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RESUSCITATION AMBULANCES
195 sufficient data on immune responsiveness as well immunostimulant therapy 3-5 to justify an extensive evaluation of a temporally combined immunosuppressive and immunostimulant therapy. Treatment with this paradoxical combination is based on the rationale that a delay in the onset of the immunologically unresponsive state prolongs survival. are now
be made available
as
country.
of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106
in
SAMUEL GROSS.
"
also
"
the duration of the pregnancy at any in time is of clinical importance. The resumption of regular ovulation after oral contraception should not be assumed to be immediate. Thus, though many women report only one " menstrual period " after stopping the pill with a view to becoming pregnant, conception may not occur for several weeks, without any further vaginal bleeding. At a special research antenatal clinic for all women suspected of poor uterine growth in Aberdeen, every month as many as 3 or 4 patients out of around 24 prove, when studied for several weeks, to have normal growth. Their pregnancy landmarks are delayed because their expected date of delivery has been calculated from a withdrawal bleeding to which subsequent ovulation bears an inconstant relationship. This is a minor variant of the secondary amenorrhoea reported by Shearman6 and others following oral contraception. This observation might be added to the minor disadvantages of oral contraception listed by Peel and Potts 7; but failure to recognise this in a suspected small-for-dates pregnancy could lead to unnecessary anxiety and even to
calculating
particular point
iatrogenic prematurity. Department of Obstetrics and Gynæcology, Foresterhill, Aberdeen, AB9 2ZD.
K.
5.
post-meridian, an equally or even more probable explanation is that the difference is that which has been ascribed to diurnal variation,l,2the cause of which is unknown, but which is certainly not due to violent exercise. If Dr. Johnson’s subjects are still available, the correct explanation, or the relative contributions of each, should be ascertainable. Department of Medicine, Guy’s Hospital Medical School,
R. J. JARRETT.
London S.E.1.
*** This letter
was
shown
to
Dr. Johnson and his L.
colleagues, whose reply follows.-ED.
SiR,ŅThe diurnal variation reported by Dr. Jarrett would not be sufficient to explain the changes we observed, but may be a contributory factor. In particular, the difference between the glucose-tolerance curves at rest and after exercise was nearly 4-fold larger at 60 minutes than the comparable diurnal variation of normal subjects reported by Jarrett and Keen. Moreover, the ferricyanide method used for the determination of glucose by these authors is less specific3, and the results are therefore not strictlv comparable with ours. R. H. JOHNSON J. WALTON H. A. KREBS D. H. WILLIAMSON.
JOHN DENNIS.
RESUSCITATION AMBULANCES SIR,-Dr. Cundy (Jan. 10, p. 95) rightly draws attention to one of the hazards of using sophisticated (and better) techniques of anxsthesia in the dental surgery, remote from the paraphernalia of resuscitation that should be available in all hospitals. Brighton Corporation has recently equipped a resuscitation ambulance which is designed to deal with respiratory and cardiac failure occurring anywhere outside hospital. The equipment of this ambulance is similar to that provided in a well-equipped intensive-therapy unit, except that all electrical apparatuS-E.C.G., oscilloscope, and D.c. defibrillator-is battery-operated, to enable it to be brought readily to the site of the emergency, and the suction apparatus is foot-operated. Similarly equipped ambulances are in use in Scandinavia and in the U.S.A. Two, devoted mainly to cardiac emergencies, are in use in Belfast and Newcastle. I suggest that if we are to make the best use of existing resuscitative techniques and apparatus, resuscitation ambulances must 3. 4.
REX BINNING.
POST-EXERCISE KETOSIS
current interest in small-for-dates SIR,-In babies, the recognition of an increasingly common source error
service in the
SIR,-Dr. Johnson and his colleagues (Dec. 27, p. 1383) claim that the difference observed between resting and post-exercise oral glucose-tolerance tests is due to the exercise. However, as the post-exercise tests were
SMALL-FOR-DATES BABIES AND THE PILL
of
every ambulance
Department of Anæsthesia, Royal Sussex County Hospital, Brighton.
Department
view of
to
Guyer, R. J., Crowther, D. Br. med. J. 1969, ii, 406. Mathé, G. M., Amiel, J. L., Schwarzenberg, L., Schneider, M., Cattan, A., Schlumberger, J. R., Hayat, M., de Vassal, F. Lancet, 1969, i, 697. Sheagren, J. N., Barth, R. F., Edelin, J. B., Malmgren, R. A.
ibid. 1969, ii, 297. 6. Shearman, R. P. ibid, 1966, ii, 1110. 7. Peel, J., Potts, M. Textbook of Contraceptive Practice. 1969.
Cambridge,
VIRÆMIA IN RABIES
SiR,-Dr. Macrae’s interesting article on rabies (Dec. 27, p. 1415) raises the question of how the virus spreads
through the body. For the virus to infect the organs he lists, it seems to me that there must be a virasmia at some If this is so, it follows that the virus has every to invade the central nervous system from the blood; and thus the (to me) un-virus-like crawl along the peripheral nerves need no longer be emphasised as the main route of infection. Browsing through an old and treasured copy of The Lancetrecently, I came across a report of experimental work done over 140 years ago which, if accurate, gives support to the virasmic hypothesis. The experiments were carried out by Dr. Hertwich of Berlin, who inoculated saliva, blood, and nervous substances internally and into fresh wounds of 59 dogs. Your annotator listed 14 results and conclusions from these experiments, of which the following are of particular interest: 1. Of 59 dogs who were inoculated, 14 became affected with
stage.
opportunity
real rabies. 5. Its vehicle is not only saliva and the mucus of the mouth, but also the blood, and the substance of the salivary glands. It does not appear to exist in the nervous pulp. Bowen, A. J., Reeves, R. L. Archs intern. Med. 1967, 119, 261. Jarrett, R. J., Keen, H. Br. med. J. 1969, ii, 341. Bergmeyer, H. U., Bernt, E. in Methods of Enzymatic Analysis (edited by H. U. Bergmeyer); p. 123. London, 1963. 4. Lancet, 1829, i, 69. 1. 2. 3.
be made available
as
country.
of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio 44106
in
SAMUEL GROSS.
"
also
"
the duration of the pregnancy at any in time is of clinical importance. The resumption of regular ovulation after oral contraception should not be assumed to be immediate. Thus, though many women report only one " menstrual period " after stopping the pill with a view to becoming pregnant, conception may not occur for several weeks, without any further vaginal bleeding. At a special research antenatal clinic for all women suspected of poor uterine growth in Aberdeen, every month as many as 3 or 4 patients out of around 24 prove, when studied for several weeks, to have normal growth. Their pregnancy landmarks are delayed because their expected date of delivery has been calculated from a withdrawal bleeding to which subsequent ovulation bears an inconstant relationship. This is a minor variant of the secondary amenorrhoea reported by Shearman6 and others following oral contraception. This observation might be added to the minor disadvantages of oral contraception listed by Peel and Potts 7; but failure to recognise this in a suspected small-for-dates pregnancy could lead to unnecessary anxiety and even to
calculating
particular point
iatrogenic prematurity. Department of Obstetrics and Gynæcology, Foresterhill, Aberdeen, AB9 2ZD.
K.
5.
post-meridian, an equally or even more probable explanation is that the difference is that which has been ascribed to diurnal variation,l,2the cause of which is unknown, but which is certainly not due to violent exercise. If Dr. Johnson’s subjects are still available, the correct explanation, or the relative contributions of each, should be ascertainable. Department of Medicine, Guy’s Hospital Medical School,
R. J. JARRETT.
London S.E.1.
*** This letter
was
shown
to
Dr. Johnson and his L.
colleagues, whose reply follows.-ED.
SiR,ŅThe diurnal variation reported by Dr. Jarrett would not be sufficient to explain the changes we observed, but may be a contributory factor. In particular, the difference between the glucose-tolerance curves at rest and after exercise was nearly 4-fold larger at 60 minutes than the comparable diurnal variation of normal subjects reported by Jarrett and Keen. Moreover, the ferricyanide method used for the determination of glucose by these authors is less specific3, and the results are therefore not strictlv comparable with ours. R. H. JOHNSON J. WALTON H. A. KREBS D. H. WILLIAMSON.
JOHN DENNIS.
RESUSCITATION AMBULANCES SIR,-Dr. Cundy (Jan. 10, p. 95) rightly draws attention to one of the hazards of using sophisticated (and better) techniques of anxsthesia in the dental surgery, remote from the paraphernalia of resuscitation that should be available in all hospitals. Brighton Corporation has recently equipped a resuscitation ambulance which is designed to deal with respiratory and cardiac failure occurring anywhere outside hospital. The equipment of this ambulance is similar to that provided in a well-equipped intensive-therapy unit, except that all electrical apparatuS-E.C.G., oscilloscope, and D.c. defibrillator-is battery-operated, to enable it to be brought readily to the site of the emergency, and the suction apparatus is foot-operated. Similarly equipped ambulances are in use in Scandinavia and in the U.S.A. Two, devoted mainly to cardiac emergencies, are in use in Belfast and Newcastle. I suggest that if we are to make the best use of existing resuscitative techniques and apparatus, resuscitation ambulances must 3. 4.
REX BINNING.
POST-EXERCISE KETOSIS
current interest in small-for-dates SIR,-In babies, the recognition of an increasingly common source error
service in the
SIR,-Dr. Johnson and his colleagues (Dec. 27, p. 1383) claim that the difference observed between resting and post-exercise oral glucose-tolerance tests is due to the exercise. However, as the post-exercise tests were
SMALL-FOR-DATES BABIES AND THE PILL
of
every ambulance
Department of Anæsthesia, Royal Sussex County Hospital, Brighton.
Department
view of
to
Guyer, R. J., Crowther, D. Br. med. J. 1969, ii, 406. Mathé, G. M., Amiel, J. L., Schwarzenberg, L., Schneider, M., Cattan, A., Schlumberger, J. R., Hayat, M., de Vassal, F. Lancet, 1969, i, 697. Sheagren, J. N., Barth, R. F., Edelin, J. B., Malmgren, R. A.
ibid. 1969, ii, 297. 6. Shearman, R. P. ibid, 1966, ii, 1110. 7. Peel, J., Potts, M. Textbook of Contraceptive Practice. 1969.
Cambridge,
VIRÆMIA IN RABIES
SiR,-Dr. Macrae’s interesting article on rabies (Dec. 27, p. 1415) raises the question of how the virus spreads
through the body. For the virus to infect the organs he lists, it seems to me that there must be a virasmia at some If this is so, it follows that the virus has every to invade the central nervous system from the blood; and thus the (to me) un-virus-like crawl along the peripheral nerves need no longer be emphasised as the main route of infection. Browsing through an old and treasured copy of The Lancetrecently, I came across a report of experimental work done over 140 years ago which, if accurate, gives support to the virasmic hypothesis. The experiments were carried out by Dr. Hertwich of Berlin, who inoculated saliva, blood, and nervous substances internally and into fresh wounds of 59 dogs. Your annotator listed 14 results and conclusions from these experiments, of which the following are of particular interest: 1. Of 59 dogs who were inoculated, 14 became affected with
stage.
opportunity
real rabies. 5. Its vehicle is not only saliva and the mucus of the mouth, but also the blood, and the substance of the salivary glands. It does not appear to exist in the nervous pulp. Bowen, A. J., Reeves, R. L. Archs intern. Med. 1967, 119, 261. Jarrett, R. J., Keen, H. Br. med. J. 1969, ii, 341. Bergmeyer, H. U., Bernt, E. in Methods of Enzymatic Analysis (edited by H. U. Bergmeyer); p. 123. London, 1963. 4. Lancet, 1829, i, 69. 1. 2. 3.