468
Epidemiological studies alone may never discover whether a high parasite-induced IgE level is in any way protective against allergic illness. In urban-rural comparisons, many other factors are important, not least the extreme poverty of medical care away from towns in some developing countries, which must weigh against the survival of asthmatic children. Ideally, both IgE level and parasite load should be studied in large carefully matched groups of skin-test-positive asthmatics and normal controls living in the same area. The nearest approach to this is possibly the study of Grove and Forbes’ in New Guinea, where atopics proved to have lower stool-egg counts than non-atopics. Such studies should be made in several different racial groups-a formidable task, but perhaps Dr Lasch can start the ball rolling with some more information about his patients in the Gaza Strip. Southampton General Hospital, Tremona Road, Southampton SO9 4XY
R. C. GODFREY
SIR,-Dr Lasch takes issue with your statementS that "there is evidence for an inverse relation between parasites and allergy" because it was based solely on the findings of Godfrey in the Gambia.9 There is, however, further evidence which you did not discuss supporting this claim. A study was carried out in the Eastern Highlands District of Papua New Guinea to test the hypothesis that a function of IgE antibodies is to assist in the control of helminth infections. Subjects were divided into asthmatic, non-asthmatic atopic, and non-atopic groups on the basis of clinical features and immediate hypersensitivity reactions to prick testing with a range of allergens. Hookworm infection was universal, but other intestinal nematodes were absent. Fsecal egg-counts were significantly lower’O while IgE and eosinophil levels were significantly higher"in asthmatic and non-asthmatic groups compared with the normal group. It was concluded that these findings were consistent with the hypothesis. It is apparent that parasites may be found in the individual asthmatic patient but that the worm burdens tend to be lower. An inverse relationship does appear to exist. Division of Geographic Medicine, Wearn Research
Building, University Hospitals, Cleveland, Ohio 44106, U.S.A.
DAVID I. GROVE
PERSONAL COST OF HOSPITAL ADMISSION
SIR,-From time to time it is suggested that patients should contribute to the cost of hospital admission, since it is assumed that during this time they are saved the cost of feeding themselves. When this was first discussed in 1970, we asked 15 consecutive patients whom we were admitting to complete forms setting out their expenses for pyjamas, dressing-gowns, and so on, and those incurred by relatives living in the same household in visiting them, including the costs of flowers, fruit, and so on. We also asked them to state their average weekly incomes before admission. The 15 patients had a mean age of thirty-nine, a mean period of admission of sixteen days, and spent averages of 7.83 on purchases for admission, 8.34 on visits from their own household, and [,6.89 on gifts from their own household, a total of 23.26, or 1.45 per inpatient day; at 1976 values this is about 3.35 a day. Only 3 patients volunteered their in7. 8. 9 10. 11.
Grove, D. I., Forbes, I. J. Med. J. Aust. 1975, i, 336. Lancet, 1976, i, 894. Godfrey, R. C. Clin. Allergy, 1975, 5, 201. Grove, D. I., Forbes, I. J. Med. J. Aust. 1975, i, 201. Grove, D. I., Burston, T. O., Forbes, I. J. Clin. Allergy, 1974, 4, 295.
daily costs of 1.04 represented 50(-, weekly income. Except for those living in frank poverty, earnings-related sickness benefit is substantially lower than normal earnings, and it is difficult to believe that anyone does anything but lose financially from admission to hospital. There are already quite sufficient taxes on sickness, the yield from hotel charges would
comes, but their average
of net
be small, and the administrative and moral costs of collection would be high. Let us hope that no more will be heard of the
suggestion. Glyncorrwg Health Centre, near
Port
Talbot,
Glamorgan SA13
3BL
JULIAN TUDOR HART REGINALD SAXTON
SHORT-STAY HOSPITAL CARE FOR MENTALLY HANDICAPPED
SiR,—The white-paper Better Services for the Mentally Handicapped (1971) tabulates figures per 100000 population for the different types of provision required for the mentally handicapped. Short-stay hospital care is not separately specified, but this is one of the most important services for the mentally handicapped living at home. Groups of parents of the
mentally handicapped invariably press for a greater availability of short-stay care facilities in hospitals and hostels. In Leeds, from a population of 600 000 in the six years 1970-75, there was a total of 657 new and old admissions (398 male 259 female) to the local hospital for mental handicap. 72 (10.0%) have remained as long-stay patients. Most of the others have been in hospital for short periods of two to six weeks for observation, assessment, and treatment or to give relief to their families at times of crisis and for holidays. In theory many mentally handicapped people should not have to be admitted to hospitals for short-stay care, but in practice the social-services department have no suitable residential facilities for those who are disturbed in behaviour, severely subnormal, and incontinent or physically handicapped. If the length of stay is about 4 weeks one hospital bed can serve 12 patients and their families during the year. For 120 admissions in a year from 600 000 population 10 short-stay beds are required, that is, 2% of the 500 beds in the hospital. This is a minimum figure since, if more beds could be made available, more short-stay patients would be admitted, especially children, who account for about 30% of all admissions. To be effective a short-stay care system for the mentally handicapped requires adequate support from a psychology department, physiotherapy and occupational and speechtherapy services, and from social workers and community nurses. At a time when limited hospital resources must be used in the most efficient way to help as many people as possible the development of short-stay care services for the mentally handacapped is worthy of priority. Meanwood Park Leeds LS6 4QB
Hospital,
D. A. SPENCER
PSYCHIATRISTS’ VIEWS ON LIQUOR LICENSING
StR,—Twice’ you have used harsh words about the Erroll and Clayson committees reports,34expecting that the relaxation of the licensing laws proposed is likely to be associated with a rise in the number of people with alcohol-related problems. Neither of the two committees nor your editorials have presented evidence of the opinion of the profession. In our attitude survey of psychiatrists’ in the Glasgow area 1. Lancet, 1972, ii, 1297. 2. ibid. 1976, i, 347. 3. Report of the Departmental Committee on Liquor Licensing Cmnd 5154 H.M. Stationery Office, 1972. 4. Report of the Departmental Committee on Scottish Licensing Law Cm nd 5354. H.M. Stationery Office, 1973. 5 Macdonald, E. B , Patel, A. R. Br. med. J. 1975, ii, 430.
Epidemiological studies alone may never discover whether a high parasite-induced IgE level is in any way protective against allergic illness. In urban-rural comparisons, many other factors are important, not least the extreme poverty of medical care away from towns in some developing countries, which must weigh against the survival of asthmatic children. Ideally, both IgE level and parasite load should be studied in large carefully matched groups of skin-test-positive asthmatics and normal controls living in the same area. The nearest approach to this is possibly the study of Grove and Forbes’ in New Guinea, where atopics proved to have lower stool-egg counts than non-atopics. Such studies should be made in several different racial groups-a formidable task, but perhaps Dr Lasch can start the ball rolling with some more information about his patients in the Gaza Strip. Southampton General Hospital, Tremona Road, Southampton SO9 4XY
R. C. GODFREY
SIR,-Dr Lasch takes issue with your statementS that "there is evidence for an inverse relation between parasites and allergy" because it was based solely on the findings of Godfrey in the Gambia.9 There is, however, further evidence which you did not discuss supporting this claim. A study was carried out in the Eastern Highlands District of Papua New Guinea to test the hypothesis that a function of IgE antibodies is to assist in the control of helminth infections. Subjects were divided into asthmatic, non-asthmatic atopic, and non-atopic groups on the basis of clinical features and immediate hypersensitivity reactions to prick testing with a range of allergens. Hookworm infection was universal, but other intestinal nematodes were absent. Fsecal egg-counts were significantly lower’O while IgE and eosinophil levels were significantly higher"in asthmatic and non-asthmatic groups compared with the normal group. It was concluded that these findings were consistent with the hypothesis. It is apparent that parasites may be found in the individual asthmatic patient but that the worm burdens tend to be lower. An inverse relationship does appear to exist. Division of Geographic Medicine, Wearn Research
Building, University Hospitals, Cleveland, Ohio 44106, U.S.A.
DAVID I. GROVE
PERSONAL COST OF HOSPITAL ADMISSION
SIR,-From time to time it is suggested that patients should contribute to the cost of hospital admission, since it is assumed that during this time they are saved the cost of feeding themselves. When this was first discussed in 1970, we asked 15 consecutive patients whom we were admitting to complete forms setting out their expenses for pyjamas, dressing-gowns, and so on, and those incurred by relatives living in the same household in visiting them, including the costs of flowers, fruit, and so on. We also asked them to state their average weekly incomes before admission. The 15 patients had a mean age of thirty-nine, a mean period of admission of sixteen days, and spent averages of 7.83 on purchases for admission, 8.34 on visits from their own household, and [,6.89 on gifts from their own household, a total of 23.26, or 1.45 per inpatient day; at 1976 values this is about 3.35 a day. Only 3 patients volunteered their in7. 8. 9 10. 11.
Grove, D. I., Forbes, I. J. Med. J. Aust. 1975, i, 336. Lancet, 1976, i, 894. Godfrey, R. C. Clin. Allergy, 1975, 5, 201. Grove, D. I., Forbes, I. J. Med. J. Aust. 1975, i, 201. Grove, D. I., Burston, T. O., Forbes, I. J. Clin. Allergy, 1974, 4, 295.
daily costs of 1.04 represented 50(-, weekly income. Except for those living in frank poverty, earnings-related sickness benefit is substantially lower than normal earnings, and it is difficult to believe that anyone does anything but lose financially from admission to hospital. There are already quite sufficient taxes on sickness, the yield from hotel charges would
comes, but their average
of net
be small, and the administrative and moral costs of collection would be high. Let us hope that no more will be heard of the
suggestion. Glyncorrwg Health Centre, near
Port
Talbot,
Glamorgan SA13
3BL
JULIAN TUDOR HART REGINALD SAXTON
SHORT-STAY HOSPITAL CARE FOR MENTALLY HANDICAPPED
SiR,—The white-paper Better Services for the Mentally Handicapped (1971) tabulates figures per 100000 population for the different types of provision required for the mentally handicapped. Short-stay hospital care is not separately specified, but this is one of the most important services for the mentally handicapped living at home. Groups of parents of the
mentally handicapped invariably press for a greater availability of short-stay care facilities in hospitals and hostels. In Leeds, from a population of 600 000 in the six years 1970-75, there was a total of 657 new and old admissions (398 male 259 female) to the local hospital for mental handicap. 72 (10.0%) have remained as long-stay patients. Most of the others have been in hospital for short periods of two to six weeks for observation, assessment, and treatment or to give relief to their families at times of crisis and for holidays. In theory many mentally handicapped people should not have to be admitted to hospitals for short-stay care, but in practice the social-services department have no suitable residential facilities for those who are disturbed in behaviour, severely subnormal, and incontinent or physically handicapped. If the length of stay is about 4 weeks one hospital bed can serve 12 patients and their families during the year. For 120 admissions in a year from 600 000 population 10 short-stay beds are required, that is, 2% of the 500 beds in the hospital. This is a minimum figure since, if more beds could be made available, more short-stay patients would be admitted, especially children, who account for about 30% of all admissions. To be effective a short-stay care system for the mentally handicapped requires adequate support from a psychology department, physiotherapy and occupational and speechtherapy services, and from social workers and community nurses. At a time when limited hospital resources must be used in the most efficient way to help as many people as possible the development of short-stay care services for the mentally handacapped is worthy of priority. Meanwood Park Leeds LS6 4QB
Hospital,
D. A. SPENCER
PSYCHIATRISTS’ VIEWS ON LIQUOR LICENSING
StR,—Twice’ you have used harsh words about the Erroll and Clayson committees reports,34expecting that the relaxation of the licensing laws proposed is likely to be associated with a rise in the number of people with alcohol-related problems. Neither of the two committees nor your editorials have presented evidence of the opinion of the profession. In our attitude survey of psychiatrists’ in the Glasgow area 1. Lancet, 1972, ii, 1297. 2. ibid. 1976, i, 347. 3. Report of the Departmental Committee on Liquor Licensing Cmnd 5154 H.M. Stationery Office, 1972. 4. Report of the Departmental Committee on Scottish Licensing Law Cm nd 5354. H.M. Stationery Office, 1973. 5 Macdonald, E. B , Patel, A. R. Br. med. J. 1975, ii, 430.
