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RABIES
1037
mouth-gag. It was turned off completely about half-way through the operation. The appearances of collapse became apparent after the mouth-pack had been removed. The lobe of the ear appeared to become dusky and its circulation sluggish -the temporal pulse was doubtful, if present, and respiration was gasping. Immediately the patient was put in as near a Trendelenburg position as the dental chair would allow, and resuscitation was started. I regret being able to give only clinical observations, for this patient’s blood-pressure and pulse were not monitored-it is not practical to do so in my opinion for dental anxsthesia. Ardkeen Hospital, Waterford, Eire.
Annual incidence of viral hepatitis at all ages, and of Down’s syndrome among children born 9 months later (Michigan, U.S.A.,
1952-64).
of viral hepatitis at all ages in of Down’s syndrome among children born nine months later. The numbers of cases of viral hepatitis in Michigan for each month since 1952 were obtained from the Communicable Disease Center, U.S. Public Health Service. Population estimates for Oct. 1 of each year were obtained by interpolation from mid-year values published by the U.S. Bureau of Census. Annual incidence-rates of hepatitis were calculated from cases in the last three-quarters of one year and the first quarter of the next-i.e., April to March inclusive. Cases of Down’s syndrome were ascertained from birth certificates, State and private institutions, hospitals, schools, lay groups, and probate-court records. Annual incidence-rates for Down’s syndrome were calculated, based on the number of live births in Michigan. The accompanying table and figure show no evidence for concomitant variation between incidence of hepatitis and births of infants with Down’s syndrome nine months later. Furthermore, the incidence of Down’s syndrome did not deviate significantly from the 15-year mean (by the multiplecomparison test based on the Poisson distribution), except for the low values at the beginning and end of the ascertainment period. These observations do not support the hypothesis of Dr. Stoller and Dr. Collmann. Our incidence-rates for Down’s syndrome are lower than the occurrence-rate of about 1.4 per 1000 live births cited by Penrose,19 but we have no reason to believe that completeness of ascertainment varied by year of birth except at the extremes of the time-period under study. Epidemiology Branch, National Cancer Institute, CHARLES R. STARK National Institutes of Health, JOSEPH F. FRAUMENI, Jr. Bethesda, Maryland 20014, U.S.A.
compared the annual incidence Michigan, 1952-64, with that
A DENTAL ANÆSTHETIC DEATH SIR,-In replying to queries raised by Dr. Smith (April 16), I find it impossible to be accurate as to details, for after such a dramatic episode one’s recollection tends to be clouded by the attempt to maintain life. The pulse was about 140 beats per minute. From the start of induction it was palpated in the temporal artery, and was difficult to feel owing to smallness of amplitude and tachycardia. I also kept the capillary-refill time in the ear-lobe under observation and this was satisfactory throughout. As regards the duration of anaesthesia, I would guess three minutes for induction and three minutes for extraction. Halothane was increased to 2 1/2%for four or five breaths because the patient appeared to resent the insertion of the 19. Penrose, L. S. Br. med. Bull. 1961, 17, 184.
J. SHANAHAN.
RABIES SiR,-I have read with interest the letter from Dr. Macrae (April 23) on the possible dangers of rabies in this country from exotic animals. I have also read1 that the Ministry of Agriculture is considering the extension of quarantine to include wild animals other than canines and felines. This step is, I feel, vital. The recent boom in the pet-animal trade has resulted in the increased importation of many foreign animals, specimens of which may be purchased from the larger pet stores in this country. Among mammals regularly sold are skunks and mongooses, two species specifically mentioned as carriers of rabies in the W.H.O. report.2 Our quarantine regulations have kept this country free of rabies since 1922, but if we are to remain in this fortunate nosition then surelv tighter legislation is reauired. School of
Veterinary Science, Langford, nr. Bristol.
JOHN E. COOPER.
TREATMENT OF VARICELLA SIR,-Dr. Bagdade and Dr. Melmon (April 16) do not mention the use of convalescent chickenpox y-globulin in the treatment of disseminated varicella, nor do they state the concentration of y-globulin in their patient’s serum. We have observed dramatic improvement after intramuscular injection of 500 mg. of convalescent chickenpox y-globulin in a boy, aged 3 years, who had severe chickenpox simulating Stevens-Johnson syndrome. Varicella-zoster virus was isolated in human thyroid-cell culture from vesicle fluid. Serum analysis revealed that the patient’s initial y-globulin concentration had been 400 mg. per 100 ml.-about half the normal for his age. Following the injection of y-globulin the temperature fell from 102.8°F to 98°F within 48 hours, and fresh lesions did not progress beyond the papular stage. Convalescent chickenpox y-globulin is obtainable from the Central Public Health Laboratory, but it is in short supply and its use is therefore limited. At this hospital we try to secure a donation of blood for fractionation from adults convalescing from chickenpox. The effect of corticosteroids on the clinical course of chickenpox was observed in a girl, aged 7 years, who was being treated with decreasing doses of prednisolone for rheumatic carditis. While on 15 mg. prednisolone per day she developed a scanty vesicular rash, typical of chickenpox, on her trunk and thighs. The lesions faded after 3 days, and as she had no constitutional symptoms the prednisolone was not discontinued. Varicellazoster complement-fixing antibody titre was less than 1/10 before the rash appeared, and rose to 1/160 on the 6th day and to 1/640 a week later. Her serum a2 and y-globulin concentrations were slightly raised, probably due to the rheumatic carditis. We should like to thank Dr. A. D. Macrae, director of the Virus Reference Laboratory, Colindale, for the virological studies. West Hendon Hospital, London N.W.9. Diagnostic Reference Laboratory, Central Public Health Laboratory, London N.W.9. 1. 2.
W. Y. LOEBL. C. E. D. TAYLOR.
Sunday Times, April 24, 1966. Tech. Rep. Ser. Wld Hlth Org. 1966,
no. 321.
mouth-gag. It was turned off completely about half-way through the operation. The appearances of collapse became apparent after the mouth-pack had been removed. The lobe of the ear appeared to become dusky and its circulation sluggish -the temporal pulse was doubtful, if present, and respiration was gasping. Immediately the patient was put in as near a Trendelenburg position as the dental chair would allow, and resuscitation was started. I regret being able to give only clinical observations, for this patient’s blood-pressure and pulse were not monitored-it is not practical to do so in my opinion for dental anxsthesia. Ardkeen Hospital, Waterford, Eire.
Annual incidence of viral hepatitis at all ages, and of Down’s syndrome among children born 9 months later (Michigan, U.S.A.,
1952-64).
of viral hepatitis at all ages in of Down’s syndrome among children born nine months later. The numbers of cases of viral hepatitis in Michigan for each month since 1952 were obtained from the Communicable Disease Center, U.S. Public Health Service. Population estimates for Oct. 1 of each year were obtained by interpolation from mid-year values published by the U.S. Bureau of Census. Annual incidence-rates of hepatitis were calculated from cases in the last three-quarters of one year and the first quarter of the next-i.e., April to March inclusive. Cases of Down’s syndrome were ascertained from birth certificates, State and private institutions, hospitals, schools, lay groups, and probate-court records. Annual incidence-rates for Down’s syndrome were calculated, based on the number of live births in Michigan. The accompanying table and figure show no evidence for concomitant variation between incidence of hepatitis and births of infants with Down’s syndrome nine months later. Furthermore, the incidence of Down’s syndrome did not deviate significantly from the 15-year mean (by the multiplecomparison test based on the Poisson distribution), except for the low values at the beginning and end of the ascertainment period. These observations do not support the hypothesis of Dr. Stoller and Dr. Collmann. Our incidence-rates for Down’s syndrome are lower than the occurrence-rate of about 1.4 per 1000 live births cited by Penrose,19 but we have no reason to believe that completeness of ascertainment varied by year of birth except at the extremes of the time-period under study. Epidemiology Branch, National Cancer Institute, CHARLES R. STARK National Institutes of Health, JOSEPH F. FRAUMENI, Jr. Bethesda, Maryland 20014, U.S.A.
compared the annual incidence Michigan, 1952-64, with that
A DENTAL ANÆSTHETIC DEATH SIR,-In replying to queries raised by Dr. Smith (April 16), I find it impossible to be accurate as to details, for after such a dramatic episode one’s recollection tends to be clouded by the attempt to maintain life. The pulse was about 140 beats per minute. From the start of induction it was palpated in the temporal artery, and was difficult to feel owing to smallness of amplitude and tachycardia. I also kept the capillary-refill time in the ear-lobe under observation and this was satisfactory throughout. As regards the duration of anaesthesia, I would guess three minutes for induction and three minutes for extraction. Halothane was increased to 2 1/2%for four or five breaths because the patient appeared to resent the insertion of the 19. Penrose, L. S. Br. med. Bull. 1961, 17, 184.
J. SHANAHAN.
RABIES SiR,-I have read with interest the letter from Dr. Macrae (April 23) on the possible dangers of rabies in this country from exotic animals. I have also read1 that the Ministry of Agriculture is considering the extension of quarantine to include wild animals other than canines and felines. This step is, I feel, vital. The recent boom in the pet-animal trade has resulted in the increased importation of many foreign animals, specimens of which may be purchased from the larger pet stores in this country. Among mammals regularly sold are skunks and mongooses, two species specifically mentioned as carriers of rabies in the W.H.O. report.2 Our quarantine regulations have kept this country free of rabies since 1922, but if we are to remain in this fortunate nosition then surelv tighter legislation is reauired. School of
Veterinary Science, Langford, nr. Bristol.
JOHN E. COOPER.
TREATMENT OF VARICELLA SIR,-Dr. Bagdade and Dr. Melmon (April 16) do not mention the use of convalescent chickenpox y-globulin in the treatment of disseminated varicella, nor do they state the concentration of y-globulin in their patient’s serum. We have observed dramatic improvement after intramuscular injection of 500 mg. of convalescent chickenpox y-globulin in a boy, aged 3 years, who had severe chickenpox simulating Stevens-Johnson syndrome. Varicella-zoster virus was isolated in human thyroid-cell culture from vesicle fluid. Serum analysis revealed that the patient’s initial y-globulin concentration had been 400 mg. per 100 ml.-about half the normal for his age. Following the injection of y-globulin the temperature fell from 102.8°F to 98°F within 48 hours, and fresh lesions did not progress beyond the papular stage. Convalescent chickenpox y-globulin is obtainable from the Central Public Health Laboratory, but it is in short supply and its use is therefore limited. At this hospital we try to secure a donation of blood for fractionation from adults convalescing from chickenpox. The effect of corticosteroids on the clinical course of chickenpox was observed in a girl, aged 7 years, who was being treated with decreasing doses of prednisolone for rheumatic carditis. While on 15 mg. prednisolone per day she developed a scanty vesicular rash, typical of chickenpox, on her trunk and thighs. The lesions faded after 3 days, and as she had no constitutional symptoms the prednisolone was not discontinued. Varicellazoster complement-fixing antibody titre was less than 1/10 before the rash appeared, and rose to 1/160 on the 6th day and to 1/640 a week later. Her serum a2 and y-globulin concentrations were slightly raised, probably due to the rheumatic carditis. We should like to thank Dr. A. D. Macrae, director of the Virus Reference Laboratory, Colindale, for the virological studies. West Hendon Hospital, London N.W.9. Diagnostic Reference Laboratory, Central Public Health Laboratory, London N.W.9. 1. 2.
W. Y. LOEBL. C. E. D. TAYLOR.
Sunday Times, April 24, 1966. Tech. Rep. Ser. Wld Hlth Org. 1966,
no. 321.