- Email: [email protected]
VIABILITY OF CADAVER KIDNEYS
664 sive drugs, including T.R.H. induce an increment of prolactin blood levels (generally considered to be a secondary effect of the drug), and this hormone could have cerebral trophism. J. J. L. is a member of the Belgian F.N.R.S. We thank Dr S. Bourdouxhe, I)r M. Parent, and Dr D. P. Bobon, for their help and the of the Institute N.D. des Anges who carried out the dynamic The T.R.H. was kindly supplied by Dr Y. Baelde (U.C.B., Brus-
nurses
tests.
sels).). Institute of Medicine, University of Liège, Radioimmunoassay Laboratory, 23 Boulevard Piecot, B 4000 Liege, Belgium.
J. J. LEGROS
Department of Psychiatry, Rue Saint Laurent, 4000 Liege.
M. BREULET
MATERNAL NUTRITION AND LOW BIRTH-WEIGHT
SIR,-Your sensible annotation
this subject (Sept. 6, does not p.445) correctly report present knowledge of the effects of the Dutch famine of 1944-45. On the basis of C. A. Smith’s classic study published in 1947, you state that the famine "caused only a small reduction in birth-weights and no effects upon perinatal-mortality rates". We have reviewed the literature in this field,’ and have conducted our own studies of the effects of the Dutch famine on the reproductive process (and on the subsequent health and mental performance of those exposed in utero). The maximum effect on mean birth-weight occurred with exposure in the third trimester of pregnancy at the height of the famine and led to a 9% reduction, from a mean of 3338 g to 3011 g.31 Whether judged small or large, this reduction was followed by a sharp rise in infant mortality in the first three months of life, especially after the first week. Exposure to famine in the first trimester did not affect mean birth-weight, although it was followed by an excess of premature deliveries of very low birth-weight.2 These infants exposed in the first trimester also suffered an excess of stillbirths and first-week deaths.5 Our study was designed to test the effect of maternal starvation on adult mental performance.6 We found no such effect, but this negative result should not be allowed to obscure the profound influence of maternal starvation on the reproductive on
process. Division of Epidemiology, School of Public Health, Columbia University, 600 West 168th Street, New York,
N.Y. 10032,
MERVYN SUSSER
U.S.A. Colombia University and New State Department of Mental
Hygiene.
York, ZENA STEIN
ADMISSION TO HOSPITAL
SIR,—One of the unfortunate side-effects of the disastrous
reorganisation of the National Health Service
is that, at any in central London, we are back to the bad old days when hospital admitting medical officers refused to give an unequivocal promise to admit even a well-described case, undoubtedly requiring admission. The vogue is again to "see it in casualty and we will decide whether or not to admit".
rate
1. 2.
Susser, M. W., Bergner, L. Pediatrics, Springfield, 1970, 46, 946. Stein, Z., Susser, M., Saenger, G., Marolla, F. Famine and Human Development. The Dutch Hunger Winter of 1944-1945. New York, 1975. 3. Stein, Z. A., Susser, M. W. Pediat. Res. 1975, 9, 70. 4. Stein, Z. A., Susser, M. W. ibid. p. 76. 5. Stein, Z. A., Susser, M. W., Sturmans, F. Tijdschr. soc. Geneesk. 1975, 53, 134, 158. 6 Stem, Z A., Susser, M., Saenger, G., Marolla, F. Science, 1972, 178, 708.
Conversation with colleagues confirms that this policvu fairly general, and one suspects that, behind the scenes that being the way things are done in the Health Service), there has been an edict from the D.H.S.S : or the regions. It is a pollcv which is ruinous to a decent relationship between a distnct’s hospitals and its family doctors: and which also undermines the trust between the G.P. and the families under his care. An associated factor is that the resident medical officer has been economised from the scene, leaving responsibility for admission to far-too-junior, inexperienced, and transient hospital doctors. What results from this misguided policy is either that the G.P., lacking any longer the stamina to engage in the battle, sends his cases to casualty departments without warning, knowing that previous discussion will be time-consuming and fruitless: or admits his patient through the Emergency Bed Service-an excellent organisation, but one which robs family doctor and patient of choice of hospital and adds to the overwhelming impersonality of the "new" Health Service. 8 Orange Street, London WC2.
BENJAMIN LEE
VIABILITY OF CADAVER KIDNEYS
SIR,-One has to remain sceptical of the statement by Dr Mathew and others (July 26, p. 137) that the viability-rate of cadaver kidneys obtained in the State of Victoria, Australia, is almost 100%. No supporting evidence is presented and this claim certainly does not follow from the reference cited.’ Department of Surgery, Medical School, University of Otago, P.O. Box 913, Dunedin, New Zealand.
DONALD LEE
A NON-SPECIFIC INHIBITOR OF RUBELLA HÆMAGGLUTININ
SIR We read with interest the letter from Dr Saeed and
Murray (Aug. 30, p. 413), who report the detection of nonspecific inhibitors of rubella haemagglutin in stored suspensions of day-old chick red cells. In the course of a survey, a breakdown in our deep-freeze accommodation compelled us to store a collection of sera at 4 cc for 10-14 days. In subsequent tests it was found that high rubella H.A.I. titres were demonstrable in many acute-phase samples that had lacked specific antibody at 1/16 when first placed at -30°C. These non-specific titres were often in excess of 1/640 and the inhibitors were not removable by manganouschloride/heparin solution. On inquiry it was clear that these samples had been collected in unsterile tubes. An organism closely related to Pseudomonas fluorescens was isolated from many of the specimens in which non-specific inhibitors had appeared. When sterile sera lacking rubella H.A.i. antibody at 1/16 were inoculated with this organism, incubation at 4°C resulted in the appearance of non-specific inhibitors that were not removable by manganous-chloride/heparin treatment. After incubation for 24, 48, and 72 hours in one test the corresponding non-specific titres were 1/64, 1/256, and > 1/512. The effect was not obtained by incorporating live or killed suspensions of the organism in the test or by adding to the wells supernatant fmd from a centrifuged nutrient-broth culture. Attempts to produce similar non-specific inhibitors in rubella antibody free sera by inoculation with strains of Staphylococcus aureus and Dr
Escherichia coli were unsuccessful. Public Health Laboratory,
Fazakerley Hospital, Lower Lane, Liverpool 1.
Scott, 76.
D.
L9 7AL.
G. B. BRUCE WHITHE K. H. TINNION
F., Whiteside, D., Redhead, J., Atkins, R. C Br med J1974.
nurses
tests.
sels).). Institute of Medicine, University of Liège, Radioimmunoassay Laboratory, 23 Boulevard Piecot, B 4000 Liege, Belgium.
J. J. LEGROS
Department of Psychiatry, Rue Saint Laurent, 4000 Liege.
M. BREULET
MATERNAL NUTRITION AND LOW BIRTH-WEIGHT
SIR,-Your sensible annotation
this subject (Sept. 6, does not p.445) correctly report present knowledge of the effects of the Dutch famine of 1944-45. On the basis of C. A. Smith’s classic study published in 1947, you state that the famine "caused only a small reduction in birth-weights and no effects upon perinatal-mortality rates". We have reviewed the literature in this field,’ and have conducted our own studies of the effects of the Dutch famine on the reproductive process (and on the subsequent health and mental performance of those exposed in utero). The maximum effect on mean birth-weight occurred with exposure in the third trimester of pregnancy at the height of the famine and led to a 9% reduction, from a mean of 3338 g to 3011 g.31 Whether judged small or large, this reduction was followed by a sharp rise in infant mortality in the first three months of life, especially after the first week. Exposure to famine in the first trimester did not affect mean birth-weight, although it was followed by an excess of premature deliveries of very low birth-weight.2 These infants exposed in the first trimester also suffered an excess of stillbirths and first-week deaths.5 Our study was designed to test the effect of maternal starvation on adult mental performance.6 We found no such effect, but this negative result should not be allowed to obscure the profound influence of maternal starvation on the reproductive on
process. Division of Epidemiology, School of Public Health, Columbia University, 600 West 168th Street, New York,
N.Y. 10032,
MERVYN SUSSER
U.S.A. Colombia University and New State Department of Mental
Hygiene.
York, ZENA STEIN
ADMISSION TO HOSPITAL
SIR,—One of the unfortunate side-effects of the disastrous
reorganisation of the National Health Service
is that, at any in central London, we are back to the bad old days when hospital admitting medical officers refused to give an unequivocal promise to admit even a well-described case, undoubtedly requiring admission. The vogue is again to "see it in casualty and we will decide whether or not to admit".
rate
1. 2.
Susser, M. W., Bergner, L. Pediatrics, Springfield, 1970, 46, 946. Stein, Z., Susser, M., Saenger, G., Marolla, F. Famine and Human Development. The Dutch Hunger Winter of 1944-1945. New York, 1975. 3. Stein, Z. A., Susser, M. W. Pediat. Res. 1975, 9, 70. 4. Stein, Z. A., Susser, M. W. ibid. p. 76. 5. Stein, Z. A., Susser, M. W., Sturmans, F. Tijdschr. soc. Geneesk. 1975, 53, 134, 158. 6 Stem, Z A., Susser, M., Saenger, G., Marolla, F. Science, 1972, 178, 708.
Conversation with colleagues confirms that this policvu fairly general, and one suspects that, behind the scenes that being the way things are done in the Health Service), there has been an edict from the D.H.S.S : or the regions. It is a pollcv which is ruinous to a decent relationship between a distnct’s hospitals and its family doctors: and which also undermines the trust between the G.P. and the families under his care. An associated factor is that the resident medical officer has been economised from the scene, leaving responsibility for admission to far-too-junior, inexperienced, and transient hospital doctors. What results from this misguided policy is either that the G.P., lacking any longer the stamina to engage in the battle, sends his cases to casualty departments without warning, knowing that previous discussion will be time-consuming and fruitless: or admits his patient through the Emergency Bed Service-an excellent organisation, but one which robs family doctor and patient of choice of hospital and adds to the overwhelming impersonality of the "new" Health Service. 8 Orange Street, London WC2.
BENJAMIN LEE
VIABILITY OF CADAVER KIDNEYS
SIR,-One has to remain sceptical of the statement by Dr Mathew and others (July 26, p. 137) that the viability-rate of cadaver kidneys obtained in the State of Victoria, Australia, is almost 100%. No supporting evidence is presented and this claim certainly does not follow from the reference cited.’ Department of Surgery, Medical School, University of Otago, P.O. Box 913, Dunedin, New Zealand.
DONALD LEE
A NON-SPECIFIC INHIBITOR OF RUBELLA HÆMAGGLUTININ
SIR We read with interest the letter from Dr Saeed and
Murray (Aug. 30, p. 413), who report the detection of nonspecific inhibitors of rubella haemagglutin in stored suspensions of day-old chick red cells. In the course of a survey, a breakdown in our deep-freeze accommodation compelled us to store a collection of sera at 4 cc for 10-14 days. In subsequent tests it was found that high rubella H.A.I. titres were demonstrable in many acute-phase samples that had lacked specific antibody at 1/16 when first placed at -30°C. These non-specific titres were often in excess of 1/640 and the inhibitors were not removable by manganouschloride/heparin solution. On inquiry it was clear that these samples had been collected in unsterile tubes. An organism closely related to Pseudomonas fluorescens was isolated from many of the specimens in which non-specific inhibitors had appeared. When sterile sera lacking rubella H.A.i. antibody at 1/16 were inoculated with this organism, incubation at 4°C resulted in the appearance of non-specific inhibitors that were not removable by manganous-chloride/heparin treatment. After incubation for 24, 48, and 72 hours in one test the corresponding non-specific titres were 1/64, 1/256, and > 1/512. The effect was not obtained by incorporating live or killed suspensions of the organism in the test or by adding to the wells supernatant fmd from a centrifuged nutrient-broth culture. Attempts to produce similar non-specific inhibitors in rubella antibody free sera by inoculation with strains of Staphylococcus aureus and Dr
Escherichia coli were unsuccessful. Public Health Laboratory,
Fazakerley Hospital, Lower Lane, Liverpool 1.
Scott, 76.
D.
L9 7AL.
G. B. BRUCE WHITHE K. H. TINNION
F., Whiteside, D., Redhead, J., Atkins, R. C Br med J1974.