279 be declined for lack of space. The to those fascinated by the capacity for rapid international communication which has evolved in the past thirty years. The Lancet has no bias towards or against contributions (i.e., articles and Letters to the Editor) from any one continent or any one country; and no-one in Adam Street has the faintest notion of how the latest annual return will differ from the previous year’s until the calculations have been feverishly completed at the end of December. Professor Fendall’s third point-the interests of local journals-does not concern only developing countries: it was being debated three decades ago in developed regions (including Australasia and Scandinavia) which have local journals. Such journals, it then seemed, became reconciled to losing many articles that were of more than local interest to U.S. or U.K. journals with a wider circulation. It is difficult to see how otherwise the information in these articles can be surely and quickly disseminated; even the most determined reader cannot hope to scan all local journals. Last week (p. 210) The Lancet published an article on experience with a mortality committee in a hospital in Kenya. The author concluded that the approach he described might prove helpful in most hospitals in developing countries. Professor Fendall would evidently have had us suggest to the author that he publish his findings in East Africa. The author might well have decided against adopting this suggestion; and, if so, he would, we believe, have been right.-ED. L.
contributions
note may
also
must
appeal
ORAL BACTERIAL VACCINE AND COLDS Sn:,—In a similar manner to that of Dr Tyrrell (Jan. 11, p. 108), our trialwas conducted on strict double-blind lines. There was no difference in the frequency and duration of colds in the two groups, whereas the severity as judged by the number of days absent showed a statistically significant reduction in the vaccine group. Our methods of recording, 1972-73, differed in that the school boarders were throughout the trial period observed by the matron and medical staff. Our experience has shown that the method of retrospective subjective impressions of colds taken at the end of a trial usually is of little value compared with the method of parallel current study. We have found a similar result with this vaccine in patients with chronic bronchitis in the older age-groups. The reduction in the number of days absent in the vaccine group was of the same order from 10-17 years, suggesting that natural acquired immunity did not occur. In their report2 Tyrrell et al. mention the work of Tomasi et awl. on the IgA local secretory antibody system. Further study’along these lines is indicated by our results. Western Hospital, London SW6.
H. C. PRICE.
Bristol.
G. HENLEY.
HETEROZYGOTE ADVANTAGE IN CYSTIC FIBROSIS SiR,—Commenting on the recent correspondence (Jan. 18, p. 167) on the as yet unidentified biological advantage that theory demands the cystic-fibrosis heterozygote to possess, would it be too fanciful to suggest that this could lie in an exceptional agreeableness of these individuals ? Such a quality has in my experience been a striking feature of the personalities of mothers of children with cystic fibrosis. Since (until perhaps recent years) 1. Price, M. C., Henley, G. Practitioner, 1974, 213, 720. 2. Tyrrell, D. A. J., Nolan, P. S., Reed, S. E., Healey, M. J. R. Br. J. prev. soc. Med. 1972, 26, 129. 3. Tomasi, T. B., Tan, E., Solomon, A., Prendergast, R. A. J. exp. Med. 1965, 131, 101.
populations have had an excess of females over males of marriageable age, exceptionally agreeable females would presumably carry a reproductive advantage. Department of Pædiatrics, Addenbrooke’s Hospital, Cambridge CB2 2QQ.
DOUGLAS GAIRDNER.
KANAM MANDIBLE’S TUMOUR SiR,-Since suggested diagnoses often become firmly entrenched in medical folk lore, I feel that Dr Stathopoulos’s suggestion (Jan. 18, p. 165) that the Kanam mandible may have been the seat of Burkitt’s lymphoma should be closely examined. " The interpretation of archaic pathology is often a task of extreme complexity " and " in palaeopathology the best opinions are often tentative opinions ".1 The changes in the Kanam mandible (interpreted by Tobias as a subperiosteal ossifying sarcoma) have been by Brothwell as a malignant tumour in which accepted " osteosarcomafit’ the macroscopic picture well although there is some difference of opinion on this diagnosis ".2 Goldstein believes the lesion to be a " sarcomatous overgrowth ".3Wells, however, states that the Kanam mandible has been " diagnosed as a sarcoma but its present status is doubtful ".4 I have also expressed reservations.5I) I feel that the changes might have resulted from any process elevating the periosteum and it is interesting to note that Brothwell, before opting for osteosarcoma, considered the possibility of trauma and low-grade inflammation with much subperiosteal new bone. I would suggest, therefore, that it is premature to consider too seriously the question of Burkitt’s lymphoma in this mid-Pleistocene fossil. It is by no means proven that the changes are even neoplastic. -
University Pathology Department, Western Infirmary, Glasgow G11 6NT.
A. T. SANDISON.
INTESTINAL ABSORPTION OF GLUCOSE SiR,—We were impressed by the work of Dr Read and others (Sept. 14, p. 624) in measuring the kinetics of glucose absorption by means of transmural electrical potentials in the jejunum. We were further gratified by the attention they devoted to our own studies, but we should like to respond to two of the issues they raised during a comparison of results. First, our use of prolonged infusion periods and of transintestinal intubation were not, as Read et al. said, necessitated by instability of the measured potential differences (P.D.S). In fact, our P.D.S were invariably stable within 15 minutes of each infusion. Using constant infusion-rates, we did not observe any motility-induced fluctuations of P.D., and the effects of any transient fluctuations (as well as of A.c. interference) were eliminated simply by attaching a 0-1 .F capacitor across the input poles of our potentiometer, without our having to resort to pharmacological manipulations such as propantheline. Our use of prolonged infusion periods and of transintestinal intubation were dictated rather by other aspects of experimental design, since we were simultaneously carrying out many additional measurements (reported separately) of net glucose, water, and electrolyte fluxes over multiple Wells, C. in Diseases in Antiquity (edited by D. Brothwell and A. T. Sandison); p. 5. Springfield, Illinois, 1967. 2. Brothwell, D. ibid. p. 330. 3. Goldstein, M. S. in Science in Archæology (edited by D. Brothwell and E. Higgs); p. 485. London, 1969. 4. Wells, C. Bones, Bodies and Disease; p. 75. London, 1964. 5. Sandison, A. T. in The Skeletal Biology of Earlier Human Populations (edited by D. Brothwell); p. 230. Oxford, 1968. 1.
contributions
note may
also
must
appeal
ORAL BACTERIAL VACCINE AND COLDS Sn:,—In a similar manner to that of Dr Tyrrell (Jan. 11, p. 108), our trialwas conducted on strict double-blind lines. There was no difference in the frequency and duration of colds in the two groups, whereas the severity as judged by the number of days absent showed a statistically significant reduction in the vaccine group. Our methods of recording, 1972-73, differed in that the school boarders were throughout the trial period observed by the matron and medical staff. Our experience has shown that the method of retrospective subjective impressions of colds taken at the end of a trial usually is of little value compared with the method of parallel current study. We have found a similar result with this vaccine in patients with chronic bronchitis in the older age-groups. The reduction in the number of days absent in the vaccine group was of the same order from 10-17 years, suggesting that natural acquired immunity did not occur. In their report2 Tyrrell et al. mention the work of Tomasi et awl. on the IgA local secretory antibody system. Further study’along these lines is indicated by our results. Western Hospital, London SW6.
H. C. PRICE.
Bristol.
G. HENLEY.
HETEROZYGOTE ADVANTAGE IN CYSTIC FIBROSIS SiR,—Commenting on the recent correspondence (Jan. 18, p. 167) on the as yet unidentified biological advantage that theory demands the cystic-fibrosis heterozygote to possess, would it be too fanciful to suggest that this could lie in an exceptional agreeableness of these individuals ? Such a quality has in my experience been a striking feature of the personalities of mothers of children with cystic fibrosis. Since (until perhaps recent years) 1. Price, M. C., Henley, G. Practitioner, 1974, 213, 720. 2. Tyrrell, D. A. J., Nolan, P. S., Reed, S. E., Healey, M. J. R. Br. J. prev. soc. Med. 1972, 26, 129. 3. Tomasi, T. B., Tan, E., Solomon, A., Prendergast, R. A. J. exp. Med. 1965, 131, 101.
populations have had an excess of females over males of marriageable age, exceptionally agreeable females would presumably carry a reproductive advantage. Department of Pædiatrics, Addenbrooke’s Hospital, Cambridge CB2 2QQ.
DOUGLAS GAIRDNER.
KANAM MANDIBLE’S TUMOUR SiR,-Since suggested diagnoses often become firmly entrenched in medical folk lore, I feel that Dr Stathopoulos’s suggestion (Jan. 18, p. 165) that the Kanam mandible may have been the seat of Burkitt’s lymphoma should be closely examined. " The interpretation of archaic pathology is often a task of extreme complexity " and " in palaeopathology the best opinions are often tentative opinions ".1 The changes in the Kanam mandible (interpreted by Tobias as a subperiosteal ossifying sarcoma) have been by Brothwell as a malignant tumour in which accepted " osteosarcomafit’ the macroscopic picture well although there is some difference of opinion on this diagnosis ".2 Goldstein believes the lesion to be a " sarcomatous overgrowth ".3Wells, however, states that the Kanam mandible has been " diagnosed as a sarcoma but its present status is doubtful ".4 I have also expressed reservations.5I) I feel that the changes might have resulted from any process elevating the periosteum and it is interesting to note that Brothwell, before opting for osteosarcoma, considered the possibility of trauma and low-grade inflammation with much subperiosteal new bone. I would suggest, therefore, that it is premature to consider too seriously the question of Burkitt’s lymphoma in this mid-Pleistocene fossil. It is by no means proven that the changes are even neoplastic. -
University Pathology Department, Western Infirmary, Glasgow G11 6NT.
A. T. SANDISON.
INTESTINAL ABSORPTION OF GLUCOSE SiR,—We were impressed by the work of Dr Read and others (Sept. 14, p. 624) in measuring the kinetics of glucose absorption by means of transmural electrical potentials in the jejunum. We were further gratified by the attention they devoted to our own studies, but we should like to respond to two of the issues they raised during a comparison of results. First, our use of prolonged infusion periods and of transintestinal intubation were not, as Read et al. said, necessitated by instability of the measured potential differences (P.D.S). In fact, our P.D.S were invariably stable within 15 minutes of each infusion. Using constant infusion-rates, we did not observe any motility-induced fluctuations of P.D., and the effects of any transient fluctuations (as well as of A.c. interference) were eliminated simply by attaching a 0-1 .F capacitor across the input poles of our potentiometer, without our having to resort to pharmacological manipulations such as propantheline. Our use of prolonged infusion periods and of transintestinal intubation were dictated rather by other aspects of experimental design, since we were simultaneously carrying out many additional measurements (reported separately) of net glucose, water, and electrolyte fluxes over multiple Wells, C. in Diseases in Antiquity (edited by D. Brothwell and A. T. Sandison); p. 5. Springfield, Illinois, 1967. 2. Brothwell, D. ibid. p. 330. 3. Goldstein, M. S. in Science in Archæology (edited by D. Brothwell and E. Higgs); p. 485. London, 1969. 4. Wells, C. Bones, Bodies and Disease; p. 75. London, 1964. 5. Sandison, A. T. in The Skeletal Biology of Earlier Human Populations (edited by D. Brothwell); p. 230. Oxford, 1968. 1.
