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VARIABILITY IN URINARY CREATININE
674 done in
metabolic ward and the
patients. The
test was carried out in a closely supervised and the falls in blood-pressure and side-effects suggested that the tablets were active and being taken. Disorders of immune mechanisms such as drug sensitivi-
these collections
laboratory
subjects were on a standard diet. Precautions were taken to Creatinine in ensure that each collection was complete. urine was determined in duplicate samples using Jaffe’s
ties, rheumatoid arthritis, disseminated lupus erythematosus, and arteritis of the aorta are common in Malaysian Chinese, and I can think of no explanation why the Coombs tests should have been negative in all the patients on methyldopa.
reaction. The results of
Bristol General Hospital, Bristol BS1 6SY.
child
are as
a
a
typical collection (mg) in
one
adult and
follows:
C. J. BURNS-COX.
VARIABILITY IN URINARY CREATININE SiR,-The assumption that the excretion of creatinine in urine over a 24-hour period is constant has been questioned lately.1-4 We present here data which suggest that this inconstancy can be extended to the excretion of creatinine over shorter periods of time. Urine was collected over 4-hour periods from 6 A.M. to 10 P.M. and as one night sample from 10 P.M. to 6 A.M. for 4 consecutive days in eight healthy adults and for 1 day in four individuals taking part in a metabolic study. In four apparently healthy children aged between 4 and 10 years, similar timed collections of urine were made for 1 day. All 1. 2. 3. 4.
one
were
Edwards, O. M., Bayliss, R. I. S., Millen, S. Lancet, 1969, ii, 1165. Zorab, P. A., Clark, S., Harrison, A. ibid. p. 1254. Bailey, R. R., de Wardener, H. E. ibid. 1970, i, 145. Pierro, A., Johnson, R. E. ibid. p. 784.
Obituary
There was considerable variation in the 24-hour urinary output of creatinine in all subjects, the variation being sometimes more than 50%. Similarly, the amount of creatinine excreted in 4-hour timed collections showed considerable variation, in some instances the variation being There seemed to be no trend in the more than 100%. the of changes in the excretion of creatinine with pattern respect to the time of collection during the day. These results indicate that urinary excretion of creatinine over 24-hour period and short-term collections is not constant, and, therefore, raise doubts regarding the validity of the use of random samples of urine and the use of creatinine in such samples as a reference standard. National Institute of Nutrition, Indian Council of Medical Research,
Jamai-Osmania, Hyderabad-7 A.P., India.
M. MOHAN RAM VINODINI REDDY.
Queen Mary’s Hospital for the East End between 1936 and 1960.
J. R.,
to
whom
we are
grateful for this biography,
writes: ARTHUR DOYNE COURTENAY BELL D.M.
Oxon., F.R.C.P.
Dr. Doyne Bell, formerly physician in charge of the paediatric department at Charing Cross Hospital, London, died on holiday in Scotland on Sept. 16, at the age of 70. Born in Prestwich, Lancashire, in 1900, of a family of consulting engineers, he was related to Thomas Sydenham. He was a scholar of Gresham’s School, Holt, and then went to St. John’s College, Oxford, where he was an exhibitioner, and dived and played water polo for the university. He
followed his clinical studies at St. Thomas’s Hospital, graduating B.M. in 1928. At St. Thomas’s he held houseappointments during which he became interested in pxdiatrics, and he was later registrar to the children’s department. This was followed by a travelling fellowship to Vienna and Berlin, where he continued his studies in paediatrics. He was elected M.R.C.P. in 1933, and returned to St. Thomas’s Hospital as honorary chief assistant to the children’s department. In 1935 he was appointed physician to the Belgrave Children’s Hospital. Further consultant appointments followed at King Edward VII Hospital, Harrow Hospital, and Woking Hospital. During the 1939-45 war he was superintendent of the East Ham Hospital and medical officer to the Heavy Reserve Squad, City of Westminster. He was also director of the children’s department of the London Hospital, and at Woking Hospital. In 1946 he was appointed physican in charge of the children’s department at Charing Cross Hospital, and assumed charge of paediatric services in the other hospitals in the group when Fulham Hospital and the West London Hospital became affiliated to Charing Cross in 1959. He held these appointments until his retirement in 1965. He was elected F.R.C.P. in 1949. He was also consultant in child health to the City of Westminster, and was physician in charge of the pxdiatric department at
" The many appointments which have already been mentioned do not reflect Doyne Bell’s personality in full, for in addition to his role as a consultant and teacher he was active in the planning of the new Charing Cross Hospital at Fulham, and it is to his foresight and experience, broadened by visits of inspection to new projects at home and abroad, that the successful planning of the new hospital, in all its complex and advanced detail, has been due. A firm chairman in committee, it was his particular genius to extract from others, often at difference, the essence of their concepts, and to weld them into a workable plan for the new
project. "
As a teacher Doyne Bell was beloved of many generations of Cross students, who attached to him an endearing soubriquet. His lucid and practical teaching inculcated his students with a pragmatic approach to paediatric problems. He was much at ease with the children he treated, and it was characteristic that he never patronised or talked down to them. One has a lively recollection of children playing with his eyeglass, after which he would put it in place and discuss their problems with them as gravely as if they were distinguished colleagues who were seeking his advice. This rapport with his young patients showed how successful he was in the management of the psychological aspects of ill children; more aware than many of his contemporaries of the psychiatric side of children’s illnesses, he encouraged the child psychiatrists to join his teaching ward-rounds. In 1957 he was president of the Pxdiatric Section of the Royal Society of Medicine, and distinguished himself by an original presidential dissertation. " It is, however, for his capacity for making relationships and warm friendships that many will remember him. Essentially a clubman, a bon vivant, genial, of polished manner, he had an intense appreciation of the refinements of the table, especially in his role of chairman of the Savile Club, where he was an esteemed and popular figure. Doyne was a lively and entertaining table companion-oysters
metabolic ward and the
patients. The
test was carried out in a closely supervised and the falls in blood-pressure and side-effects suggested that the tablets were active and being taken. Disorders of immune mechanisms such as drug sensitivi-
these collections
laboratory
subjects were on a standard diet. Precautions were taken to Creatinine in ensure that each collection was complete. urine was determined in duplicate samples using Jaffe’s
ties, rheumatoid arthritis, disseminated lupus erythematosus, and arteritis of the aorta are common in Malaysian Chinese, and I can think of no explanation why the Coombs tests should have been negative in all the patients on methyldopa.
reaction. The results of
Bristol General Hospital, Bristol BS1 6SY.
child
are as
a
a
typical collection (mg) in
one
adult and
follows:
C. J. BURNS-COX.
VARIABILITY IN URINARY CREATININE SiR,-The assumption that the excretion of creatinine in urine over a 24-hour period is constant has been questioned lately.1-4 We present here data which suggest that this inconstancy can be extended to the excretion of creatinine over shorter periods of time. Urine was collected over 4-hour periods from 6 A.M. to 10 P.M. and as one night sample from 10 P.M. to 6 A.M. for 4 consecutive days in eight healthy adults and for 1 day in four individuals taking part in a metabolic study. In four apparently healthy children aged between 4 and 10 years, similar timed collections of urine were made for 1 day. All 1. 2. 3. 4.
one
were
Edwards, O. M., Bayliss, R. I. S., Millen, S. Lancet, 1969, ii, 1165. Zorab, P. A., Clark, S., Harrison, A. ibid. p. 1254. Bailey, R. R., de Wardener, H. E. ibid. 1970, i, 145. Pierro, A., Johnson, R. E. ibid. p. 784.
Obituary
There was considerable variation in the 24-hour urinary output of creatinine in all subjects, the variation being sometimes more than 50%. Similarly, the amount of creatinine excreted in 4-hour timed collections showed considerable variation, in some instances the variation being There seemed to be no trend in the more than 100%. the of changes in the excretion of creatinine with pattern respect to the time of collection during the day. These results indicate that urinary excretion of creatinine over 24-hour period and short-term collections is not constant, and, therefore, raise doubts regarding the validity of the use of random samples of urine and the use of creatinine in such samples as a reference standard. National Institute of Nutrition, Indian Council of Medical Research,
Jamai-Osmania, Hyderabad-7 A.P., India.
M. MOHAN RAM VINODINI REDDY.
Queen Mary’s Hospital for the East End between 1936 and 1960.
J. R.,
to
whom
we are
grateful for this biography,
writes: ARTHUR DOYNE COURTENAY BELL D.M.
Oxon., F.R.C.P.
Dr. Doyne Bell, formerly physician in charge of the paediatric department at Charing Cross Hospital, London, died on holiday in Scotland on Sept. 16, at the age of 70. Born in Prestwich, Lancashire, in 1900, of a family of consulting engineers, he was related to Thomas Sydenham. He was a scholar of Gresham’s School, Holt, and then went to St. John’s College, Oxford, where he was an exhibitioner, and dived and played water polo for the university. He
followed his clinical studies at St. Thomas’s Hospital, graduating B.M. in 1928. At St. Thomas’s he held houseappointments during which he became interested in pxdiatrics, and he was later registrar to the children’s department. This was followed by a travelling fellowship to Vienna and Berlin, where he continued his studies in paediatrics. He was elected M.R.C.P. in 1933, and returned to St. Thomas’s Hospital as honorary chief assistant to the children’s department. In 1935 he was appointed physician to the Belgrave Children’s Hospital. Further consultant appointments followed at King Edward VII Hospital, Harrow Hospital, and Woking Hospital. During the 1939-45 war he was superintendent of the East Ham Hospital and medical officer to the Heavy Reserve Squad, City of Westminster. He was also director of the children’s department of the London Hospital, and at Woking Hospital. In 1946 he was appointed physican in charge of the children’s department at Charing Cross Hospital, and assumed charge of paediatric services in the other hospitals in the group when Fulham Hospital and the West London Hospital became affiliated to Charing Cross in 1959. He held these appointments until his retirement in 1965. He was elected F.R.C.P. in 1949. He was also consultant in child health to the City of Westminster, and was physician in charge of the pxdiatric department at
" The many appointments which have already been mentioned do not reflect Doyne Bell’s personality in full, for in addition to his role as a consultant and teacher he was active in the planning of the new Charing Cross Hospital at Fulham, and it is to his foresight and experience, broadened by visits of inspection to new projects at home and abroad, that the successful planning of the new hospital, in all its complex and advanced detail, has been due. A firm chairman in committee, it was his particular genius to extract from others, often at difference, the essence of their concepts, and to weld them into a workable plan for the new
project. "
As a teacher Doyne Bell was beloved of many generations of Cross students, who attached to him an endearing soubriquet. His lucid and practical teaching inculcated his students with a pragmatic approach to paediatric problems. He was much at ease with the children he treated, and it was characteristic that he never patronised or talked down to them. One has a lively recollection of children playing with his eyeglass, after which he would put it in place and discuss their problems with them as gravely as if they were distinguished colleagues who were seeking his advice. This rapport with his young patients showed how successful he was in the management of the psychological aspects of ill children; more aware than many of his contemporaries of the psychiatric side of children’s illnesses, he encouraged the child psychiatrists to join his teaching ward-rounds. In 1957 he was president of the Pxdiatric Section of the Royal Society of Medicine, and distinguished himself by an original presidential dissertation. " It is, however, for his capacity for making relationships and warm friendships that many will remember him. Essentially a clubman, a bon vivant, genial, of polished manner, he had an intense appreciation of the refinements of the table, especially in his role of chairman of the Savile Club, where he was an esteemed and popular figure. Doyne was a lively and entertaining table companion-oysters