It may be advisable to carry out hsematological investigations, and not only haptoglobin determinations, before the insertion of prosthetic valves. The finding of normal values before operation will more strongly suggest that any postoperative hxmolysis is caused by the insertion of the ball-valve. Otherwise it may be difficult to exclude the possibility that the hyperhoemolysis existed preoperatively and was, for some reason, aggravated after operation. M. MICHAËLSSON Department of Pædiatrics
University Hospital, Uppsala, Sweden.
P. O. PETERSSON
We have started using this screening test. The incidence chorionepithelioma in Israel is low as in other Western countries and it is not easy to obtain permission for grafting in every patient with a hydatidiform mole. We hope other investigators will try this procedure in order to test our idea that chorionepithelioma develops in women when there is a genetic similarity between husband and wife. N. BEN-HUR Department of Plastic Surgery, E. ROBINSON Hadassah University Hospital, Z. NEUMAN. Jerusalem, Israel. of
CHARITY BEGINS AT HOME SIR,-In your review (Jan. 9) of The Works of Sir Thomas Browne edited by Sir Geoffrey Keynes there is the statement that " several familiar expressions originated in Religio Medici and Urn Burial " including " Charity
with chorionepithelioma in whom a husband 6 homograft, by in. (10 by 15 cm.) in diameter, has survived for over two months so far. These findings were recently confirmed by Mathe et al.4 It is known that some hydatidiform moles undergo transformation to chorionepithelioma. We suggest, therefore, that every woman with a mole is grafted with her husband’s skin. In those cases where the husband homograft is not rejected, we would advise against further pregnancies because of the danger of choriocarcinoma development.
The Oxford Dictionary of Quotations gives the credit tc Sir Thomas Browne (1605-1682) and the quotation as Charity begins at home, is the voice of the world ": some years ago I pointed out that John Wycliffe used this phrase nearly three hundred years before and the editor, Bernard Darwin, replied that this would be noted in the next edition. Alas, it was not! he asked Shortly after Richard II became King in 1377, " to draw an answer to the Whether the Wycliffe up question: Realm of England can legitimately, when the necessity 01 repelling invasion is imminent, withhold the treasure of the Realm that it be not sent to foreign parts, although the Pope demand it under pain of censure and in virtue of obedience due The Pope cannot to him." In his pamphlet Wycliffe said: demand this treasure except by way of alms and by the rule of charity. But this claim of alms and all demand for the treasure of the realm ought to cease in this case of our present need. Since all charity begins at home, it would not be the work of charity, but of fatuity, to direct the alms of the realm abroad, when the realm itself lies in need of them." "
It is possible that the phrase was already commonly used in the 14th century. Indeed it has been suggested that it stems from Terence (194-159 B.C.) who wrote " Proximus sum egomet mihi ......" in Andria, act IV, scene I.
Hill House, Near
R. E. SMITH.
POSSIBLE SCREENING METHOD FOR PREVENTION OF CHORIONEPITHELIOMA IN WOMEN WITH HYDATIDIFORM MOLE
SIR,-Chorionepithelioma in a woman is a tumour derived from the tissues of both husband and wife.’ In orderto reject this partial homotransplant, Doniach suggested an immunological treatment2 based on Medawar’s finding that pre-treatment of laboratory animals with donor leucocytes was followed by accelerated rejection of the skin graft taken from the leucocytes’ donor. According to Doniach, treatment with their husbands’ leucocytes and adjuvant improved the condition of patients suffering from chorionepithelioma. We reported3 two patients with chorionepithelioma in whom normal donor skin homograft was rejected but husband homograft persisted. The isoantigen studies and the failure to develop leucoagglutinins supported the view that there was genetic similarity between the tissues of the husbands and the patients. Lately the same response has been obtained in a 371. Dowling, E. A. Sth med. J., Nashville, 1957, 50, 211 (cited by W. A. 2.
Bradwil and B. L. Toy, Ann. N.Y. Acad. Sci. 1959, 80, 197). Doniach, I., Cookston, J. H., Cope, T. I. J. Obst. Gynœc. Brit.
1958, 65, 553. 3 Robinson, E., Shulman, J., Ben-Hur, N., Zuckerman, H., Neuman, Z. Lancet, 1963, i, 300.
Public Health Housing, 1961 THE third and last volume of statistics on housing from the 1961 Census5 consists of one table, which gives information about private households for each district of England and Wales. Much of this information has already been given for regions in the firstand secondvolumes. The number of houses in England and Wales increased by 18% between the 1951 Census and 1961, but there were large differences between regions. The greatest increase (31 was in eastern and southern England. The average household consisted of 3 people, but one household in six in the whole country, and more than one in three in the West End of London, was a person living alone.
Although a census would not normally be due7 until 1971, statistics more recent than those of the 1961 Census will be needed much sooner for the planning of land use, capital investment, schools, and hospitals. In April, 1966, an interim census will be taken from a 10% sample of the population. The information gained will not necessarily be accurate for small areas, but it will be sufficiently reliable for the country as a whole, and for the large, populous areas where it is most needed. A sample is, of course, very much cheaper than a full census. International
The W.H.O. Committee on International Quarantine reports that the number of notified cases of smallpox in the world fell from 98,871 in 1963 to 47,493 (with 9862 deaths) in 1964. For the first time in many years, no case of smallpox was imported into any country by sea or air. But international sanitary regulations were being infringed in two ways. Firstly, cases have been brought to the notice of the committee in which diplomats have ignored the regulations, although, since they are as likely as anyone else to transmit communicable diseases, they have no diplomatic privilege in this regard. , Secondly, some doctors are apparently willing to give certificates of vaccination to people who have not been vaccinated, and people who have been vaccinated give their valid certificates to others who have not. The committee will seek ways of overcoming these dangerous practices. 4.
Mathé, G., Dausset, J., Hervet, E., Amiel, J. L., Colombani, J., Brule, G.
J. nat. Cancer Inst. 1964, 33, 193. 5. Census 1961. England and Wales. Housing Tables, part Housing Indices. H.M. Stationery Office. 1965. 11s. 6. See Lancet, Jan. 23, 1965, p. 211. 7. See ibid. Feb. 13, 1965, p. 380.