1416 CHILDHOOD SEIZURES

SIR,-It is possible that the way in which Mr Harrison and Taylor (May 1, p. 948) present their follow-up data on childhood seizures has overemphasised the seriousness of one seizure (or group of seizures) occurring only in the first two years of life. In the analysis of the various aspects of their follow-up information, all their patients are grouped together, irrespective of the time of onset, total number, and duration Dr

of seizures. This method of presentation may be obscuring some important difference between subgroups of these children. For instance, in a follow-up study of epilepsy in the approximately 5000 children in the National Survey of Health and Development; it seemed clear that children who have one seizure (or one group of

seizures) in the first two years of life are rarely the same children who have continuing or even occasional epi-

lepsy later on. This implies that if the data of Harrison and Taylor were presented to show the fate of these two groups separately, the prognosis of children with continuing or latero, iset epilepsy might be very much worse than that of children who have only infantile seizures. Occupational achievement and income are analysed by Harrison and Taylor in respect of remitted or continuing epilepsy, but the time of remission is not stated. Further subdivision into (a) seizures before the age of 2 years only, (b) seizures remitted since age of 2 years, and (c) continuing epilepsy, might well show an important gradient of poor prognosis. It is necessary to avoid causing undue concern to parents of infants who have an isolated seizure, and by a simple rearrangement of their data, Harrison and Taylor could throw further light on this important point. Professorial Unit,

Mapperley Hospital Nottingham NG3 6AA

*** This letter has been shown follows.-ED. L.

J. E. COOPER to

Mr Harrison, whose

of childhood seizure disorders for any age of onset. We do feel that the sociological perspective of epilepsy has been ignored or, perhaps more accurately, confused with the medical perspective, in particular by what we would regard as the arbitrary removal of certain groups in the study of prognosis of seizure disorders. This we hold to be responsible for the discrepancy between the doctors’ perception of the significance of some types of seizures and that of the patients or parents. We may be at fault for insufficiently stressing the sociological bias of our paper which we trust is now apparent. As a result we hope that there will be a greater appreciation of why some parents with a child who has a seizure at any age may be extremely frightened. Development Research Unit, Department of Psychiatry, University of Oxford, Park Hospital for Children, Headington, Oxford OX3 7LQ Human

R. M. HARRISON

RECURRENT HERPES SIMPLEX

SIR,—Dr Boyd (March 20, p. 650) is puzzled by the restricted distribution of the vesicular rash of herpes simplex. May I suggest that the circumoral distribution of herpes-simplex lesions could be explained by the fact that this region is the part of the trigeminal dermatome which receives both an abundant blood-supply and a liberal sensory innervation. Since replication of the herpes type-I virus is sometimes favoured by an increase in temperature this simple anatomical fact may explain why the eruption favours the circumoral region. Medical School, University of Tasmania, Hobart, Tasmania, Australia

RUPERT G. SHERWOOD

reply SMOKING AND THE FETUS

SIR,—Iwelcome Professor Cooper’s letter suggesting that the

SIR,—Dr Davies and his colleagues (Feb. 21, p. 385),

one

with Rush,’ have suggested that a large part of the effect of maternal smoking during pregnancy on birth-weight is mediated through low maternal weight gain, with only a very small additional direct effect on the fetus. On the other

presentation of our data overemphasises the seriousness of seizure (or group of seizures) occurring in the first two years of life. It gives an opportunity to underline the purpose of presenting the data in the way we did. We do have sufficient information to rearrange the data in the way Professor Cooper suggests and intend to do so in a future publication. This rearrangement does indicate better and worse prognosis for certain groups and may produce a more favourable prognosis for the group Professor Cooper suggests. It should be emphasised, however, that because of relative mortality-rates, the rearrangement of data to indicate the significance of age of onset for prognosis is not as simple as sug-

together

MEANS

±

S.D. OF MATERNAL AND INFANT VARIABLES ACCORDING TO

MATERNAL SMOKING HABITS

gested. Such a discussion, however, misses the point of the paper. It was exactly our concern with the anxieties and fears of parents which brought us to arrange the data in the manner we did. The paper was biased towards viewing epilepsy from a sociological perspective rather than a predominantly medical one. That is, we were concerned to present epilepsy or the sequelæ of childhood seizures as they might be seen by the layman. Our data show that, at that time, of all children who have ever had a fit or seizure, one in ten died, one in ten went to an institution, and one in five now has chronic epilepsy. It is precisely these children who are the noticeable residue and represent to the general public the outcome of childhood seizures.

Surely if doctors are to reassure parents who have a child who has a seizure they must have some appreciation of the sort of fear and anxieties parents could bring into the consultingroom. In this context the lay community’s experience of what happens to all children with seizures is of utmost importance. We have no wish to paint an unnecessarily gloomy picture 1.

Cooper, J. E. Br. med. J. 1975, i, 1020.

Dr Mau (May 1, p. 972) reports the findings of a Gerstudy in which there is no association between smoking habit and maternal weight gain. The results of a French study, carried out since 1971 in the maternity hospital at Haguenau (Alsace), accord with the German study. Maternal weight gain was calculated by subtracting the usual weight before pregnancy from the weight before delivery. The well-known relation between smoking and birth-

hand,

man

1.

Rush, D. D. J. Obstet. Gynœc. Br. Commonw. 1974, 81, 746.

1417 was observed, but no relation at all between weigh and smoking during pregnancy was found. Moreover, th gain absence of difference in placental weight, as well as the exis tence of histological signs of hypoxia in the placentae of smok ing womenenable one to suggest that smoking has a direc effect on placenta and fetus, even it is not the only effect.

weight

easily and equally be made for the overseas doctors who contri-

I.N.S.E.R.M. (U. 21),

bute 27% of the medical manpower of the National Health Service and whose fate in the hands of employers relating to training and discrimination is, perhaps, worse than that of women. I hope that the suggestions made by the Community Relations Commission and noted by you on June 19 (p. 1361) will be supported.

94800-Villejuif, France

Service de

A. SPIRA

Gynécologie-Obstétrique,

Hôpital Civil, 67500-Haguenau

B. SERVENT WOMEN IN MEDICINE

SIR Thank you for your helpful editorial (June 12, 1280) on the problems facing women in medical practice.

p. It

seems that these difficulties arise nowadays not so much from decisions reached by men deliberately designed to harm the careers of women doctors but more from a failure to consider these matters at all. Though there has been some recent consideration of these subjects by some medical writers, both male and female, it is interesting to note that your editorial (no doubt not meant to be exhaustive) contained no references dated between and 1975. What is now required is that consideration be given to the specific problems of a sizeable minority of the profession. When medical women were a rarity it was perhaps understandable that their difficulties were neglected. Now around a fifth of the profession are female, and with the abolition of the quota system for admission to medical schools it can be anticipated that the proportion of women doctors will rise to perhaps half by the end of the century. The implications of this change on medical staffing patterns in the U.K. cannot any longer be

1623

ignored. We will have to introduce flexible training schemes to enable with family commitments (and, indeed, some men) to acquire skills needed by the community and so to achieve their own potential. Failure to do this may mean that the current doubling of medical-student numbers will in the end produce few more working doctors than are now produced. The waste, both in financial and in human terms, is more than we should be prepared to accept. A start was made in this direction by the part-time training posts for women doctors with family commitments introduced by the D.H.S.S. in 1969. Such posts are no longer funded by the Department but by the regions, as a consequence of the 1974 reorganisation. Now, when a hospital wishes to make such an appointment and has a woman doctor wishing to take it up, the regions say they have no funds. Here is an actual deterioration of the situation. Perhaps, since we no longer have a female Secretary of State nothing else can be expected. We do, however, still have a Chief Medical Officer at the D.H.S.S. who confesses to "a terrible sense of guilt for his own sex". Perhaps he could expiate some of his guilt by solving this limited problem. The Medical Women’s Federation is the only organisation whose sole concern is the promotion of the interests and careers of women doctors. It is considering what to do about the representation of its views to Government and within the councils of the profession. I urge all medical women to join the M.W.F. in order that their views may be heard, in an attempt to avoid repeating the mistakes of the past. women

Medical Women’s Federation, Tavistock House North, Tavistock Square, London WC1H 9HX

ANNE L. GRÜNEBERG Hon. Secretary

SIR,-Your editorial was most interesting reading. A small group of fully trained doctors find themselves at a gross disadvantage due to their sex, and I reciprocate your sentiments. All the arguments that you have made for the women doctors can 2. Spira, A., congr.

Philippe, E., Spira, N., Dreyfus, L., Schwartz, D., Gynec. Obstet. (in the press).

VIIIth Wed.

"Shangri-la" Highfield Park Heaton Mersey Stockport, Cheshire SK4 3HD

S. S.

CHATTERJEE

SIR--Dr Sterling’s article (June 12, p.1285) and your editorial in the same issue have again drawn attention to some of the problems of woman (or, of course, other) doctors who can work only part time. Dr Sterling shows the high standard of training that can be achieved on a part-time basis but stresses that more part-time consultant posts need to be created by regional health authorities. While concurring in this I feel that many women still meet problems at the training stage. Not all regions are as far-sighted as Wessex which "has shown that, despite decentralisation of funds, an appropriate budget can be created" for part-time training. On the question of finance HM(69)6 merely states that "while no special additions will be made to revenue allocations, hospital authorities are asked to provide in future estimates for the cost of retraining women doctors and of arranging for their re-employment". Although some regional hospital boards previously allocated funds specifically for the purpose, some regions are now telling districts that the moneys must be met from their own budget. Naturally, in this time of financial stringency, requests for such posts are unlikely to succeed. This policy (or lack of it) is short-sighted. Increasing numbers of women are being admitted to medical schools, and future staffing of the N.H.S. will depend on adequate provision for part-time work, whether for continuing training or for

retraining. Department of Chemical Pathology, Westminster Medical School, London SW1P 2AR

JOAN F. ZILVA

D.N.A-ASE IN TREATMENT OF INFECTIOUS MONONUCLEOSIS

SIR There is

no specific therapy for infectious mononucand treatment (antimicrobial agents, (l.M.) symptomatic leosis salicylates, corticosteroids) fails to shorten the course of the’ disease. !.M. is now thought to be a self-limited lymphoma-like illness caused by the herpes-like D.N.A.-content Epstein-Barr virus (E.B.v.) or a closely related one which, however, in some people may produce a malignant lymphoma. The evidence for this statement is based on histological (Reed-Sternberg cells), cytological, virological (E.B.v.), serological (heterophilic E.B.v.-antibodies), and epidemiological (increased risk of2 Hodgkin’s disease in patients with previous i.rK.) features.1 Multiplication of D.N.A. (viruses of herpes, adenoviruses) may be suppressed with pancreatic D.N.A.-ase (E.C. 3.1.4.5). In clinical trials, D.N.A.-ase proved to be effective against adenoviral conjunctivitis, herpetic keratitis, and herpes zoster.3 Assuming a viral aetiology and taking into consideration the activity of D.N.A.-ase in diseases caused by D.N.A. viruses a comparative study of therapeutic effectiveness of D.N.A.-ase in patients with !.M. was undertaken. In the trial were 30 patients, 23 males and 7 females, aged 15-22 years at the time of illness (1973-75). All patients had characteristic clinical (fever, tonsillitis, adenopathy, enlarged liver and spleen, rash), hsematological (absolute lymphocytosis with increased

1. Mackinney, A., Cline, W. Br. J. Hœmat. 1974, 27, 367. 2. Rosdahl, N., Larsen, S. O., Clemmesen, J. Br. med. J. 1974,

ii, 253.

3. Salganik, R., Mosolov, A., Trukhachev, A., Pankova, T., Tomsons, V. 9th int. congr. Microbiol. 1966, abstr. p. 544.

Letter: Smoking and the fetus.

1416 CHILDHOOD SEIZURES SIR,-It is possible that the way in which Mr Harrison and Taylor (May 1, p. 948) present their follow-up data on childhood se...
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