hexachlorophane toxicity, all products containing this chemical were withdrawn from the hospital. Simple surface-active agents and ordinary talcum powder were substituted for the Phisohex ’ and hexachlorophane powder which had been used for baby bathing and cordstump care, respectively. Secondly, all neck-abscess babies were housed in the same hospital, and, despite the long incubation period, it was seen that the first three cases occurred in babies all born in the same week but some six weeks after the withdrawal of hexachlorophane. From the date of birth of the oldest baby who developed glandular swelling in the neck until the closure of the hospital, a hundred and sixty births were recorded. The nine cases of cervical abscess therefore represent an incidence of 5-6%, which is considerably higher than that reported from mid-Worcestershire by Dr. Ayliffe et al. Health Department,
J. DEWAR.
Elgin.
City Hospital Laboratory,
I. A. PORTER
Aberdeen.
Department of Bacteriology, University of Aberdeen.
H. G. SMYLIE
INTERSTITIAL TRANSLOCATION IN MAN an interstitial non-reciprocal translocation is of great theoretical and practical importance, since it challenges the dogmatic integrity of the telomere and its identification depends on the newer differential chromosomal staining methods. The reports by Dr. Gray and his colleagues (July 8, p. 92) and Mrs. Grace and her colleagues (July 29, p. 231) of an interstitial translocation are, to our knowledge, the first such reports in man, and we should like to report another example of an interstitial translocation involving the distal portion of 2q inserted into the proximal portion
SiR,-The finding of
of 12q. family was ascertained because 3 of the 4 children mentally deficient. The first mentally retarded child is a 17-year-old girl who was the product of a first marriage. She is institutionalised with a diagnosis of " cerebral The
are
agenesis " and was not examined. The mother’s second marriage resulted in 3 liveborn children and 2 spontaneous
Fig.
1-Maternal
chromosomes
involved
(Giemsa banding technique). The arrows indicate the break point the inserted 2q segment into 12q.
on
in
translocation
the normal
no.
2 and