1304 THE ROYAL COMMISSION AND LONDON SiR,—I should like to comment on the excellent review by Professor Rhodes last week (p. 1233). As a non-London graduate, I take exception to the view that passing the M.R.C.P. London in a shorter time than others is necessarily equated with higher ability. As Professor Rhodes states towards the end of his article, examiners in the three universities of Oxford, Cambridge, and London are often largely drawn from the London schools. Surely this has an important bearing on those that take their first medical degrees in these schools and their subsequent performance in the M.R.C.P. examination. Again the fact that the accent in the teaching hospital tends to be more academic than practical means that, although the three major specialties of medicine, surgery, and obstetrics are well-served, other subjects, in particular such topics as
venereology, ophthalmology, public health, and mental disorders, are often poorly taught, if at all. in provincial schools with their closer and more diverse ties with the community. I would agree that amalgamation for its own sake will do little to improve this state of affairs, which largely depends on the prejudices and bias of the teachers themselves. Chadwell Health Hospital, I. M. LIBRACH. Romford, Essex.
This is less likely
VASECTOMY FOR VOLUNTARY MALE STERILISATION SIR,-Dr. Constable (last week, p. 1246) rightly stresses the importance of obtaining two consecutive negative spermcounts after vasectomy before contraceptive precautions are abandoned. It is the policy of the Simon Trust to advocate this in its literature and in its voluminous correspondence, not only with applicants for vasectomy but also with doctors and surgeons. The point, which is of course one of vital importance, has frequently been stressed also in letters and articles in the Press, both medical and lay. L. N. JACKSON Hon. Director, Simon Population Trust 18/20 Lower Regent Street, London, S.W.1. Voluntary Sterilization Project. _
TRISOMY AFTER COLCHICINE THERAPY
SIR,-The effect of colchicine on cell division is well known but we are not acquainted with any study on the effect of the drug when taken medicinally on the frequency of aneuploid cells in the blood of patients. Cestari et al.l in this laboratory observed an increase of tetraploid cells in cultures of peripheralblood lymphocytes of a patient who was already under treatFREQUENCIES
conceivably originate from non-disjunctions secondary to slight disturbances induced in the mitotic spindle by therapeutic doses of colchicine. The finding of an increased frequency of cells with 47 chromosomes in the blood of each of our three patients suggests that they have a greater risk of producing trisomic offspring than normal people and that it is wise to refrain from reproducing while under colchicine treatment. It is also suggestive that one of these three patients came to our laboratory, as did the patient of Cestari et al., to submit his abnormal child to cytogenetic study (the result was positive for D.s., with karyotype 47,XX,G+). Since we have 27 D.S. patients registered in our cytogenetics unit, this raises the frequency of parents of such patients who were under colchicine treatment at the time of the conception of the D.S. child to 2/54. We are publishing a full account of our Brasileira de Medicinae Ciencias Biol6gicas.
in the Revista
Laboratory of Human Genetics, NOMAIHACI RAMOS FERREIRA. Department of Biology, Department of Orthopaedics ARMANDO BUONICONTI. and Traumatology, University of São Paulo, São Paulo, Brazil.
HORMONAL CHANGES DURING EXERCISE SIR,-Studies in this laboratory confirm the findings of Roth et al.l and Hunter and Greenwood2 showing rises in
serum-human-growth-hormone (H.G.H.) during physical exercise. However, we have demonstrated a completely different pattern of H.G.H. secretion after exercise in subjects according to their degree of physical fitness. 14 healthy men, aged 23-28 years, 8 fit and 6 unfit as classified by their aerobic capacity,3 were studied. The mean aerobic capacity, in ml. 02 per kg. per minute, was 64 (range 58-78) in the fit subjects, and 28 (range 24-32) in the unfit subjects. An indwelling polyethylene catheter was placed in an antecubital vein after an overnight fast, and 40-60 minutes elapsed with the subjects at rest before the basal samples were taken. The subjects then pedalled the bicycle ergometer at a speed of 19 km. per hour with increasing work-loads which were designed (from previous experience) to cause complete exhaustion in 30 minutes. Blood-samples were taken during, and for up to 120 minutes after, the exercise. Serum-H.G.H. was measured by the radioimmunoassay method of Lazarus and
2. 3. 4.
Roth, J., Glick, S. M., Yalow, R. S., Berson, S. A. Metabolism, 1963, 12, 557. Hunter, W. M., Greenwood, F. C. Br. med. J. 1965, i, 804. Astrand, P. O. Acta. physiol. scand. 1960, 49, suppl. 167, p. 45. Lazarus, L., Young, J. D. J. clin. Endocr. Metab. 1966, 26, 213.
OF ANEUPLOID AND PERITETRAPLOID CELLS IN BLOOD OF
PATIENTS UNDER COLCHICINE TREATMENT
with colchicine at the time of conception of a child with atypical Down’s syndrome (D.s.). This prompted us to carry out a quantitative study on the production of aneuploid cells by colchicine treatment. We studied cultures of lymphocytes from three gout patients under colchicine treatment and from healthy controls of the same sex and age and found in the patients a significant ment
increase of cells with abnormal numbers of chromosomes both
tetraploid and peridiploid (see accompanying table). The latter 1.
Cestari, A. N., Vieira Filho, J. P., Yonenaga, Y., Magnelli, N., Imada, J. Revta bras. Biol. 1965, 25, 253.
Response of serum-human-growth-hormone (in ng. per ml. on ordinate) to exercise. Continuous line = values in 8 fit subjects 11 S.D. Dotted line= values in 6 unfit subjects -t-11 S.D.
1305 The basal rose
similar in both groups, and
during exercise in both fit and unfit subjects. However,
in the fit group H.G.H. returned to basal levels within 30 minutes, whereas in the unfit group it continued to rise for a further hour before decreasing (see accompanying figure). Studies during submaximal exercise showed that the H.G.H. level rose only in the unfit group. The above results indicate that it is important to know the physical fitness of the subjects and the rate of energy expenditure when assessing the response of H.G.H. to exercise, and suggest that the rapid return of H.G.H. to basal levels following vigorous muscular exercise is a characteristic of physical fitness. JOHN SUTTON JOHN D. YOUNG L. LAZARUS Garvan Institute of Medical Research, J. B. HICKIE St. Vincent’s Hospital, J. MAKSVYTIS. Sydney.
C-REACTIVE PROTEIN A NORMAL
IMMUNOGLOBULIN ? SIR,-In analyses of 50 sera of healthy blood-donors for C-reactive protein (C.R.P.), using a dilution of a commercially available anti-C.R.P. serum and the Ouchterlony immunodiffusion technique, we have shown a single precipitation line in all cases. Comparing the precipitates of these sera with the specific c.R.p. line of 25 abnormal c.R.P.-positive sera, we found identical immunological reactions in all. Comparative immunodiffusion studies with monovalent antisera to IgA, IgG, IgM, and IgD, showed no identical reactions. The immunoelectrophoretic position of the C.R.P. precipitate in normal sera
corresponded to that of c.R.P.-positive sera. We found, by quantitative immunodiffusion, that on average the C.R.P. concentration in normal sera was eight to ten times lower than in c.R.P.-positive sera. An exact value cannot be given, since we lack a standardised concentration of pure C.R.P. antigen. We suppose that c.R.P. is
class of normal immuno-
globulins which probably acts as a non-specific antibody at the very beginning of immune response of infectious diseases or inflammatory processes. It obviously disappears in the phase of specific-antibody production. At present we should like to designate the C.R.P. as IgC protein. The details of these findings, including technical and experimental conditions, will be published in the near future. M. P.-M. is a fellow of the Alexander von Humboldt Foundation, Germany.
Abteilung für klinische Immunologie des Universitätskrankenhauses der Universität Erlangen-Nürnberg, Erlangen, West Germany.
MANUEL PEREZ-MIRANDA HILDE CH. GOETZ.
Mentally M Adolescents At the end of last year in Scotland 204 young people aged between fifteen and nineteen were receiving inpatient treatment for mental illness; of these, 42 were in adolescent units, 14 in psychiatric units attached to general hospitals, and the remainder in adult wards of mental hospitals. In the current year two further adolescent units, providing thirtyfour beds in all, have been opened. Quinine Secretary of State for the Home Department has accepted the Poison Board’s recommendations to include quinine in Part 1 of the Poisons List and, subject to certain exemptions, to restrict retail sale to prescription only. The
HENRY PATRICK HANNIGAN M.B. N.U.I.
Dr. Harry Hannigan, who was honorary physician to Stockton and Thornaby Hospital whilst running a general practice in Stockton-on-Tees, died on Nov. 22 at the age of 82. He
born in County Donegal and studied in Dublin, M.B. in 1911. After several house-posts he became medical officer to La Forestal hospital in Argentina, and in 1914 he was promoted senior medical officer to the hospital at Guillermina. In the following year he joined the R.A.M.C., serving for three years in France, and this close contact with British soldiers was later to influence him in deciding to practise in England. From 1918 until his demobilisation in 1920 he took charge of the British Military Hospital at Muttra, India. He then resumed his career in Argentina, but after some time returned to Dublin to do postgraduate work. In 1924 he entered general practice at Stockton-on-Tees, and he was soon appointed to the staff of the Stockton and Thornaby Hospital. He retired from hospital work in 1948 but continued in private practice as a family doctor until the age of 74. was
A. C. writes: "
Though Harry Hannigan gave lcng service as an honorary he will always be remembered as a devoted family doctor, the doyen of his line. With great energy and skill he spared nothing in the service of his patients. He influenced many young doctors who have since adopted his professional ideals, and he set a high standard for himself and for those who worked with him which he maintained throughout his professional life. He was frequently ahead of younger colleagues in his reading and was always very reluctant to accept the fact that nothing further could be done in a difficult case. After some indecision he decided to spend his retirement among his
friends on Teeside, rather than return to Ireland which he loved so dearly. His remaining years were active ones; he enjoyed listening to music and reading books, and above all visiting his many friends. He continued to attend medical meetings until a few weeks before his death and never ceased to be absorbed by the changes in medicine and in those who practised it."
Appointments M.B. St. Andrews, M.C.PATH. : consultant pathologist, Stobhill General and associated hospitals. BATCHELOR, P. J., M.B. Lond., F.R.C.S.E., D.L.o.: consultant in E.N.T., Royal Halifax Infirmary. BATTEN, ALISON M., M.B. Edin., D.P.H.: assistant county M.o. and M.o.H., Newport, Cowes, and Isle of Wight Rural District Council. BRANTHWAITE, MARGARET A., M.B. Cantab., M.R.C.P., F.F.A. R.C.S.: consultant
ANDERSON, J. M.,
anaesthetist, Brompton Hospital. BRUGGEN, C. P. L., M.B. Edin., D.OBST., D.C.H., D.P.M.: consultant psychiatrist, Hill End Hospital, St. Albans, and the Tavistock Clinic, London.
BURRAGE, MAUREEN V., B.A., M.B. Lond., D.C.H., D.OBST. : principal M.O. and assistant paediatrician. Isle of Wight County Council. CooKE, B. J. E., M.B. Lond., M.R.C.O.G. : consultant obstetrician and gynaecologist, Bournemouth and East Dorset area. EvANS-PROSSER, C. D. G., B.M. Oxon., F.F.A. R.c.s., D.OBST.: consultant anaesthetist, Winchester area. FORD, GILLIAN R., B.M. Oxon., D.o.: senior M.o., research and special studies section of the Department of Health and Social Security, London.
JAY, B. S., M.D. Cantab., F.R.C.S., D.o.: consultant ophthalmologist, Moorfields Eye Hospital, London. LEIGH, D. A., M.B. Lond.: consultant clinical pathologist, High Wycombe and Amersham
MCCLURE, I. A., B.A. Cantab., M.B. Edin., F.R.C.S.E. : consultant E.N.T. surgeon, Ayrshire area. RAITI, S., M.B., M.R.C.P., D.C.H.: consultant physician in endocrinology, Queen Elizabeth Hospital for Children, London. WARRELL, D. W., M.D. Sheff., M.R.C.O.G. : consultant obstetrician and gynaecologist. United Manchester Hospitals. WATSON, K. C., M.D. Aberd., F.C.PATH. : consultant microbiologist, central microbiology laboratories, Western General Hospital, Edinburgh. WILLIAMSON, D. M., M.D. Leeds, M.R.C.G.P., D.I.H.: consultant dermatologist, Pontefract and Goole