- Email: [email protected]
TABLET IDENTIFICATION
918
pointed out that there was, in that ten-year period, little change in the number of registered but not legal abortions.
be
These
are an
index of the criminal-rate.
(3) That the competence of the criminal practitioner has not increased in that period. It is noted also that Dr. Huldt’s (March 2, p. 467) article lists the number of notified " pregnancies. It is therefore automatically weighted against criminal abortion, for it is the "
secrecy of criminal abortion which appears to be
one of its attractions. Presumably the experience of Stockholm parallels that of Sweden as a whole. If it does not, it is questionable whether any meaning can be attached to the figures. In Sweden, in 1947,11 there was a total of 150,000 births and legal abortions. Fifteen years later, in 1962, this had dropped to 111,400. In Stockholm, there was a rise in the combined criminal and spontaneous rate over that period. If the drop in the births and legal abortions were due to the fact that fewer women were becoming pregnant as a result of improved methods of contraception, then even if the combined criminalspontaneous abortion-rate had remained constant, the ratio criminal-abortion/pregnant-women would have increased. In other words, a larger proportion of pregnant women resorted to criminal abortion in 1962 than in 1947. If the fall in the total births and legal abortions was due to a greater pregnancy loss, this could be accounted for only by an increase in the criminal-abortion rate, since it is presumed that the spontaneous-abortion rate remained constant. It is not surprising that the legalisation of abortion does not reduce the criminal-abortion rate for the following reasons: (1) with legalisation, women become more abortion conscious and the pool of demand for abortion increases; (2) as the Law is not prepared to accept the same indications for abortion that the criminal practitioner accepts, the legal abortion cannot replace the criminal one; (3) when abortion is legalised, the Law is in the position of doing for Mrs. A what the criminal abortionist does for Mrs. B and they become allies in a common cause; hence, there is considerably more tolerance on the part of the Law toward the criminal practitioner, as pointed out by the council of the Royal College of Obstetricians and Gynxcologists. 12 In Sweden, until recently, the legal-abortion rate has been kept low by rejecting as many as 38%" of applicants, thereby refusing some and deterring others. It seems that this may no longer be true, and the only hope of containing legal abortion lies in entangling the woman hopelessly in red tape between the application for abortion and the final decision. Sweden is stuck on the horns of this dilemma. The Law must either permit an abortion which it does not believe is warranted or run the risk of driving the woman to the criminal practitioner. It is faced with the fact that, having made abortion legal, it may hope to exert some control over the number of legal abortions or over the number of criminal abortions. But not over both. Attempts to limit the former, will increase the latter. It has been obvious for many years that legalisation of abortion merely increases the number of abortions. All the Law actually does is decide how many of these it is going to
C. P. HARRISON. TABLET IDENTIFICATION SIR,-In his letter (March 9, p. 538) Dr. Whitney attempts to rekindle interest by the profession in the topic of drug identification by use of a coded imprint. Our study 13 would " certainly support his thesis. By use of Lilly’s " Identi-Code of rose to exceed as to identification accuracy 95%, opposed less than 60% using Hefferen’s identification guide,14 and the 11. The Swedish Institute for Cultural Relations with Foreign Countries. Therapeutic Abortion and the Law in Sweden. 12. Report of the Council of the Royal College of Obstetricians and Gynæcologists. Br. med. J. 1966, i, 850. 13. Symonds, J., Robertson, W. J. Am. med. Ass. 1967, 199, 664. 14. Robertson, W. O., Shoman, A., Caldwell, J., Hurst, B. Lancet, 1963,
i, 1004.
time required fell from 11-2 minutes to less than 15 seconds. With each manufacturer using a distinct trademark imprint (44 of 50 do already), a simple code of one letter and two digits permits a surfeit of choices for each manufacturer-2600 if sequence is maintained, 7800 if not. As never before, a concerted effort is needed to secure adoption of this marking technique for all solid-dosage forms. School of Medicine, University of Washington, Seattle, Washington 98105.
WILLIAM O. ROBERTSON.
ANTINUCLEAR ANTIBODIES IN INFECTIOUS MONONUCLEOSIS SIR,-We have read with interest the report of Dr. Kaplan and Dr. Tan (March 16, p. 561) on the presence of speckled antinuclear antibodies in two-thirds of 21 sera from patients with infectious mononucleosis. We have reported previously a similar high incidence (58 out of 100 patients) of an antinuclear factor (A.N.F.), using human liver tissue as nuclear antigen in the immunofluorescence technique; in most cases, the fluorescence pattern of this A.N.F. was of the speckled type, though sometimes only a nucleolar staining pattern was seen.1 However, our results indicate that the A.N.F. found in such
patients might
be
organ-specific, though
not
species-specific,
since there was reaction with nuclei of human and animal livers, but not with nuclei of the following human tissues: thyroid gland, gastric mucosa, kidney, parotid, and white blood-cells. Only in a few instances did some high-titre sera react with other tissue nuclei also. We have had the same difficulties as Dr. Kaplan and Dr. Tan in obtaining reproducible results when using sera that have been stored and subjected to repeated freezing and thawing. We agree that only by using fresh sera can constant reactions be obtained. For that reason, a prospective investigation is now being performed 2 on a series of 94 sera from 48 patients with infectious mononucleosis. The preliminary results confirm the high incidence of speckled antinuclear antibodies which react with liver nuclei in such patients. In addition, they show that approximately half of the positive sera contained speckled A.N.F. which reacts with nuclei of rat kidney and human gastric mucosa, though not with other nuclei so far tested. It is possible that the discrepancy between the results obtained in our two series may be due to the repeated freezing and thawing of sera in the first experiments. However, the high incidence of speckled A.N.F. that reacts only with liver nuclei which we also found in the second series suggests that this factor may primarily possess specificity against a nuclear antigen in liver nuclei, and secondarily cross-react with nuclei of other tissue, mainly kidney tissue. This view can be supported by the finding of a similar transient " liver-specific " A.N.F. of the speckled type in 10 out of 17 patients with acute infectious hepatitis, but not in sera from patients with obstructive jaundice. Furthermore, speckled A.N.F. has previously been found in sera from animals subjected to experimental immunological liver-cell damage.3 In this connection, in patients with cirrhosis of the liver the A.N.F. found is mostly of the speckled type if liver-cell damage predominates. A.N.F. of the homogeneous type is found mainly in sera from patients with chronic, active hepatitis resulting in heavy infiltration into the liver of mononuclear cells but only slight liver-cell damage.4 The finding of speckled liver A.N.F. in 20 sera from 100 inpatients with apparently uncomplicated, though severe, acute tonsillitis might suggest that some of these patients also had infectious mononucleosis. Actually, low titres (non-diagnostic) of heterophile antibodies were found in 11 of these 20 sera. In our experience, the positivity of control sera derived from blood-donors has been rather high. However, 1. Elling, P., Faber, V. Acta path. microbiol. scand. 1967, suppl. 187, p. 21. 2. Lauersen, Th., Stuip, S., Faber, V. Unpublished. 3. Popper, H., Schaffner, F., Rubin, E., Barka, T., Paronetto, F. Ann. N.Y. Acad. Sci. 1963, 104, 988. 4. Doniach, D., Roitt, I. M., Sherlock, S. Clin. exp. Immunol. 1966, 1, 237.
pointed out that there was, in that ten-year period, little change in the number of registered but not legal abortions.
be
These
are an
index of the criminal-rate.
(3) That the competence of the criminal practitioner has not increased in that period. It is noted also that Dr. Huldt’s (March 2, p. 467) article lists the number of notified " pregnancies. It is therefore automatically weighted against criminal abortion, for it is the "
secrecy of criminal abortion which appears to be
one of its attractions. Presumably the experience of Stockholm parallels that of Sweden as a whole. If it does not, it is questionable whether any meaning can be attached to the figures. In Sweden, in 1947,11 there was a total of 150,000 births and legal abortions. Fifteen years later, in 1962, this had dropped to 111,400. In Stockholm, there was a rise in the combined criminal and spontaneous rate over that period. If the drop in the births and legal abortions were due to the fact that fewer women were becoming pregnant as a result of improved methods of contraception, then even if the combined criminalspontaneous abortion-rate had remained constant, the ratio criminal-abortion/pregnant-women would have increased. In other words, a larger proportion of pregnant women resorted to criminal abortion in 1962 than in 1947. If the fall in the total births and legal abortions was due to a greater pregnancy loss, this could be accounted for only by an increase in the criminal-abortion rate, since it is presumed that the spontaneous-abortion rate remained constant. It is not surprising that the legalisation of abortion does not reduce the criminal-abortion rate for the following reasons: (1) with legalisation, women become more abortion conscious and the pool of demand for abortion increases; (2) as the Law is not prepared to accept the same indications for abortion that the criminal practitioner accepts, the legal abortion cannot replace the criminal one; (3) when abortion is legalised, the Law is in the position of doing for Mrs. A what the criminal abortionist does for Mrs. B and they become allies in a common cause; hence, there is considerably more tolerance on the part of the Law toward the criminal practitioner, as pointed out by the council of the Royal College of Obstetricians and Gynxcologists. 12 In Sweden, until recently, the legal-abortion rate has been kept low by rejecting as many as 38%" of applicants, thereby refusing some and deterring others. It seems that this may no longer be true, and the only hope of containing legal abortion lies in entangling the woman hopelessly in red tape between the application for abortion and the final decision. Sweden is stuck on the horns of this dilemma. The Law must either permit an abortion which it does not believe is warranted or run the risk of driving the woman to the criminal practitioner. It is faced with the fact that, having made abortion legal, it may hope to exert some control over the number of legal abortions or over the number of criminal abortions. But not over both. Attempts to limit the former, will increase the latter. It has been obvious for many years that legalisation of abortion merely increases the number of abortions. All the Law actually does is decide how many of these it is going to
C. P. HARRISON. TABLET IDENTIFICATION SIR,-In his letter (March 9, p. 538) Dr. Whitney attempts to rekindle interest by the profession in the topic of drug identification by use of a coded imprint. Our study 13 would " certainly support his thesis. By use of Lilly’s " Identi-Code of rose to exceed as to identification accuracy 95%, opposed less than 60% using Hefferen’s identification guide,14 and the 11. The Swedish Institute for Cultural Relations with Foreign Countries. Therapeutic Abortion and the Law in Sweden. 12. Report of the Council of the Royal College of Obstetricians and Gynæcologists. Br. med. J. 1966, i, 850. 13. Symonds, J., Robertson, W. J. Am. med. Ass. 1967, 199, 664. 14. Robertson, W. O., Shoman, A., Caldwell, J., Hurst, B. Lancet, 1963,
i, 1004.
time required fell from 11-2 minutes to less than 15 seconds. With each manufacturer using a distinct trademark imprint (44 of 50 do already), a simple code of one letter and two digits permits a surfeit of choices for each manufacturer-2600 if sequence is maintained, 7800 if not. As never before, a concerted effort is needed to secure adoption of this marking technique for all solid-dosage forms. School of Medicine, University of Washington, Seattle, Washington 98105.
WILLIAM O. ROBERTSON.
ANTINUCLEAR ANTIBODIES IN INFECTIOUS MONONUCLEOSIS SIR,-We have read with interest the report of Dr. Kaplan and Dr. Tan (March 16, p. 561) on the presence of speckled antinuclear antibodies in two-thirds of 21 sera from patients with infectious mononucleosis. We have reported previously a similar high incidence (58 out of 100 patients) of an antinuclear factor (A.N.F.), using human liver tissue as nuclear antigen in the immunofluorescence technique; in most cases, the fluorescence pattern of this A.N.F. was of the speckled type, though sometimes only a nucleolar staining pattern was seen.1 However, our results indicate that the A.N.F. found in such
patients might
be
organ-specific, though
not
species-specific,
since there was reaction with nuclei of human and animal livers, but not with nuclei of the following human tissues: thyroid gland, gastric mucosa, kidney, parotid, and white blood-cells. Only in a few instances did some high-titre sera react with other tissue nuclei also. We have had the same difficulties as Dr. Kaplan and Dr. Tan in obtaining reproducible results when using sera that have been stored and subjected to repeated freezing and thawing. We agree that only by using fresh sera can constant reactions be obtained. For that reason, a prospective investigation is now being performed 2 on a series of 94 sera from 48 patients with infectious mononucleosis. The preliminary results confirm the high incidence of speckled antinuclear antibodies which react with liver nuclei in such patients. In addition, they show that approximately half of the positive sera contained speckled A.N.F. which reacts with nuclei of rat kidney and human gastric mucosa, though not with other nuclei so far tested. It is possible that the discrepancy between the results obtained in our two series may be due to the repeated freezing and thawing of sera in the first experiments. However, the high incidence of speckled A.N.F. that reacts only with liver nuclei which we also found in the second series suggests that this factor may primarily possess specificity against a nuclear antigen in liver nuclei, and secondarily cross-react with nuclei of other tissue, mainly kidney tissue. This view can be supported by the finding of a similar transient " liver-specific " A.N.F. of the speckled type in 10 out of 17 patients with acute infectious hepatitis, but not in sera from patients with obstructive jaundice. Furthermore, speckled A.N.F. has previously been found in sera from animals subjected to experimental immunological liver-cell damage.3 In this connection, in patients with cirrhosis of the liver the A.N.F. found is mostly of the speckled type if liver-cell damage predominates. A.N.F. of the homogeneous type is found mainly in sera from patients with chronic, active hepatitis resulting in heavy infiltration into the liver of mononuclear cells but only slight liver-cell damage.4 The finding of speckled liver A.N.F. in 20 sera from 100 inpatients with apparently uncomplicated, though severe, acute tonsillitis might suggest that some of these patients also had infectious mononucleosis. Actually, low titres (non-diagnostic) of heterophile antibodies were found in 11 of these 20 sera. In our experience, the positivity of control sera derived from blood-donors has been rather high. However, 1. Elling, P., Faber, V. Acta path. microbiol. scand. 1967, suppl. 187, p. 21. 2. Lauersen, Th., Stuip, S., Faber, V. Unpublished. 3. Popper, H., Schaffner, F., Rubin, E., Barka, T., Paronetto, F. Ann. N.Y. Acad. Sci. 1963, 104, 988. 4. Doniach, D., Roitt, I. M., Sherlock, S. Clin. exp. Immunol. 1966, 1, 237.