125 THE DOCTOR IN THE HOSPITAL
hospitals. Electron microscopy of faecal extracts showed duovirus particles in 82 babies. No recognised bacterial "
"
pathogens
were
isolated.
During these months, diarrhoea has been endemic in four of the hospitals and epidemics of diarrhoea of 2-3 weeks’ duration have occurred in four hospitals. In affected babies, the illness lasted only 12-48 hours with the passage of watery fasces often positive for sugar by ’Clinitest ’.4 These findings will be reported elsewhere in more detail. The incidence of this reovirus-like particle and of the recently reported 29-30 nm. particle5 in babies with diarrhoea remains to be determined. Further studies on the aetiology of neonatal diarrhcea should employ electron microscopy of faecal extracts, routine tissue culture, and standard bacteriological techniques in order to assess the relative importance of viral and bacterial pathogens. Department of Gastroenterology,
Royal Children’s Hospital, Melbourne, Australia 3052. Department of Microbiology, University of Melbourne, Australia 3052.
D. R. G. R.
J. S. CAMERON F. BISHOP P. DAVIDSON R. W. TOWNLEY.
I. H. HOLMES B. J. RUCK.
VIRAL ANTIBODIES IN THYROTOXICOSIS
SIR,-The pathogenesis of thyrotoxicosis is unknown. Since, to our knowledge, viral antibodies have not been studied in patients with thyrotoxicosis we undertook a preliminary investigation. The titres of complementfixing antibodies against influenza A and B, mumps, and measles, and hxmagglutination-inhibiting antibodies against rubella were determined in sera from 88 patients with thyrotoxicosis (77 with Graves’ disease, and 11 with toxic multinodular goitre). All patients were thyrotoxic at the time blood was collected, but a few had been diagnosed several years previously. These results were compared with sera from age and sex matched hospital inpatients with non-thyroidal disease, collected over the same period. The results are shown in the accompanying table. The frequency of antibodies to influenza B was much greater in the thyrotoxic group. These results are obviously preliminary and the difference in influenza-B antibodies cannot at this stage be accepted as of pathogenetic significance. However, the results do suggest that a more extensive study is warranted. A. JOASOO. Department of Medicine, Division of Microbiology,
Department of Nuclear Medicine, Prince of Wales Hospital, Randwick, N.S.W., Australia.
P. ROBERTSON.
LABORATORY
SIR,-Your leading article (June 14, p. 1327) highlights of the problems facing chemical pathology and chemical pathologists. Chemical pathology is not a popular career choice for medical graduates, possible reasons being the hybrid nature of the job and the relatively poor financial some
rewards.
The chemical
pathologist
have clinical
emphasise one role for the chemical pathologist, that of a metabolic physician, although this aspect of training has been emphasised previously.l You fail to point out the consultant role of a chemical pathologist in advising his clinical. colleagues on chemical investigations. In the setting of a teaching hospital it is difficult to appreciate this role, but in the district hospital the chemical pathologist acts as a consultant to general practitioners and consultants. Why do we need a medical graduate to head a chemical pathology laboratory ? You rightly say that in some quarters few tears would be shed if this were not so. One of the most important functions of a chemical pathologist in the future is a combination of clinical and managerial skills. Equipment and tests are becoming more costly, so the chemical pathologist must carefully evaluate whether the setting up of new tests is justified or whether older tests can be dropped. It is, of course, arguable that this could be equally well performed by non-medical graduates, but only a medical graduate can prevent a completely on-demand service. With regard to the United States, my experience is admittedly limited to private, prepaid, and Government services in certain areas, but in these there is expansion of medical control rather than retraction for the reasons I have stated. Clinical Laboratories, Stanford University Medical Center, and Palo Alto Veterans Administration Hospital, California 94304, U.S.A.
TOM HARGREAVES.
OUTPATIENT SURGERY
SIR,-Your leading article (June 21, p. 1366) on day-case gives a balanced view of the advantages and problems. It is essential, however, for those responsible surgery
for allocation of nurses to realise that doing hernias and similar operations as a day case does not relieve the pressure on the general surgical wards. In fact it makes it worse, because a higher proportion of patients on the ward are having major surgery and therefore need more intensive
nursing. I. P. C. MURRAY.
Charing Cross Hospital, Fulham Palace Road, London W6 8RF.
4. 5.
must
knowledge to help clinicians solve clinical problems and also be well versed in chemical techniques. He or she is also the managerial head of a complex organisation. You
Kerry, K. R., Anderson, C. M. ibid. 1964, i, 987. Appleton, H., Higgins, P. G. ibid. 1975, i, 1297.
FREQUENCY
1.
Hargreaves, T. Lancet, 1967, ii, 1409.
AND LOG. TITRES OF ANTIBODIES
A. G. JOHNSON.
hospitals. Electron microscopy of faecal extracts showed duovirus particles in 82 babies. No recognised bacterial "
"
pathogens
were
isolated.
During these months, diarrhoea has been endemic in four of the hospitals and epidemics of diarrhoea of 2-3 weeks’ duration have occurred in four hospitals. In affected babies, the illness lasted only 12-48 hours with the passage of watery fasces often positive for sugar by ’Clinitest ’.4 These findings will be reported elsewhere in more detail. The incidence of this reovirus-like particle and of the recently reported 29-30 nm. particle5 in babies with diarrhoea remains to be determined. Further studies on the aetiology of neonatal diarrhcea should employ electron microscopy of faecal extracts, routine tissue culture, and standard bacteriological techniques in order to assess the relative importance of viral and bacterial pathogens. Department of Gastroenterology,
Royal Children’s Hospital, Melbourne, Australia 3052. Department of Microbiology, University of Melbourne, Australia 3052.
D. R. G. R.
J. S. CAMERON F. BISHOP P. DAVIDSON R. W. TOWNLEY.
I. H. HOLMES B. J. RUCK.
VIRAL ANTIBODIES IN THYROTOXICOSIS
SIR,-The pathogenesis of thyrotoxicosis is unknown. Since, to our knowledge, viral antibodies have not been studied in patients with thyrotoxicosis we undertook a preliminary investigation. The titres of complementfixing antibodies against influenza A and B, mumps, and measles, and hxmagglutination-inhibiting antibodies against rubella were determined in sera from 88 patients with thyrotoxicosis (77 with Graves’ disease, and 11 with toxic multinodular goitre). All patients were thyrotoxic at the time blood was collected, but a few had been diagnosed several years previously. These results were compared with sera from age and sex matched hospital inpatients with non-thyroidal disease, collected over the same period. The results are shown in the accompanying table. The frequency of antibodies to influenza B was much greater in the thyrotoxic group. These results are obviously preliminary and the difference in influenza-B antibodies cannot at this stage be accepted as of pathogenetic significance. However, the results do suggest that a more extensive study is warranted. A. JOASOO. Department of Medicine, Division of Microbiology,
Department of Nuclear Medicine, Prince of Wales Hospital, Randwick, N.S.W., Australia.
P. ROBERTSON.
LABORATORY
SIR,-Your leading article (June 14, p. 1327) highlights of the problems facing chemical pathology and chemical pathologists. Chemical pathology is not a popular career choice for medical graduates, possible reasons being the hybrid nature of the job and the relatively poor financial some
rewards.
The chemical
pathologist
have clinical
emphasise one role for the chemical pathologist, that of a metabolic physician, although this aspect of training has been emphasised previously.l You fail to point out the consultant role of a chemical pathologist in advising his clinical. colleagues on chemical investigations. In the setting of a teaching hospital it is difficult to appreciate this role, but in the district hospital the chemical pathologist acts as a consultant to general practitioners and consultants. Why do we need a medical graduate to head a chemical pathology laboratory ? You rightly say that in some quarters few tears would be shed if this were not so. One of the most important functions of a chemical pathologist in the future is a combination of clinical and managerial skills. Equipment and tests are becoming more costly, so the chemical pathologist must carefully evaluate whether the setting up of new tests is justified or whether older tests can be dropped. It is, of course, arguable that this could be equally well performed by non-medical graduates, but only a medical graduate can prevent a completely on-demand service. With regard to the United States, my experience is admittedly limited to private, prepaid, and Government services in certain areas, but in these there is expansion of medical control rather than retraction for the reasons I have stated. Clinical Laboratories, Stanford University Medical Center, and Palo Alto Veterans Administration Hospital, California 94304, U.S.A.
TOM HARGREAVES.
OUTPATIENT SURGERY
SIR,-Your leading article (June 21, p. 1366) on day-case gives a balanced view of the advantages and problems. It is essential, however, for those responsible surgery
for allocation of nurses to realise that doing hernias and similar operations as a day case does not relieve the pressure on the general surgical wards. In fact it makes it worse, because a higher proportion of patients on the ward are having major surgery and therefore need more intensive
nursing. I. P. C. MURRAY.
Charing Cross Hospital, Fulham Palace Road, London W6 8RF.
4. 5.
must
knowledge to help clinicians solve clinical problems and also be well versed in chemical techniques. He or she is also the managerial head of a complex organisation. You
Kerry, K. R., Anderson, C. M. ibid. 1964, i, 987. Appleton, H., Higgins, P. G. ibid. 1975, i, 1297.
FREQUENCY
1.
Hargreaves, T. Lancet, 1967, ii, 1409.
AND LOG. TITRES OF ANTIBODIES
A. G. JOHNSON.
