Campbell1 seems to have taken the article of Davison al. a little personally, but their objective was, surely, to point out that new operators with little experience should not expect such precise results as those obtainable by et
r’#"j.......,,_k.o.l1 n.....A 1-,,;C’O
Diagnostic Ultrasound Department, Royal Infirmary, Dundee DD1 9ND.
A DUTY TO HOUSE
A. D. CHRISTIE.
Campbell, S. Lancet, 1973, ii, 1145. Davison, J. M., Lind, T., Farr, V., Whittingham, T. A. ibid. p. 1329 Davison, J. M., Lind, T., Farr, V., Whittingham, T. A. J. Obstet Gynœc. Br. Commonw. 1973, 80, 769.
1. 2. 3.
POLYMYALGIA RHEUMATICA AND LIVER DISEASE
SIR,-The paper by Dr Long and Dr James (Jan. 19, 77) draws attention to this association. I have used the
serum-alkaline-phosphatase test in the routine screening of over a hundred patients with polymyalgia rheumatica and I have not seen elevated figures. Although the diagnosis of polymyalgia rheumatica is often described as classical " there are, in fact, no agreed criteria, and it is clear from published reports of the frequency of associated phenomena -for example, synovitis-that the criteria of various observers differ considerably. My observations suggest "
that liver disease must be rather a rare association of polymyalgia rheumatica. Perhaps the moral to be drawn is that diagnostic criteria analogous to those put forward by the American Rheumatism Association for rheumatoid arthritis, or the Duckett-Jones criteria for rheumatic fever, should be designed for polymyalgia rheumatica. Such criteria would not be exclusive, but at least they would be reproducible between observers in studies of the treatment of the disease or complications of polymyalgia rheumatica. Royal National Hospital for Rheumatic Diseases, Bath BA1 1RL.
A. ST. J. DIXON.
NEURAL-TUBE DEFECTS AND TWINNING
SIR,-In suggesting that dizygotic twinning and anencephaly may be associated, Dr Elwood (Jan. 5, p. 31) mention Knox’s " fetus/fetus interaction " which not only envisages such an association but suggests how it might arise. The hypothesis is that single-born children with neural-tube defects are the survivors of pairs of dizygotic twin embryos who did not share certain gene-based recognition characters (one or more of them sex-linked). In the presence of certain environmental factors, it is envisaged that such twins might interact so that one would be eliminated and the other sustain a neural-tube defect. This concept was originally put forward merely as a model that fitted the low sex ratios for these defects and most of the findings in family studies, but there are now two further lines of evidence which seem to point the same way. One of these pointers is mentioned by Dr Elwoodthe reports of anencephalic births to mothers who had taken clomiphene, which can cause multiple ovulations. The other new evidence is the fulfilment by recent British data 2,3 of a prediction by Knox that, if his hypothesis were correct, the preponderance of females among anencephalics would tend to be greater during periods when prevalence at birth was relatively high than at other times.
University Department of Community Medicine, York Place, Manchester M13 0JJ. 1. 2. 3.
Knox, E. G. Devl Med. Chld Neurol. 1970, 12, 167. Leck, I. Teratology, 1972, 5, 303. Rogers, S. C., Morris, M. Br. J. prev. soc. Med. 1973, 27, 81.
NONE of the statistics is really reliable, but M.p.s from the big cities generally fear that the problems of urban homelessness are getting worse. Given the stagnant state of the housing programme, the disappearance of cheap lodging houses, the sale of institutions like the old Rowton Houses to earn more profit as hotels, that’s scarcely surprising. So urban M.p.s were not pleased when the Local Government Bill last year abruptly removed certain duties placed on local authorities by an Act of 1948 to look after homeless people, and replaced them simply by powers to carry out these functions. To a good local authority, it was argued, this would make very little difference: but to a bad one, wouldn’t it provide a good excuse for backsliding ? Mr Jock Stallard is Labour M.p. for St. Pancras, which, as an area well populated with railway terminals, knows more about homeless people than most. Brooding on these matters over Christmas, he resolved to put down an amendment to this year’s Local Government Bill, reimposing a duty on local authorities to provide temporary accommodation for those in urgent need, which was defined as " need arising in circumstances which could not reasonably have been foreseen " or other circumstances such as the consequences of fire, flood, and eviction. Several other inner-city Labour n2.r.s at the thick of the housing battle quickly added their names to the amendment: but so, more to the point, did four Conservatives. Now an opposition can do what it pleases in the way of amendments to bills, but it is only when it begins recruiting allies on the Conservative benches that a Government gets worried. When the amendments go down on report, as this one did, the spectre of defeat is not quite so menacing as it is in a committee, since the number of Government M.p.s in the House deeply concerned by the issue may well be heavily exceeded by the number who are not. Still, in this case, there was certainly the possibility of a revolt; and in any case, " Government votes down bid to aid homeless " is not the kind of headline any administration will normally strive to earn. So on Jan. 23, when the report stage was taken, Mr Rossi, the new junior Minister at the Department of the Environment, came armed with a peacemaking proposal. No, the Government would not resume the imposition of a duty on local authorities, he said: but it did intend to issue directions; and the beauty of that was that they could attach directions to specific cases and fire them at individual local authorities. Indeed, as Mr Rossi developed his case, directives became not just an alternative to a duty but a positive improvement. It was hoped to issue a set of directions early next month, printing permitting, which would tell local authorities to arrange accommodation for those in need of care and attention, those in other kinds of urgent need, and those needing help on medical and welfare grounds. This was enough to satisfy the prospective Con-
servative rebels, and it might have pleased most of the Labour men too until their front-bench spokesman, Mr Oakes, said that statutory duties beat directives any day because statutory duties could be enforced in the courts, enabling defaulting authorities to be chased not only by Government Departments but by action groups like Shelter. So the House divided, and Labour was beaten by 20 votes. But Mr Stallard was still able afterwards to wear the satisfied smile of a man who has helped to move a Government. DAVID MCKIE.
Some eight years ago one of the patients I treated was a magnificent old boy who was crippled by angina and by dyspnoea. His 17jr st. was obviously doing him no good, so some of this had to come off. He was given a strict dietsheet detailing the caloric content of the various foods and drinks, and as a result he drew up a most entertaining diet-sheet for himself. He started on the assumption that hock and whisky in sufficient doses were indispensable to life, and this only allowed him boiled endives and a few Energen’ rolls before his calories were used up-the hock, by the way, was to be disguised from his wife by being served in a soup-plate as mock turtle soup. For all his flippancy, he stuck to his calories, got down to 13 st., and did so well that I did not see him again until he came to see me recently about another matter. I asked him about his angina, and his use ofTrinitrin’, and he enthused, I have caught some bloody fine salmon with that stuff -the only time I ever use it is when fishing. Years ago I ,
Obituary CHARLES RUDD M.B.Birm., F.R.C.S.G., D.O.M.S. Mr Charles Rudd, honorary consultant ophthalmologist to the United Birmingham Hospitals, died on Jan. 17. He was born in Birmingham in 1892 and was educated Handsworth Grammar School and the University of Birmingham, graduating M.B. in 1916. He immediately joined the R.A.M.C., in which he served until 1920. Subsequently he was house-surgeon, resident surgical officer, and surgical registrar at the Birmingham and Midland Eye Hospital. He was later appointed to the consultant staff of the Birmingham and Midland Eye Hospital, the Queen’s Hospital (later the United Birmingham Hospitals), West Bromwich and District Hospital, and Nuneaton General Hospital. He was also a lecturer in ophthalmology in the University of Birmingham, a member of the Faculty of Ophthalmologists, of the Ophthalmological Society of the United Kingdom, and of the Midland Ophthalmological Society, of which he, was president in 1946-47. In 1938 he was Middlemore lecturer. Charles Rudd was a most charming, friendly, and generous colleague. He had a wonderful sense of humour and his company was always pleasurable and stimulating. He had countless friends and no enemies. After retirement from his hospital appointments he continued in very active practice for many years, and he enjoyed golf, bridge, and a full social life. His colleagues and patients will remember his skill, his friendship, and his humour with
sratitude. A. G. W. W.
a fine fish on the line and then got an awful anginal pain, and by the time I had found my tablets and got relief, the fish had got off-together with my new tackle. Now,
as soon as
salmon move in the water, I take a trinitrin lost a fish."
INFANT AND ADULT OBESITY
Night Celebrations) capricious carlin, Nature, My gude-man braw, o’ goodly stature, Now turns into a flodgel creatureMackly na mair; To see him thus, sae fat o’ feature, Is my despair.
eats what wouldna feed a wraith: A starveling he would be, in truth, But every meal adds to his girth
And my dismay. Yet his twa partners, gluttons both, Thin-bellied stay. A
journal* I have lately seen Imputes not plumpness to a gene: Becomes, it says, the well-stuffed wean A wamie wight. 0’ my gude-mither I should mean And
Glossary. Braw=handsome; carlin=a witch; flodgel=big, fat; mackly=well-proportioned; mean=to complain against; wamie=big-bellied, corpulent; wean=infant; gude-man= husband; gude-mither =mother-in-law. *
See Lancet, Jan. 5, p. 17.
Regional Hospital Board:
BHALLA, K. K., M.D.Lucknow, M.R.C.P.: consultant physician, Bolton and district hospital group. BoYEs, B. E., M.B.Edin., M.R.C.P., M.R.C.P.G.: consultant physician, Hyde and Glossop hospital group. CAWLBY, M. I. D., M.D.Lond., M.R.c.P.: consultant in rheumatology and rehabilitation, Wrightington, Preston and Chorley, and Wigan and Leigh hospital groups. DAVE, V. K., M.B.Wales, M.R.C.P. : consultant dermatologist, Salford, and Wigan and Leigh hospital groups. *HESLING, CONSTANCE M., M.B.Lond., M.R.C.P. : consultant chest physician, Wythenshawe and North Cheshire hospital group. OGDEN, J. R., M.B.Manc., M.R.C.O.G. : consultant obstetrician and gynaecologist, Burnley and district hospital group. RAWSTHORNE, G. B., M.B.Aberd., r.R.c.s.E.: consultant general surgeon, South Cheshire hospital group. RIDGwAY, A. E. A., M.B.Cantab., F.R.C.S., D.o.: consultant ophthalmologist, United Manchester Hospitals and Manchester R.H.B. SHARMA, V. N., M.B.Lucknow, B.sc.Aligarh, M.R.C.PSYCH., T.D.D., D.P.M.: consultant psychiatrist, Preston and Chorley area. SONI, S. D., M.D.Poona, M.R.C.P.E., M.R.C.PSYCH., D.P.M.: consultant psychiatrist, Greater Salford area. YouNG, I. M., M.B.Manc., D.M.R.D. : consultant radiologist, Wigan and Leigh, and Wrightington hospital groups. YUILL, G. M., M.B., B.sc.Manc., M.R.C.P.: consultant neurologist, North East Manchester hospital group. * Amended announcement. North-East
Metropolitan Regional Hospital Board:
DALLOS, VERA, M.B., B.sc.Lond., M.R.C.P.: consultant in accident and emergency, Whipps Cross Hospital. DovE, P. R., M.B.Lond., M.R.C.PSYCH., D.P.M. : consultant psychiatrist, Harlow hospital group. DURANCE, R. A., M.B.Cantab., M.R.C.P. : consultant in rheumatology and rehabilitation, Colchester and district hospital group. EDELMAN, JoY B., M.B.Lond., M.R.C.P. : consultant physician, Ilford and district hospital group. EDWARDS, A. J., M.cHIR.Cantab., M.sc.McGill, F.R.C.S.: consultant general surgeon, Forest hospital group.